Today was my penultimate day on what has been potentially my last ever placement as a medical student. For the past 4 weeks, I've been based in the Young People's Department at the psychiatric hospital. This provides care for young people aged between 13 and 17 who suffer from a range of mental health problems.
I haven't made any particular secret of the fact that, whilst I have found this placement fascinating and at times really enjoyed myself, I've also found things bloody difficult. I know that no one really has a particularly great time during their adolescent years, but having suffered from mental health problems myself (detailed here if you're interested/haven't read my blog before) which began when I was a teenager, this last few weeks have dragged up several uncomfortable memories. This may make uncomfortable reading for anyone easily "triggered" by talk of self harm, depression, suicide etc.
Where I grew up, we didn't have a separate adolescent psychiatry department. Anyone under 18 was sent to the Child & Family Mental Health Service. I vividly remember my first appointment there. I was 15 and it was the Christmas holidays. The department was located in an old, probably Victorian, terraced house which hadn't been particularly well renovated. The room I was seen in was freezing. There were two people seeing me; a middle aged lady who was a social worker and a younger man who introduced himself as a "trainee doctor" - I suspect that he was a psychiatry registrar but at the time I was pretty convinced he was a medical student. They sat behind a desk for the whole consultation and the seats for us (my parents were with me) were a good few metres away from them. There was also a little window at the top of the wall where someone else was apparently watching what was going on. On the wall were several posters about how to deal with your child's difficult behaviour and advising against smacking. There were toys all over the floor.
My first impression was that they thought I was a child (which of course I was, at least legally, but what 15 year old doesn't think they're incredibly grown up?). I don't recall much of the discussion we had. I remember them repeatedly asking whether I'd ever been abused, and then later taking great delight in asking my parents to leave the room so that they could ask me again. Actually I only wanted my parents out of the room because I knew they'd be upset if they knew the extent of my depression etc, but the doctor and social worker seemed pretty desperate to uncover some horrific trauma which must have caused my problems. The only other thing I remember was that right at the end, they asked what I would like if I could have 3 wishes. I still get a bit emotional when I remember my responses, because actually I think they'd be exactly the same if I were asked the same thing now. Firstly, I wanted to be pretty. Secondly, I wanted to be cleverer. Finally, I wanted to be better at music. They seemed rather bemused that I didn't say I wanted to be happy, but even now there are still moments when I think that if I had those things, everything else in my life would/will miraculously fall into place and I would be happy. ,
I didn't go back after that first appointment. They put me on fluoxetine the first of many antidepressants I took. They also wanted me to have CBT but I declined. In retrospect, I probably should have gone for it, but at the time the only time I could cope with being "mental" was to tell myself and everyone else around me that it was due to "a chemical imbalance in my brain". Taking medication to correct this was fine. To have CBT would have been admitting that my thinking was fundamentally flawed and that it was therefore some weakness of character resulting in my problems and not a "proper" illness. Of course I know now that that isn't true, but the explanation I got was such that that was what I believed at the time.
Over the past 4 weeks I've met lots of young people who've suffered with, amongst other things, depression and self harm. Self harm is a strange phenomenon. No matter how much I read about it, I can't fully understand it. What I do know is that for me personally, there was an addictive element to it. Just as a recovering alcoholic may struggle to sit in a pub and watch other people drinking, I as a recovering self harmer find seeing obvious evidence of others' self harm incredibly hard. I know that it was a maladaptive pattern of "coping" with problems. I know it didn't make things any better in the long run. I know that not doing it is much, much better for me than doing it. Yet each time a teenage girl (they were mostly girls) came in with the tell-tale lacerations on her forearms, I felt a strange pang of envy. I do not envy their mental distress. I do not envy the having to wear long sleeves even at the height of summer. I do not envy the having to sprint from the bathroom to the bedroom after a shower so no one would see the cuts. But somewhere deep down inside, a part of me feels an odd craving to cut.
Although I have struggled with many things over the years, self harming hasn't been a major issue for me since before I came to university. I wonder, sometimes, whether I will ever be totally recovered from this issue. Will I be always fighting it? Each time I see a patient who has self harmed, will I have to fight the urge to go back to that pattern of behaviour? I don't know. Possibly. As I get better at coping with emotions - something I am learning more about all the time - I hope the desire will be less strong.
The most positive thing I can take from the past four weeks is that I have survived. Some days were ok, some were great, some were awful, but I got through. Perhaps, one day, I'll be ok...
Thursday, 26 April 2012
Saturday, 14 April 2012
Changeover Day
Just over a week or so ago was changeover day,- the day when junior doctors move to new jobs. Under the current UK system, all newly qualified doctors work for two years in "foundation posts" where they spend 6 blocks of 4 months working on a range of specialties and developing the skills they will need for their future careers.
As a student, I don't usually think too much about changeover days. Sometimes it's a shame when they happen halfway through a rotation as the staff you have got to know for a while all change, but that aside they don't really impact on us too much. This last changeover day has played on my mind for one reason, and one reason only. Next changeover day will be the day that I START WORK.
I've probably stated numerous times before that as a graduate medic I've been at uni for seven years. I'm in more debt than I care to think about, my younger sisters are both self-sufficient professionals (as are lots of my friends) and at 25 I feel that it's high time I stopped "tax dodging" and got myself out into the world of work. This does not make the prospect any less terrifying.
If you're planning on being ill at all, try to avoid the first week of August!
As a student, I don't usually think too much about changeover days. Sometimes it's a shame when they happen halfway through a rotation as the staff you have got to know for a while all change, but that aside they don't really impact on us too much. This last changeover day has played on my mind for one reason, and one reason only. Next changeover day will be the day that I START WORK.
I've probably stated numerous times before that as a graduate medic I've been at uni for seven years. I'm in more debt than I care to think about, my younger sisters are both self-sufficient professionals (as are lots of my friends) and at 25 I feel that it's high time I stopped "tax dodging" and got myself out into the world of work. This does not make the prospect any less terrifying.
If you're planning on being ill at all, try to avoid the first week of August!
Monday, 26 March 2012
4:30 Psychosis
Doesn't have quite the same ring as "4:48" but I have been waking up at 4:30 most mornings recently. (If the original reference is lost on you, it's the title of a play/monologue written by the late Sarah Kane. I highly recommend it to anyone who is interested in mental illness. Kane suffered from depression and eventually took her own life; whilst 4:48 Psychosis is not regarded as a suicide note it certainly provides an interesting insight into the suffering she endured in her later years)
Insomnia is a pretty common complaint. I'm sure most people have had times when for various reasons they've slept badly - exams, breakups, bereavements etc. You know the drill. You're physically exhausted but mentally can't switch off. You get into bed but no matter how you toss and turn, you can't get comfortable. You feel simultaneously too warm and too cold. You may drift in and out of sleep - each time you look at the clock some time has passed yet you feel no less tired. Your head and limbs ache no matter how you lie. Finally, your alarm goes off and you drag yourself up, battling the sometimes overwhelming nausea that follows a poor night's sleep.
I am what my GP has scientifically termed a "crap sleeper". As a baby I apparently slept pretty well, but as a child I remember being the first to wake up most mornings. I used to get up and make my Mum and Dad tea and breakfast in bed just for something to do. I always had a book beside my bed and I remember I used to keep a torch under my pillow so that I could read under the covers once the lights were turned out. I suppose if I'd have been a more annoying child who got out of bed and wanted to play all the time, my parents might have taken me to a doctor about my poor sleep patterns, but as it was they didn't really affect anyone else so I was left alone.
I go through phases of sleeping relatively well and phases where my sleep pattern is atrocious. I've tried a variety of medications (some work better than others but generally the better they work, the more of a "hangover" I have the following morning). I've tried cutting out caffeine. I've tried setting myself a strict routine of going to bed and getting up at the same time every day. Generally my sleep is at its best when I have given up on trying to sleep properly. I'm not sure why, but that's the way it seems to work.
It strikes me as odd that sleep is such a primitive function and yet it seems to cause so much trouble. I've read a variety of articles on sleep patterns recently. They have suggested everything from having 2 hour naps throughout the day but never a long sleep to sleeping whenever you feel tired. Sleep is an incredibly important function. Experiments into the effects of sleep deprivation have almost universally been terminated early because of the detrimental effects on participants. Lack of sleep will kill a person more rapidly than lack of food. Despite the obvious importance of sleep, there is no consensus on how we should do it best. Oh, and noone's exactly sure what it's for either!
Almost 3:30am not - suppose I should attempt to sleep again!
xxxx
Insomnia is a pretty common complaint. I'm sure most people have had times when for various reasons they've slept badly - exams, breakups, bereavements etc. You know the drill. You're physically exhausted but mentally can't switch off. You get into bed but no matter how you toss and turn, you can't get comfortable. You feel simultaneously too warm and too cold. You may drift in and out of sleep - each time you look at the clock some time has passed yet you feel no less tired. Your head and limbs ache no matter how you lie. Finally, your alarm goes off and you drag yourself up, battling the sometimes overwhelming nausea that follows a poor night's sleep.
I am what my GP has scientifically termed a "crap sleeper". As a baby I apparently slept pretty well, but as a child I remember being the first to wake up most mornings. I used to get up and make my Mum and Dad tea and breakfast in bed just for something to do. I always had a book beside my bed and I remember I used to keep a torch under my pillow so that I could read under the covers once the lights were turned out. I suppose if I'd have been a more annoying child who got out of bed and wanted to play all the time, my parents might have taken me to a doctor about my poor sleep patterns, but as it was they didn't really affect anyone else so I was left alone.
I go through phases of sleeping relatively well and phases where my sleep pattern is atrocious. I've tried a variety of medications (some work better than others but generally the better they work, the more of a "hangover" I have the following morning). I've tried cutting out caffeine. I've tried setting myself a strict routine of going to bed and getting up at the same time every day. Generally my sleep is at its best when I have given up on trying to sleep properly. I'm not sure why, but that's the way it seems to work.
It strikes me as odd that sleep is such a primitive function and yet it seems to cause so much trouble. I've read a variety of articles on sleep patterns recently. They have suggested everything from having 2 hour naps throughout the day but never a long sleep to sleeping whenever you feel tired. Sleep is an incredibly important function. Experiments into the effects of sleep deprivation have almost universally been terminated early because of the detrimental effects on participants. Lack of sleep will kill a person more rapidly than lack of food. Despite the obvious importance of sleep, there is no consensus on how we should do it best. Oh, and noone's exactly sure what it's for either!
Almost 3:30am not - suppose I should attempt to sleep again!
xxxx
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!
xxx
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!
xxx
Saturday, 10 March 2012
What A Week!
The Learnaholic has had a bit of a rollercoaster week. After scary-but-actually-ok hospital appointment on Thursday, Friday was the last day of my surgical placement. Big relief as I didn't enjoy it much (although it was much, much better latterly). I also had visitors in the form of Mummy and Daddy (and puppy) Learnaholic for the weekend.
Despite plans for long walks along the beach and going out into the hills, miserable weather meant we actually ended up spending a lot of time drinking coffee and eating cake. Absolutely not complaining! Also, Daddy Learnaholic is very clever and fixed all the things around the flat which have been broken (like the kitchen light which didn't work for almost a year...). I had a bit of a heart-to-heart chat with Mummy Learnaholic about my "issues" and it turns out I am rubbish at hiding things because she's known all this stuff for years! It's good that she knows what's going on though, means I won't be constantly biting my tongue around her in case I give things away. We had a really nice weekend together. I do really miss them as I'm so far away most of the time. That was the first time I'd seen them since Christmas.
On Monday I started my new placement, however this was overshadowed by the death of a family friend. It was very sudden so everyone was pretty shaken up by it. I feel a bit guilty about being so far from home at times like this, as I'm not able to support people as much as I'd like. I also can't make the funeral. I will send a note and some flowers to his wife but I haven't quite worked out what to say just yet. I don't suppose there is ever a "right" thing to say or do in this situation.
This week of placement has been all teaching, so I haven't met any patients yet. I did have to go to the mortuary on Tuesday morning for teaching in confirming death and all the associated paperwork, which was pretty difficult under the circumstances, but I suppose it will be coming in pretty handy once I'm working. I've also done some "breakaway techniques" training so that I can escape from aggressive patients, which was good fun although the bruises still haven't gone away! The rest of teaching was less eventful, but I did enjoy getting to role-play a stroppy teenager (although I may have traumatised one or two of my classmates!).
Yesterday I had to go back to my last placement to get all my paperwork signed off as my supervisor wasn't around for the last couple of weeks I was there. I got an unexpectedly good mark. After our last meeting, I was expected a bare minimum pass, but I actually got the same mark as I got for my medical placement before Christmas, so either I impressed all the other staff whilst he was away and they fed back to him, or he really felt sorry for me because I cried last time I saw him! He did mention the importance of "work-life balance" again which is getting a little dull now but I appreciate that he meant well.
This week has also caused a bit of a career panic. On Wednesday morning we had a careers session. Although it was largely focussed on psychiatry and general practice, all the comments about how difficult and expensive post-graduate exams are, how competitive it can be to get onto specialty training etc made me panic a little. On top of that, my supervisor yesterday was emphasising the importance of a strong portfolio to me. In his words, nowadays "noone gets in for being a nice chap or knowing Mr Smith" and it's important to have lots of publications, presentations, extra-curricular achievements - eek! I am, however, trying not to think about it too much. I think I work pretty hard and have a not-too-terrible CV so far. At the moment, my biggest priority is passing my OSCEs in June!
I'm quite looking forward to next week. I'm starting my new placement (psychiatry) properly on Monday. I'm also meeting up with a couple of friends during the week, and on Thursday I think I might go to my first "Skeptics in the Pub" event, which should be fun. Hope everyone is enjoying the weekend x
Despite plans for long walks along the beach and going out into the hills, miserable weather meant we actually ended up spending a lot of time drinking coffee and eating cake. Absolutely not complaining! Also, Daddy Learnaholic is very clever and fixed all the things around the flat which have been broken (like the kitchen light which didn't work for almost a year...). I had a bit of a heart-to-heart chat with Mummy Learnaholic about my "issues" and it turns out I am rubbish at hiding things because she's known all this stuff for years! It's good that she knows what's going on though, means I won't be constantly biting my tongue around her in case I give things away. We had a really nice weekend together. I do really miss them as I'm so far away most of the time. That was the first time I'd seen them since Christmas.
On Monday I started my new placement, however this was overshadowed by the death of a family friend. It was very sudden so everyone was pretty shaken up by it. I feel a bit guilty about being so far from home at times like this, as I'm not able to support people as much as I'd like. I also can't make the funeral. I will send a note and some flowers to his wife but I haven't quite worked out what to say just yet. I don't suppose there is ever a "right" thing to say or do in this situation.
This week of placement has been all teaching, so I haven't met any patients yet. I did have to go to the mortuary on Tuesday morning for teaching in confirming death and all the associated paperwork, which was pretty difficult under the circumstances, but I suppose it will be coming in pretty handy once I'm working. I've also done some "breakaway techniques" training so that I can escape from aggressive patients, which was good fun although the bruises still haven't gone away! The rest of teaching was less eventful, but I did enjoy getting to role-play a stroppy teenager (although I may have traumatised one or two of my classmates!).
Yesterday I had to go back to my last placement to get all my paperwork signed off as my supervisor wasn't around for the last couple of weeks I was there. I got an unexpectedly good mark. After our last meeting, I was expected a bare minimum pass, but I actually got the same mark as I got for my medical placement before Christmas, so either I impressed all the other staff whilst he was away and they fed back to him, or he really felt sorry for me because I cried last time I saw him! He did mention the importance of "work-life balance" again which is getting a little dull now but I appreciate that he meant well.
This week has also caused a bit of a career panic. On Wednesday morning we had a careers session. Although it was largely focussed on psychiatry and general practice, all the comments about how difficult and expensive post-graduate exams are, how competitive it can be to get onto specialty training etc made me panic a little. On top of that, my supervisor yesterday was emphasising the importance of a strong portfolio to me. In his words, nowadays "noone gets in for being a nice chap or knowing Mr Smith" and it's important to have lots of publications, presentations, extra-curricular achievements - eek! I am, however, trying not to think about it too much. I think I work pretty hard and have a not-too-terrible CV so far. At the moment, my biggest priority is passing my OSCEs in June!
I'm quite looking forward to next week. I'm starting my new placement (psychiatry) properly on Monday. I'm also meeting up with a couple of friends during the week, and on Thursday I think I might go to my first "Skeptics in the Pub" event, which should be fun. Hope everyone is enjoying the weekend x
Friday, 9 March 2012
What's Eating You?
I've been meaning to write this post for the past week but it's taken until now for me to have the time to sit down and properly work out what to say.
Last Thursday I had my first appointment with the Eating Disorders service. Although I've had issues with my eating on and off for probably the past 10 years, it's only in the past year that I've really accepted how much of an issue it's become. I am lucky enough to have an excellent GP who I've known since I moved here. She's very approachable and knows me pretty well, which meant bringing up the subject was a lot easier than it could have been. Anyway, in short, I spoke to her about things last summer, got referred to the specialists and was seen last week.
I wanted to write this on the off-chance that someone might read it who had been struggling themselves and been afraid to get help. Walking into the appoiuntment was one of the scariest experiences of my life. I had no idea what would happen, and I knew it was quite likely that they would want to weigh me which made me totally panic.
I really needn't have worried. The consultant was absolutely lovely; extremely perceptive and very understanding. He made me feel like my issues were not unusual, and he repeatedly emphasised that it was just another illness and nothing to feel ashamed of. He didn't weigh me because I told him uncomfortable it would make me.He's arranging a variety of things to help, including dietetic support, therapy and continuing medication.
Having got through the initial appointment I really feel like I have a chance at controlling this, rather than it continuing to control me. I'll let you know how things go, but I just wanted to reassure anyone in a similar situation that there's nothing to be scared of.
xxx
Last Thursday I had my first appointment with the Eating Disorders service. Although I've had issues with my eating on and off for probably the past 10 years, it's only in the past year that I've really accepted how much of an issue it's become. I am lucky enough to have an excellent GP who I've known since I moved here. She's very approachable and knows me pretty well, which meant bringing up the subject was a lot easier than it could have been. Anyway, in short, I spoke to her about things last summer, got referred to the specialists and was seen last week.
I wanted to write this on the off-chance that someone might read it who had been struggling themselves and been afraid to get help. Walking into the appoiuntment was one of the scariest experiences of my life. I had no idea what would happen, and I knew it was quite likely that they would want to weigh me which made me totally panic.
I really needn't have worried. The consultant was absolutely lovely; extremely perceptive and very understanding. He made me feel like my issues were not unusual, and he repeatedly emphasised that it was just another illness and nothing to feel ashamed of. He didn't weigh me because I told him uncomfortable it would make me.He's arranging a variety of things to help, including dietetic support, therapy and continuing medication.
Having got through the initial appointment I really feel like I have a chance at controlling this, rather than it continuing to control me. I'll let you know how things go, but I just wanted to reassure anyone in a similar situation that there's nothing to be scared of.
xxx
Thursday, 8 March 2012
Making Changes
Some of you will know that I've recently had a bit of a blog-related stress. I'd always thought that I was pretty much anonymous uunless you knew me, bbut after speaking to a friend it transpired that it was pretty easy to work out my identity if you so desired. Now, I've always been pretty careful about what I say on here. I don't mention names, locations, diagnoses etc. I pretty much behave myself so I'm unlikely to reveal any inappropriate behaviour. However, I hadn't realised how easy it was to misinterpret some of the things I'd said.
I've taken the old blog down, but posted everything I'd originally said there on this blog. I have made some modifications and clarifications where it seemed necessary, but the content is largely unchanged.
I just want to make a few things clear. These are just things that have been recently brought to my attention and I think it's best they're addressed so I can move past this.
1 - With regards to my mental health, my regent is aware of the situation and none of my doctors have any concerns about my fitness to practice.
2 - I do not and have never used hard drugs. In a previous post I mentioned something regarding controlled drugs - as I've now stated, this was in reference to working in a pharmacy.
3 - I do not believe any patient I may refer to is identifiable - I avoid mentioning locations, symptoms or specific diagnoses. If you think something I've said is dodgy and potentially breaks confidentialty, let me know.
I think that's everything addressed and I'm looking forward to getting back to blogging properly :)
xxx
I've taken the old blog down, but posted everything I'd originally said there on this blog. I have made some modifications and clarifications where it seemed necessary, but the content is largely unchanged.
I just want to make a few things clear. These are just things that have been recently brought to my attention and I think it's best they're addressed so I can move past this.
1 - With regards to my mental health, my regent is aware of the situation and none of my doctors have any concerns about my fitness to practice.
2 - I do not and have never used hard drugs. In a previous post I mentioned something regarding controlled drugs - as I've now stated, this was in reference to working in a pharmacy.
3 - I do not believe any patient I may refer to is identifiable - I avoid mentioning locations, symptoms or specific diagnoses. If you think something I've said is dodgy and potentially breaks confidentialty, let me know.
I think that's everything addressed and I'm looking forward to getting back to blogging properly :)
xxx
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!
xxx
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!
xxx
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!
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!
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