General Practice Work Experience - Day 4

My last day, thanks to my mum who booked us plane tickets for friday (yes, I am blogging from Sweden)! I was with a nurse again today, it was a weight management clinic morning primarily, but there were other people who came in with different issues too like dressings that needed to be redressed and ears that they wanted to be syringed. 

Although it was a long morning and it would have been nice to have shadowed another doctor, it was still a valuable day. Again I'm going back to the massive variety of patients who came through the door, but it really is astonishing. It sounds odd, but I really had no idea how much diversity of people we have! 

I have always been a believer of treating patients with a holistic approach. It isn't going to do them any good if they are being treated for their physical problem but feel no better as a result, maybe due to their family situation at home or perhaps they are getting stressed at work. I think the doctor's job is to make patients feel better in every sense, not just physically. Of course this does however have to be judged by each individual situation as it arises, but this is my general principle. The nurse provided a fine example of this.

Despite being the person in charge of weight management in the practice, she knew her priorities. She would always ask the patients how they were in other areas of their life, and she made sure that they had their own priorities straight too. For example some patients had far too much on their plate in other areas of life to worry about getting a couple of pounds off in the week, despite religiously turning up every fortnight to have a meeting with the nurse about their weight. The nurse was able to 'see the wood through the trees'. She didn't insist on the patients spending the ten minutes talking about weight if she could tell it wouldn't help them. Some consultations seemed to turn into full on counseling sessions! But the important thing is that she knew that helping them with their other problems would, at that stage in their life, have a much greater effect on them becoming healthier than worrying about losing a few pounds. 

Don't get me wrong, I know that doctors they need do everything they can to cure patients with physical or mental problems. But sometimes I just don't think that it is enough on its own for the general, all around well-being of people.

Overal then this week has been an enlightening experience of life in general practice, as well as seeing how other healthcare professionals like nurses work within a GP practice not just doctors, which before I had no idea about really. But also and especially in fact, in how to treat different patients in the non-medical side; how to communicate with them and judge what other treatments they may need. It has reinforced my belief in the importance of a holistic approach to medicine.

General Practice Work Experience - Day 3

I'm afraid I didn't have time to do this post on thursday, but late is better than never!

On wednesday I was in the immunization clinic with two nurses. I was mostly babies and toddlers with their parents who came through the door to have the regular MMR vaccines, whooping cough and others.

Again, I really enjoyed it. You're probably fed up with me saying that, but it genuinely is true! It was really interesting to see how the nurse treated the children; it seemed to come so naturally to her to engage them in what was going on (as much as she could anyway, there's only so much one can do to engage a newborn!). But the most interesting thing for me was how she treated the siblings. This is something that I'm especially passionate about, making sure that when dealing with something which families are involved with, everyone is included in what is happening and everyone should understand what is being done. The nurse did this very well with parents, but also with the siblings, depute lots of them being just three or four years old. She was careful to make sure that they were prepared for their brother or sister screaming once the needle had gone in and she explained in child-friendly terms why there was a need for it. It is really important I think to get them involved. 

I only had the morning though, and went home at about 12 when the appointments were finished. Even still it was a very valuable experience in how families should be involved in the treatment of their loved ones, as well as just getting more of a feel for day-to-day life in a GP surgery.

General Practice Work Experience - Day 2

So today was my second day at the surgery. I went out with a district nurse today, shadowing her as she went out to see patients who can't get to the surgery themselves.

I wasn't expecting every patient we saw today to be elderly, but that was the case. I asked her about it and she told me that almost everyone she sees is elderly, most obviously because they have limited mobility as a result of their age which, I suppose, seems obvious when I think about it. Though she did say that she saw one young woman once who had had a Cesarean section, but the elderly in general have much more long-term problems that they need help with regularly.

Just as yesterday, the nurse was wonderful with the patients. She always knew exactly what they would like to talk about, and even if they want to talk or not. It seemed completely instinctive to her and I could tell that the patients had a lot of respect for her. I would most definitely like to have this sort of bedside manner as a doctor; it's so important to make the patients feel comfortable around you when you're having to be intimate with them, and to get information out of them when necessary too. People are much more likely to open up when they feel comfortable.

It was lovely seeing all the patients today and having a chat with them too; most are living alone and really look forward to the nurse coming. It adds some excitement to their day and it was a privilege to be a part of this, most were really interested in what I was doing and my ambitions.

Tomorrow I'm going to be in the childhood immunisation clinic which, again, I'm really looking forward to! I have been informed though that it often gets very loud with lots of screaming babies so I'm hoping it's not too bad tomorrow!

General Practice Work Experience - Day 1

This week I am doing four days of work experience at a General Practice surgery, partly shadowing doctors in consultations, going out with a district nurse, and seeing what some of the administration is like. I did my first day today which started off with signing the confidentiality agreement, then I was invited to shadow one of the doctors for the morning.

I was struck straight away this morning by the massive variety of cases she was faced with in such a short space of time. As time went on I was amazed by how she adapted between patients. One moment she was comforting the depressed and mourning, the next laughing about her holidays with a patient with a throat infection. She explained to me a bit about each patient in between appointments, and from what she was saying I could tell that one very important thing about being a GP (and, I suppose any type of medical doctor) is that you can't always take things at face value. After a considerable number of patients she would tell me that the pain wasn't as bad as they made out, or that she had only referred the patient in order to reassure the patient that there was nothing wrong with them, despite knowing full well herself that physically, the patient didn't need it. So I could see how a doctor needs to look outside the obvious and read between the lines in order to treat the patient the best possible way.

Another thing that hit me from the first appointment was the intimacy that the patients trust the doctor with. Not just physically, but patients seem to open up their feelings to a GP in a way that one would never see anywhere else. This puts the doctor in such a responsible position; they have to be able to deal with this trust in the right way and uphold this unique relationship they have with the patient.

I also had the opportunity to ask the doctor what she thought the best and worst bits of the job were. She clearly loved her job and said the thing she most enjoyed about general practice was being able to get to know patients' stories and being able to follow their lives through a number of years. It seemed to me that for some patients, the GP was the only constant thing for them and so sometimes all they needed was a chat and an empathetic listening ear to offload their problems to.

The worst part of the job for her was having to give people bad news, especially when they didn't expect anything like it, and I can imagine this must be one of the hardest things for a GP to do. But she also said that she hates all the paperwork!

I hadn't realised before today how key teamwork is for a GP, as you don't really see this side of it from a patient's point of view; it all goes on 'behind the scenes'. But she was constantly phoning other people within the practice to organise different things for the patients which I suppose makes sense when I think about it. It was a surprise though seeing as from the outside, being a GP does seem to be quite a solitary job in comparison to for example a medic in an emergency department of a city hospital.

I spent the afternoon with two nurses doing routine immunisation injections for people going abroad, nerve impulse checks with diabetics, dressing leg ulcers and ear syringing. This too was interesting, seeing how the different jobs within the NHS vary and work so well together. Being able to see this contrast between doctors and nurses though has made me more sure that I want to be a doctor rather than a nurse. It's a very important job the nurses do and I know that their training is getting more and more scientifically based, but I would just love to be leading the diagnosis stage of treatment for more complex illnesses.

Today has been very interesting and tomorrow I am going back to the surgery before spending a day out with the district nurses. I'm looking forward to what tomorrow has in store!

Eye problems

Apologies for how long its been since my last post, it's a bit of a busy time with exams coming up. I've read and seen a lot of very interesting things since then but I'm going to write about a minor problem with my eye I recently discovered.

I woke up on Thursday morning and I found my eye itchy and blood shot in the corner. At first I thought it was conjunctivitis, but when the itchiness and redness didn't spread or worsen and there was no 'gunk' I decided to look it up. I have attached a picture of it (it's not very nice - sorry!).

I after some research I think the small red dot is a subconjunctival haemorrhage, which is where a capillary in the eye bursts and bleeds under the conjunctiva, the clear protective layer over the eye. It is usually symptom free and clears up within a few days on its own, but it can come with some itchiness or discomfort. It's often a lot worse than my case; I saw some pictures where the whole white of the eye had gone completely red. It must be quite a shock to wake up with that one morning! Still, it's usually harmless and as a result of scratching whilst sleeping or strain such as sneezing or coughing. Occasionally it can be as a result of high blood pressure, and the likelihood of getting it is increased with a condition like haemophilia, or if you're taking blood thinners such as aspirin.

This would explain why it's only itchy in one patch, and why there's no 'gunk' to go with it. The only thing I can't quite work out though is why the vessels around the dot are so inflamed, so please offer some advice if you have any.

I definitely enjoyed researching this, it was more exciting because I had real symptoms to explain and I feel satisfied with my diagnosis. I thought with being a doctor the best thing would be talking to the patients and making them feel confident in your ability, but this has shown me just how much I would enjoy working out what's wrong with them, and it's so satisfying getting the right answer (I think I have anyway...). I knew I would enjoy it, but not this much! I'm sure I will have some much more exciting cases to work out too.

Paediactrics and the 'Primary School Programme'

Although this isn't directly linked to medicine, I recently started the 'Primary School Programme' at my school which has unexpectedly opened my eyes to paediatrics. This is where a group of  three of us visit a particular primary school for an hour each Friday for about five weeks and we teach year four students a series of fun lessons to do with theme parks.

The first lesson was Friday the 2nd March, and despite the school forgetting we were coming and us having to teach twice the number of children in half the time that were expecting with only two of us, I found that I really enjoyed it. It was lovely to see them enjoying the games we taught them and it was really satisfying when I went around the groups and found one that didn't understand the rules, and I explained it to them in a different way that enabled them to understand and have fun with it. Also I found how children have very different priorities to adults, and things are important to children that aren't important to adults. For example I had to sort out a squabble over who put the elastic band over the top trumps cards! I had to deal with this sensitively - I didn't want to upset either of them by making out like it wasn't important when obviously, for them, it was.

So this then has really opened my eyes to working with children. I think it would be interesting to work in an environment where I would have to make an effort to see the situation from the point of view of the child, to understand how the situation should be dealt with when they are heavily involved.

Basingstoke Hospital Work Experience - Day 5

My last day! It was sad to leave today, I was really beginning to get to know the porters and the hospital well and I was enjoying it more and more as the days went on. However the whole week was a really great experience, and more than anything the best thing about it was just to experience the hospital environment and to get an idea of how a hospital works from an inside perspective.

Today I was stationed with the same porter as yesterday morning which I was happy about, it's lovely to see how he cheers up patients and makes them feel at ease even though he is only in contact with them for a few minutes. As usual we did a wide variety of jobs and he allowed me to push a patient in a bed to x-ray and back again once they had finished with him. I found it was my turn to make him feel at ease and to cheer him up and I enjoyed it a lot. We also had to transfer a child of about 10 to MRI and this made me realise how children have to be treated in an entirely different way to adults, I had never thought how completely different paediatrics is to every other specialty.

So overall, this week has taught me how incredibly hard hospital staff have to work. I could tell this about the porters from my first day, but I noticed more and more as I experienced the hospital that the doctors, nurses and other healthcare professionals were working non-stop, and a lot of the time for longer than their shift. One doctor I spoke to asked if I wanted to be a doctor and after I said yes she replied "do you want to work 16 hour shifts?". This was a difficult question to answer at the time despite her exaggeration; no one wants to spend their lives just at work. But if it comes with the territory of doing a job that you love for the rest of your life, it is most definitely a sacrifice worth making.