Yesterday I sat in on surgery again with another female doctor. There were several cases through the afternoon and surprisingly two people came in, both who were having medication reviews, who were taking methotrexate. Methotrexate was used in this case to treat rheumatoid arthritis which can cause severe pain and swelling in the joints and is an autoimmune disease. I was also able to help examine the eye of a patient, which was a particular highlight, who was suspected of having conjunctivitis. There was also another patient who was suffering from pain in the knee from sport which was due to what was suspected inflammation of the medial meniscus. I think what I learnt most about today though was the need for a doctor to not only be knowledgeable and scientific but also to be very empathetic. It seemed that the happiest patients that left the surgery weren’t those who had been given a prescription or been told that they were alright but those that felt the doctors understood and sympathised with what they were going through. It was also apparent how patient a doctor has to be, particularly with people who suffer from dementia and are unable to carry out instructions, when trying to diagnose or carry out a review on them. There was a startling contrast between the male and female doctors of the practice and interestingly enough between doctors who had trained in different cultures, which just shows the different ways that you can approach things despite all working to the same common goal.
Yesterday was a very interesting final day. In the morning I sat in with the practice nurse who saw several patients. There were several people who were having B12 injections which are to treat Vitamin 12 or folate deficiency anaemia. For the patients that I saw, the vitamin B12 deficiency was not due to diet and so the patients were having the injection every three months. There was a very stark contrast in the way that the nurses and doctors interact with patients. Whereas the doctors had a much more formal relationship, the nurse’s was friendlier and they were able to spend longer with each patient. It definitely emphasised that I’d rather be a doctor than a nurse, as I think it’s not only patient interaction but also being more involved in diagnosis that is more appealing to me.
I also went out on rounds again with the senior doctor where we visited several patients. I’m finding that I’m becoming much more familiar with names of places in the town that are only known to doctors such as “Misery Mansions”. We visited an elderly patient who was becoming progressively worse at a nursing home where the doctor thought in the end that it was due to the symptoms that she had. He explained that you have to base your decisions and be able to explain them in relation to the information that you have. In this case it seemed that it was the combination of medications that she was taking that was contributing to her feeling unwell.
I think that all round this week has been a very valuable learning experience, but particularly interesting watching the way that different situation were handled with different patients. I’m hoping now that I’ll be able to find some work experience in a hospital so as to be able to compare primary and secondary care for myself.
This week has seen the start of my work experience at a GP’s surgery. I went in this morning and met the practice manager who has explained to me how a GP surgery operates. Basically it seems that the surgeries receive funding from the government to act as a small business, the amount of funding depending on the number of patients and the number of services that are delivered. The surgeries also receive money from a programme known as QOF which is the “Quality and Outcomes Framework” which aims to ensure that high quality car is consistently delivered.
Today, I also went on rounds with the senior doctor who was visiting those who were unable to come into the surgery. Primarily, we went to nursing homes where we visited several patients who the nurses expected of having chest infections or other symptoms. Unlike if an otherwise healthy child or adult had the same symptoms, the doctor prescribed antibiotics due to vulnerability of that population. We also went into the local hospital which is a “community” hospital and visited several patients there. I found this particularly interesting, especially seeing the difference between primary and intermediate care. We visited a couple of patients here, one with a fractured radius and one with a fractured proximal humerus both due to mechanical falls. Both patients were elderly and the main reason that they were still in the hospital was for rehabilitation before being able to manage at home.
It did strike me how inefficient making rounds were, as it took nearly fifteen minutes to see each patient rather the only a five minute consultation due to the need to travel around.
Yesterday was another very interesting day at the GP practice. I sat in with the senior partner and doctor of the GP practice during morning surgery. He saw about 20 patients in the morning session which was just over two hours long which all had quite different cases most of which I hadn’t heard of before. I also learnt some of the basic things such as the four signs of inflammation which are calor, rubor, tumor and dolor – heat, redness, swelling and pain. This appeared several times but most prominently in a patient who was suspected of having cellulitis. Cellulitis is a skin infection that is commonly caused staphylococcus and streptococcus bacteria and is treated by oral antibiotics. During the morning surgery I was also taught how to take a person’s blood pressure which was quite exciting and use an ophthalmoscope, otoscope and glucometer.
I went out on rounds again and visited a nursing home where we carried out six month reviews on some of the patients. These reviews are to avoid what was described as “fire fighting” visits in emergencies. The doctor basically assessed a person’s mental state, weight, mobility and so forth, which means that they have up to date medical data. Therefore in an emergency it is much easier to decide whether a person is particularly vulnerable and needs to be admitted to hospital or not.
During the afternoon, I also sat in surgery with a different doctor where I got to put into practice some of my newly acquired skills such as taking blood pressure on the patients which was a particular highlight. I was also told the necessity of taking several readings as the first blood pressure will be quite high especially, i imagine, if it is an untrained student taking it.