Category Archives: work experience

Work Experience – Day 5

Friday was the final day of my work experience at the QEH, and its safe to day that despite my hectic and busy week I definitely didn’t want to leave.

Again, I spent the morning doing the TSS ward round, but this time with a consultant, two F1 students and two ‘soon to be’ F1 students. There were a few patients I had seen every day of the week, showing that despite the aim for patients to leave TSS after 72 hours in the current situation of the NHS and QEH, this just wasn’t possible as beds, clinics and homes were not available for them to go to. The consultant had a very busy day, so the ward round was completed quickly, with lists and lists of jobs for the F1’s to do before they went home. After discharge letters, taking bloods, requesting scans and looking at X-rays, I spent the afternoon in a gastroenterology clinic.

The clinic was a different environment to that of the ward, and reminded me much more of a GP surgery. There were a variety of patients with different symptoms and illnesses, some losing weight unexpectedly, some gluten intolerant, some with IBS. In the same way as symptoms and illnesses varied, there were patients form all walks of life, elderly, a young mum with her 3 year old, a teenage girl, an alcoholic who appeared to have been drinking already. Again, each was spoken to differently despite the same questions being asked, depending on if they were nervous, experienced in controlling illness, alone or with family. There were two cases which stood out for me, the first a young anorexic girl, who was being investigated as the cause for her anaemia was unknown. The consultant realised when she was alone, that this would be a difficult consultation as she had nobody to support her – calling in a nurse to ‘chaperone’ eased and relaxed the environment, meaning there was comfort for her when she broke down in tears. This was a difficult conversation as she was worried the consultant would tell her GP her weight, missing her parents (who were on holiday) and worried about her future. The consultant was reassuring, never rushing or pushing her and making time for all their patients, something which is easily lost in a busy afternoon.

Breaking bad news is, I’m sure, something every doctor dreads. Unfortunately, the end to my work experience placement was not a happy one. The consultant I had been shadowing had to break the diagnosis of lung cancer to a patient. During an ultrasound of her liver, shadows had been found, and later scans showed that these were also found into her lung. While it seemed the patient was almost expecting this diagnosis, it was still an incredibly difficult conversation, again with a nurse present . The doctor was very clear that he wanted to keep the patient in the loop, as many decisions and discussions were taking place behind their back. The important aspect of this conversation was making the patient aware of the support network available for them, the opportunity to ask any questions and to write any down when she thought of them to ask later.

I had an incredible, eye opening week during my work experience. I would recommend it to anyone considering medicine, as it has shown me both the highs and the lows of life in  a hospital. I have realised the sometimes mundane tasks of an F1 doctor (sometimes they felt like secretaries) and how doctors are seemingly always rushing from one place, clinic or ward to another. Most importantly, it has shown to me that its a tough career, busy, with a lot of responsibility and hard work, but if you truly enjoy and love what you do (as everyone I met did) it is definitely worth it.

I am definitely excited for the future, and everything it may bring.

Work Experience – Day 4

Thursday was a very exciting day at the QEH, as it was the day the new F1 students began shadowing for their placements which began last week. Therefore, after the TSS ward round in the morning, I joined in learning about the computer systems, request forms and how the ward generally runs. the security of the NHS became apparent when I was told every website/system had to have a different password, and each be changed every month.

The systems for looking at blood results, X-rays, booking scans and researching patient histories were all shown to me, alongside the referral forms and blood book. After this, I enjoyed speaking to the two new F1 students on TSS, one of which trained in Malta and the other in Plymouth. It was interesting to hear their views on gap years, reapplying and their own university experiences, as well as the challenges they have faced along the way. I was particularly impressed by one of the students, who I couldn’t help but think I would love to be my own doctor. She always had her eyes on the patients, walking them back to their beds when they got confused and speaking to them when they were obviously bored or distressed. A particular moment was occurred when watching a lumbar puncture, where a (scarily) large needle is inserted between the vertebrae to remove fluid. This fluid also circulated the brain and so can be used to detect small bleeds. The patient was a young woman who was obviously distressed during the procedure. The F1 student brought her tissues and water, reassured her and told her to squeeze her hand through the pain. For me, this was the best and most impressive piece of practice I saw all week – all be it the most simple.

I spent the final part of the afternoon back in endoscopy, watching procedures and learning again about how the equipment (air and water) worked. Seeing how different patients were spoken to and experienced the procedures was interesting, as it was an unpleasant experience for everyone. It was a really interesting and insightful day, surrounded by the excitement of the new F1 students and it definitely confirmed that medicine is the only career I want to undergo!

Work Experience – Day 3

Continuing the reflection of  my work experience at my local hospital, the end of the week was just as exciting as the start. Wednesday began with the TSS ward round again, where I continued to learn how to interpret chest x-rays, and followed the treatment of many patients I had seen before. The lady with jaundice due to her liver failure was still smiling despite her deterioration, however the ward was also filled with new patients we had not seen before. A particularly memorable case was a drug overdose, a young woman with a suspected tear in her oesophagus who was reluctant to undergo any treatment, but after speaking to a doctor relaxed into the hospital environment and was much more willing to cooperate. Perhaps the highlight of my day were an elderly couple who warmed everyone’s hearts – she was desperate to have him home. After speaking to them for a while, ‘just a touch of heart failure and pneumonia’ wasn’t going to worry them, and in her words was nothing they couldn’t handle. Her positivity and supportiveness of her husband was endearing, and I couldn’t help but smile at her excitement towards his discharge.

I spent the afternoon at the endoscopy unit with a consultant, watching and learning about the  procedures he undertook. The first of which  was a colonoscopy of a young and cheerful (slightly drowsy due to the medication!) male. It was particularly interesting to see the tiny ulcers in his colon, and how small biopsies and photographs could be taken using the equipment. As he was an outpatient, he was given steroids to take home to and reduce the inflammation. The second procedure I witnessed was a stark contrast to the first, a frail, elderly man who was an inpatient. He had a gastroscopy, which was used as a diagnostic procedure, hoping to find the source of a bleed. By this point the blues had stopped, but the end of the oesophagus was inflamed with ulcers. However, this was a particularly interesting case as the consultant made me consider whether this invasive procedure was a good thing for patient, who was so frail and elderly. The possibility of over investigating was an interesting and complex one, and led me to believe that if it was my grandparent, I wouldn’t want the procedure done unless they were in serious pain, or it was urgently life threatening. These procedures are simple with relatively few risks, but they are also unpleasant and undignified.

Wednesday definitely opened up my eyes to the harsh realities of medicine and the unpleasantries of certain procedures. I really enjoyed learning and speaking to patients on ward rounds and finding out about their own hospital experiences.

Work Experience – Day 2

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.

Work Experience – Day 1

This week, I am lucky enough to have a placement at my local hospital, on the MAU and TSS wards. The MAU ward is the medical assessment unit, where patients are examined and then referred to specialisms, sent home, or moved to other wards. The TSS unit stands for the Terrington Short Stay Unit, and was where I was placed today. Here, many patients are admitted due to a fall, problems with diabetes or problems which come through A&E which aren’t life threatening. The aim for a maximum stay at the TSS unit is 72 hours, however today I have seen the stresses and strains of the unit, and how this is not always possible.

Surprisingly, while not one of my first experiences in a healthcare setting, today was one of only a couple of times I have been on a hospital ward. My family and I are lucky enough not to fall ill very often, so it was a hugely eye opening experience. It is a tough environment, bright lights, loud noises and machines, ill patients and lots of people who need help, however I found I quickly found my feet and the ward became much less daunting.

I began my day following two F1 students and a consultant doing the ward round, seeing just under 30 different patients. I saw a number of fascinating conditions, including sepsis, jaundice and been able to listen to an abnormal respiratory sound –  ‘crackling’ and compare it to a healthy lung. From looking at the scans of the patient, I then saw that what was supposed to be a black area (lung) was patched with abnormal white areas, causing the crackling. This was explained to me to be fluid, which needed to be monitored incase it worsened. I learnt a lot medically, from simple abbreviations, to little pieces of knowledge about diseases and illnesses, however a key part of this for me was patient interaction. The consultant led the ward round, asking the F1 students questions and for their opinions, however, he spoke differently to each patient, both making himself easy to understand and the patients as comfortable as possible. Nobody wants to be in hospital and I’ve seen today how a friendly doctor, who listens to the stories a patient has to tell, can really improve a patients’ experience.

What I didn’t like about the TSS ward, was the emphasis on discharge. There seemed to be rush to get people out as someone was always waiting for a bed, and the F1 students were being pushed to discharge patients quickly by the nurses. It is a ward with an incredibly quick turnaround, and on speaking to one of the F1 students I shadowed for the rest of the day, she told me that she wished she had more time to follow her patients’ stories and really get to know them, rather than just treat them and send them on their way. This has really made me consider which aspects of medicine I might like to pursue, as I feel that this following of a patient and their story – both medical and personal, is an aspect of medicine really important to me, and one that you might not get in a ward such as TSS or A&E.

Having said this, I really enjoyed my insight into medicine today, as packed full of paperwork and stress as it may be. I saw both what I consider to be good and bad practice, and both upbeat and unhappy patients – a reality of medicine. Perhaps one of the loveliest and most heartwarming aspects of today was husband and wife, on adjacent wards just the other side of the wall from each other. The husband of the couple just wanted to sit and hold his wife’s hand, and this was facilitated for as much as possible by the TSS team, as they obviously appreciated just how much it improved their stay.

RSM Medical Careers Day

Last week, I alongside many other aspiring medics spent the day at Oakham School, for a ‘medicine day’ offered by the Royal Society of Medicine. It was an incredibly interesting day, and shed light on the application process and specialisms. Being a doctor is an incredibly varied role, and I love the potential that there is to choose a career which definitely suits you. However, it is easy for anyone to find out about the application process, course structures and entry grades, so I wanted to take some time to reflect on the medical professionals who gave their time to speak to us about their careers during the day. Two of which were presentations which particularly stuck with me, and another a comforting realisation.

The Trainee Years – Dr Brinda Christopher 

Dr Brinda Christopher is the president of the Sports and Exercise Medicine section of the RSM, and currently works for Tottenham football club. Admittedly, I have never particularly considered the role of doctors in this environment – thinking that the players would always turn to a physiotherapist. However, I found it explained to be an interesting field of medicine – and an uplifting one. Dr Christopher mentioned that a part of her choice of specialism was due to the unlikelihood of encountering death, as she herself finds it difficult to deal with. This has opened up my eyes to other aspects of medicine, where I have previously thought that dealing with death is something with is inevitably common as a Doctor. This shows that medicine can really be chosen to suit you, and hugely warped around your personality and what you want to do.

The road to being a doctor, is undoubtedly a long and winding long. Five or six years at med school, two foundation years, specialist training and a LOT of exams. However, I have no concern about whether or not it is worth it – it is an incredibly interesting, rewarding and important career, and the process is fitting considering as a doctor, you never stop learning. I learnt a lot from this talk about the stresses associated with being a Doctor, that many of these come from dealing with a huge system and not particularly the patients themselves. There are always quotas and deadlines to meet, making a hospital environment a fast moving one. It was emphasised during this talk, that being a doctor is not a career, but a lifestyle choice. While this is something I have witnessed first hand, it was not something which, before now, I had considered. Perhaps because I have taken it in my stride as an expected part of the job, but something I thought well worth mentioning.

Dr Christopher’s talk opened my eyes up to a field of medicine I was not previously aware of, and has encouraged me to take a look into what other specialisms which I am unaware of, are available. However, it was also an honest talk, the pros of being a doctor were equally weighted with the cons – moving around a lot, dealing with death, bullying in medicine and the stresses of the job. This appealed to be as I did not feel like I was looking onto the profession through rose-tinted glasses, and that some of the realities of being a doctor were brought to my attention.

So You Want to Be a GP – Dr Mohammed Saqib Anwar 

I had never even considered a career as a GP before this talk, I was convinced there would be little variety and an extortionate amount of time-wasting patients. However, this talk proved to me how a GP is often the first point of contact of the NHS. The first time a patient brings their potential illness to the attention of a medical professional, and that it is not only physical illnesses GP’s have to worry about it. Any doctor has a duty of care, and this extends far beyond diagnosis – it is incredibly hard for a patient to confide in you, if you are not approachable or have not build a rapport with them. Working in the medical profession is not about preventing death, it is about improving quality of life and providing standardised care to everyone. Those who repeatedly ‘waste time’ through appointments are not actually wasting time, as they are concerned about their health – the one time you turn them away, they may actually have fallen ill.

Being a General Practitioner is not a boring job, variety is encountered through clinics everyday. Although, the opportunity for other roles was highlighted to me throughout this day. Dr Saqib Anwar has a huge roles in media management, is faculty chair at the Royal College of General Practitioners and a primary care adviser for Care Quality Commission. When giving us a run through of his last two days, it included press releases, meetings and clinics – showing the life of a GP to be much more interesting than I initially thought. These two speakers were incredible, and gave a thoughtful insight into life as a doctor is two very different roles. My eyes have certainly been opened up to the prospect of different specialisms – even though it is years away.

The last speaker I would like to mention however, is a F2 student. Medicine is competitive, and not everyone gets in first time around, however this speech demonstrated to me that if it is truly what you want to do, there is more than one pathway into life as a doctor. This junior doctor was one of those people, and went on to do a biomedical sciences degree. After these three years, he gained a place on a graduates course – and from what I could see, hasn’t looked back since. So as a final message, don’t give up. Getting into med school is tough and challenging and just because you don’t achieve it first time around, doesn’t mean that you won’t make an excellent doctor.

This was only a small aspect of the day, but these talks definitely opened my eyes up to the endless possibilities within medicine. The day itself, was another affirmation that this is what I want to do, and worth the hard work. I learnt not only about the variety of life as a doctor, but left with some negatives to consider and a yearning for the next eighteen months to hurry up, so hopefully I can start med school!

Sources: RSM Medical Careers Day [23.03.17]

Medicine Masterclass – Cambridge

For me, yesterday was a truly inspiring day. I attended the Cambridge masterclass for Chemistry (natural sciences) in November, and can honestly say while an interesting day it proved that Chemistry is definitely not what I want to pursue. The recent medicine day however contributed greatly to my desire to be a doctor, with 3 medicine based lectures. It was entirely useful as it gave a quick taster of the ‘science’ aspect of medicine, what information lectures may contain and even how to approach studying medicine.

Lecture 1: How blood goes around the body (Dr Dunecan Massey)

Lecture 2: Nature’s medicine cabinet: from root to remedy (Sonja Dunbar)

Lecture 3: Pain and lessons from the naked mole rat (Dr Ewan St. John Smith)

We experienced 3 scientific lectures and an admissions lecture. While the day was a little daunting as I went alone, it was easy to meet likeminded individuals and learn about why they want to study medicine, alongside what they thought of their work experience. I also found the Q&A sessions with students useful in asking the ‘real’ questions and hearing the honest answers from people with first hand experience of the process. What did I learn from the day? While a lot about naked mole rats and intestines and the interesting aspects of botany, these were not the most significant aspects. It confirmed that I will happily walk into a day of lectures on medicine, and that it is truly a career I am interested in. Not only because of the people I will meet but because of the science behind it. Having the knowledge to be able to improve and save lives is an incredible opportunity and one I’m certain that as a future doctor, I will cherish.

I recommend the Cambridge Masterclasses to any student considering medicine or Cambridge, as they are an incredible opportunity to experience both the course and the city. I think the University has an incredible and unique teaching style, and it is definitely one I would to to consider further in the future. I am hoping to decipher the notes I made in the lectures and blog them in the future, so keep a look out!

Day Centre for Dementia Patients

Since September, I have been volunteering at a day centre for dementia patients on a Friday morning. This is something I really enjoy every week – getting out of school into a new environment, being able to help give the carers a break and of course, being able to communicate with new people. However for me, it is much more than this. It is incredible being able to see how much my presence brightens the patients day, even if by the next week they have forgotten who I am entirely. I have had countless heartwarming conversations with people who love talking about what they can remember; their schools, the war, their jobs, but who also love finding out what it is I’ve been up to and how things have changed since then. Aside from this, being able to prompt their memories in a safe environment is really rewarding, as they have all had incredibly interesting lives, and they smile and laugh as they remember things themselves.

However, this week was a little different and slightly more challenging. While of course, each patient has very individual needs and has differing stages of dementia, up until now they have all been able to talk to me during my time there. Although, a new lady now attends the centre on a Friday, who not only has dementia and is confused about where she is both in time and physically, but no longer has teeth so is very difficult to understand.

At first I’ll admit it was a little daunting, and I felt really empathetic as she was obviously initially very distressed. However, after a couple of games and some encouragement from her friend and member of staff, it was lovely to see her laughing and smiling too. What I learnt specifically from this volunteering session, is that patients do not need words to be able to respond to you, and that actually it really doesn’t matter if they can’t. This lady loved having me talk to and laugh with her, and would light up occasionally on the topic of food! An integral part of care in such an environment is taking the time to get to know each individual, and to be someone who is flexible, adapting to each unusual question or situation which may arise.

It is very easy to forget that elderly dementia patients had lives before their diagnosis, and helping them remember that is a key part of caring for them. We play numerous memory games and quizzes, and while some engage more than others it is lovely to find out more and more about each person who attends the centre. Too much of the time the media is obsessed with the few care homes or centres with corrupt individuals and inadequate care, and until I myself started volunteering I didn’t realise how much of a positive environment these places can be.

I would recommend this form of work experience to everyone, it is something I was never sure I would enjoy but always wanted to try, and is now the only thing which gets me through double maths on a Friday morning! For me, this is not about getting experience in a healthcare environment anymore, it is about being able to make a difference to a persons day, to give the carers who work numerous days at a time a bit of a break and an opportunity to do some paperwork, but mainly to engage with people who rarely meet new people and are always so grateful for my time.

Working With A Midwife

Last week, I was lucky enough to undertake work experience with a specialist midwife who deals particularly with safeguarding patients. While predominantly an observation based placement, on Wednesday I took part in a Level 3 Safeguarding course, alongside paediatricians, nurses, radiologists and midwives. This was an incredible opportunity and allowed me not only to speak to healthcare professionals but to understand the approach they take to patients who are vulnerable, or whom they suspect may be physically or mentally abused, mentally ill or a substance misuser.

From this experience, I gained an insight into how important patient care is, and really getting to know your patient. Enabling them to talk to you about what may be their worries increases their chances of getting out of an abusive relationship, reporting sexual abuse or even admitting that they just need help. Similarly, the importance of minor worries being referred was hugely evident, and I learnt that safeguarding is about the accumulation of information to prove whether Child Protection, Early Help or Children In Need plans need to be provided for example. Small bits of information pieced together give a much larger picture. An example of this is, in one instance, if a mother of a baby has special needs and struggles to learn new skills then there is a slight worry. However, if she then is not financially stable, isn’t attending appointments and is with a partner with a history of abuse, then there is a huge worry and intervention needs to be seriously considered. Therefore, this was a huge eye opener to the variety of the role of not only doctors but all healthcare professionals, and that patient care is a varied and in-depth practice, and in some instances more important than clinical techniques.

Similarly, on reflection this work experience taught me how much being in a hospital or medical environment is being part of a team. The importance and significance of every role be it doctor, midwife, nurse or family supervisor just to name a few, was hugely apparent. But more importantly, without constant communication between these roles, patients would not receive adequate care, and could potentially maintain living in a serious environment. I have learnt that working in healthcare is not an individual profession, and patient care is always the priority.