The musings of a fourth year English medical student

Tuesday, 7 November 2017

THE FINALS COUNTDOWN


Something weird has happened. Somehow, I am already in fourth year and I’m prepping for the infamous final medical school exams.

Despite how astonishingly quick this is all going, I absolutely love fourth year. The timetable is almost entirely composed of hospital placements, with only two lecture days in the whole year! I cannot tell you how much I hate lectures, hence why I’m loving this year so much.

The structure of the year is as follows:
  • Four days per week of placement, 8am-4pm or 9am-5pm
  • 1 tutorial day each fortnight 9am-3pm at university
  • 1 day each fortnight for self-study


People treat you differently when you’re in the older years. You are given more responsibility; people are more interested in your opinion. You actually get to practice being a doctor. While some jobs like ringing the pathology lab are very boring and tedious, others like scrubbing in theatre or helping clerk a patient in SAU feel fantastic.

Of course it’s not always perfect. I didn’t enjoy the five hour ward round, where I hadn’t eaten or had a sip of water while the patients tucked into their fish and chips. My heart sank when a CT1 was continuously bleeped, who turned to me and said, “I hate my life”. It was frustrating seeing some patients repeatedly readmitted for non-medical reasons. I’m stating the obvious here, but the NHS is in crisis. It’s not an exaggeration. I do worry how this will affect my training; will I still enjoy the job if the pressures continue to rise to unprecedented levels?

My other issue is the dreaded e-portfolio that you never ever escape from. It is incredibly strict. You have a list of the minimum number of histories, exams and procedures you must carry out during your placement. The first challenge is finding someone who is free to supervise you. However, you can’t use the same person more than twice. Ideally you should be doing these tasks in front of consultants, as they are more experienced. Then you have compulsory study modules to attach and reflections on clinical practice. It’s a pain, but I may as well get used to it, as its demands will only increase throughout the training.

This is such a fantastic year. In spite of the negatives, I feel reassured that the hard work will be worth it. Loving placement has to be a good sign, right?

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Sunday, 10 September 2017

BACK TO REALITY



Well, Summer is over and so it’s back to placement.

Going into fourth year feels scary. At my university, we sit our medical finals in fourth year, not fifth year. Cue immense pressure and frantic worrying! Most of the time spent this year is in clinical placement. I chose to change hospitals and am in a small district general. Personally I think the smaller the hospital the better the teaching. I was in a large university teaching hospital in second year, where nobody knew my name. Then in third year I moved to a district general, where I felt like I had a place and people didn’t just look straight over my shoulder. Now I am in an even smaller district general and I cannot say enough good things about it. Everyone seems to have more time to teach; everyone wants to teach, which is ironic now that I’ve left my ‘teaching’ hospital.

In spite of how wonderful I think the placement is going, I am lacking so much confidence. When I’m asked to do some bloods or a cannula I have 5 seconds where I freeze up – I dread that I’m going to mess it up. Sometimes I am too scared to speak up and ask to be involved more. It can be hard to pipe up and say “I want to go to theatre, too, please”. I really have to force myself to be brave, because what you put in is what you get out of the placement.

On Friday I was really struggling. I felt as if I had got to know a patient and they seemed to be very polite and sweet. Then we had a long chat about this patient with the consultant and the problems they faced. We were all dodging the elephant in the room, until the consultant said: “I don’t think [they’re] going to leave hospital”. I have been involved in the care of dying patients before, but this felt so much worse. This person was not actively dying, but things weren’t getting better. Now that I felt I knew them better, I felt even more sorry for them and cried quite a lot when I got home. I’m not sure how I’m going to feel when I next see them.


I do feel drained and scared, but I also know there’s nothing else I would rather be doing. I can’t think of any job more rewarding or interesting.
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Thursday, 3 August 2017

5 THINGS I HAVE LEARNT ABOUT MEDICINE



I am just over half way through my medical degree and wanted share what I've noticed about this crazy job I've signed myself up to!



You will never work a 9-5


This may seem obvious, but if you work in the NHS (and probably in the private medical sector, too) a ‘normal’ working day doesn’t exist. Even if you do purely clinic-orientated work, normal working hours don’t exist. Nothing ever runs on time, and your moral duty often results in working well beyond your set hours. You may need to get to clinic/General Practice early so that you can plough through the mountain of important paperwork. And you never get paid those extra hours you put in. There’s no ‘flexi-time’; you can’t take time off because you had no lunch break and worked an extra 3 hours the day before.


There’s a reason it is a vocation rather than a career


Adding to the previous point, your job extends well beyond your set working hours. Doctors have annual appraisals, and they need evidence to show they keep up to speed with advances in their speciality. This includes reading journals every week, attending conferences, teaching, potentially juggling an academic role alongside their clinical role. Medicine is seen as a vocation because these extra hours are part of the dedication required. This is the standard, and shows that when you decide to be a doctor  you decide to commit a lot of yourself to the job.  Of course, anyone who wants to be exceptional in any field has to put in crazy hours – it’s not unique to medicine!


Listening and watching is just as important as book knowledge


I’m not the smartest medic out there. However, as Osler once said “Listen to your patient; he is telling you the diagnosis”. I have learnt so much more from patients by taking a step back (sometimes literally) and observing how they act, their surroundings and what they say, than from what is written in their notes.


You need a backbone and a tough skin to survive the medical environment


People are rude. When I started my first placement I was absolutely petrified, and I get nervous every time I start a new rotation. People will try to walk over you, and I’ve learnt the hard way that standing up for yourself gets you more respect than just sitting back and taking it. People are a lot nicer when you’re keen, polite but also not a wallflower. Chocolates definitely help as well.


The best doctors love their jobs


You can be the smartest student and work harder than anyone else, but if you don’t love your job then what’s the point? The doctors that have inspired me the most have been the ones that wanted to teach and get genuinely excited when they talk about medicine. Of course it’s not always fun, there are lots of stressful and sad moments. But the doctors who really seem to love their jobs are the ones I aspire to be like, regardless of how many letters they have after their name or how far through they are in their training.
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Sunday, 9 July 2017

2 YEARS POST DOUBLE JAW SURGERY




Wow, I can't quite believe it has been two years!

I was told age 15 that the jaw pain I was getting was due to an overbite, which could only be corrected by a bimaxillary osteotomy. 

So, four years of brace-wearing later I had the operation. It took five and a half hours under general anaesthetic and it has changed my life.

In short, I have no regrets of going through with it. However, post-op was not smooth sailing. I've documented throughout this blog that I have struggled with depression, and I was right in the midst of it around the time of the operation. 

After it, I struggled with full time studies and the healing process, which must have contributed to the deterioration in my mental health. I'm not saying for a second that it was the cause, but it didn't help. 

Mental health aside, I physically felt like shit for a long time afterwards. I was frustrated I couldn't do all the things I used to do - I felt like I couldn't be me.

Luckily I haven't had any serious long term complications. My bite has moved back a few mm, but I am still thrilled with my results. Unfortunately I have a small amount of pain on a daily basis on my left side. 

At a recent appointment with my surgeon, he showed me that the side where I feel this pain shows some condylar resorption on x ray. He seems to think this is the likely cause. I have to say I know nothing about this but from what I have read about, my symptoms seem to mirror those described. Nothing can be done to alleviate this and we can't predict how long this pain may continue for. 

It was a long process and massive chapter of my life. Having this operation, plus a previous operation to remove your wisdom teeth for preparation, is a serious undertaking. I am so glad I did it, and am grateful to have the NHS who paid for everything. Being an outpatient and then inpatient has helped me so much in my medical training as well. I hope I can use this experience to be a better doctor one day. 

Pre op

Same day post op

6 months post op



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Friday, 7 July 2017

HALFWAY POINT



Finally, third year of medical school is over! What a year it has been.

The year structure was entirely different to the previous years; we moved away mostly from lectures and were thrown into medicine, surgery and specialities. This has been the year I realised how much I want to be a doctor. I knew for several years that I wanted to do it, but my hospital placements have solidified those beliefs. I'm not the brightest student, but I do believe I am suited to medicine, and I have the personal qualities you need to be a good doctor.

I honestly enjoyed every placement, and consequently I have no idea what I want to specialise in! Each rotation had its pros and cons, but often it was the teaching that made the speciality interesting. I may not know what type of speciality I will pursue, but I do have a clear idea of what kind of doctor I want to be. Being a medical student has allowed me to be a fly on the wall during many consultant's clinics and ward rounds. I have seen how they behave, and taken from it how I think a doctor should act. Little things, such as making the effort to personally call in each patient and hold the door open for them. Looking the patient in the eye, and never forgetting to ask them if they have any questions. Making them feel like they are the ones making decisions; having control of their health during sometimes frightening situations. Helping them to look and feel presentable after an intimate or embarrassing examination. And I never want to be that consultant who can't be bothered to wear disposable aprons and gloves in infective bays / rooms.

As well as learning how I want to be a kind doctor, I also feel I have learnt to stick up for myself. Back in second year I was petrified to be on the wards. I didn't want to get picked on or be told I'm in the way. Now I don't feel like I'm wasting people's time -  I'm there to learn. So, when the nurse is annoyed that I didn't get that cannula right first time or being told I'm taking up space, I explain politely that I'm doing my best. I haven't managed to confront or challenge things I don't agree with but I'm getting there. Being an extra set of eyes and hands can help the doctors and HCPs you're shadowing.

Ultimately, everything I am learning feels like it has a real purpose. It's hard to get excited about diseases in a cold dank lecture theatre. But when you elicit a sign on a real patient, or feel like you've helped someone, you see the point of the vast amount of knowledge expected. I'm so excited for the next two years.
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Saturday, 27 May 2017

FEAR OF TRYING



At school I was very ambitious. I would set myself targets and I would give 100% of myself to those targets. I loved it. I loved pushing myself.

The comfort was that when I set those targets, I had a lot of self-confidence. I almost always achieved those ambitions, and so whenever I would set the next target I was pretty certain that it would happen.

All of that changed when I got to medical school. My physical health was suffering, my mental health was suffering, and my confidence was knocked by a few of my teachers and consultants on the wards. I felt very unwelcome and undeserving of my place. I started to question if I could do this, if it was worth trying.

I started to believe that I could never excel in medicine. If I passed, that would be a miracle. I resigned myself to never being that person who gets published. I stopped asking questions – I stopped challenging myself. After all, several doctors told me I was going to be a GP in various ways. And without bashing general practitioners, of whom I have a tremendous amount of respect for, I was made to feel like it was a predetermined path rather than my own choice.


I love studying medicine, but my confidence has taken a real bashing. I’m trying to be the old Kate who wasn’t afraid of trying to be better. Who wasn’t afraid of a challenge, but relished it.
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