Monday was most eventful, in fact the activities had the year running at high stress levels for most of the day. Started with an early morning feedback on how the pathway has been. Cue us complaining for an hour about all the things that are wrong, the med school pretending to listen but never claiming liability for anything. Not being at fault is a big thing for the medical school.
My GP got a particularly slating for being useless, paternal and not letting us do anything. Although informative ive got friends who help in minor surgery at their GP and id rather be doing that then drinking yet another cup of tea. (more on the fun and frolics of GP week at another time) Also worked out that we had missed at least 4 teaching sessions over eight weeks, no wonder our knowledge base is so poor but as per usual its not the med schools fault.
So onto the thrill of our clinical competencies which are staggered throughout the morning and early afternoon. Three stations with 5 mins for the introduction, explanation and skill then a minute for feedback. Cannulation, IM injection and venepuncture for all of these things it is very important that you take your time. 5mins is in no way enough time, plus the pressure of knowing there is a time limit stresses one out even further. Despite our pleas about this issue they insisted that it would be fine and threw us into the exam cubicles.
Cubicle 1 - Cannulation
Examiner - Crazy GU frottage Consultant
Quick nod of the head as a hello to the examiner and I'm off talking to a plastic arm(PA).
Me - 'Good afternoon Mrs.Lation, the Dr has informed me that you need to have a cannula put into your arm so we can give you some fluids. This simply involves me passing a small thin tube into a vein in your arm, a needle is used to pass the tube so it will be a little uncomfortable. Is that OK with you'
PA - silence
Me - 'Excellent in which case I'll begin now first i need to check your name tag, Now your full anme is Connie Lation (see what theyve done there!), is that correct and your date of birth is xx/xx/xxxx'
PA - Silence
Me - Right then Mrs.Lation I'll just wash my hands and gather the equipment you wait here and make yourself comfortable'
Wash hands with slimey alcogel, start to throw all the required equipment into a tray, prepare saline flush after checking date, then onto the gloves.
Here is where it started to go wrong, putting gloves on after alcogel is a nightmare as its never dried in time. I start by trying to get my thumb into the little finger part, break that glove then proceed to break one more before im just about ready to begin. The gloves on quite on fully so fine motor control is going to be difficult.
At least point in time my body decides to introduce a parkinsonian tremor into the occasion. Trying to resheath a needle with a trembling hand is not fun.
Me - 'Right then Mrs.Lation i'm going to put this tourniquet round you arm and it will feel a little tight, do tell me if you feel too much discomfort'
PA - Yet more silence
Find veing insert cannula, get flashback, get excited about the presence of flashback, remove needle, vein starts spurting blood out...
Me - 'Its normal to get a little bleeding during this procedure so don't worry.
Examiner - Chuckles loudly to self in corner.
Flush cannula and recap - BUZZZZ end of time and theres no dressing on cannula ah well thinks i, got it in at least.
Examiner - still chuckling 'You've left the tourniquet hence why your patient is bleeding out and going a bit necrotic, plus why are you shaking so much you're normally fine'
Me - 'Gay, gay, gay, gay opps you didnt hear that'
Station 2 - Intramuscular injection and drug dosage
Examiner - Nice enough respiratory consultant
Afternoon to the the examiner and this time im presented with an actual mannequin to converse with.
Roll off injection chat and bizarrely thought to ask about allergies, despite it not being in the study guide.
Potter off to grab equipment, not even bothering to try and coverse with the mannequin.
Drug dosage time
Gentamycin at 3mg/Kg to be given in 3 injections over 24 hrs.
So that 240mg over 24 hrs and 80mgs per injection. They gave us a calculation that cancelled itself out, truly we must be thick. I had to check it twice to ensure it was that easy.
40mg per ml so two mls check amount with examine and show him syringe with 2mls in as was requested in the intro on the door.
Jab the mannequin with a good minute to spare.
Examiner 'Wow first full house of excellents all day did you used to be a nurse'
Apparantly if you need an IM injection I'm the one for the job.
Cubicle 3 -Venpuncture
Examiner - Random female consultant
Yet again a silent plastic arm
So i role of the prep paragraph about what the blood test is for when the results will be back etc, then occasionally comment to the arm as i stab it. Got blood first time managed to fill in all the forms and finish inside the time.
Examiner - You should try and maintain conversation with the 'patient' throughout.
Well i would never have guessed that i urge you all to try talking to an inanimate object that doesnt reply. Im used to it but its still a pain and it never feels normal.
Ive done at least 10 lots of bloods on acutal people so i would like to think this is a better judge of my competence than drawing red ink from a plastic arm.
Other people managed to do just as badly:
One student managed to get a needlestick injury
One of the arms had what looked like veins but were actually skin folds so it took some students 4 attempts to get blood.
One student nearly flooded the place with the tourniquet left on and unable to find the cannula cap. The red stains on the floor are gonna be there for a while.
Plenty of people didnt get blood, or get round to injecting or messed up the calculation.
Lets just say the pubs round here made a lot of money that night.
Today the med school issues this response to our complaints:
Following our feedback session I fed back to the head of clinical skills the essence of your concerns that there was insufficient time to perform the skill. They have more or less agreed that all sites found this to be the case, and part of his reply is copied here, which hopefully will reassure you.
“Therefore, it is likely that the standard setting process will result in a lower pass mark than would have otherwise been the case. In short, the students should wait before assuming ……... We will review the timings for further runs”.
In short they are taking no responsibility or letting us all resit the tragic ones as a first attempt.
Im not really surprised.
Wednesday 28 February 2007
Thursday 22 February 2007
The incompetence of surgeons and relatives
Today was a very mixed bag of experiences. Started off fine with some clinical skills practise as we have a set of 3 competencies on Monday. Its most entertaining as the plastic arms we have to practise on bleed like hell, hence why mine was sitting in a puddle after a simple cannulation. Nothing like an actual person but it gives you an idea what to expect, apart from that the arms dont lash out or complain like hell. I know you dont like needles but your sick and i need to draw some blood - deal with it.
Anywho was pottering out of the medical school bout 11am when i notice a voicemail on my phone, nothing unusual its normally my mum however this one was number witheld which always worries me somewhat. It was one of the admin ladies from the med school enquiring where I was a i should have been at feedback. ( we have to present a patient in depth to a consultant once a week usual friday) OH CRAP thinks I, i dont have a patient, im in my jeans, my buddy is AWOL and more importantly the board said 2pm on Friday when i was last on the ward at 6pm Tues. I have no obligation to go on the ward weds and shouldnt have been there till 2pm this afternoon. So quite when this appeared on the board is anyones guess. They also sent me a handy email 1min after the voicemail at 10.16am - useful really useful. Cue me marching to reception all guns blazing demanding some kind of explanation, all they offered was the Dr's extension so i could ring and grovel despite it being their fault. Typical lowest person on the ladder thusly its my fault. We rearranged feedback for tomorrow but itll be during his theatre and he'll be pissed for us missing today joy of joys. This was a vascular consultant DejaVu as it happened to a friend of mine last term, same guy same circumstances, one would think he'd learnt his lesson but alas no.
The day picked up as i headed to the surgical recieving unit. Managed to clerk 4 patients and take 6 lots of blood, not quite there with the cannulation yet but that ought come with practise. 2 of the patients were in a great deal of pain but more then willing to talk to me and let me stick them with needles. The fact of the matter is that I'm merely doing the leg work for the junior doctor at some point when you are admitted someone will ask you many ridiculous questions and stick you with sharp things. Im less stressed, have had more sleep and not quite as disillusioned. Which is why patient three really got to me or at least her relative did.
She had come in with a ?obstruction and was waiting to be clerked and have bloods done so i took up the oppurtunoity to do something productive. Got to the bed to be told i wasn't to attempt her bloods as her veins were like stone, fair enough Ill just do the history and examination. So i ask her about why shes come in, all the related questions about her waterworks and bowels, but her brother does most of the talking which is a touch odd in itself. During this it is hinted that the lady has a history of bladder Ca with a recent admission. thusly my next question is about her past medical history. I explain that i understand its complicated and difficult but could they give me a quick overview. Well this started the brother off 'Is this really necessary, cant you see she's ill, you can get this all from the notes etc'. Swiftly on thinks I to the basic questions on family history and smoking/alcohol status and those are the final nail in the coffin. 'look i cant see how this is relevent, i really dont think appropriate that you're doing this, does it matter how much she smoke'. Well yes it is important we dont ask questions for the hell of it, our time is limited and if the actual doctor was doing this they would ask the very same questions. So i explained this concept with my most apologetic smile on and pottered back to the office via another patient of mine. On my return to the office who did i find but the brother having a full on rant at the ward clerk on what he though to be appropriate in this situation. Which is when you start to think 'Yes im sorry your sister has cancer but plese deal with it for the ten mins while im trying to do my job'. He proceeded to have a go at 2 consultants and a nurse on the ward, relatives hould really learn to behave themselves if they want the patient to get the best care. We kind of resent them now for being rude ignorant and generalised pains in the butt.. Im losing my compassion already that can't be good.
8am ward round tomorrow then best find a patient to present.
Anywho was pottering out of the medical school bout 11am when i notice a voicemail on my phone, nothing unusual its normally my mum however this one was number witheld which always worries me somewhat. It was one of the admin ladies from the med school enquiring where I was a i should have been at feedback. ( we have to present a patient in depth to a consultant once a week usual friday) OH CRAP thinks I, i dont have a patient, im in my jeans, my buddy is AWOL and more importantly the board said 2pm on Friday when i was last on the ward at 6pm Tues. I have no obligation to go on the ward weds and shouldnt have been there till 2pm this afternoon. So quite when this appeared on the board is anyones guess. They also sent me a handy email 1min after the voicemail at 10.16am - useful really useful. Cue me marching to reception all guns blazing demanding some kind of explanation, all they offered was the Dr's extension so i could ring and grovel despite it being their fault. Typical lowest person on the ladder thusly its my fault. We rearranged feedback for tomorrow but itll be during his theatre and he'll be pissed for us missing today joy of joys. This was a vascular consultant DejaVu as it happened to a friend of mine last term, same guy same circumstances, one would think he'd learnt his lesson but alas no.
The day picked up as i headed to the surgical recieving unit. Managed to clerk 4 patients and take 6 lots of blood, not quite there with the cannulation yet but that ought come with practise. 2 of the patients were in a great deal of pain but more then willing to talk to me and let me stick them with needles. The fact of the matter is that I'm merely doing the leg work for the junior doctor at some point when you are admitted someone will ask you many ridiculous questions and stick you with sharp things. Im less stressed, have had more sleep and not quite as disillusioned. Which is why patient three really got to me or at least her relative did.
She had come in with a ?obstruction and was waiting to be clerked and have bloods done so i took up the oppurtunoity to do something productive. Got to the bed to be told i wasn't to attempt her bloods as her veins were like stone, fair enough Ill just do the history and examination. So i ask her about why shes come in, all the related questions about her waterworks and bowels, but her brother does most of the talking which is a touch odd in itself. During this it is hinted that the lady has a history of bladder Ca with a recent admission. thusly my next question is about her past medical history. I explain that i understand its complicated and difficult but could they give me a quick overview. Well this started the brother off 'Is this really necessary, cant you see she's ill, you can get this all from the notes etc'. Swiftly on thinks I to the basic questions on family history and smoking/alcohol status and those are the final nail in the coffin. 'look i cant see how this is relevent, i really dont think appropriate that you're doing this, does it matter how much she smoke'. Well yes it is important we dont ask questions for the hell of it, our time is limited and if the actual doctor was doing this they would ask the very same questions. So i explained this concept with my most apologetic smile on and pottered back to the office via another patient of mine. On my return to the office who did i find but the brother having a full on rant at the ward clerk on what he though to be appropriate in this situation. Which is when you start to think 'Yes im sorry your sister has cancer but plese deal with it for the ten mins while im trying to do my job'. He proceeded to have a go at 2 consultants and a nurse on the ward, relatives hould really learn to behave themselves if they want the patient to get the best care. We kind of resent them now for being rude ignorant and generalised pains in the butt.. Im losing my compassion already that can't be good.
8am ward round tomorrow then best find a patient to present.
Rude mnemonics
With the large volume of information our medical brians are expected to hold we use as mnay craft ways as possible to aid our memory. Studies have shown that mnemonics especially those which are funny or rude stick in our minds and are easier to recall.
So enjoy these classics who knows you may even learn something!
CRANIAL NERVES:
Oh Oh Oh To Touch And Feel Virgin Girls Vaginas And Hymens or
On Occasion, Old Tim Taylor Asks For Very Good Vagina And Head
Olfactory, Optic, Occulomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
SACRAL INNERVATION OF PENIS
S2,3,4 keeps your penis off the floor.
PENIS AUTONOMIC INNERVATION ACTIONS
"Parasympathetic Puts it up. Sympathetic Spurts it out".
"Point and Shoot": Parasympathetic Points it, Sympathetic Shoots out the semen."
SUPERIOR ORBITAL FISSURE: STRUCTURES PASSING THROUGH
"Lazy French Tarts Lie Naked In Anticipation Of Sex"
Lacrimal nerve, Frontal nerve, Trochlear nerve, Lateral nerve, Nasociliary nerve, Internal nerve, Abducens nerve, Ophthalmic veins, Sympathetic nerves
CARPAL BONES
‘Some lovers try positions that they can’t handle’
Scaphoid, Lunate, Triquetrum, Pisiform, Trapezoid, Trapezium, Capitate, Hamate
RENAL FAILURE: symptoms/signs
"My Big Nob Vibrates Gently In Her Purulent Pelvis":
Malaise, Breathlessness, Nausea, Vomiting, GI motility, Headache, Pruritis, Pigmentation
So enjoy these classics who knows you may even learn something!
CRANIAL NERVES:
Oh Oh Oh To Touch And Feel Virgin Girls Vaginas And Hymens or
On Occasion, Old Tim Taylor Asks For Very Good Vagina And Head
Olfactory, Optic, Occulomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal
SACRAL INNERVATION OF PENIS
S2,3,4 keeps your penis off the floor.
PENIS AUTONOMIC INNERVATION ACTIONS
"Parasympathetic Puts it up. Sympathetic Spurts it out".
"Point and Shoot": Parasympathetic Points it, Sympathetic Shoots out the semen."
SUPERIOR ORBITAL FISSURE: STRUCTURES PASSING THROUGH
"Lazy French Tarts Lie Naked In Anticipation Of Sex"
Lacrimal nerve, Frontal nerve, Trochlear nerve, Lateral nerve, Nasociliary nerve, Internal nerve, Abducens nerve, Ophthalmic veins, Sympathetic nerves
CARPAL BONES
‘Some lovers try positions that they can’t handle’
Scaphoid, Lunate, Triquetrum, Pisiform, Trapezoid, Trapezium, Capitate, Hamate
RENAL FAILURE: symptoms/signs
"My Big Nob Vibrates Gently In Her Purulent Pelvis":
Malaise, Breathlessness, Nausea, Vomiting, GI motility, Headache, Pruritis, Pigmentation
Wednesday 21 February 2007
ALLIA (A life lived in Acronyms)
As I sat in a particularly dull lecture on self harm I got to thinking about how much we depend on shortcuts to get us through the day. The medical community is particularly fond of these as its quick plus its coded just to confuse patients even further. Quite often after discussing my day at the hosiptal with my housemates, there would be a dozen acronyms to clarify so they could understand what on earth I was jabbering about.
Here at MSX we learn things by PBL, CS, SSU's, SSl's, CPC's and SG. They test us using ISCE's, CC's and AMK. When patients are admitted we do their BP, assess their GCS, FBC, LFT's,TFT's and least we forget assess their ABC. What medications are they on perphaps a SSRI, GTN or OCP. Thats before the diagnosis; have they had an MI, do they have MS, have they got Ca, is their AAA about to burst or maybe just some D&V. Still not decided well its time for more tests, be it a CT, MRI, AUSS, CXR, KUB or an ECG. Diagnosis made its time for treatment is it to be a CABG, ERCP, POP or simply a trip to OPD. Then theres the ones they dont teach you in medical school GOK and NFX.
Its a surprise we don't talk in acronyms when talking about going for a walk, what we did at the weekend or the current events.
Heres the decoding if you feel like learning!
Here at Medical School X (most schools have a code they use) we learn things by Problem Based Learning, Clinical Skills, Special Study Units's, Structured Supported learning, Clinical Pathological Conference's and Small Group. They test us using Integrated Structured Clinical Exam's, Clinical Competencies's and Applied Medical Knowledge. When patients are admitted we do their Blood Pressure, assess their Glasgow Coma Scale, Full Blood Count, Liver function test's,Thyroid Function Tests's and least we forget assess their Airway, Breathing, Circulation. What medications are they on perphaps a Selective Serotonin Reuptake Inhibitor, Glyceryl TriNitrate or Oral Contraceptive Pill. Thats before the diagnosis; have they had an Myocardial Infarction, do they have Multiple Sclerosis, have they got Cancer, is their Abdominal Aortic Aneurysm about to burst or maybe just some Diarrhoea & Vomiting. Still not decided well its time for more tests, be it a Computerised Tomography scan, Magnetic resonance Imaging, Abdominal UltraSound Scan, Chest XRay, Kidneys,Urethra and Bladder or an ElectroCardioGram. Diagnosis made its time for treatment is it to be a Coronary Artery Bypass Graft, Endoscopic Retrograde CholangioPancreatography, Plaster Of Paris or simply a trip to Out Patients Department. Then theres the ones they dont teach you in medical school God Only Knows and Normal For X (x stands for a place most often heard as normal for cornwall).
Here at MSX we learn things by PBL, CS, SSU's, SSl's, CPC's and SG. They test us using ISCE's, CC's and AMK. When patients are admitted we do their BP, assess their GCS, FBC, LFT's,TFT's and least we forget assess their ABC. What medications are they on perphaps a SSRI, GTN or OCP. Thats before the diagnosis; have they had an MI, do they have MS, have they got Ca, is their AAA about to burst or maybe just some D&V. Still not decided well its time for more tests, be it a CT, MRI, AUSS, CXR, KUB or an ECG. Diagnosis made its time for treatment is it to be a CABG, ERCP, POP or simply a trip to OPD. Then theres the ones they dont teach you in medical school GOK and NFX.
Its a surprise we don't talk in acronyms when talking about going for a walk, what we did at the weekend or the current events.
Heres the decoding if you feel like learning!
Here at Medical School X (most schools have a code they use) we learn things by Problem Based Learning, Clinical Skills, Special Study Units's, Structured Supported learning, Clinical Pathological Conference's and Small Group. They test us using Integrated Structured Clinical Exam's, Clinical Competencies's and Applied Medical Knowledge. When patients are admitted we do their Blood Pressure, assess their Glasgow Coma Scale, Full Blood Count, Liver function test's,Thyroid Function Tests's and least we forget assess their Airway, Breathing, Circulation. What medications are they on perphaps a Selective Serotonin Reuptake Inhibitor, Glyceryl TriNitrate or Oral Contraceptive Pill. Thats before the diagnosis; have they had an Myocardial Infarction, do they have Multiple Sclerosis, have they got Cancer, is their Abdominal Aortic Aneurysm about to burst or maybe just some Diarrhoea & Vomiting. Still not decided well its time for more tests, be it a Computerised Tomography scan, Magnetic resonance Imaging, Abdominal UltraSound Scan, Chest XRay, Kidneys,Urethra and Bladder or an ElectroCardioGram. Diagnosis made its time for treatment is it to be a Coronary Artery Bypass Graft, Endoscopic Retrograde CholangioPancreatography, Plaster Of Paris or simply a trip to Out Patients Department. Then theres the ones they dont teach you in medical school God Only Knows and Normal For X (x stands for a place most often heard as normal for cornwall).
Tuesday 20 February 2007
Doc I've got a pain in my belly
Turn up to A&E today expecting to see the usual handful of patients hanging around. Ours doesn't seem to be the busiest A&E in the world in fact we usually end up fighting over patients. Today however the world and his wife were coming in on foot or by ambulance. All of the cubicles were full and their were ambulance trolleys stacked in the corridor. As we entered there were 6 stretched patients waiting to be booked in. It came as no surprise that the teaching we were supposed to get on abdo pain was cancelled (a real shame as last weeks pair said it was awesome) but we were free to find ourselves some relevent patients. Im normally all for an afternoon off due to cancellation but this the the 3rd time in 3 weeks so I'm starting to feel a distinct lack of knowledge. So onto the 'shop floor' we went, dodging behind trolleys and tyring not to get in the way. Typically there was not a single patient out of about 30 that had come in with abdo pain. At least half of them were 'collapse', this is usual frail old ladies passing out not my favourite type of thing to deal with as dementia oftne plays a part. If i get demented in my elder years I think being shot may be the way forward, its an awful illness that eliminates you from society and distances you from the people you love, very distressing for all involves.
Anyway we took this as an oppurtunity to do a runner up to the SRU (surgical recieving unit), which patients with acute surgical problems are sent in straight from their GP's to be assessed by a surgeon or more likely a medical student and then the surgical house officer (read 'lackeys'). It has to be one of my favourite places to be in the hospital, the HO's are always eternally grateful for your help and you get to clerk and take bloods on as many people as come through the doors. Its one place where your contribution helps the patient out, as it means they get seen quicker plus you've had an important hand in their care. Plus its usually full of acute abdomens, alas today not quite as full as i would have liked. There were plenty of patients but many had non-abdo probs or were demented and unable to speak to us.
One lady in particular struck me today most probably because she was screaming blue murder and shouting all the time. She had a gangrenous foot and that had progressed to a leg that was simply not viable, amputation was simply her only option. To complicate things she had severe dementia and had been shunted from nursing home to nursing home, the family werent even aware of all the problems that were there. Its truly horrifying to see these things happen to people, most wouldnt let their pets get into that state but their own mothers seem to get less consideration. Put them in a home and they become somebody elses problem.
Some pretty none descript abdo problems came through after that which we clerked and drew blood from. 6 weeks ago the thought of just strolling in and taking blood filled me with dread having only ever taken from a plastic arm before but once you've taken that first vial its easy peasy. In fact today i managed a really hard vein first time, even the reg was surprised. My life would be a whole lot easier if my partner in crime wasnt so dim. Honestly some of the questions she comes out with are just ridiculous. Recent classics have included:
'Whats a normal persons oxygen saturation in room air?' (for ll you non medics its 98-99%, below 95% and we worry)
'Can we have more abdo exam teaching' This is stupid simply because we've had at least 3 teaching sessions this year and have already been examined on it 3 times, if you don't know it by now then just go home. Made worse by the fact we missed out on some good neurology teaching.
Plus she's always stealing my patients, i do all the leg work and then she yoinks them away to present at feedback honestly the cheek of it!
2 more weeks of her then its time for a fresh buddy who just happens to be my housemate. We will either be team awesome or crash and burn only time will tell.
Anyway we took this as an oppurtunity to do a runner up to the SRU (surgical recieving unit), which patients with acute surgical problems are sent in straight from their GP's to be assessed by a surgeon or more likely a medical student and then the surgical house officer (read 'lackeys'). It has to be one of my favourite places to be in the hospital, the HO's are always eternally grateful for your help and you get to clerk and take bloods on as many people as come through the doors. Its one place where your contribution helps the patient out, as it means they get seen quicker plus you've had an important hand in their care. Plus its usually full of acute abdomens, alas today not quite as full as i would have liked. There were plenty of patients but many had non-abdo probs or were demented and unable to speak to us.
One lady in particular struck me today most probably because she was screaming blue murder and shouting all the time. She had a gangrenous foot and that had progressed to a leg that was simply not viable, amputation was simply her only option. To complicate things she had severe dementia and had been shunted from nursing home to nursing home, the family werent even aware of all the problems that were there. Its truly horrifying to see these things happen to people, most wouldnt let their pets get into that state but their own mothers seem to get less consideration. Put them in a home and they become somebody elses problem.
Some pretty none descript abdo problems came through after that which we clerked and drew blood from. 6 weeks ago the thought of just strolling in and taking blood filled me with dread having only ever taken from a plastic arm before but once you've taken that first vial its easy peasy. In fact today i managed a really hard vein first time, even the reg was surprised. My life would be a whole lot easier if my partner in crime wasnt so dim. Honestly some of the questions she comes out with are just ridiculous. Recent classics have included:
'Whats a normal persons oxygen saturation in room air?' (for ll you non medics its 98-99%, below 95% and we worry)
'Can we have more abdo exam teaching' This is stupid simply because we've had at least 3 teaching sessions this year and have already been examined on it 3 times, if you don't know it by now then just go home. Made worse by the fact we missed out on some good neurology teaching.
Plus she's always stealing my patients, i do all the leg work and then she yoinks them away to present at feedback honestly the cheek of it!
2 more weeks of her then its time for a fresh buddy who just happens to be my housemate. We will either be team awesome or crash and burn only time will tell.
Monday 19 February 2007
Its a way of life not just a job
Doctors have one of the highest burnout rates in the country, more than likely because we never swtich off. Even if we do appear to switch off, theres a small part of us prepared for the collapsing woman in the supermarket or the heart attack at the theatre. Its part of our calling to help whether the white coat is hung on us or on a peg in our lockers.
As a medical student its easy to ignore this fact as you chill out in front of the tv or have a few pints at the local as at the end of the day no patients are your responsibility. However if we come across a member of the public in need we're back in the doctor zone in the way we think speak and act. Quite simply we can't help it.
Just last week i was walking across the hospital residences car park on the way to some friends for dinner (I myself live safely off hospital grounds!) when i saw an elderly gentlemen wandering towards some garages in his pj's and slippers. Now it was cold and wet outside and I could just as easily have walked on by without saying a word. Something in my brain clicked and I wondered over to this chap to enquire what he was doing out at this time of night. He replied that he was on his way to a town high street 20miles away and that his wife was following close behind. Many would have considered this chap a tad looney and left him be, however to me he just presented as a confused old chap. I enquired as to whether he was staying at the hospital, to which he wasnt sure, neither was he sure of the town we were in. (this is common where im training as the county has only one acute hospital and patients are often many miles from home). A quick check revealed he had a hospital wrist band on so i had to convince him that going back to the hospital was the way forward rather than his slightly odd ideas. It took me a good 30mins from the time i met this lovely gent to delivering him to the safety of a ward (all beit the wrong one!), 30mins i had other plans for but when it came to the crunch was more than willing to give up.
Either that or its my concious making up for not responding to the call for a first aider in sainsburys. On that occasion myself and my colleague had rationalised that the supermarket was so close to the hospital there would be an ACTUAL doctor somewhere in the close vicinity either that or someone had taken a minor tumble. I felt bad as we walked past the aisle but my guilt increased as the ambulance drove past us with lights and sirens blazing.
Its hard for us to know how much help we can be in accidents, often we're advised to just stay out of the way rather than go roaring in declaring you're a medical student.
In fact i was at a wedding in the summer when the brides mother came rushing over as one of her elderly relatives had collapased and was vomiting. after enquiring is this was merely a joke i shook of my heels and pegged it across the marquee whilst thinking dear lord now i have to say something intelligent. I got it together enough to question about her medical history and what exactly had happened. Nothing major in the history however she was at least 90, it was a boiling summers day and she hadnt drunk that much. A simple case of dehydration that i was able to advise on and save everyone the hassle of a trip to hospital.
Now helping there truly made my week!
As a medical student its easy to ignore this fact as you chill out in front of the tv or have a few pints at the local as at the end of the day no patients are your responsibility. However if we come across a member of the public in need we're back in the doctor zone in the way we think speak and act. Quite simply we can't help it.
Just last week i was walking across the hospital residences car park on the way to some friends for dinner (I myself live safely off hospital grounds!) when i saw an elderly gentlemen wandering towards some garages in his pj's and slippers. Now it was cold and wet outside and I could just as easily have walked on by without saying a word. Something in my brain clicked and I wondered over to this chap to enquire what he was doing out at this time of night. He replied that he was on his way to a town high street 20miles away and that his wife was following close behind. Many would have considered this chap a tad looney and left him be, however to me he just presented as a confused old chap. I enquired as to whether he was staying at the hospital, to which he wasnt sure, neither was he sure of the town we were in. (this is common where im training as the county has only one acute hospital and patients are often many miles from home). A quick check revealed he had a hospital wrist band on so i had to convince him that going back to the hospital was the way forward rather than his slightly odd ideas. It took me a good 30mins from the time i met this lovely gent to delivering him to the safety of a ward (all beit the wrong one!), 30mins i had other plans for but when it came to the crunch was more than willing to give up.
Either that or its my concious making up for not responding to the call for a first aider in sainsburys. On that occasion myself and my colleague had rationalised that the supermarket was so close to the hospital there would be an ACTUAL doctor somewhere in the close vicinity either that or someone had taken a minor tumble. I felt bad as we walked past the aisle but my guilt increased as the ambulance drove past us with lights and sirens blazing.
Its hard for us to know how much help we can be in accidents, often we're advised to just stay out of the way rather than go roaring in declaring you're a medical student.
In fact i was at a wedding in the summer when the brides mother came rushing over as one of her elderly relatives had collapased and was vomiting. after enquiring is this was merely a joke i shook of my heels and pegged it across the marquee whilst thinking dear lord now i have to say something intelligent. I got it together enough to question about her medical history and what exactly had happened. Nothing major in the history however she was at least 90, it was a boiling summers day and she hadnt drunk that much. A simple case of dehydration that i was able to advise on and save everyone the hassle of a trip to hospital.
Now helping there truly made my week!
ABC's
When one first begins medicine you expect your opinion of the world to change. You know the things they teach you at school are now useless and that you wont be able to look at a person without checking for disease. However you would think the simple things would stay the same alas even my ABC's are no longer what I thought. Gone are the days of A is for apple B is for Boat replaced by complicated mneumonics that spring to mind everytime the first three letters of the alphabet are uttered.
Theres the ABC's of assessing the patient:
A - Airway
B - Breathing
C - Circulation
D - Disability
E - Exposure
Alongside the ABC's of psychiatry.
A - Appearance
B - Behaviour
C - Cognitive
S - Speech
M - Mood
I - Insight
T- Thought
H - Hallucinations
Who would have thought the abc's could get so complicated?
Theres the ABC's of assessing the patient:
A - Airway
B - Breathing
C - Circulation
D - Disability
E - Exposure
Alongside the ABC's of psychiatry.
A - Appearance
B - Behaviour
C - Cognitive
S - Speech
M - Mood
I - Insight
T- Thought
H - Hallucinations
Who would have thought the abc's could get so complicated?
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