Disclaimer: I am not a representative of the bed management in the NHS and therefore all opinion are solely my own. This is not to instruct or guide patient management in the NHS but merely a collection of anecdotes I have to illustrate the current situation.
We as humans are a social species. By that, I mean, we have the intrinsic need to meet and engage in conversation. Even people who call themselves ‘introverts’ have the innate requirement for social interaction. It is a physiological phenomenon, which eons of evolution has not gotten rid of. Or more precisely, eons of evolution has preserved our ability to connect to one another. Despite that, the modern human is not very good at engaging in conversation with another human, effectively. Continue reading
A week ago I met with a patient who was staying in hospital for a few days after having had bowel surgery. He was upbeat. Telling me about plans for when he would go home. Telling me about various events in his life. I took a history. In medicine, ‘taking a history’ basically means finding out as much as you can about a patient, as efficiently as you can, so that you can plan their treatment and hospital stay optimally. It requires practice and there is a technique so I thought I’d get some practice in. I was feeling quite happy by the end of the chat. The patient was jovial and I had done my duty. I got up to leave, smiled briefly and he went back to reading his newspaper. I went home that night, narrated my experience to my family and thought nothing more of it. Continue reading
Medical dramas on TV were my favourite because I always imagined myself to be like Turk from Scrubs – cool and smart, or Dr. House – grumpy but loveable or Meredith from Grey’s anatomy – dramatic and brilliant, her hair always perfect.
This was me Monday morning: Stethoscope falling out of my bag, having no clue where the patient files are kept and forgetting my water bottle so that by 5:30 pm on my first day on emergency medicine placement, I looked more like a drowned rat than a medical student on placement.
Placement is essentially practical, hands-on experience at doing what doctors do. Except I know less than half of what the most juniour doctor knows and I’m pretty sure that I’m getting in the way more than I’m actually helping. Not to mention being a medical student qualifies me to be able to do exactly nothing on my own – and patients know this!
Take this morning, for example. I was sat in an acute ambulatory unit in the acute medical unit, waiting to take blood samples (venupuncture) for the first time ever on a real patient. Previously I’d always practiced on a mannequin. The first patient just flat out refused. The second one looked a little dubious but agreed in the end but his arm kept shaking, revealing his inner doubts on my ability (not entirely misplaced!). The thirds patient was eerily calm. That was good and I managed my first ever independent venupuncture. There was red stuff coming out…pretty sure it was blood!
Hospitals are busy places. You have acutely sick patients. Porters moving beds and patients around the wards. Nurses caring for their patients, doctors doing this that and other. And the bustling wards are a beautiful place to learn about the weird, common, rare and simple interesting pathologies of the human body. A sick heart can make so many sounds. Just a quick listen can illicit if somebody has a pleural effusion or more like a pneumonia. A quick chat to a nurse will tell you whether the patient is a returning patient or a new admission. The juniour doctors always know what management plan a patient is on. You simply can’t get bored. I do feel selfish in the knowledge that whilst I am here I’m really only helping myself learn.
But there’s always a moment that you remember. And I think for me today it was a small fraction of a second that sealed the deal for me. We were on ward and I wasn’t doing anything particular. All I did was look up whilst I was examining a patient and smile. I apologised for taking so long and not letting the patient finish a sudoku puzzle.
The patient just smiled back and replied: ‘you are the future. You’ve got to learn somehow’
It occurred to me quite suddenly that placement is fun and enjoyable and really exciting. But at the same time I’m not just learning for myself. By ensuring I know my medicine properly today, I’m having an impact, however small, on the lives of real people. They’re not just a disease. They’re a person.
I walked out from the ward whilst relatives were visiting. And as I walked near the doors, the patient from this morning recognised me and said ‘goodbye’.
I don’t know why but it made me smile. I might not be Turk or Dr. House or Meredith. But these small moments make me feel even more cool and smart and on top form than any doctor I’ve seen on TV.
After all, TV is fiction and hospital medicine is reality!
I started medical school about 5 months ago with a lot of excitement and moderate levels of apprehension. Whilst some myths were debunked (No, I don’t have to actually use a needle on a patient until a long while later!) some held true…(Yes, PBL and tutorials are basically fun chats while eating snacks and discussing hypothetical patients). Believe it or not, I actually know how a stethoscope works now, I can kind of communicate with you about your pain and I actually know more science than I thought I did. Continue reading