Continuing my work experience placement at the QEH, I had another really interesting and insightful day. I began my day following the consultant on the TSS/MAU ward round, what I found particularly interesting was looking at chest x-rays, and listening to the sounds of patients’ lungs. For those with crepalations (crackling noises), looking at the X-ray reinforced the probability of infection, due to the amount of ‘white space’ seen. One particular patient with heart failure and pneumonia had an especially fascinating X-ray, with white areas appearing in lines – as if down each bronchiole. The consultant explained to me that because of the heart failure, not enough blood and thus oxygen was reaching the span of the lungs, causing the infection to occur in this manner.
I saw a variety of patients, from the elderly with infections and some heart failure, to a young man who had overdosed on drugs, a woman with seizures and another with jaundice, explained to be due to her liver failure. The young man who had overdosed, was my first experience of a rude and unpleasant patient, who could not understand how the doctors could not spend their entire day with him. However, he was dealt with calmly by an F1 doctor, who explained that his requests were underway and some pain relief would be along shortly. I was however, occasionally disappointed at how doctors would sometimes walk away from patients when they were speaking to them, and in one case, left a frail elderly lady confused about the future of her treatment.
In the afternoon, I sat in a diabetes clinic, listening to consultations with a diabetes nurse, nutritionist and endocrinologist. Here, I was surprised at how well the nurses knew their patients, but also how medicines were not relied upon. While diabetes is managed by insulin, I also learnt that diet (carb counting) and exercise where really important in managing diabetes. Encouraging their patients to learn about how their diabetes and insulin works, and it being explained on a one to one basis seemed really effective, in giving patients the tools they needed to control their diabetes with less (expensive) medication. As the diabetes nurses had a very niche area of work, it meant that they could see their patients frequently, and give them small ‘snippets’ of information to take away at once. Not overwhelming them, I was told that this made large changes to occur in small intervals.
I have really enjoyed my time at the QEH so far, gaining an insight into both the positives and negatives of working as a doctor, and the hospital environment as a whole. I am certainly looking forward to what the rest of the week will bring.