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.
The session itself was very useful and I feel that I learnt quite a lot. If only we'd had lectures on the kidney 4 years ago... perhaps PBL wasn't the best choice for me. I have an amazing ability to remember stupid facts that i'll probably never need to know, this is at the expense of remembering useful concepts. I haven't got the foggiest idea about renal physiology, I just about know my proximal from my distal tubule but other than that its just a load of wee.
I can tell you how many people are waiting for a kidney transplant and how long transplants last
(god knows why I remember that!) - but I can't tell you anything about ADH.
I've decided to pretend that kidneys don't exist - its much easier that way. I guess a career in renal is out then.
Thursday, 31 January 2008
Kidneys - What Do They Do?
Monday, 28 January 2008
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.
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.
Friday, 25 January 2008
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.
Thursday, 24 January 2008
Bits and Bobs 2
My Portfolio meeting turned into a bit of a lame affair. I managed to waffle on for so long that the dean barely had any time to actually look through my portfolio so it didn't really matter what I had in it although he seemed quite pleased. In the past we've had some interesting debate about the course, PBL and such but yesterday was little more than a relaxed chat. I was left sort of unfulfilled because I usually enjoy moaning although I did manage to get in a few important things which the dean seemed rather concerned about.
New year's resolutions update: Well I'm not doing TOO badly really. Since the 1st of Jan, I've done some exercise and more work than usual. I've kept my car fairly clean but most impressively i've not had any chocolate, sweets, crisps or biscuits - I've almost given in a few times - so much so that I had a bag of wine gums in my hand but I forced myself to put them back. Improvements are still necessary though, more exercise and more work.
I'm still enjoying my GP placement especially having my own surgeries. Although its slightly annoying when people book appointments with me when all they want is a repeat prescription as I can't help them and it only takes 2 minutes.
Not a lot else to say really - will blog again later.
Tuesday, 22 January 2008
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.
So I'm wondering what else should I put in my portfolio. Perhaps I should just print out my blog although I don't think that would go down too well. Some of my posts might be useful though. Fortunately today is my 'study day' so I've got plenty of time to get my portfolio in order, although saying that its already 11:00 and I've got a million and one other jobs to do today. I will do a SWOT analysis, for those of you who don't know, that is a breakdown of my Strenghts, Weaknesses, Opportunities and Threats. That should be interesting, perhaps I'll share it over at the real little medic.
My portfolio meeting could go one of two ways, it could be an easy half hour chat where I don't approach anything controversial, or it could be a half our discussion about what I really think, I've yet to decide which way to take it. A few people seem to think the dean is a bit scared of me (well not scared, so much as, apprehensive), mainly because back in 3rd year my portfolio meeting (usually strictly half an hour) took an hour as I had a list of things to talk about so long that he never even looked at my portfolio.
I actually think these portfolio meetings are rather important for a couple of reasons. Firstly there is the portfolio, nobody likes to admit it but its a fairly important aspect of being a medic, nurse or anyone else really. Its particularly relevant to medical students and doctors as reflective writing is key to the 'white box' application forms used throughout nowadays. And IF you ever finally get to be interviewed, its always useful to have a good, up-to-date, polished portfolio. More importantly as a medical student, these meetings give us individual time with the dean to express our concerns, feelings, thoughts and worries. I think this is a very important aspect of life as a medical student - but hey, maybe its just me.
I really like the dean at my hospital. Unlike every member of staff I've ever come across affiliated with the university (no offence PHD Scientist - I've never come across you so you don't count) he is actually willing to listen and empathise. He might not be able to offer a solution to things but he'll certainly let you rant away at him (at least he lets me). Sure he has his own peculiarities but don't we all? I know some people don't like him because of this, but I think he's a genuinely nice guy.
Any suggestions for portfolio material are welcome...
Saturday, 19 January 2008
Wanted: TLM for Stealing His Own Debit Card
Here is a letter I've just sent to Wetherspoons about today's events.
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.
At 2:49pm, our party of 3 was ready to order, unfortunately, when we were eventually served at the bar, there were no burgers. According to your menu, burgers are available all day every day, well let me tell you, that is a blatant lie as they sure as hell weren’t available this afternoon. After returning to the table (number 48 incase you’re interested), and consulting the menu again, I returned to the bar with a new order. This time I was told there was no scampi – what sort of restaurant is this? Having queued up for the 3rd time I was eventually able to order. Then came the part where I am supposed to pay for the meal, perhaps I should have expected that things would not go smoothly. Having handed over my HSBC debit card (at 3:03pm) I was rudely told that “Its been declined, gunna have to keep it”, I was then told that the machine had said my card must be retained, however the rude and unhelpful barmaid would not show me the machine. She did make a very brief phone-call to her manager who confirmed that my card would have to be retained and without anymore information my card was wrapped up and bundled into the till. I was asked for alternative payment, which I gleefully provided the £21.67 in the form of cash (one £20 note and one £5 note, both NOT stolen). I was given no information whatsoever about what would be done with my card (despite me offering an explanation as to why the card might have been declined – in that I’d requested a new card that morning from the bank), nor did anyone ask who I was or if I could provide any identification which I would have happily provided had it been requested.
I returned to my table, rather bamboozled by what had just happened. Realising that I’d just let my card be taken by a complete stranger I promptly returned to the till and asked for the card to be destroyed. Unfortunately the person I’d spoke to previously was no longer behind the bar and I was told that they would come to my table when they returned. They never did bother to return and after eating my steak pie (which I shall come onto later) I returned to the till to speak to the barmaid I’d spoken to originally. This time I was told that they couldn’t destroy the card so I asked to speak to her manager, I was again told that they’d come to my table. The manager, who looked barely old enough to drink let alone manage a pub, finally did come to the table and explained to me that they had to retain the card and that policy dictated it would be sent to “head office, then onto the police.” I would have been very interested to read this policy, unfortunately I wasn’t allowed to. She politely explained that it was “my word against theirs” – what she meant by this I’m not quite sure, she clarified this by saying “if you’d stolen the card, you wouldn’t exactly admit it would you?” I was obviously going to get nowhere with this so I told her that I would phone my bank for their advice before phoning the police to report my card stolen by your barmaid. I phoned my bank and reported the card stolen by Wetherspoons. Following that, safe in the knowledge that my card could no longer be used and having decided not to phone the police because I was accruing car parking charges and didn’t really have the time to wait around for this to be sorted out, we finished our drinks and left.
I can just about understand why my card was retained, but it not being destroyed is an infringement of my personal privacy. My personal card details are now available to anyone, including my account number and sort code. What baffles me most is that if I had indeed stolen the card (which, if it isn’t obvious by now, I didn’t), absolutely no effort was made to clarify who I was by asking for ID, no effort was made to contact the police and no effort was made to apprehend a potential thief. Why even bother to retain the card if you’re not in the least bit bothered that someone might be standing there who could have stolen my card? I would have been seriously pissed off knowing that you’d let whoever stole my card sit there for 2 hours without the slightest effort being made to check who he was. Perhaps that is beside the point, but as far as I’m concerned my HSBC debit card was stolen by your barmaid this afternoon at 3:03 pm. I expect, if the situation is reported to the police by yourselves, then the card will be flagged up as stolen as I reported it so at 4:00pm this afternoon. In which case, the police will probably be interested to speak to me about having stolen my own card. I’ll be more than happy to cooperate with the police as it was in fact, a Wetherspoons barmaid who stole my card.
I wish I could say that is the only problem we encountered this afternoon, unfortunately I can’t. We ordered 2 steak pies, unfortunately one of them was burnt to a crisp. The meat was charred and solid as a rock, entirely inedible. The staff were kind enough to replace this steak pie but only about 35 minutes after the other 2 meals had been finished.
Having queued 3 times in the first place, spending the majority of time trying to sort out the debacle with my debit card and waiting an extra 35 minutes for another pie, we had wasted an extra hour and my car parking charges had escalated to an extortionate £1.80.
Fortunately the good company meant this meal was not an entirely infuriating experience but Wetherspoons did everything seemingly possible to make it so!
I shall not be eating at a Wetherspoons in the near future and I look forward to hearing from the police with regards to the theft of my debit card.
If you require any further information please do not hesitate to contact me either by phone, letter or email
Yours Sincerely,
The Little Medic
