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?”

Clinical Week 1

Beilinson_Hospital_ward_1950I’ve survived the first clinical week. After two years incarceration in mostly lectures and the recent week of back to back induction talks, my patient hungry classmates and I were released into hospital wards.

However, the new found freedom we’ve been craving has sometimes left many of us feeling like spare parts, trailing behind junior (F1) doctors and not knowing enough to help properly yet. We’re dressed as doctors, reinforced by shiny new stethoscopes around our necks but with little experience of using them.

I’m not beating myself up as it’s only the first week and we’re still discovering hospital protocols but so far a good recipe has been to i) find a cooperative doctor ii) be nice to nurses and iii) find friendly looking patients who will consent to histories and examinations.

Me: “Hello Mr X, my name is MSL and I’m a medical student. Could I talk to you about why you’re in hospital?”
Patient: “Sure doctor”
Me: “I’m actually still a medical student”
Patient: “Oh, OK”
Me: “So Mr X, why are you here today”
Patient: “Well I’ve had this pain for 3 days now doctor”
Me: “I’m a medical student
Patient: “OK doctor”

My initial concern about being mistaken for a qualified doctor is semi valid for some patients but is wasted on staff who look me up and down and spot my “Medical Student” ID badge, Oxford Handbook of Clinical Medicine (aka cheese and onion) or notice me waiting around awkwardly. Actual doctors have a pager clipped to their belt/handbag and hurry around efficiently with patient lists in their hands. The pager is like a little time bomb except nobody knows when it is going to go off. Consultants walk around in expensive shoes and suits – no pager.

So far so good, not many pointy questions and no humiliation in front of patients yet but I did hear a rumour that a consultant made one of the doctors cry.