Learning from Doctors & Patients

Amount-Learned-blackboard

Starting clinical rotations has been a really satisfying experience so far and I’m learning a lot. However, I think I could be learning more and this is mainly due to i) different kinds of doctors and ii) opportunities to see patients.

i) Types of Doctors:
We rely a lot on feedback and teaching from the doctors but there seems to be two categories of doctors on the wards.

The first are always: “busy and have no time to teach at the moment.” I never bother doctors who look stressed or busy but some consistently have no time to teach or completely ignore students during ward rounds – so I no longer feel comfortable asking. They are great doctors apparently and I’d learn a lot from them – but not being able to engage them, I won’t know.

Luckily, most doctors are in a second category; a different class who are really cooperative, sometimes actively seeking out students and recommending interesting patients for us to take histories from and perform examinations on – in addition to letting us present our findings back to them. Sometimes, we’re given the chance to be the first in the team to see the patient, write up the notes and present to the consultant. A small step but it’s a massive boost and a great feeling to be useful!

If you’re a doctor in this second category, I’m grateful and will try to follow in your footsteps!

“Want to see a patient with: a pan-systolic murmur / suspected appendicitis / a replacement mitral valve / Dupuytren’s contracture……?

Yes please.

ii) Seeing Patients:
The second factor that determines how much we learn is the amount of patients we see. This unfortunately involves good timing, luck and being in the right place at the right time. I have to add that patients are amazing, even though the majority of them are really sick, they still give us consent to practice on and learn from them.

Unless our team is on call, the earliest we can usually see patients is after the morning wash and breakfast. The race to examine and take histories begins – until the air fills with the unmistakable aroma of overcooked food and boiled to death vegetables signifying the imminent lunch trolley and protected mealtime when patients have to be left alone.

Other things to factor in are doctors on ward rounds, nurses, physiotherapists, pharmacists and phlebotomists who obviously get priority. Then of course there are fellow students who might reach the patient beforehand. So, an interesting patient who we can actually see is like gold dust!

After lunch – we squeeze in a few more hours seeing patients before visiting time when friends and relatives appear in the corridors, troop into the wards and fill patient bays, huddling around each bed.

The end result is that although we spend all day in a hospital jammed full of patients, there are only a few opportunities to actually see them!

As we students are the ones hanging around looking the least busy, we’re usually the ones who get asked the questions:

“Can I talk to you about my Mum/Dad/Husband/Wife……? How is he/she doing then Doc?”

“Erm… I’ll ask one of the doctors as they know more than me about your Mum/Dad/Husband/Wife

Cue, friend/relatives’ downward glance at my name badge. “Oh you’re only a student?”

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Clinicals Here I Come

In years 1 – 2 we achieved most of our learning through lectures with regular but occasional placements in hospitals plus sessions with GPs (family doctors). 3rd year means starting the clinical part of our medical education where we’ll be members of a “firm” in teaching hospitals and seeing patients full time. I love patient interaction so this is an exciting transition and is the stage of medical school that I’ve been really looking forward to. I still have to kind of pinch myself to prove that it’s happening!

Part of me is guarded about what being in a clinical firm will be like as an extra mature student. Traditionally, age correlates with seniority and students are the youngest in the firm but in my case, there’s a good chance I’ll be older than even the consultant. Until now it hasn’t been an issue and In a lecture hall I’m just another face (albeit a wrinkly one) in a large crowd. A clinical firm is a small team so I’ll stick out. How will I be perceived? Could I be mistaken for a qualified doctor or even as an old fraudster impersonating a medical student?

I’m also wondering whether I’ll be able to answer the questions that consultants and registrars will throw at me. Do they really humiliate their students and juniors? I’ve learned an amazing amount since starting medical school but I feel that I’ve forgotten a lot too. My classmates have voiced similar concerns and we’ve been told: “It’s in there somewhere and comes rushing back when you need it” – Well I hope so as I’m going to need it all very soon and I don’t feel anything rushing about up there.