My rotation just passed involved all the areas of acute care - anaesthetics, ED, ICU etc. It was fab as a medical student, especially on ED. Getting your own patients to clerk, do bloods and investigations on, take round to CT, refer and discuss with seniors, actually made me feel like a doctor. I felt useful and part of the team, helping to bring the waiting time down and doing jobs for everyone.
I was at a major trauma centre so my time on resus was great, very '24 hours in A&E', and also fascinating medicine. The acute assessment and diagnostic side of things is so interesting, especially with all the ultrasound technology etc. they have. Trauma pathophysiology really grabbed me, and also lead me to pick up a physiology book for the first time in about three years.
I can really understand how the faster paced, 'sharp end' of medicine grabs people, but I think for me I would miss the follow-up too much. Even now there's still patients who float into my head and I wonder what happened to them after they were wheeled away.
There were also some incredibly upsetting cases, a neonatal death, multi-mortality RTC etc. I can imagine it is a very emotionally draining speciality.
For example, an elderly lady was brought in with type 1 respiratory failure, severe confusion and drowsiness, and x-ray showed a florid chest infection. She was already elderly with multiple co-morbidities, and BiPAP on resus was failing to bring her O2 sats up. A quick decision needed to be made about escalation of care and DNACPR status, all the while still waiting for her family to arrive. Emotionally difficult for all involved, as DNACPR was decided and the lady eventually went into cardiac arrest and passed. Dealing with death in such a fast-paced way was not something I was used to. Previously, my main experiences with death had been in a Palliative setting, where it is profoundly prepared for, still upsetting, but much more time and consideration has gone into 'planning the death' for want of a better phrase. Although, the consultant told me it was unusual for someone like this lady (in a care home etc.) to not already have a DNACPR decision in place.
Anaesthetics was okay, I got to intubate, do lots of cannulas and LMA's, but I just didn't really enjoy it, not sure why. Maybe it was because of the acute NHS bed crisis, something that underlined all of my time in acute medicine actually. At least one list a day (normally many more) was cancelled due to there being no beds, meaning there was lots of running from theatre to theatre trying to catch them in time to be useful. Then of course there was competition with ODP students, paramedic students, and other medical students! I just always felt like I was awkwardly stood in corridors knocking on scrub windows and bothering people, maybe I just need more confidence.
I enjoyed ICU, but I didn't feel like I could do very much. And my feet! The agony! Those 12 hour shifts with little to do left me dreaming of bringing my own chair to sit on.
Overall, whilst really enjoying my time on the various acute specialities, I don't think they're for me. I can really appreciate why a F2 job in ED would be invaluable though, I feel like I learnt so much there.
29 December 2016
First rotation of 4th year
I'm back in medicine after a year out intercalating, and whilst it has been nice to get back into clinical practise I was apprehensive. Trying to remember which blood bottles were for what, and even a basic neurological exam proved difficult for me on the first week back.
However, I did have a gentle start back I was on a oncology attachment at a DGH. I really enjoyed oncology, and am starting to think it might be the speciality for me. I feel like the marriage of science and art is ever present in it, as you utilise complex cellular, pharmacological and radiological knowledge, with a truly holistic approach to your patients. Working in a DGH and staying in hospital accomodation was nice as well. I really got to know the whole team and the clinical areas, and felt like I had more autonomy over my timetable than you find in the large teaching hospitals.
In DGH's I feel like you get a lot more teaching, and have much more free reign of the hospital. In the main city I train in, you often feel like a redundant spare part, taking up precious space and time.
The actual oncology attachment mainly involved clerking patient's and sitting in on clinics. I tried to make sure I clerked with patients with common oncological emergencies, like spinal cord compression and neutropenic sepsis. One (obvious) hard thing in oncology was of course the devastating impact cancer has on patients and their loved ones. I saw an absolutely lovely lady who presented with spinal cord compression, after being in remission for 9 years. Her and her husband were incredibly anxious and distressed, but trying to stay positive. Her bone biopsy quickly confirmed that it indeed was a recurrence of her previous cancer, with a prognosis of <1 year to live, really grim. Despite that though, the patients were truly wonderful - I know that is a cliché, but it is the truth, and with the constant advancements in technology and treatments, there is huge motivation and drive within all the staff. The doctors and nurses were all kind and a lot of fun, this reminded me of some advice an orthopaedic surgeon once gave me 'find a speciality where you get on with everyone', promising!
Next I had a placement on GP, I find GP a snooze-fest, but I understand it's important. Our GP practise was particularly bad, we seemed to have 1-2 hours of clinic in the morning, a 4 hour gap, and then 1 hour of teaching in the afternoon... My placement group and I spent most of our time sat in a small pre-fab building doing SDL. I didn't see a patient alone until the end of my second week, back in 3rd year I had solo clinics daily! The disparity between different placements is always maddening, but hard to avoid for med school I guess. To be honest it probably didn't help that it was almost 1.5 hours drive away, adding a lovely 3 hour commute to what started to seem like a pointless day.
I just struggle to see the appeal of GP, I know it means you won't have nights and weekends, but honestly sitting in a room alone all day, trying to sort out complex (mainly) psychosocial problems and vague symptoms in 10 minutes, being continually vilified in the press, sounds like my idea of hell.
Once interesting difference was this was the first GP I was in to employ a physician associate (PA), a relatively new profession within healthcare, essentially brought in as a quick fix to plug the gap in doctors (as far as I can tell). It was an... interesting experience. Not necessarily positive, I've had much better experiences with hospital PA's. I can see the positives of the scheme, but I think PA's competencies needs to be more widely defined and understood, to be utilised properly.
Anyways, this once again just cemented that GP is not for me. We were all absolutely buzzing as we drove away for the last time.
However, I did have a gentle start back I was on a oncology attachment at a DGH. I really enjoyed oncology, and am starting to think it might be the speciality for me. I feel like the marriage of science and art is ever present in it, as you utilise complex cellular, pharmacological and radiological knowledge, with a truly holistic approach to your patients. Working in a DGH and staying in hospital accomodation was nice as well. I really got to know the whole team and the clinical areas, and felt like I had more autonomy over my timetable than you find in the large teaching hospitals.
In DGH's I feel like you get a lot more teaching, and have much more free reign of the hospital. In the main city I train in, you often feel like a redundant spare part, taking up precious space and time.
The actual oncology attachment mainly involved clerking patient's and sitting in on clinics. I tried to make sure I clerked with patients with common oncological emergencies, like spinal cord compression and neutropenic sepsis. One (obvious) hard thing in oncology was of course the devastating impact cancer has on patients and their loved ones. I saw an absolutely lovely lady who presented with spinal cord compression, after being in remission for 9 years. Her and her husband were incredibly anxious and distressed, but trying to stay positive. Her bone biopsy quickly confirmed that it indeed was a recurrence of her previous cancer, with a prognosis of <1 year to live, really grim. Despite that though, the patients were truly wonderful - I know that is a cliché, but it is the truth, and with the constant advancements in technology and treatments, there is huge motivation and drive within all the staff. The doctors and nurses were all kind and a lot of fun, this reminded me of some advice an orthopaedic surgeon once gave me 'find a speciality where you get on with everyone', promising!
Next I had a placement on GP, I find GP a snooze-fest, but I understand it's important. Our GP practise was particularly bad, we seemed to have 1-2 hours of clinic in the morning, a 4 hour gap, and then 1 hour of teaching in the afternoon... My placement group and I spent most of our time sat in a small pre-fab building doing SDL. I didn't see a patient alone until the end of my second week, back in 3rd year I had solo clinics daily! The disparity between different placements is always maddening, but hard to avoid for med school I guess. To be honest it probably didn't help that it was almost 1.5 hours drive away, adding a lovely 3 hour commute to what started to seem like a pointless day.
I just struggle to see the appeal of GP, I know it means you won't have nights and weekends, but honestly sitting in a room alone all day, trying to sort out complex (mainly) psychosocial problems and vague symptoms in 10 minutes, being continually vilified in the press, sounds like my idea of hell.
Once interesting difference was this was the first GP I was in to employ a physician associate (PA), a relatively new profession within healthcare, essentially brought in as a quick fix to plug the gap in doctors (as far as I can tell). It was an... interesting experience. Not necessarily positive, I've had much better experiences with hospital PA's. I can see the positives of the scheme, but I think PA's competencies needs to be more widely defined and understood, to be utilised properly.
Anyways, this once again just cemented that GP is not for me. We were all absolutely buzzing as we drove away for the last time.
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