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.
Friday, 25 January 2008
The Patient's Agenda
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
Friday, 18 January 2008
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.
The NHS should always be striving to improve, if it wasn't it would be a failure. Things cannot be improved without identifying the failures within the system but when these failures are picked up by the media, the onslaught begins. Doctors seem to be easy pickings at the moment for the media, barely a day goes by without reading a story about GPs and their "huge salaries for hardly any hours". What about the good work that the GPs do? Of course we don't hear about this, the media aren't interested in positive things.
Yesterday we heard that the NHS spends £8.2bn on prescription drugs, well of course it does, what is is supposed to do? Give out sweeties instead? Sure there are problems, in that at least some of this figure is made up of unnecessary branded medications, or even drugs which just get wasted. But what about the millions of people who rely on these drugs, nowhere in the article does it mention that this £8.2bn improves the quality, or even saves the lives of millions of people in the UK. There are improvements to be made of course, encouraging doctors to prescribe cheaper, generic alternatives rather than branded drugs. Putting the price on medications is a good idea just to give the general public an idea about how much some of these things cost. But seriously, the way these stories are reported in the media, anyone would think that the NHS may as well just thrown £8.2bn down the toilet. This is obviously the media's fault, everybody knows that negative stories sell far more papers than positive ones.
What worries me is that people listen to and on the whole believe almost anything the media tells them. As a result, people are going to start turning against doctors, not in a raging mob storming the hospitals sort of way, much more subtle than that but it will have consequences and they sure as hell won't be good.
Even politics these days is more about the media than the actual policies, Mr Brown and Mr Cameron are more worried about their media image than they are about improving things in the UK. The Labour party don't run this country - the fucking media do!
This country is fucked up.
* I don't think the NHS is Shit, I was merely paraphrasing the numerous stories littering the headlines about how rubbish the NHS is.
Wednesday, 16 January 2008
OSCEs From The Other Side
This is the second time I've written this entire post, stupid blogger autosave GRRRRR! (anyone who knows where the setting is to turn off word verification for posts will win lots of appreciation)
If you read my last post you'll know that today I volunteered as a patient at the 3rd year OSCEs. I've done this a few times now and its really interesting to see the way things work from the other side.
A new undergraduate centre has just been built at our hospital and by 'just been built' I mean its not actually finished yet. Despite that, for some reason someone decided that the OSCEs would be held in the new skills lab. I arrived early this morning to find the entrance covered in scaffolding, machinery and debris all around the building and a number of workmen sat doing not very much at all - perhaps that is why it wasn't finished yet. The building isn't officially open yet but today went ahead as planned, fortunately they'd just about finished the new skills lab but I swear to god they must have been working until about midnight last night. I arrived early and had a wander round the new building which is much larger than the old (but relatively new itself) one. The new skills lab is huge which is good, but many of the seminar rooms are rather small and won't be much use for group work. Someone with the eyesight of mole obviously picked the carpet, it is absolutely vile, the whole building is covered in these very odd looking carpet tiles which must have been acquired on the cheap from some dodgy bloke down the market as most of them don't even match.
Anyway, enough of that, onto the exam itself. My station was something like this "Please examine this patient for enlarged kidneys. He presented with abdominal pain and weight loss." So it was basically a focused abdominal examination concentrating on the kidneys. This seemed to throw many of the third years who were expecting to have to do a full abdominal examination. I'd forgotten just how young and fresh (that sounds wrong) the 3rd years are, they're all fresh out of pre-clinicals and all so gentle (well, almost all). So I spent the morning with my top off being prodded and poked all over the place. Oh, and it was bloody freezing in this new building, they've obviously not bothered to install the heating yet!
The difference between students was quite remarkable, there were some who were excellent, some who were awful and many in between. There were 3 who stood out, and they were well above the rest, interestingly they were from the same base hospital and my observations were that this hospitals students were significantly better than the others. The better students are easily identified even before they've introduced themselves. The reason for this, and the key to being successful at OSCEs is confidence, or even false confidence. If you approach each station confidently then you can do pretty much anything and still get a good mark. Of course there is a line, which if crossed puts you in the arrogant category, and then you're in trouble right from the start. You don't have to have exceptional knowledge to do well in an OSCE, its much more about confidence and even more about ticking the examiners own requirements.
Because it was really cold, the 30 or so students who examined me today all had freezing cold hands, which was just a tad annoying. Worse than that, having 30 people poke or ballot your kidneys is rather uncomfortable, by the end I swear both of my kidneys were probably enlarged. Some of them didn't actually know where or how to feel the kidneys, and on more than one occasion it was quite painful. In one case I actually winced involuntarily which the examiner noticed, this meant that the person in question failed the station, although to be honest, they were not very good anyway. Thankfully most people didn't bother to palpate my bladder, otherwise i'd have spent the entire time needing to wee. Consultants always say that it is obvious who has actually examined real patients and I always thought that was an exaggeration but today you really could see those who'd examined patients and those who didn't know their kidneys from their ribs. Some of them decided that I did indeed have enlarged kidneys, quite where they got that idea from I don't know.
I once again saw just how objective the OSCEs can be but I don't suppose there is much that can be done about that. On one occasion I almost unconsciously tried to help one of the students by giving them hints (like nodding and shaking my head as they pondered the answers to some of the examiners questions.) I didn't mean to help anyone in particular and the examiner just laughed because he realised it was an accident.
Anyway, it was once again fun, interesting and useful experience. I don't know if I'll get another chance to do it before finals, if not, next time it'll be me. shitters.
Tuesday, 15 January 2008
OSCE Fun (not really sure those words go together)
Tomorrow brings with it the 3rd Year OSCEs, now they’re not real OSCEs, in the sense that they’re summative rather than formative (maybe that is the wrong way round?!). That basically means they don’t mean a thing with regards to progressing through medical school. Its more of a practice for the summer 3rd year OSCE which is important.
You won't be surprised to hear that I'm again modelling tomorrow which means I get to lie on a bed all day and be prodded and poked by the 3rd years. I wonder what my station will be this time. I've got a pretty good idea but again I'm not going to share any details just in case any 3rd years are reading.
I enjoy being a model for the OSCEs, I get £20, I get to revise something I might not have done for a while and I get free drinks and biscuits - shitters - no biscuits - stupid new years resolution! Probably for the best, last time I ate my way through 2 boxes (admittedly only stealing the best ones).
If you've not already done so, read the latest about PBL at the real little medic.
If you're new and need an invite just drop me an email to imamedicalstudentgetmeoutofhere[at]hotmail.co.uk
