Half a doctor hits the wards

halfadoc

New Member
Perfecting my gormless look

December 2011:
Hectic. The one word I would use to describe my life over the last few months. And the reason that this blog has gone far too long neglected. Why so busy you ask? (And you would ask, if you realised that at my medical school, 4th year is actually one of the easier ones)
Well here is a quick summary of why (bulletpointed, for timesaving ease - yours and mine!)

1. I've just started my Neurology rotation, this is easily the hardest rotation of the year plus the specialist neurology centre is not in the same city as my medical school so we have to do quite a bit of travelling in this rotation which eats into our time further. Plus means I have tried a little bit (not as much as I should sadly) to do some work outside of rotation time in order to get my brain around wellll the brain.

2. Involved in multiple committees at the moment, apparently one position just wasn't enough for me when I applied for things last year ;)

3. University sport. Totally my own decision admittedly again, but my teams in a real chance of winning our league this year and theres no way I'm going to let them down now after 4 years of us floating at or very near the bottom of the table!

4. Money, money, money. Once you get to your fifth year of study, the NHS and the student loan company combine forces to steal the food from your mouth. You are no longer eligible for SLC to pay your tuition fees but you are still eligible for maintenance loan. Fortunately the NHS step in from this stage and pay your tuition fees for you - fantastic! Wrong. Very nice in the long term I'm sure, however in the short term the fact that you are getting an nhs bursary technically (even if you are not getting any maintenance money - this is parental means tested) means the SLC give you less maintenance loan. So long term = less debt. Short term = less money to live on. Even though our years are far longer than they have been before (2 week xmas, no easter, 3 week summer, party time is over) and so that reduced amount has to stretch much, much further.
The result of this is that many of us have to work more at this stage (in the paid work sense) far more than we did in lower years (especially as we no longer have that long summer holiday to work and use for getting our banks out of the red!) even though now is the stage that we should be working less. So paid work has also eaten some of my "spare" time.



5. A research project that is a complete nightmare. See posts on dissertation for my love of research at the best of times! That one was a doodle to get started compared to this one!

So I've not just been watching J.Kyle rather than blogging (tho there has been the occasional bit of that, who needs good television shows :p ) but I'm going to try and get back on top of blogging again now!

Neurology rotations interesting so far, but challenging. Its definitely composed of quite a few doctors who enjoy grilling medical students to eat for lunch. Mostly I either a) answer wrong b) saw errrrm i dunno and look gormless or c) look desperately at other students around me for help who tend to avert their eyes to avoid getting dragged into the carnage themselves! Of course there is the very very occasional d) option which is me fluking a correct answer. However this is very occasional and would probably be more convincing to the interrogating doctors if the answer wasn't accompanied by a questioning upwards inflection to my voice! Still, learning's what the rotation is all about so hopefully by the end of it not all of my right answers will be flukes! Wish me luck :).

Halfadoc xx


More recent blogs available at Life as 1/2 a doctor !
 

halfadoc

New Member
The eternal struggle to get into clinic

March 2012:

Everyone knows getting into a secondary care clinic as a patient can be difficult, what with the occasionally massive waiting lists etc. But sometimes it feels like its just as hard to get to sit in a clinic as a student!

One of the main problems is often persuading whoever is sitting on reception to allow you to even find out from the doctor if they are happy letting you sit in on their clinic. My year at medical school is massively over sized because lots my orginial year intercalated like myself but very few of the orginal year below intercalated meaning that when we dropped back down into the year below the new year group was suddenly massive. As a result the medical school had to find a way to squeeze us all in to clinical sessions somehow. The result of this has been having clinics that are further away, clinics which have more students in than ideal and some lectures where we have literally had to share seats!

The doctors running clinics have agreed to take a given number of students per a clinic which is higher than normal in order to try and prevent us losing out on clinical experience, so this year clinics that traditionally only took 1 person now take 2 and some 2 people clinics now take 3 students. Unfortunately news of this either hasn't reached nurses/ person manning reception desk or they just don't approve of so many students in one clinic and make it difficult for us to get in there anyway. Its a difficult position for us to be in because on one hand we as medical students to do not want to get on the wrong side of the nursing staff and they do have the power to stop us from getting to clinic, on the other hand if we don't get into the clinics we are timetabled for then we will fall down on attendance as it is very difficult to get into another clinic as a different student will be timetable for that one (and whilst there are an irritating subset of students who will happily steal a clinic from you by turning up a lot earlier than the scheduled time meaning when you get there on time you get told "No sorry theres already too many students here", I am proud to say I am not one of them).

So clinics become an exercise in diplomacy just to get into them, and then if after all that struggle you end up with a doctor who doesn't teach you and entirely ignores you, it certainly doesn't leave you in a particularly great mood by the time you've wasted a multitude of hours learning nothing....

I've just started ophthalmology and so because its not a particularly sensitive area, I have been scheduled to sit in a clinic every wednesday morning for four weeks where there are 3 students in the room. The corner where us students were crammed was tight (i was quite literally hugging up to the sink) but the patients side of the room was still spacious and none of them seemed to mind us being there and the doctor was more than happy to have all three of us and said he was used to having so many students on a wednesday morning. Yet you wouldn't have thought this was a weekly occurrence from the response I got from the nurse when I turned up 5mins before the clinic was scheduled (and standardly 30 mins before the doctor actually appeared!):

Me: Hi I'm a fourth year medical student, i'm due to sit in a clinic with Dr x *winning smile*
Nurse: *Impatient shake of head* No there's already two students here, you will have to come back some other time.
Me: Oh ummmm we are timetabled to have three of us here every wednesday.....
Nurse: *tuts* That too many.
Me: Oh ummmm err its just thats what we are timetabled...* apologetic look*
Nurse: *sigh* Do we really NEED three of you??
Me: Resists urge to say that we are students and the department never really needs us but we need to be here for our education and are due to be here and the hospital recieves extra funding for taking students and being a teaching hospital
Me: ummm errrr timetable errrr errrrr ummmm :/
Nurse: SIGH, fine follow me, will see if the doctor lets you stay when he arrives.
Me: *scuttles after*

Fortunately this particular clinic ( if I had a pound for every time I had had this conversation this year I could probably stop renting and buy my own house, sadly sometimes we never get into the clinic we are meant to be attending) was good (I finally managed to see the Optic disc through an ophthalmoscope, wooooop!) and the doctor very kindly taught us lots despite being busy. Good thing it was good as I predict the same struggle this wednesday, and next and next and then it will some other poor group of students turn :p. So spare a thought for the poor student (s) huddling in the corner next time you see the doctor they may have had more of a struggle to get to be there than you!


More recent blogs and some handy (hopefully!) applicant advice at Life as 1/2 a doctor: How to apply to medical school without losing your mind

Halfadoc x
 

halfadoc

New Member
Physician don't heal thyself


As well as having hospital rotations this year, I also have 8 morning GP practice visits. A couple of months back one of my visits was postponed a week before it was due to happen because the GP was ill which I remember thinking was quite worrying because to be able to give a weeks notice of illness the GP was clearly suffering from more than just a mild infection.

When I did have my visit with him I wasn't going to ask what had been wrong with him but he quite happily told me what had happened of his own accord and it was a good warning story about the dangers of self diagnosing when you are a medical professional...

Basically he had been having a very stressful few weeks and had been feeling quite tired and rundown and noticing periods where his heart skipped beats but as he didn't really have time to get checked out he just ignored these until one day at work when he got angina like pains. So not feeling he had time to get to his own GP surgery (and fortunately doctors cannot prescribe medication for themselves) he asked his gp to fax him over a prescription for GTN spray (the reliever of angina) and said he would get to the surgery for an appointment later in the week. His GP quite rightly refused to do so unless the GP came in immediately for an ECG. So the GP moodily agreed to do this but was annoyed at having to when he was so busy. A good thing he did tho......

On having the ECG it was discovered that the gps chest pain was not due to the traditional cause of angina (the hearts own arteries getting "furred" up with fat gradually over the years causing a narrowing artery and so reduced amount of blood being able to get through causing the hearts muscle to not always get enough oxygen especially at times when the hearts muscle is having to work harder eg when the patient is stressed or exercising) but because he had such severe bradycardia (slowing of the heart) that his heart was simply beating too slowly for enough oxygen to reach the hearts muscle for it to undertake even this reduced level of work. He was having up to 7 second gaps between beats. GTN spray works on angina by dilating the constricted arteries to an extent, as this was not the priniciple cause of the GPs pain it was unlikely to relieve his symptoms and bits of his heart muscle will have started to die off (not to mention the fact that other vital organs such as the brain will also have been depleted of oxygen). So thanks to the GPs own GP refusing to be persuaded to prescribe without seeing him, the GP was rushed in to have an emergency pacemaker fitted, something which actually would fix his heart problem, and now he admits he feels better and has more energy than he has for years.


Whilst doctors undoubtably have the knowledge to technically diagnose and treat themselves, when it comes to their own symptoms they can be blinded and biased by their own beliefs about themselves and health agendas. Self diagnosis...not a good idea!

Interestingly I've noticed that when it comes to adult doctors they are likely to be quite dismissive of potentially serious symptoms whereas medical students are the complete opposite (at least based on my housemates, close friends and self) and even a simple 2 second itch is proclaimed to be pruritus secondary to kidney failure. Honestly we've all probably used our stethoscopes more times to listen to our lungs when we have a cold than to actually examine patients! Sometimes we do get it right tho..or at least describe our symptoms in such a correct way that persuades the doctor we are right or leads them to treat us accordingly just to shut us up!


I wonder when the hypochondria wears off and the apathy sets in ?

For more recent blogs go to Life as 1/2 a doctor :)

Halfadoc x
 

halfadoc

New Member
Blonde medic moment: number 1



Ok, I've been thinking about how I can make sure I blog more even when I'm busy, and I've come to the conclusion that sometimes it might be better to write short posts about amusing moments even if they are not necessarily recent events or coming in chronological order with my main longer posts...


So here starts a new series of posts that I will slot in whenever I feel like it (and whenever they happen) "Blonde medic moments".


So, yeah, I'm pretty blonde in both a literal and metaphorical sense (however much I argue against the blonde stereotype when everyone else suggests it..), so sometimes on the wards I do some pretty stupid stuff, bad times perhaps but good blogging stories? Maybe :).



Blonde medic moment: number 1

An elderly care teaching ward round in third year...

So we are round an elderly lady's bed being taught by the consultant, there are only three of us and one of the other students is examining the patient who is sitting in her chair; I am the only student standing on the far side of the bed.

Now unfortunately the elderly care ward has a tendency to be very hot and whenever we stand around a patients bed with the curtains pulled on that particular ward for some time I suffer from feeling really faint and like I'm actually going to faint or be sick (neither would probably be deemed particularly professional!). So whenever I can I try to lean/ prop myself against things on the ward (eg. half sit on a radiator), perhaps not particularly professional either but when I feel like I'm about to faint I'll go for anything that might ease the faintness slightly! This ladies bed was unfortunately lacking in anything I could lean against and was incredibly hot and I was feeling awful, which is what lead to the first blonde moment (and probably chronologically was my first on the wards though certainly has not been the last!)....

As the patient was sitting in her chair, I decided to subtly lean slightly onto my hands which were on her bed (and yes I know, infection control wise I probably shouldn't have been but I promise that a) I had used alcohol gel on entering that patients bed area and b) It was that or potentially be sick on her bed..the greater infection control risk!). Now what I hadn't realised as I did this was that firstly the patient had a special air mattress (not sure what her reasons were but special mattresses tend to be for reasons like stopping bed sores) and secondly that the valve was right near where I was standing...

Yes, you guessed it, suddenly there was a loud raspberrying sound and the bed started deflating rapidly before our eyes. The other students were not touching the bed...

I didn't actually even try and say this... that probably wouldn't have gone down well!
The consultant was actually a very nice consultant and looked at me with a mixture of amusement, exasperation and pity as I turned beetroot and frantically (and unsuccessfully) tried to fiddle with the valve and stop the bed from deflating. In the end he continued teaching and I had to sheepishly ask a nurse to re inflate the patients fully deflated bed after we were finished. Not my finest moment but probably not my worst either... more to come in the future :p.

More up to date blogs at Life as 1/2 a doctor !

Halfadoc xx
 

halfadoc

New Member
An average week of a fourth year medical student: Monday


Well this series of posts will literally do what they say on the tin.. I'm going to tell you exactly what I've been up to this week, it probably won't be in much reflective detail (unless I get carried away...hopefully not, I've got work to be doing!) but it will give all of you out there thinking of doing medicine a realistic idea of what clinical years are like. I have to say though fourth year is our easiest clinical year so maybe I will do the same next year when I am a final year just so you don't think its too easy!


Monday:

7.00: First alarm... *snooze*
7.10: *reset alarm for 7.30*
7.30: *Snooze*
7.40: *Manually snooze for another 5 minutes*
7.45: Finally sit up, and grab energy drink placed next to bed last night (I was finally being constructive late last night and stayed up till 3.30am as a result as I know me and if I didn't then the task I was doing would remain half done).
lidl energy drink medical student blood.jpg

Lidl energy drink, dragging me through medical school since 2009 (the year I moved to a house ridiculously near my local lidl ;)

8.05: Finally make it out of bed, grab some passable clinical clothes, quick wash and get ready.
8.15: Boil kettle! Yep, more caffeine.
8.17: Discover milk gone off, *swear*. Put cold water into coffee and drink it black *bleurgh*.


8.22: Running late! To the hospital!!



08.35: Arrive at eye hospital (currently on ophthalmology)
08.40: Get into scrubs - this mornings session is watching eye surgery.
0.9.00- 12.10
Watch 3 x Vitrectomys - these are operations to remove the vitreous humor (a gel between lens and the retina which should be clear) from the eye. These patients were having this operation because an "Epiretinal membrane" had formed on their macula and they needed to have the vitreous removed and then this membrane removed (membranectomy), there are other causes for this operation though such as retinal detachment.

I got to watch one of the operations through the "spare" microscope head, which made me feel totally badass and like I was on greys anatomy (even though a) It was eye surgery not neurosurgery and B) I wasn't doing anything just watching and making sure I didn't touch the surgical field!).


You get an unbelievable view down the microscope compared to the screen where I watched the other two operations, and you really get to appreciate how skilled and impressive the ophthalmologists are - they have to be able to make the tiniest movements ever, no room for those with shaky hands here!

We received quite a lot of teaching during the morning from both the consultant and the scrub nurse, a very welcoming team :).

An interesting morning but I have to say I do find eye surgery quite gross, though that's partly due to watching Final Destination 5 recently, regret seeing that before my ophthalmology rotation!!


final-destination-5-eye surgery death.jpg
The eye lasering scene from final destination.... the instrument holding her eye open is the same as is actually used, fortunately nothing else was the same as in the film!!



12.10- 13.45: A quick trip to lidl (milk!!) then lunch and a nice coffee with milk made from coffee I bought from the plantation near where I was on elective in Tanzania. Its is AMAZING coffee and normally properly wakes me up but today I was too tired for even that to combat the midday sleepiness. Grab another lidl energy drink to take to lectures in case I'm falling asleep.

14.00-15.30: Lecture on back of the eye pathologys, its ok and quite well taught but theres quite a lot to get through and it does drag a bit, energy drink was a good call!!

15.30- 16.15: We go down to the clinics to be taught fundoscopy and practice on each other. Unfortunately this was a bad clinical skill for her to choose to teach us as probably is one of the few skills we have got to practice quite a bit recently, so this wasn't amazingly helpful.

16.15-16.45: I still need most of my clinical skills signed off in my dreaded logbook and this is the last week of ophthalmology (we only have 3 weeks its not like I've been incredibly lazy!) so I manage to grab a nurse who had previously said that he would help us get these skills signed off. I practice on another student and her on me (she already had the skills signed off but he was a very good teacher so hopefully this was still useful for her!) and get a couple of them signed off but more importantly actually do learn quite a lot, he was brilliant.

17.00 - 17.35: Back home and writing this blog!! Have a committee meeting at 6pm which will probably be a couple of hours, and then I plan to come back home, tidy my room quickly (I'm trying to turn over a new leaf and be all tidy and organised...this is very unnatural for me! I was doing quite well at keeping my room tidy but then I was ill at the end of last week so fell a bit behind on everything, need to get it sorted now before it becomes a tip which will take hours to sort out again!) whilst pizza is in oven and then after dinner get some work done. Will see ;).

So that's my Monday :), tune in tomorrow for my Tuesday...

Halfadoc x

P.S This was a while ago now, I am now a fifth year, for more recent blogs please see: Life as 1/2 a doctor: March 2012
 

halfadoc

New Member
An average week of a fourth year medical student: Tuesday


So what actually happened after my committee meeting yesterday? Yeah, the room didn't get tidied and no work was done, oppsy. Instead my partner came round and we ate pizza and chatted to my housemates, oh well!
Still new day, new chance for that essay to get written....

8.15: Actually get up despite having the morning off! (The advantages to dating a final year who does not have mornings off!). Its a lovely day here in my part of the country, feels almost like summer :).

09.00 ish : Get showered and changed and start being constructive in the form of emails and phone calls I've been putting off for a while. Oh and of course : Coffee!

10.30-12.30: Got my room back to spotlessly tidy, looks much nicer now :)


12.30: Coffee and toasted teacake break :) then a quick spot of ebaying (I need a desk chair - house came unfurnished and still haven't got one and haven't had any room in bedroom for said chair until recent tidying spell ;D)
1.30: Head to afternoon clinic, take a textbook with me because last time the doctor didn't turn up for ages....
1.45-2.30: *Read textbook*

2.30: See an interesting patient with one of the nurses, he is virtually blind in one eye (can only see light and movement) and has extremly bad vision in the other eye due to a cataract which was due to be operated on a few weeks ago but they discovered during the pre op assessment that he had an eye infection so the operation had to be postponed.


When the nurse got him to read down the eye chart with his "good" eye, it wasn't immediately obvious which line he was trying to read as what he was saying didn't resemble any of the lines in the slightest, the nurse asked him again to read the top line multiple more times before she was sure that that was the line he was trying and his eye sight was simply that bad. This means this patients vision at SIX metres was so bad that he couldn't see a letter which was sized so those with normal vision can see it at SIXTY metres, so pretty bad!!


I wasn't too impressed with the nurse in general with this patient though because he was a fairly confused elderly gentleman and she was quite grumpy/ rude with him just because sometimes he took a bit longer to understand her instructions. I know she must be busy but I do hope that however busy I get in the future I don't lose patience with those who for no fault of their own take up a little bit more time than the average patient.

snellen chart cartoon.jpg

My patient couldn't read the top line of a "snellen chart" like the one shown in this cartoon


2.40ish: Doctor arrives
The first thing he asks me is what clincal skills I still need completing which saves me the awkwardness of asking him, so this is quite nice :). The patients are for the most case pretty bog standard follow ups and mostly all patients with glaucoma who have to be monitored once/twice a year. I get to do my clinical skills though and rather than it just being a matter of getting the sign offs, the tips he have definitely helped my actual ability so this part of the clinic was useful.

The doctor quizzes me on a various things throughout and for the most part I actually do pretty well as they mostly happen to be the bits I read whilst waiting for him. WINNER!!

4.30 ish: Clinic still on going but Doctor signs off my clinic and suggests I see if theres anything more interesting going on in the A+E department but if not tells me I can go home because "you have above average knowledge about the eye anyway" - wooo never has bringing a textbook with me ever been such a good idea before! There were other students in A+E so I couldn't get in and headed home.


4.45: Have somehow bought FOUR desk chairs for £5.98 (all together!) second hand from ebay. Interesting.... I wonder if I can sell the other 3 using the Friday ad and make some profit?!

5.00- 6.30: Been sitting out in the garden enjoying the surprisingly warm weather with my lovely rabbit Chunks (he's erm a sturdier build than most rabbits) running about while I type this and sort out a few other internet things. Its been a pretty good day!

chunks tired mini lop rabbit halfadoc relaxing in garden.jpg
Chunks tired after all that hopping about

Normally at this time on a tueday I would be at sports training, but we had our last "BUCS" (the university league) match last week and also the rest of the uni are now on their easter holidays (damn them!) so I'm free to get on with work, joy! So time to conquer some more of that essay... wish me luck!

Halfadoc x

More recent posts available at www.halfadoctor.blogspot.com!
 
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halfadoc

New Member
The average week of a fourth year medical student: Wednesday


7.30- 8.25: The usual excessive pressing of snooze!
8.30-8.45: The equally usual rush to get ready and quickly downed coffee
8.50: *Once again running late!!*

snooze alarm halfadoc.jpg
^ I really do wish these things had never been invented!

9.05-12.30: A morning in the eye hospitals A+E department
Eye hospital A+E is in someways much like a regular A+E in that patients can just self refer and turn up on the day with eye problems and wait to be seen, equally GP's (and because its the eyes: opticians) can suggest to patients that they attend the A+E and refer them.

In some other ways though its very different to a normal A+E, for starters I saw a number of patients today (and during subsquent mornings I have sat in on this department) who had appointments booked for them for a weeksa time to come back and check things are progressing/improving as they should. This makes it almost more like a clinic or GP appointment system - in regular A+E if a doctor told a patient to bring themselves back into the A+E department to be rechecked they would probably receive some very harsh words from colleagues and hospital doctors! But I suppose the eye is such a specialised area that there no point telling the patient to get their GP to recheck them in a week because without the special equipment the eye hospital has and years of specific expertise in that area, a GP wouldn't stand a chance of picking up any reasonably subtle but important eye changes.

Saw quite a few interesting patients today but also had a lot of waiting about in between patients due to the nature of A+E and amount of refering to other departments the poor overworked registrar had to do. Here are the top three most interesting patients:

1. A patient who had herpes zoster (aka shingles) and had been unfortunate enough to get eye involvement with her shingles and was first seen by the eye team last week and now was being followed up.. She had whats called "Herpes Zoster Opthalmicus" which simply refers to the region that her shingles had appeared (it is in the opthalmic division of the trigeminal nerve) - over the right hand side of her forehead going down to below her eye. The worrying possible complication of when shingles affects this area is that it can cause eye problems such as uveitis, conjunctivitis, keratitis and ocular nerve palsys although these are reasonably rare. This patient when she first presented to her GP the previous week was recorded as having something called "hutchinson's sign" which is where there are shingle vesicles on the tip of their nose. This is significant as the nerve which supplies this area (the nasociliary branch) also innervates the globe of the eye, so patients with this sign are twice as likely to develop eye involvement with their shingles (where as having herpes zoster opthalmicus with vesicle on the eyelids does not increase risk from herpes zoster opthalmicus where the vesicles are just on the foreheard).

herpes zoster opthalmic eye.jpg
Herpes Zoster Opthalmicus


Unfortunately for todays patient she had got eye involvement and had developed anterior uveitis a week ago. Uveitis is inflammation anywhere in the uveal tract and the anterior part just means it was affecting the front of the eye. However after a weeks treatment the patient was actually doing a lot better, but has to slowly come off the eye drops over the next 8 weeks to try and prevent worsening/ recurrence.

2. A patient with a coldsore (herpes simplex causing a dendritic shaped corneal ulcer) in his eye!! Another unlucky chap as this is reasonably rare as well.

3. An eleven year old who came in with the most swollen eye I have ever seen outside of medical pictures. Poor poor boy it looked so painful. Apparently it is an infection probably from within his body although he feels systemically well at the moment. He was referred straight across the road to the childrens hospital to have IV antibiotics because the doctor wasn't sure if he had slight orbital cellulitis which is serious as it can be both sight and life threatening as it can enter the meningeal cavity (in other words there is a small risk of developing meningitis from it).


periorbital cellulitis halfadoc.jpg
The boys eye looked pretty similar to this but without the red scabs this childs eye has


Wednesday afternoons are usually off for "sport", I am probably one of the rarer medical students who does actually use them for this but as I said yesterday BUCs matchs are finished now so this time is now available :)


12.45- 4.30: Had a nice lunch out in the sunshine with my rabbit hopping about, met the new next door neighbours because they were peering over the wall watching their cat who was out in this area for the first time. Made friends with the next door neighbours quickly when they spotted Chunks and exclaimed that they had rabbits too and held theirs over the wall to meet me!

Wrote some of this blog out there and did a little ophthalmology reading but then actually got too hot (remarkably for march!) so I've headed back inside and am ready to do a serious amount of essay work! (I did do some yesterday, but lots more to do).

Till tomorrow!

Halfadoc

Many more recent blogs about being a scary final year at Life as 1/2 a doctor (plus the rest of this average week series!)
 

halfadoc

New Member
Hi all, theres several more posts in between the previous one and this one and they are all at Life as 1/2 a doctor: Quotes from my first week and a bit as a junior doctor.. but ive fallen very behind on copying them all across. In summary though, I made it through fifth year and am now an FY1 working at a very busy hospital near you...

Heres one of my posts from this year:

Quotes from my first week and a bit as a junior doctor..

Well its been an eventful and exhausting week and a bit as a "proper" junior doctor. There's so many anecdotes and stories I could tell you about that I don't know which one to focus on, instead I thought I would share a few quotes to give you a flavour of how the week has been. As ever please remember none of these quotes/descriptions are entirely accurate so if you think you recognise yourself or a relative, you almost certainly don't... All of these quotes however are versions of things said to me during my first week or so of work.

Patient: You're a doctor?!? I thought you were a work experience student! (this was the response of the second patient I said "I'm one of the doctors" too, the first one simply said I looked to young to be a doctor)

Gentleman that I'm trying to put a cannula in: Don't worry, just have a try. (firstly isn't it my job to tell him not to worry - clearly need to work on calm expressions! Secondly I'd actually got it in by this point and was just sticking it down..)

Consultant: "And this is wrong.... and this is terrible....and this drug needs to be stopped...and why hasn't this been done...." "I'll forgive you this time as your new but.." - None of the aforementioned mistakes were my own management plan, they were the more senior juniors but I get it, prinicipal role of the FY1 doctor is to be the whipping boy for everyone else's errors.

Lovely senior nurse: Did you write [plan I had scribed but at instructions of FY]? Mr [above consultant] is on the warpath about [minor mistake by FY2 in plan] but don't worry I told him you weren't on the ward.
Be nice to the nurses and they will look after you!

Disgruntled patient: What an earth am I paying for the nhs for?!

More "senior" junior doctor friend: Do you want me to lie and say it will get better?
Me: Yes please!

FY2 + nurse: Halfadoc, go tell Mr Z that his investigation has been cancelled today so he has been nil by mouth for nothing. Again, FY1 = everyones whipping boy/ person to be given the most disheartening tasks.

FY2: Make sure you test his anal tone.

Conversation overheard between FY2 and ortho surgeon: Lucky you having to keep testing Mr Y's anal tone. FY2: Nah I'm getting the FY1 to do it haha.

Consultant grilling me: Come on, this is simple!

Younger patient who I have stayed several hours late for to try and ensure his treatment gets finally started that evening: Do you have kids? [No] Then you can't understand.

Lifesaver ward pharmacists: Did you mean to do x/y/z? [Always no].
Lifesaver ward pharmacists: Would you like to add x/y/z? [Always yes]

FY1 colleague on another awful-paedics ward: We've got to make sure we go to lunch together so its not so lonely and so we can discuss problems.
Day 8: We finally go to lunch at same time but only because there is a compulsory lunchtime teaching.

Lovely senior nurse: Here I baked some cake, have a piece.
I repeat: Be nice to the nurses and they will look after you!

Still, 10 days till pay day! Swings and roundabouts etc! Hope thats given anyone considering medicine a realistic idea about the glamourous first days of being a junior doctor.


Dr Halfadoc xx

More posts at Life as 1/2 a doctor
 

halfadoc

New Member
My first week on call

On the 12th day on call,
The hospital sent to me:

12 thousand bleeps,
11 nurses insisting,
10 BM's a-leaping*,
9 drug charts completing,
8 NOFs a-breaking **,
7 TTOs for writing,
6 bowels delaying,
5 arterial gases,
4 calling pts,
3 stolen pens,
2 D.T's***,
And cake with a KFC!

(Numbers may be altered for comic affect...)

*BMs = blood sugars
**Neck of femur - common and bad fracture in old people.
***delirium tremens - occur when alcoholic s are withdrawing

Dr Halfadoc xx

Ps Many more posts that are not copied here are available at: http://halfadoctor.blogspot.co.uk/
 

Martigan

Super Moderator
FY2: Make sure you test his anal tone.

Conversation overheard between FY2 and ortho surgeon: Lucky you having to keep testing Mr Y's anal tone. FY2: Nah I'm getting the FY1 to do it haha.
Made me laugh. Though I'm sure it will feel less funny in 14 months time...
 

halfadoc

New Member
The reality of life as an FY1

So I'm now in my tenth month as a foundation year doctor working at one of the busiest hospitals in the country (great job picking there Halfadoc!) . I'm not going to apologise for having thoroughly neglected my poor blog even though its something I never intended to happen and gives me the occasional sharp guilt pang before I forget about it again (probably due to being distracted by remembering another of the 1 000 000 life tasks I have forgotten to do).

The reality of life as a junior doctor is that at points of the rota I am so busy, so tired that I scarcely can summon the energy to do the bare essentials of eating and washing before I go to bed. This isn't deliberate hyperbole and I do not think it is that far from the truth at times. It isn't the entirety of life as a junior doctor either but when on the "easy" rota shifts you often find you need to spend your slightly increased spare time catching up on the washing you neglected during busier patterns, attending own health/dental appointments, paying bills, hoop jumping for the dreaded e portfolio (an online method of assessing Junior doctors using a series of tasks that are about as useful as the labours of hercules) paying in ash cash cheques (not all chores are bad!) etc etc. The remaining spare time not surprisingly you often feel like spending as selfishly as possible ;). I used to be reasonably keen at playing sports (albeit in a lazy halfhearted kind of way).This year I have attended exactly one training session and one competition - in which I came second to last in, I guess the lack of training has caught up with me. So that is why my blog has been neglected badly enough that if it were a patient in the NHS it would probably have gain a DNAR (do not resuscitate) form by now.

So is it all bad?
No. But you have days/weeks when it feels that way.

However there are moments that bring you back and make it feel worthwhile again and here are a few examples to stop this post sounding all doom and gloom:

Mrs Jenson, the lovely old lady who recently submitted to me cannulating her with a stiff upper lip that all too few of the patients have and afterwards thanked me for doing what is after all a painful procedure (though not as painful as some patients suggest) and gave me a handful of her chocolates as thanks. She wouldn't take no for an answer and I was very grateful for her as that handful of chocolates was in fact the total of my lunch for that 12.5 hour shift.
Mrs Smith, I met this lady whilst they were in the surgical high dependency unit where I was the sole junior doctor for a nerve wracking few weeks. She was there throughout my time and had a really rough time of it. She'd had a surgery to remove a bowel tumour which had left her with a stoma. Unfortunately the stoma wasn't working and she had a condition called Ileus which basically means her remaining bowel had gone on strike. This is very common after bowel surgery but this poor lady had it worst than most. She was in high dependency for weeks, required a repeat operation after a leak from where she her bowel had been joined up at which point she developed prolonged ileus yet again. She was very ill and very low in mood and yet in spite of this had her relatives bring in regular chocolates for the ward staff and once even summoned me over and gave me a box of chocolates and said it was just for me for the help I had given her (naturally I did share it with the nurses as I had certainly nicked theirs to keep me going through skipped lunches). She also used to say "god bless you " to me on a regular basis which as an atheist made me feel a bit guilty but I appreciated the kind sentiment. This lovely lady fortunately did go home shortly after I left the unit.
The adrenaline rush of a crash call and amazing feeling when the patient DOES regain an output.
A thank you from a healthy patient who is going home.
Pay day. I didn't do medicine for the money and theres a lot of better, easier ways of earning the same or more and definetly earning more per an hour. However when times are tough and you barely can keep going at least it is a day to focus on.
(As ever all names/ details have been changed.)

Lately I've been re reading Max Pembertons junior doctor book and realising what an accurate portrayal it really is of life as a junior doctor. I read it before medical school, and I thought I understood what he was saying and what being a junior doctor would/could be like, but I'm now not sure you can until you are really there. I don't think even medical school fully made me realise what it would be like. I particularly however liked this quote from his book: "I was never naive enough to think that medicine would be a bed of roses, I just never realised there'd be so many nettles"

For this weekend however this fy1 is enjoying the sunshine safe in the knowledge of impending annual leave and the e portfolio finally being handed in.

Till next time,

Halfadoc x

More posts available at : http://halfadoctor.blogspot.co.uk/ (and pretty pictures/cartoons too ;D )
 

halfadoc

New Member
Bedside manner anecdote part 1

Me attempting to calm down very angry and aggressive patient: (About 4th attempt at explaining to the patient that she has had an intracranial haemorrhage which is why she needs to be in hospital and that she needs to calm down (stop punching us!) so we can examine her) So the reason you are in hospital is because you became unwell at home so your husband has brought you in, your brain scan has shown you have had a bleed on your brain. Do you understand this?

Angry patient: Well you dont even have a bleedin' brain!

Well played patient, well played.

Halfadoc x

Ps catch up with more of my posts at http://halfadoctor.blogspot.co.uk/
 

halfadoc

New Member
Rubbish Handovers

Doctors are often slated for their terrible handovers between shifts. Whilst nurses have a rigid formal handovers at every shift change, we have formal handovers between SOME shifts but informal between others (for example the day doctor may bleep the twilight doctor with something that is yet to happen such as blood coming back, this is often quite haphazard. The twilight doctor will then formally handover at the end of their shift in a sit down meeting to the team of doctors on overnight including senior doctors. I've noticed Often the very minimal change of sitting down and having someone senior present improves the quality of the handover and how much information is given. However the twilight doctor may be handing over stuff from the day teams list so their handover will be limited by what the day team originally told them.)

Here's a handover I recieved this weekend:

Night shift doctor : Oh and Mr Y hasn't had his xray yet.
Me: What is the xray for?
Night doctor: Not sure
Me: ... What type of xray
Night doctor: Oh erm Chest xray.
Me: Ok can I have his hospital number
Night doctors: (Has this and gives it to me but only after I ask)

I later hunt down Mr Y's request form purely so that I can find out why he is having one. At this point I discover its not a chest xray but a lower leg (fairly different ends of the body!) and he is having for the potentially very serious issue of ?osteomyelitis (infection of the bone). So I was very glad I looked!

I received this handover at a formal type handover so perhaps sitting down doesn't always solve "medical-chinese-whispers" after all. In summary, we as profession do need to work on our handovers. (This example is the worst I can think of but there are plenty of other slightly rubbish ones). This weekend has reminded me about the importance of trying to both handover well and make sure I ask the right questions of those handing over to me so that I know what is going on. Geeky though it is I recommend all those reading this try to remember to do their handovers in a formulalic way such as the "SBAR" system.
(See full blog at Life as 1/2 a doctor for a picture of what this involves as this blog is currently not allowing me to add a picture! More posts also available there)
Happy handing over!!

Halfadoc x
 

halfadoc

New Member
The unwritten rules of being a junior doctor/ 25+things you wished you knew before becoming a doctor

Well I thought it was about time that I did a junior doctor version of my post about things you wished you knew before starting medical school ( Life as 1/2 a doctor: 80 + Things you wish you knew before you started medical school ) so here goes:

1. (And this is the most important) Never say the "q" word. The q word is the dirtiest swear word of the medical world. In the rare event your day is "Quiet" DO NOT SAY IT!! If you do utter the word then be prepared to be blamed by all staff when seemingly every patient on the ward becomes deeply unwell.

2. When referring a patient you can prepare your referral as much as you like and still guarantee the senior you are discussing with will ask that one aspect you forgot to look up such as the all important serum-rhubarb level.

3. Crash bleeps like to go off when you are in the middle of a procedure or breaking bad news

4. Crash bleeps like to get cancelled as soon as you arrive at the correct location having run from the opposite end of the hospital.

5. As per above "crash call cardio" is an excellent way of getting your recommended exercise.

6. The patients you get called to see with low urine outputs/ poor oral intake will probably have drunk and/or peed substantially more than you have during your on call shift.

7. You will have to make some truely awful referrals/ investigation requests at the recommendation of senior doctors (surgeons I'm looking at you) and by the end of your fy1 year you could probably make a decent second hand car salesman after the amount of shit you have been peddling to other specialities all year.

8. For the above the words "my consultant would like" absolves you from blame for crap referrals.

9. You will get blamed and/or shouted at for the crap referrals anyway.

10. A great ward sister/ charge nurse who likes you will make your rotation survivable. Doubly so if said nurse is also an avid ward baker.

11. You will just be finding your feet in a speciality when you rotate to the next one. Return to go, do not pick up 200.

12. The most difficult to bleed patient will also be the one who needs daily/ twice daily bloods.

13. You won't have to do a female catheter until there's a patient that none of the nurses can catheterised and then suddenly you are expected to be the expert...

Rest of this post continues at :Life as 1/2 a doctor: The unwritten rules of being a junior doctor/ 25+things you wished you knew before becoming a doctor along with many more posts that never made this forum, please follow my actual blog if you want the full blog experience ;)

Halfadoc x
 
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