Sunday, 26 February 2012

Exam Chat

Over the past week, I have spent a lot of time thinking about my exams in June. That sounds a long way off, and it is, but this time last year I had properly started the hardcore revision and I feel slightly weird that I haven't started studying for these exams yet. I think the oddest thing is that because I have no written exams (two OSCEs, one of 5 minute stations and one of 10 minute stations) there are no past papers to go over so I feel like I have no idea what could come up.

We had a "mock" OSCE during my last placement but that was only quite short. I'm trying to remember what came up in that and I recall the following salient points:

- Check the femoral pulses first in a lower limb vascular exam (apparently starting distal and saying "that's there so the more proximal ones must be ok" won't cut it)
- Being able to use a hand-held doppler is useful
- If it feels like a spleen, it is a spleen - not a kidney trying to trick you
- If there is reference material, read ALL of it, not just the first bit you see in your sense of blind panic
- Have a differential for your findings. Even if you know the patient and you know exactly what their diagnosis is.
- Never, ever, ever (ever, ever, EVER) forget the occupational history. Especially if the patient has dermatological or respiratory symptoms.

That's about it - presumably they were the stations I embarrassed myself in, hence why I can remember them. I was, erm, a bit tipsy when getting my feedback so I don't recall that much about it (we went to the pub for a swift pint whilst waiting for the feedback session, but I can't handle booze at all and someone bought shots - I am convinced the consultant knew I was wasted but he didn't let on - I tell myself it's because I did really well in his "pet" area)

I keep trying to work out what could come up and I am totally clueless. Obviously lots of practise at examining and history taking is useful (basically what I've been doing all year on placements anyway) but I also need to do some proper studying. I do recall someone saying a few years ago there was a patient with Cullen's and Grey-Turner's signs coloured on them in felt tip. And no, I can never remember which one is flank and which is periumbilical!

Any suggestions for what to study before a final year OSCE much appreciated!


Sunday, 19 February 2012

Struggling a little

I know before I even write this that this is going to be a moany, annoying, rather teenage-sounding post. I am warning you now so that you have the option of clicking on that little red X in the top right-hand corner of the screen before I bore you to tears.

As I may have mentioned, I am not at all enjoying my current placement A couple of weeks ago, I went to see a consultant I'm doing some work with as we needed to discuss the paper we're attempting to finish off. Being a) lovely and b) perceptive, he soon noted that I wasn't my usual self (apparently I'm normally rather "Tigger-ish") and asked what was wrong. Without going into too much detail, I mentioned that I was having a bit of a rubbish time on placement. To cut a long story short, the following week I ended up going and having a chat with him about what was happening - largely hoping for some advice. This culminated in him going to speak to my current supervisor to explain the situation (I didn't know he was going to do this until after the event). That prompted me to email my supervisor myself and telling him basically that I was having a bit of a rubbish time, apologising for probably spending less time on the wards than I should and assuring him that I was keen to learn and was using time off the wards to study.

I thought this was pretty much the end of it and planned to ignore the bitchiness and crack on with the final few weeks of my block. However, although I still have 2 weeks to go here, my supervisor is away for those 2 weeks so we had a meeting on Friday so that he could do my final assessment. It was honestly one of the strangest meetings I've ever had. He wasn't impressed with me at all, so I basically told him that I was very sorry but I'd been really struggling and I felt that rather than stay on the wards feeling useless, I would rather study privately as it would be more productive. You know how uni likes to remind students that they're adults and in control of their own learning? Seems this is only true when you decide you learn best the way they tell you to learn... He wasn't horrible or anything. In some ways I wish he had been, but there we go. Anyway, he's actually going to give me my grade when he's back to give me 2 weeks to get myself a better mark...

Once we'd finished discussing what an inadequate student I was (ok, I'm exaggerating), we then moved on to what seems like everyone's favourite subject at the moment - my lack of a life. I'm a little embarrassed to admit that he actually made me cry when he brought this up. There are only so many times you can stand to be told that you're fat, lazy and pathetic without getting upset. Ok, those weren't the exact words he used, but his persistence in telling me it was important to exercise and keep myself physically fit hammered the point home well enough.

I can't say there is much point to this, but sometimes a good rant helps, even if it's only through the medium of my keyboard!

On a happier note...

Actually, despite my last entry, things aren't all doom and gloom. Forgive me for my excitement and big-headedness in dedicating an entire post to this but... I got published :-D A little bit giddy about this to be honest! Ok, so it was a piece my tutor was commissioned to write and he was kind enough to let me do a bit of it, but still, it's the first time I've seen my name in print that way. It comes up on PubMed and everything *giggles like a maniac* Fingers crossed it's the first of many for me!

Sunday, 12 February 2012

In which I get upset about a patient

It's odd how different human beings are. How even two people who can be considered relatively similar may be confronted with the same situation and respond completely differently.

I remember a discussion I had with a friend of mine about our placements at the start of fourth year. She was on neurology at the time, and had seen a patient newly diagnosed with a progressive condition. I couldn't understand why on earth she was so upset by it. She'd gone home, she told me, and cried. Her poor patient was "only 50" and seemed "unaware that there was no treatment". I didn't understand why that was so sad. Sure, progressive neurological conditions are horrible, but her patient was 50. Thousands of people are diagnosed in their 20s - including a relative of mine, who died in her 40s. That night, I phoned my Mum. I was worried, really worried. I'd always thought I was a caring person, but perhaps I was wrong. My friend was obviously extremely moved by something that didn't really bother me. Since then, I've seen probably a few hundred patients, each one with their own (often tragic) story to tell. At most, I've felt a little sad for them.

Last night, for the first time, I was genuinely upset by a patient I'd seen. I was moved to the point of tears, felt nauseated, couldn't focus. I can't explain why it was last night that this really hit me. The patient was a child* I'd seen on my elective who was diagnosed with an advanced malignant condition. He was 3. He'd only been ill for 2 weeks. Something about this child really got to me, and I've found myself thinking of him numerous times over the past few months. Perhaps it was his family set up (older sibling and then twins) being the same as mine. Maybe it was that despite having worked with many children who have cancer, I've never actually seen the process of diagnosing it. Possibly it was that he was just so cute and cheeky. Who knows. Whatever the reason, he affected me in a way I haven't been affected before.

We are all different and we all have different reactions to scenarios we are confronted with. Our own experiences and personalities shape how we respond, but sometimes we can't see any logical reason for the emotions stirred up inside us. As a future doctor, I am well aware that I will shed many more tears for patients. Patients and their friends and families will in turn make me happy, sad, angry, amused and a whole range of other emotions. In my opinion, the important thing is that I care for them all appropriately, regardless of how I feel about them.

When I started medical school, I wanted to know everything. I wanted to be the sort of doctor who could answer any question, who could "solve" any mysterious case, who knewthe solutions to the rarest of problems. I still think that would be great (if unrealistic). But for now? I just want my patients to feel that I care.

*I would hope that by not mentioning where I was and keeping the medical details vague that confidentiality is not broken here but if anyone senior thinks I'm being unwise, please do say something.

Thursday, 9 February 2012

General happenings

On Tuesday I received some rather exciting news - the abstract I submitted for the RCPCH meeting in May has been accepted! I'm quite nervous as I've never done a proper presentation before (even though it's just a poster so it isn't too stressful) but hopefully it will be really good experience as no doubt I'll need to do more presentations in future. It's also hopefully going to make a nice little addition to my CV.

I'm spending a fair amount of time working on a paper at the moment, and I'm actually really enjoying it. Rather sad, but there's something satisfying when you are finally able to make some decent conclusions after spending a while looking at something. I'm hoping to finish it off fairly soon and then if I'm lucky it might lead to publication, which would be nice. Of course, once it's done I'll need to find myself a new project so I should probably start harassing people now so they give me something to do. I've had a couple of ideas of things which might be interesting to study but of course they've all been done already so I'm not sure whether there would be any point actually doing them.

Uni is difficult at the moment but I'm trying to rise above it. The new middle grades who started last week are really nice, which is good as it's them who will probably do the bulk of my assessment. I got a pretty decent mark for my mid-block assessment; I'm pretty sure the SHO assessing me was far too generous but I won't argue! I'm struggling to get DOPS (direct observed practical skills) completed as there isn't much I'm actually allowed to do - I actually sunk to the level of getting one completed for hand washing, something which is listed as something you can be assessed on, but not really something where useful feedback is going to happen.

After posting my "confession" last week I feel a lot more positive about the mental health aspect of things. The fact that it isn't a "dirty little secret" any more is probably helping a lot. I can't pretend I'm totally on top of things, but I think I'm ticking along on a relatively even keel at present.

My big goal for myself at the moment is (aside from managing to get through my current placement) is to come up with my own research idea and then actually carry it out. At the moment I've only helped other people carry out studies they've devised, and I'd like to get more involved in the planning process. Obviously as a student there are limitations to what I'll be able to do but it would be nice to approach someone and say "I want to research X, would that be feasible and can you help me?" rather then just "Please give me some work". I'm not sure when this will actually happen, but at least thinking about it is keeping my mind actve :)