Thursday, 22 March 2012

The Other Side

As I've mentioned recently, I have my fair share of medical experience on "the other side", ie as a patient. I won't bore you all with all my (frankly relatively minor) health woes, but suffice to say my GP seems to be on a mission to refer me to as many different specialists as possible. This is rarely an issue, although sometimes causes slightly weird conversations, such as (at a BLS session in second year) "you look very familiar, how do I know you?" "you anaesthetised me last week" "oh *awkward pause* I hope you feel better now".  That could have been a lot more embarrassing for both parties if the answer had been "you treated my *insert intimate health problem here* recently".

There are two things I find decidedly awkward about being both a patient and a medical student. One is something that I've thought about in the past but that has struck me again more recently. It's accepted, especially if you live/train in a smallish area, that at some point you're going to be taught by someone who's treated you or vice versa. The GMC advises that, where possible, you shouldn't be taught by someone who is currently treating you. Obviously, sometimes this is unavoidable, particularly if you are in a particularly small geographical area or you are being treated by someone extremely specialised. Fortunately I've never had to be taught by someone I'm a patient of at that moment in time. I have, however, been taught by several people who had previously treated me and I am at present under the care of a doctor who has taught me several times over the past couple of years.

Being taught by a doctor who once treated me is not a particular issue, however there is one specific situation that I've encountered twice now which I find rather strange - being taught by someone who you've had a particularly negative experience of as a patient. Now I know as well as anyone that doctors are not superhuman and have their bad days, but it's a bit strange when you've come close to harm as a result of somebody's bad day and are then supposed to treat them as a knowledgeable professional when they are teaching you. In particular, if a tutor is stressing the importance of doing xyz and you know for a fact that they don't always do that - because they didn't do it when they were treating you. It's very easy to just dismiss everything they say thereafter because you've experienced something they tell you not being the case. In the two examples which spring to mind, the teaching sessions were not particularly crucial to my education as they were things we'd covered in multiple other sessions. It just made me wonder what it would be like for other students who have had numerous more interactions as patients than I have and may possibly have experienced more serious negative consultations etc. I suppose it's part of being a professional that you take people at face value and write off your poor interaction as them having had an off day. Hopefully I'm mature enough that it doesn't affect my studies or how I participate in teaching - even if sometimes there's a rather loud voice in my head yelling "nonsense!" when certain people are talking!

I suppose the above rather inarticulate paragraph relates to a difficulty in being a medical student who has been a patient. The second "difficulty" I've encountered relates more to being a patient who is also a medical student. Medical students are renowned for being hypochondriacs. We all joke about having "medical student's disease" - ie thinking that we're suffering from every condition we've every studied. At exam time last year several of my friends suggested that my attacks of sweating and palpitations could be due to a phaeochromocytoma (a tumour which produces adrenaline) or an overactive thyroid (given that they only occurred when I was feeling particularly stressed and resolved as soon as exams were over, I'm going to assume that the diagnosis was actually "exam stress"). It sounds somewhat nonsensical, then, when I say that medical students and doctors are really, really bad at actually going to the doctors. Yes, every time I have a headache I briefly run through a list of potentially fatal diagnoses (sub arachnoid haemorrhage - not acute enough, brain tumour - not worse in the mornings, multiple sclerosis - no neurological deficit) but equally when I am actually unwell I can take some persuading to actually go visit my GP. I would recommend that if you suspect you may have a chest infection or your asthma is playing up, you go and see someone before you become so breathless that you can't speak in sentences anymore - if you do you might get sent in to the acute medical assessment unit where you're on placement and have to be examined by the consultant who is in charge of all students on medical placements. It's really awkward and embarrassing. Just don't go there.

Why is it that we are so reluctant to seek medical attention? I think there's definitely a large component of thinking that our symptoms aren't serious enough  to be deserving of a doctor's time - after all, that old lady we admitted last week was walking around with a raging pneumonia for 3 weeks before she saw her doctor, so our cough/pain/bleeding/whatever is just not worth wasting someone's time over. I find that this is something which has worsened dramatically for me since I was told about "heart sink" or "fat file" patients. This is a horrible term that some (and I must stress NOT all, by any stretch) health care professionals use to describe patients who are forever appearing with a variety of ailments and complaints which rarely turn out to have any identifiable organic cause - the term "fat file" is obviously because they have huge volumes of notes, and "heart sink" because they walk into the room and your heart sinks knowing that they will have another complaint you are unable to resolve. I now have a dread of being labelled one of these "heart sinks". I'm relatively young and have seen, as I mentioned, various specialists for different problems. I'm horrified by the idea of being that patient who the GP dreads, that person who is discussed at practice meetings because no one knows what to do with them any more... I know realistically that I probably am not the type of patient our tutors mean when they talk about this sort of thing - but it doesn't stop me thinking twice (or three or four times) before actually seeing my doctor!

Right, I was up at 6 to go to a clinic 2 hours away so I think it's bedtime now!


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