I'm A Medical Student Get Me Out Of Here

[imamedicalstudent]

The NHS is Shit*

You know, anyone would think the NHS does nothing but kill people! A quick look at the Health page of BBC news shows so many negative stories its ridiculous, at the most there are 1 or 2 positive stories (which are usually more about scientific advancement than the achievements of the NHS). We all know there are problems with the NHS and that improvements are needed, after all, there are usually 3 or 4 stories every week in the papers about the failures of the NHS. When was the last time you read something positive about the NHS? What about all the lives saved by the hard working doctors and nurses? I can't even remember the last time I read a story praising the work of the NHS or its workers. People wonder why morale is low in the NHS, the negative picture painted by the media certainly doesn't help.

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[imamedicalstudent]

Wanted: TLM for Stealing His Own Debit Card

Here is a letter I've just sent to Wetherspoons about today's events.

------------------------------------------------------------------------


TLM's House
TLM's City
January 19, 2008

Dear Mr/Mrs Weatherspoon,

This afternoon (Jan 19th) at approximately 2:43pm missbliss and I, along with a friend entered ..... (a pub, somewhere) What followed was the perhaps the most annoying meal I’ve ever had......



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[imamedicalstudent]

Wherefore Art Thou Portfolio

Tomorrow I meet with the dean at my hospital to review my portfolio. Along with most of my colleagues, my portfolio is something which tends to get neglected until shortly before its due to be reviewed. We've had the idea of a portfolio hammered into us since we started medical school but particularly in the clinical years. I was going to describe exactly what a portfolio is, or is supposed to be, but I can't. I don't really know. I mean sure, I get that its supposes to be a record of your progression, your achievements, your reflection and all that but I'm still not entirely sure what this is made up of. I quite enjoy reflective writing (never thought I'd hear myself say that), that is one of the reasons I enjoy blogging - not that I often do much deep reflection here but you get the idea....


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[imamedicalstudent]

The Patient's Agenda

Any doctor, or even any patient will know that most people go to the doctors with their own agenda. A lot of the time they've got their own thoughts and ideas about what is wrong with them, sometimes they know exactly what treatment they want and occasionally they come in with the intent try and get something out of you which they don't deserve.

Its difficult to pick out these patients unless you know them and their history well and even then you can never quite be sure. Every doctor has their own 'heart sink' patients who persistently visit the doctor with chronic, often vague problems. What is their agenda I wonder? They've already been investigated up to the eyeballs, they've already tried numerous tablets with no effect, and there is little more that can be done. And so, a never ending cycle begins whereby these patients come for regular review, they're the ones that often take 25minutes even though very little can be done.

This morning I had 5 patients, and they all had pretty text book symptoms, they were all there on their own agenda and they had an idea what they wanted. I find it useful to ask what patients are most concerned about - this usually elicits exactly why they've come to see you and so you can actually help, even just by offering reassurance.

Sometimes patients trick you. I've seen this a couple of times recently. Firstly a patient came to see me and when I brought the doctor in to review the case, they denied everything as I presented their history to the doctor. I don't mean just picking up mistakes in my history I mean flat out denying that they'd ever said things to me, they ended up reporting an entirely different set of symptoms to the doctor. Why? Why would anyone do that? It made me look ridiculously stupid. I have an idea about why they did it, but still - bonkers. I seemed to remember this happened a couple of times back when I did psychiatry also, one of the reasons I despise it so much. Another patient came to see me. They seemed very unsure and nervous but I built up a good rapport and was able to find out all about the problem. I'd had a quick flick over the recent history on the computer and noticed a couple of previous visits with the same thing. So, I presented to the doctor who decided that they should be referred and off the patient went. Only after I'd dictated the referral did I take a detailed look at her past history to find that she'd been referred previously for the same thing. Shame that they'd neglected to tell me anything about their past history despite me asking specific questions about it.

So what did I learn today, well I learnt that patients really do often have their own agenda and they're often reluctant to deviate from it, so much so, that in some cases they even lie. How exactly do they expect to be treated then?

Perhaps this post is slightly hypocritical as in the past I've probably been quite selective with the truth to a doctor in order to fulfil my own agenda. That is unavoidable, I know too much about the system.

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[imamedicalstudent]

Communication Skills

This afternoon we have 4 hours of communication skills, we tend to have 3 or 4 communication sessions scattered througout each clinical year. The sessions do tend to drag a bit but they're certainly not entirely useless. Sessions in the past have included; breaking bad news and dealing with angry patients. They use actors as simulated patients and we each take it in turns to practice situations. This is very useful as it doesn't matter if you make any mistakes or mess up telling someone they're going to die, of course they're not actually going to die as they are actors. But it means that if and when the time comes for you do it for real, you'll at least have some experience of the situation. The dealing with angry patients sessions last year was interesting, the actors are very good and do tend to get quite into their character so it can be quite realistic.

This afternoon's session is on ethics, I suspect this should be quite useful as we don't do ethics at any other time really.

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[imamedicalstudent]

A Lesson in Ethics

Today's communication skills session was on ethics, it was a useful session and brought up some interesting discussion. Its also a potential OSCE station for finals so it was useful in that respect too. The session was based around simulated consultations and I thought I'd share some of the cases with you to get your thoughts and opinions.

1) You are an FY2 in GP practice, an elderly patient's relative comes to see you. They are concerned that their elderly relative is unfit to drive. They would like you to contact the DVLA.
The elderly patient does not see that he has a problem despite arguments with his relatives and is reluctant to come and see you.

What do you do?

2) Last week a pregnant young woman came to see Dr Pickles at your practice with PV bleeding. Today, her sister has come to see you to complain that Dr Pickles did an internal examination on the pregnant woman without informing her that he would do so and without having a chaperone. The sister is also concerned that this internal examination may have led to the patient having a miscarriage later that day.

What do you do?

3) You are an F1 on the ward, a patient comes to you and reports that she just saw a more senior doctor "sniffing a white substance". She is reluctant to make a written statement or to follow-up the complaint, although she is very concerned.

What do you do?

4) You are an F1 on the ward. A social worker has asked to see you about Miss 'Caine, unfortunately Miss Caine discharged herself earlier that day and her whereabouts are unknown, you hope her GP will persuade her to return. Miss Caine was an IV drug abuser who has Hepatitis B. The GPs referral letter mentions that Miss Caine's 13yr old son, Tom, has Hepatitis B. As far as you know, Miss Caine, and her son, may or may not be aware of this diagnosis. Tom is currently in social services care, he is in a house with 2 other children and has been known to bite in the past. The social worker wants to know about Miss Caine's care and about Tom. She needs to know if he has Hep B and is a danger to those around him.

What do you do?


I ended up having number 4, which was apparently the hardest, fortunately the argumentative simulated patient was away today. I'll post what I said in the comments later.

Answers on a £10 note to the usual address.



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[imamedicalstudent]

Kidneys - What Do They Do?

As finals are approaching fast, we're having a series of revision sessions from consultants. Yesterday's we had 2 hours on kidneys. This seems to be a notriously neglected topic by medical students, at least at my medical school. I remember back in 1st year we had a PBL case on the kidney and we were supposed to learn EVERYTHING about the kidney in a week or so with no support lectures whatsoever. I gave up before i'd even began and along with many of my collegues ended up neglecting the kidneys entirely. Fast forward 4 years to last night and this revision session was more like a first-vision....


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[imamedicalstudent]

Wetherspoons Reply

I'm sure you remember this disasterous meal we had a couple of weeks ago at Wetherspoons. Well, I got a reply to my complaint letter this morning....

Read the reply letter here:
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[imamedicalstudent]

The Grim Reaper Comes To Town

Today was communication skills part 2 and today, in 3 hours, we learnt how to talk about death. In fact, we learnt how we talk to a wife about her dying husband. I was excused from the simulated patient experience this week having done it last week although a sadistic little bit of me wanted to have a go. There were 3 scenarios this week all based around Mr and Mrs Prostate, unfortunately Mr Prostate was dying of metastatic disease. The first scenario, Mr Prostate had just been admitted after his GP had failed to control his pain adequately. His wife had hugely unrealistic expectations about her husband’s condition and was busy planning a 2 week break in the Lake District whilst poor Mr Prostate was actually dying. His wife wanted to speak to you, as the F1 to see what you were doing for him. The second scenario was based a couple of days later and Mrs Prostate wanted to speak to you about her husbands worsening condition. In the final scenario, a day later, Mrs Prostate had come to collect the death certificate and wanted a word with you.........


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[imamedicalstudent]

The Solution

I've found a solution to my dilemma regarding giving up sweets, chocolate, crisps and biscuits.

Today is Shrove Tuesday, otherwise known as Pancake day (HURRAY!). This means that Lent begins tomorrow. As of tomorrow I'll be giving up said items once again for the 40 day duration of Lent.

The cleverest among you will have noticed that this gives me the rest of the day to eat as much junk as I possibly can. In order to accomplish such a feat I will spent today gorging myself on mini eggs. I've already eaten 200g worth and expect to have devoured several billion calories worth by midnight. This option has the added bonus of satisfying the 8 of you who think I should have restarted my junk food habits, beginning with an atrocious binge on mini eggs, and those of you who think I should have continued my efforts with no such binge. It'll also satisfy my overwhelming urge for mini eggs.

Whether or not this will make the beginning of lent any more difficult i'm not quite sure but in order to counter the effects of several million mini eggs I am going to to swimming this evening!

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