A year ago, a year ahead.

Last week was fairly standard for me as a 3rd year medic in the middle of psychiatry placement. (Many of you know my less than adoring thoughts toward psychiatry, but that's not the purpose of this post).

For the second year medics it was ESA 3 time, the pre-clinical exams that had me and my housemates and friends so wound up and frantic 12 months ago now seem like a delightfully hazy memory. The in-depth physiology and theory has no doubt mostly slipped from my memory in the year since then. Many medics on our course say that the pre-clinical exam is actually the most difficult we sit on our course, by the time we get to finals the questions are more general and clinically relevant. Perhaps I should brush up any way just to be safe!

Whilst 1 year ago I was sitting exams, the year above us found out this week what foundation schools they have got into (ie, where they will be working in their first jobs as junior doctors come August). This is quite exciting and also a reminder to me not to rest on my laurels. Job applications will be around before we know it and hopefully by next year I'll have a doctors job lined up too!

But for now I'll just get back to finishing off my Psychiatry portfolio, revising for Thursday's test and praying to the weather and travel gods that my flight to Canada for Christmas isn't delayed/cancelled!

Merry Christmas!

Scrubbing in

After a long and luxurious 2 week summer holiday (ok it was rather a short and busy holiday as I spent time visiting family and working at Leeds Festival as a first aider). I've been back at the grindstone for 4 weeks in another new specialty block. This time it's the turn of orthopaedics (bones) and anaesthetics (putting people to sleep)!

Ortho a refreshing change from the constant theory of medicine - the patients problem is usually pretty simple to diagnose (a quick history, exam and x-ray- you can have an answer in 10 minutes) and the treatment often involves either a plaster cast or the use of power tools rather than complicated drugs mechanisms.

Anaesthetics on the other hand is a lot about the complicated drugs - I appreciate Anaesthetists have a big responsibility (making sure you are fit for surgery, and keeping you alive and as pain free as possible before and for a while afterwards) but for the most part once they've drifted you away to sleep they do indeed shave time to sit doing the crossword (or watching the rugby on their ipad!).

This block has also given me my first chance to scrub in on major surgery and even stitch up the patients afterwards. I'm not set on being a surgeon but there is something invigorating about it (in small doses). It's nice to not have to think quite so much and to actually do!

I'll be sure to miss all this doing when I head to my next specialty. Psych! (eurgh...)

On-the-job training.

It's now been 6 months in clinical placements and we're settling into the pattern of life and work in the hospital.

My Friday was less like the day of a student and more like that of an F1

• Turn up on the ward, visit each of my consultant's patients and make a record in the notes. 
• Pick up a pile of blood forms from the nurse's desk and head around the ward collecting blood from willing arms. The process of filling in the little forms on the blood bottles takes longer than the process of taking blood itself, making sure the right blood tests are done for the right people.
• Run up the stairs to deliver the patients bloods to the lab. 
• Update the Registrar (that's a doctor somewhere inbetween a Jr and a consultant) on the patients I've seen and check if he has any more jobs for me. 
• Get asked to cannulate one of the patients I saw earlier. Not able to get a good enough vein this time (doh!) but she reassures me that even the chemo nurses have touble cannulating her. 
• A quick 20 min lunch (luxury!) 
• Afternoon seminar where I give a case presentation to other students and a couple of the doctors. 
• Home time, rinse & repeat. 

This is basically our 9-5(ish) job but sadly without the wages. 2 more weeks of placement left now before we get a much needed 2 weeks of R+R before it all starts up again. For me that means orthopaedics, better get working on my muscles!

Milestones

Today marks 1 year until the opening ceremony of the 2012 London olympic games. It's also pretty much 2 years until I leave the comfort of med school and start work as a junior doctor!

You hear a lot of horror stories "Don't get ill in August!" It's not just because you get us baby doctors fresh out of medical school, the second years and registrars (basically almost everyone except the consultants) are moving on to new posts. And just to make things even better, it's likely a good number of the cosultants will be away sunning themselves on a beach somewhere!

I'm now 6 months into my clinical rotations and getting a bit of a taste of what life will be like for me in 2 years time. As an F1 (first year doctor) you are the regular face on the ward. You are the one who goes and checks on the patients every day, organise most of the daily medical care and have the 'pleasure' of dealing with the relatives.

Lots of practice still before we get there. Let the countdown begin!

Real Blood!!

You may remember in a previous post of mine I commented on how in our clinical exams we all felt rather silly talking politely to a plastic fake arm before taking blood from it. Well it must have paid off because today in the hospital, I got to take blood from a real patient with a REAL arm! (2 in fact!)

I wasn't the first in my house to do this, several of my medic housemates have come home equally excited at doing this pretty basic skill on a proper person for the first time. I definitely feel like I have joined the club. I'm sure we won't be so excited in a few years when we are the junior doctors responsible for taking bloods from 20 patients a day, but for now, the novelty of remains.

The very nice and helpful house officer (junior doctor) who supervised/helped me with my first bloods seemed happy with my effort. The first patient (who incidentally didn't know she was the first until I was finished) said "OW" loudly as I put the needle in, but the second lady even said "Thank-you" when I was done - Success!!

Tomorrow is my first 'on-call' - we'll see how that goes.....

Thoughts and impressions of GP land.

Wow, it feels great to be out of a lecture theatre and actually being a mini-medic!

General Practice was a great starting block for me because, without pushing me out of my comfort zone too much it reinforced what I do know, and showed me what I don't know.

The first phase of medical school, however you are tought it, gives you the basics you need for going out there and getting started in practice.

• Technique for how to take a history and examine a patient
• A working knowledge of most common conditions (and some rare as hell ones!)
•  Some understanding of what bloods we take and what tablets we give.
• An inferiority complex to keep you hungry for more knowledge!

All of this set me in good stead for GP, throwing me in at the deep end and taking my own consultations. The hardest thing for me at this stage was not taking a history and diagnosing the problem, it was diagnosing it with enough confidence to roll with it and start recommending treatment. But I had a go nonetheless.

 General Practice is the shop-front of medicine. Unless you come into A&E with your arm hanging off (or a similar malady). It is your GP who diagnoses you, treats you, refers you and generally knows you. In future it is thought 50-75% of doctors will need to be GPs to meet the needs of the population. The vast majority of long-term conditions are dealt with in your GP practice without you needing much input from the high flying hospital doctors at all.

Is GP rewarding, sure it is. You get to see patients journey from start to finish (cradle to grave in some cases.) You never know what is coming through the door next (although with some patients you can make an educated guess!). However, no getting around it, it can be a bit repetitive. Wherever you work you will see a lot of coughs, a lot of rashes, a lot of ear infections and a lot of sick notes.

A few highs and lows for me
Highs

• Taking a history, figuring out the 'answer' to the patient's problem and getting it RIGHT!
• 6 week baby development checks (they're cute and I'm a softy!)
• Going 'on the road' with the out of hours Drs and helping poorly people in their own homes
• Earning respect from a patient who came in the door, looked me up and down and said "I've got socks older than you!"
• Performing my first PR exam (not sure this is a high, but it was a first!)

Lows

• Telling a mum her 2 year old's birthday party will have to be postponed because they've got chicken pox
• Baby vaccine clinics - cute as it is, you feel mean making them cry!
• Practicing 'breaking bad news' with simulated patients, actually it was a great experience and really useful, but I felt I'd been knocked for 6!
• QOF, don't get me started!
• The endless, ENDLESS coughs!

So, whist I have great respect for GPs and the amount of knowledge they need at their finger tips all the time. It's probably not for me.

Onward, to hospital medicine!.......

Facing the Change

You cannot have read UK health media in the last few months and not have become aware of the major NHS reforms proposed by the current (I can't really call them 'new' anymore) government.

There are plenty of rumours and strong opinions flying around. Although when I attended a recent BMA (British Medical Association) Q&A meeting I was surprised to find that most people (including GPs and event the BMA chief himself) were still somewhat unsure about what exactly the reforms will mean for day-to-day practice.

I asked the doctors present if they felt ready for their proposed commissioning/management role and the answer was almost unanymously 'No'. The BMA chief conceded that some form of extra training would be required, although to provide it before the health bill is passed would appear as admitting defeat so the BMA and other organisations are dragging their feet.

What does this mean for students? Another year of med school to do an MBA perhaps?
What does this mean for older GPs? Do they have to re-learn how to do their job?

Even those who are 100% opposed to the changes admit it is likely the bill will be passed in some form. The BMA has a special representative's meeting on March 15 (mini-medic will be there!) to debate and propose specific changes to the bill. You can also campaign directly to your MP with their lobbying toolkit.

Whether the government will listen..... well that's another question!

Next stop: GP Land

I found out this week that my first 2 month placement will be in a (hopefully local) GP practice. Hopefully a gentle easing-in to clinical medicine.

After that it's back to the wards for 2 general medicine blocks.

Anyone who knows how clumsy I can be will be pleased to know it's almost a year til I get my hands on a scalpel!

Exciting times

Well, I finally made it. After all the lectures and exams I am finally getting out there in a clinical setting. This medicine s**t just got real!

I've had a great 2 weeks so far, firstly with community children's services and then on a hospital renal ward this week.
A few highs and lows from clinical phase so far.

Highs 

• Visiting infant school for the day and meeting a charming little boy with transverse myelitis who will likely be in a wheelchair for the rest of hid days but won't let that stop him making his own way in the world.
• Getting real extended contact with patients so I am a friendly face they can recognise and have a chat with and not just a student who came and poked and prodded them once. 
• Invaluable experience from first hand consultant teaching. Being praised by the consultant for my knowledge of the patient histories after he'd just yelled at all his registrars. (Granted I'd had a lot more time on my hands than they had)
• Wandering around the hospital in scrubs with a stethoscope in and feeling like I belong there (shallow I know- but we're all allowed those little pleasures in life!)

Lows

• Starting work at 7am - the tea hasn't kicked in by that time!
• A 4 hour talk from a clinical physchologist on children dying. Heavy, yes. Useful, yes. but by the third hour we had had more than enough information and were just being needlessly depressed
• Being yelled at by an irate frenchman when the busy nurse who he had assumed was his personal translator could not be found!

I wouldn't change it for the world. If the first 2 weeks were anything to go by, the next 2 years are going to be fun!

Meeting a body

This week, as I have another 3 weeks off before beginning placements, I asked one of the pathology lecturers from my medical school if I could shadow her and get some experience of the specialty.

Contrary to populer belief and silent witness, Pathologists don't solve crimes. But they do sometimes solve mysteries.

During my 2 days as a shadow pathologist I spent a lot of time looking down a microscope at potential skin and breast cancer samples, I sat in on a skin cancer and renal transplant meetings, and (most memorably) I observed a post-mortem!

The pathologist doing the autopsy was a good and inclusive teacher talking me through the procedure, testing my anatomy and pathology knowledge and generally getting me involved. If you're not very keen on grizzly details, cease reading now perhaps...

Post-mortems are not very glamorous affairs, the pathologists remove each of the organs in turn and slice them to look for any signs of disease and a possible cause of death. Often everything from mouth to the other end of the gut is removed in one piece and viewed as a system. For me a personal hilight (if you like that sort of thing!) was to finally see in the flesh and hold my first brain (for reference, the brain in the photo is not a real one!!)

Once they're done they organs are returned to the body (usually in blue plastic bags!) and the person is sewn up to be returned to their families. The pathologist informs the coroner of the main cause of death (and any other related factors that may have indirectly contributed).


Whilst the topic of pathology is hugely interesting (and hugely important, linking in with all parts of medicine), I think the day-to-day life of a pathologist is not for me. I would miss the patient contact ..... and probably have less friends too!

Moving on up!

Yesterday being in clinical phase got a bit more real when we received access to the clinical student web pages and a general timetable from now right through til finals!

Whilst I don't know yet where I will be for each 'block', this is what I will be doing over the next year, known as junior rotation.

• 2 'medical' blocks
• Surgery  
• General Practice
• Orthopaedics and Anaesthesia
• Psychiatry

What we do now know is that we do get a limited amount of holiday (2 weeks in summer when the new F1s start work and 2 weeks at Christmas) and the best bit - no major exams until March 2012!

Following these exams we get an elective where we can practice medicine somewhere exciting elsewhere in the world, then more blocks back in the UK until finals in May 2013.

Clinical induction starts on Tuesday, can't wait to get stuck in!

New Years Resolutions

2010 was a busy year, with 3 sets of major exams and a dissertation over the summer to take up the one main break we did get. Whilst it's a relief to be through all that, 2011 looks to be just as busy and more exciting, with clinical on the way.

Last night I was one of the thousands of people lining the Embankment of the River Thames in London to watch 2011 start with an impressive firework display. A memorable way to mark a new year and a new start.

'DrS' on the british medical association's Doc2Doc forum brought up the subject of New Years Resolutions. I pondered what mine would be.

• To actively try and get the most out of all the clinical experience I can get, and keep on top of my portfolios. 
• To find more time to read aroound the subject AND to read some non-medical books too!
• To keep this blog up to date (hold me to this!)
• To keep in touch more with my friends away from med school. 
• And (this is a more traditional NY resolution) to get back down to the weight I was when I started med school- keeping active in my downtime :-)

Happy New Year to you all from the mini-medic!