The GP Inside

This week was the last of my 8 week community (GP) placement, given that my foundation years don't include a GP placement I might well have spent my last days in a GP.

When I started medical school the one thing I was sure of was that I didn't want to be a GP - under any circumstances. I'm not entirely sure why I felt this way, but I was determined, despite the fact that about half of us would ultimately end up as GPs, that I would pursue a career in hospital medicine. During my first GP placement in 3rd year my opinion changed for a few short weeks but this was mainly due to having a brilliant GP supervisor rather than me uncovering a hidden love for coughs and colds. My 4th year GP placements only reinforced my original thoughts that general practice wasn't for me. I was therefore dreading 5th year and its 8 week stint of general practice. 9 weeks ago, I was looking for any excuse to avoid as much time in GPs as possible, I volunteered for every meeting possible to avoid a morning or afternoon here and there. In fact, I'd rather have spent 8 weeks tied up, naked, covered in scorpions.

Why is it then, that I sit here 8 weeks later, rather sad that my time in GPs is over? Maybe its the dictaphones (I'm still not bored of them), or maybe its a new-found love of general practice. Perhaps love is too strong a word, but I've definitely mellowed towards general practice. Not so much that I'm not destined for a career as a GP but I can certainly see why the lifestyle appeals.

I've thoroughly enjoyed this 8 week placement, helped by the fact I was at a nice practice with a lovely supervisor but I think its more than that. I enjoyed having my own surgeries, my own patients and my own room, its a rather nice feeling when a patient comes back to see you when they're feeling better. Maybe its the novelty of having my own patients that made the experience so interesting and useful - a novelty that would rapidly wear off as 'heart-sink' after 'heart-sink' patient knocks on the door and sits down with a list.

I've learnt a lot in the last 8 weeks and it will undoubtedly be useful when I'm in the position of looking after my own patients in hospital.

I'm still fairly sure I don't want to be a GP but I can see it definitely has its benefits, and perhaps I shouldn't rule it out to the extent that I did before I'd even started medical school.

Next we have 4 weeks in A&E, something which i'm really looking forward to. So begins the last 8 week block of 5th year, where has this year gone?

If A Job's Worth Doing

I thought I might reflect a little more on my job allocation.

Already facebook is full of groups, one for each deanery with splinter groups now forming for each individual hospital. This means that not only can I spy on what other people I know are up to but can also see who my colleagues are likely to be come August. I'm not sure whether this is a good thing or a bad thing, it means I’ve already pre-formed opinions on some of those I’ll be working with, but the groups are useful for sharing information (something which there is a significant lack of elsewhere).

The allocation process itself was interesting to say the least. I can't decide what to think about the whole thing but I'm surer than ever that it’s more of a lottery than anything else. When the whole process started I was quite apathetic towards the whole thing, I thought it was probably the best of a fairly bad idea. Once I got my score (from application form and academic ranking) I was still rather apathetic, I did muster some feeling when I asked for the individual breakdown of my score (so the score I got for each question on the form - still with me?). There is something quite bizarre about my individual question scores but I shall say no more about that here. I submitted my ranking of all 300 or so jobs, without much expectation. I wasn't particularly bothered about what I ended up with. And so, fast forward to yesterday, it was a very pleasant surprise to find a rotation almost perfectly suited to me. Apparently the rotation I ended up with was about 15th on my list (of a total of 300-odd), which I think is pretty good considering I went for probably the most popular ones.

There is only one problem with my rotation in that it is at different hospitals for F1 and F2. There is a significant geographical distance between them which will probably result in more home changes for us and job changes for missbliss which is not what we wanted. Although that is slightly annoying I’d much rather it is that way round with a good rotation than have a bad rotation at the same hospital. Other than that, my rotation is almost perfect - the only other thing I could have possibly wanted was a gastro placement rather than renal but I’m not complaining in any way, shape or form.

Amazingly I avoided psychiatry - what a result! I also avoided obs and gynae, GP, geriatric medicine, breast surgery and a multitude of other things which I have no interest in what-so-ever.

I'm by far most excited about the F2 year with A+E, Orthopaedics and Paediatrics. (If they change it, I WILL scream, shout, cry, etc, etc. I guess the next job will be to decide what career I want to pursue. Shitters.

It seems that I was lucky in this lottery (makes a bloody change) and I’m really looking forward next year, to a new place, to new people, hell, I’m even almost looking forward to finals in a sadistic sort of way.

Pretty Damn Pleased

After much pressing of 'F5' this morning the job allocation suddenly appeared. At first glance all you could see was a code which unless you'd memorised the list meant nothing.

On checking what the code actually meant, I was pretty damn pleased with my foundation jobs. I will be moving hospitals between F1 and F2 unfortunately but the rotation is pretty perfect.

So, what am I going to be doing? Well....

F1

Renal Medicine
Vascular Surgery
Acute Medicine/Surgery

F2

A&E
Orthopaedics
Paediatrics

The F2 year suits me perfectly, I couldn't have wished for a better year. The F1 year is more generic and i'm less excited about it but its still pretty good. I'm slightly worried about starting out on renal medicine as I've never done any renal and know next to nothing about kidneys. I'm also not entirely sure what acute Med/Surg is.

So it seems that the foundation lottery has been quite generous to me. Wahey. Hope everyone else got what they were after.

Now I just have to pass. Arghhhh!

J-Day

Today is Job-Day. Or at least it's supposed to be, wouldn't surprise me if it was postponed.

I thought the results would be puiblished at midnight - they weren't and are still not there as yet.

I hope the site will cope under a barage of 'F5' presses.

Watch this space....

"Not The End Of The World"

Today we had an all day communication skills session. Sounds like a real barrel of laughs eh? Even more so when it’s about terminal cancer and dying! There was an interesting start to the morning, as an icebreaker exercise (despite being in the same groups in previous sessions and having spent the last 2 and a half years together) we had to pretend to be QVC presenters in pairs. This provoked much eye-rolling, not only by me but most of my colleagues and there were understandably no volunteers so I volunteered the tutor to go first. To be fair, he did, and he showed it how it should be done. So, in turns we spend 5 minutes trying to sell ridiculous objects that the tutor had brought along ranging from a Cliff Richard CD to 2 self-help books on parenting. To start with I thought this exercise was pointless and ridiculous but when it came to my turn I was actually quite enthusiastic, unlike my partner who looked like she’d rather be dancing naked on the town hall steps. Our ‘item’ was an original artwork (a collage concoction put together by the tutor’s daughter I think). I actually had fun trying to sell this fantastic piece to my audience who were at the ready with their phones and credit cards. It was mentioned that perhaps medicine is the wrong career for me and that I perhaps have a future with QVC.

Anyway, from there, the day got more depressing as it went on. The case ran all day with a series of simulated patient sessions. By early afternoon the ‘patient’ had taken a turn for the worse and didn’t have long left. I was lucky in some ways when my scenario came round. The patient’s son had come from London and wanted to talk to me, the F1, about his father’s condition. This made it fairly easy from my point of view as all I had to do was not tell him anything because of patient confidentiality, of course I had to tell the son this and empathise at the same time. All in all, it was quite successful despite me refusing to tell him anything – I think we had quite a nice SP (simulated patient), others might have shouted at me. I felt a bit sorry for the poor chap who drew the short straw and had to tell the son that the patient had died – the SP was very good and promptly broke down there in-front of him. “Not the end of the world” was perhaps not the best phrase for him to use.

I can never really decide what I think about communications skills. I really like the simulated patient aspect and actually learnt quite a few tips today. We had a pretty good tutor who didn’t drag things out too much and was quite concise. The simulated patient sessions are very useful experience indeed and in a sadistic sort of way I enjoy doing them myself (not quite enough to volunteer openly though). I think they’ll come in useful in reality when we face some of these situations in the real world. I just hope I remember some of the tips I learnt. My feedback was generally good and the tutor was surprised when it was announced that I wanted to be a surgeon. Apparently surgeons are generally lacking in the communication skills department.

The sessions can be quite voyeuristic as you’re sat there looking into the lions den, watching as one student acts out a scenario being critiqued by all those around. Sometimes it goes well, others, things can go a little wrong. It’s rather obvious who’re going to be the best communicators come August and it’s not always the ones you expect. I was pleasantly surprised, if not shocked, at how good some people were and nobody was really bad. I wonder, will those with better communication skills be the better doctors?

Old Enough To Be Your Doctor?

The only reservation I ever have about university (apart from the atrocious error of judgment in choosing this particular one) is that I was too young when I started. I was barely 18 (only by a couple of days) when I started the 5 year journey of university. I've always been one of the youngest in my year and I’ve always wondered what would have been different if I’d been in the year below. Children's lives are defined by their school year group and there can be up to a year between students in the same groups. I started school at the age of 4 although I was allowed to fall asleep in the corner in the afternoons whilst the older children were kept awake! I wonder how long it takes for the August babies to catch up with their September friends - is there even anything to catch up? I'd say so - 1 year is a long time when you're 4 or 5! I always enjoyed being one of the youngest in my year at school, especially when it became clear that I was cleverer than many of those around me (how arrogant is that for a child?!)

Anyway, back to topic. I started university and was among the youngest around, in fact, I’ve never met anyone younger than me in my year - although statistically there must be some people younger than me (don't Scottish school years differ anyway?). I was surrounded by people who'd taken gap years and traveled the world, people who'd already done other degrees or people who already had entirely different careers but fancied a change. I was mature for my age, but compared to the people around me, was still relatively immature. I'd toyed with the idea of a gap year but for various reasons decided against it, I wonder now if it would have made any difference to my time at university. I don't regret not doing so, I just wonder what would have been different. Fortunately we've had the chance to do some traveling and it was great, I’m hungry for more.

I remember thinking when I started that I'd still be one of the youngest in the year group 5 years later when we all became doctors. Now that prospect is getting ridiculously close. Others around me have done intercalated years, resit years, or were just older when they started. So come August (pending finals) I’ll probably be one of the youngest out there, there is a high probability that I’ll be the youngest in the SW deanery what with 6yr courses, intercalation etc etc. Personally I think that’s quite cool, I’m not sure the patients will though. I think I look about my age so I’m certain I’ll get plenty of comments about being too young to be a doctor, behind my back mostly I expect. It doesn't bother me, they're probably right. Who would you want to be treated by? The 35 year old doctor who spent 10 years as an accountant before deciding on a career in medicine or fresh faced me who'll still be 22.

Medstudentitis and Medstudentpartneritis.

Well it seems that between me and missbliss in the last 24 hours or so we've had more contact with medical professionals than ever before. You remember I saw my GP yesterday morning with a chronic sore throat that I’ve had since before Christmas, I didn't feel ill at all with it but the irritation is driving me bananas!

Anyway - I’ll start the story where the last one left off.

I picked missbliss up from work and we went straight back to the doctors, it was the end of surgery and they were running significantly late. I already had my own ideas about what was wrong with missbliss and fortunately the GP agreed. He looked up some protocol and considered admitting her for a millisecond, had she vomited, she'd have been spending the night in hospital apparently. He decided it wasn't quite that serious and instead gave her a prescription for antibiotics. This time I had got involved and said that I was a medical student which made the consultation much smoother in my opinion. The locum GP was very friendly despite his vibrating phone (which he later answered but was apologetic for) whilst examining missbliss. His explanation of a urine dipstick was also rather amusing, he didn't know I was a medical student at that point and told us all about the little sponges which change colour. Anyway, we went away happy, with some decent treatment and safe in the knowledge that my diagnosis had also been right - makes a change!

After deciding on an early night we tucked up in bed to watch some Buffy. At about 10:15 I woke up with a roaring fever, although I felt ridiculously cold and was shaking so much missbliss awoke thinking it was a repeat of our summer earthquake experiences. I'd never had a fever like that before; I also had an awful headache and felt really nauseous. I was actually quite worried, as was missbliss - I had no reason to have such a fever and it was very unlikely that I had the same thing as missbliss. I've never done so before but I had missbliss phone the out of hour’s service. I must say I was rather disappointed when a nurse rang back and told me to take paracetamol and ibuprofen in the most patronising manner possible. If I hadn't been slightly confused I might have explained that I was a medical student and wasn't stupid and that I was fully aware it was probably viral (although she saw fit to tell me it was definitely viral - no question about it!) So I laid there - awake for hours now burning hot despite not having any cover at all. There is no way I could have gone to my GP placement today so I phoned in poorly when I awoke this morning.

I kept myself dosed up on ibuprofen and paracetamol all day long and was beginning to feel better - although my chronic sore throat was taking its toll. But not long ago I began shaking again feeling awfully cold. I know it’s probably viral but I've never had such a fever before and it was pretty dam scary.

Meanwhile, missbliss has been looking after me all day bringing me food and squash, despite having an illness all of her own. Poor cherub.

Unless I'm substantially improved in the morning I don't think I’ll be able to manage driving to GPs tomorrow either, besides, I'll only infect my patients. Being ill sucks.

"Little Medic to Room 6 Please"

I went to see my GP today, and characteristically was a good 15 minutes early, despite the fact the surgery is 4 minutes walk around the corner. Anyway I'm quite happy to sit there and read my book until it’s my turn. My appointment was for 10:20 and the GP registrar was only running 10 minutes late.

The consultation itself was strange. I'm 90% sure the GP didn't know that I was a 5th year medical student and as such, I felt quite patronised at times. I used a number of medically related words which your average lay (or is it ley? I never know) person probably doesn't know, unless they've read in depth on the internet. The registrar was very nice, although a bit bamboozled by my presenting complaint. There isn't a lot wrong with me, it’s more a persistent annoyance than anything else but I thought it’s about time I got it checked out. I'm not quite sure what I was hoping for - perhaps that is why I don't feel particularly fulfilled by the consultation. I think the GP thought I was looking for antibiotics; although I made it quite clear I wasn't (must be a rarity in GPs). He promised he'd phone me back later with some more advice - although he hasn't yet.

It made me think about the complexities of treating medical professionals. I know some of my colleagues go in to see their GPs and tell them exactly what they want. Whether or not they get it is another matter. Some people say that they're a medical student, others prefer to remain anonymous. A fellow medical student came to see me during one of my surgeries recently and whilst it was only for a trivial complaint. I couldn't help feeling ever so slightly awkward. I remember witnessing a consultation between my supervising GP and a patient who was the young son of another GP. It worked very well, and was very professional, much more ethical than treating your own friends and family. I wrote about patients having their own agenda quite recently but what happens when that agenda is an informed one, from another medical professional. It must make things a little harder to deal with when there are differing opinions between the GP and the 'patient'.

Anyway, I'm going back the GP this evening with missbliss and her problem, which promises to be an interesting consultation. I have my own agenda based on my diagnosis (which is pretty barn door obvious to be honest), I know what treatment she needs, and I expect nothing less. Perhaps I’m wrong for doing so, but hopefully the GP will agree and everyone will be happy!

How Hard Is It To Be On Time?!

There is only one excuse for being late - being dead (ok, so maybe are a few more than that..)

How hard is it to be on time. A ridiculous proportion of my patients today have been late, 1 didn't even bother to show up at all?! I understand that GPs are often running late, but that is often unavoidable due to the 10 minute appointment system and it is certainly no excuse for patients being late. I have half hour appointments which are almost always concluded within half an hour so I'm never running late - that is until Miss X turns up at 10:15 and knocks me all out of kilter.

If I was a GP, patients being late would drive me bananas! If you've got a genunie reason, i.e. unforseen circumstances then fair enough but if you're just being lazy and or late for the sake of it then you may as well not bother coming at all. Although, if you're not going to bother coming, it'd be very kind of you to at least ring and let the surgery know. GPs should do what dentists do and charge for DNAs (Did Not Attend), that might make patients think twice about not bothering with their appointments.

I'm a lateness nazi as it is and I can't stand being late (note: this often leads me to be ridiculously early for things - much to missbliss's displeasure) but if I ever become a GP unless you've got a damn good reason for being late - you won't get seen. Simple as.

Computerised Fate

My future (or the next two years of it) are now in the hands of the Severn deanery computer system. I finally plucked up the courage to click submit yesterday after weeks of wrangling over the order of the 287 jobs I had to rank. In the end, I didn't have to rank all of them but I still had to rank way more than my friends in the NW (who have about 12 to 16 jobs to rank having already been allocated to hospitals). I devoted hours to this ranking process, i'm not sure why, part of me wishes there was a lucky dip option. I'm resigned to the fact I might well end up with anything, anywhere.

In 10 days (as long as there no problems) the 7000 or so final year medical students eagerly awaiting the results, of what for many, is little more than a lottery, will find out their fate for the next two years. What will it be first? Medicine, Surgery, Psychiatry, A&E, Paediatrics or something even more obscure. Who knows.

Personally i'm not all that bothered with what I end up with. Most F1 jobs are going to be fairly similar whatever you're doing. My first choice which i'm 90% sure I won't get included the unlikely subject of gynaecology. A week in wednesday will be an interesting day fo' sure.

I understand that those of you not involved in this process you'll have little idea what i'm talking about. I can tell you, its exceptionally important to the 7000 people waiting to find out the reslts of what has been a 2 or 3 month process.

Just One More Thing

I don’t know what it is about Fridays, particularly Friday afternoons but nearly all my patients today had a list of 3 or 4 different things. Now for me, this isn’t as much of an issue as everyone who sees me has a half hour appointment but the GPs get 10 minutes, and very rarely do people book double appointments if they’ve got a list. It works quite well if they come and see me as they can take all the time in the world telling me their life stories and I can condense what they say into a short summary for the GP.

“Whilst I’m here...”, “Just one more thing...” are a couple of the favourites. Sometimes they’ll bring you a nicely written list. Either way, it can get just a touch irritating when patients expect all their problems to be dealt with. Oh well, its friday. yay.

Before I go - i've jus about finished ranking all 287 odd jobs in my chosen deanery - now I just have to click submit and wait patiently until the 20th of Feb to find out what my first job will consist of and where it will be.

Oh and just one more thing – I’ve made a rare post over at the real little medic, check it out if you’ve not already done so.

Dream Catcher

Would someone kindly invent a dream recording machine please?
Thanks.

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!

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.

This is the first ‘teaching’ that we’ve had on dying and death and to be honest, although I was initially quite skeptical, it was quite useful. The simulated patient/actor was very good indeed she made the experience quite believable and I’m almost embarrassed to say it was quite moving at times, I dread to think what it’ll be like for real.

Several important things came out of today’s communication skills. Firstly the potential mismatch between relative’s expectations and reality. It is very easy to skirt around the topic of death and not approach it, but this can reinforce unreasonable expectations. The student who dealt with the second scenario where Mrs Prostate was very upset and at times angry, tried exceptionally hard to hint that Mr Prostate might becoming towards the end of his life, but the patient was left confused. The student felt unable to mention the words dying or death, which is perfectly understandable, after discussion the group decided it was important to try and prepare the relative for the worst, even if that meant discussing death. I believe the phrase was “hope for the best, prepare for the worst” and I think that sums things up quite well.

This post is rather emotionally numb, not at all like I intended it to be. Today’s situation wasn’t real, but it happens every day in real life. In 6 or so months time that might well be a real situation I find myself in, I can say for certain that I’m not looking forward to that! Although 3 hours is an extraordinarily small amount of time to spend on such a topic, I do feel ever so slightly more prepared for such an eventuality in the real world, it won’t make it any easier though.

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.

CLICK TO ENLARGE

I must say, I’m rather disappointed with their response. It seems a bit like; "Yeah whatever....blah, blah, blah." I did think they might have sent me some vouchers of some sort, sadly not, even their customer service sucks. They've failed to address a couple of my issues, 1) Why they made no attempt to work out who I was, 2) Why they accused me of stealing my card but weren't the least bit interested in apprehending a thief, and 3) The awful food which we had to wait ages and ages for. I'm tempted to write to them with a reply, but I’m not sure I can be arsed.

In other news, where the hell did January go? I'm pleased to report that I successfully fulfilled my resolution to have no sweets, chocolate, crisps or biscuits in January. There was so much temptation and at times I had sweets in my hand in a shop but I resisted the temptation. Admittedly I did have 1 chocolate mouse trifle in my lunch box one day but I was almost forced to by missbliss so I couldn't argue. Question is, what do I do now? (Please answer the poll) I could continue but I’m getting rather desperate. If I start eating such things again it'll be difficult to restrain myself to eating sensible portions or I could just revert to my multiple kit kats a day diet.