Ageing: my hospital musings

Around us, every-where, people are ageing. In the UK, our population is largely moving towards a structure where we have less people being born and more people living on to an older age. But when you look at the healthcare system, there is little infrastructure to cope with the resulting ageing population.

Today, I went volunteering and did my own ‘ward round’ which consisted of chatting to the patients and checking that they had all that they needed in the way of water and other basic amenities. As I went, I asked how people were doing bracing myself for the fact that the question ‘are you doing ok’ is something of a dangerous one as the answers I am given are often outside my volunteer training and current skill set. This is deeply frustrating as I would love to be able to do more for the patients I interact with, yet even simple tasks such as accompanying someone to the bathroom I’m not allowed at my level. More and more over the past few weeks I have noticed how growing old is totally degrading and that often – as weird as it sounds- I have had a tendency to wrongly romanticise ageing (but don’t retired people look like they have such fun? Coffee dates, walking around national trust gardens- need I say more?) In reality, it can be totally degrading: it can become difficult to carry out basic functions, such as feeding yourself, and you’re reverted back to the child-like state of being totally dependent on others to help you. But there’s a huge difference between the situation of a child and of someone who’s elderly: old people aren’t cute so they are overlooked, leaving a shortage of funding and manpower to service their needs. (*see bottom of post).

Contrast the elderly with a baby: a baby can neither feed itself, nor use a toilet but yet people are willing to change their nappies and treat them with love and patience all because they are under the blessing of being rather sweet. Of course I am not saying that babies should be abandoned by the wayside, but why, when we have an ageing population (and this is certainly the case in the town I live in) is there a lack of dignity and care for those who are growing older as their independence slips away from them. Most of us will be faced with the reality of growing old, yet we avoid the thought of what it will actually be like for us. What if we end up in hospital due to a stroke or early onset dementia? What then? Surely we would want there to be enough support so that we could remain cared for even at our most vulnerable. Sadly, this is not paid much thought to until we happen to find ourselves in a care home one day.

The health care system is all about providing care indiscriminately for those who are in need, at the time that they need it, but it’s becoming increasingly hard to do that and hospitals are entering into health care politics. I am not criticising the work that the staff do, as I have witnessed countless members of the team endeavouring to care for each patient with the warmth and respect that they deserve and value. No, rather I am calling out the fact that something is not working and this is leaving gaps in the structure and functioning of the health care team that we so value.

I recognise that I am not the most educated person on the effects of the changing age demographic in our country and its relationship to the situation of the NHS, but as an active member of the community and an aspiring medic, I’m reserving the right to comment on what I observe! There’s so much of the conduct of the members of the health service that is inspiring and admirable and it distresses me that no matter how hard they work, there is never enough energy and time to give to their patients. While I have never witnessed abuse on my ward, I have witnessed what I will call ‘unintended neglect’ with patients refusing to drink for fear there won’t be anyone to take them to the toilet!  Something does need to change, and it’s not going to be a decrease in the country’s elderly population. So what else needs to give? Only time will tell.

*I wrote this post a few weeks ago and it has sat unedited since then. Rather interestingly, I read an article in the daily telegraph today about the crisis in care of the elderly. It described how cases of abuse and neglect rose by 33% between 2013/14-2015/16. However, cases of abuse in children also rose by 4% in just 2 years, highlighting how my earlier comment about the cuteness of children safeguarding them may have been made rather naively.

 

 

 

 

 

“What is a doctor?” – according to children

Asking kids what they think about doctors

 

I have always loved children and was intrigued to determine how they view the profession I am hoping to enter into. So, I decided to ask some children from the ages of 5-11 their opinions on doctors to see what they thought. Here’s what they said…

 

1.Do you enjoy going to the doctors?

Child 1: NO!! Because they’re horrible! They hurt you.

Child 2: No as well as yes. Because partly, if you’re ill and you’re really nervous, because doctors can do anything, like they know if you’re ill, so if you turn up like ‘I’m ill my stomach really hurts’, and they go, ‘you’re not ill’, you feel really embarrassed about yourself saying ‘I’ve got a massive fever’ and everything. But yes, partly because, if I had a cold, and actually it was a sign of something, then yeah, I might die or something and I’d go just in case…

Child 3: they get this toothpaste stuff and, one, LIE TO ME and say it’s not a toothpaste, when it actually wasn’t (…his sister digressed that he was actually talking about the dentist!)

 

2.What do doctors do?

Child 4: (child of a GP): Dunno… my Dad cuts people’s warts off.

Child 2: They help you.

Child 1: My Mums becoming a doctor and she has to wipe people’s bums (sister said: she’s becoming a nursing assistant!)

 

3.Whats your favourite part of going to the doctor’s?

Child 1: They give you sweets at the end!

Child 3: When..when… at the end, we always get stickers. Always.

Child 4: Leaving.

Child 5: um…I quite like, cos, um, if they’re normally quite nice to you,  if you’re quite scared they are quite nice.

 

4.Have you ever been to hospital?

Child 2: Well, basically, when I was about 4, I cut my thumb and when I came back to England to get my stitches out, after they’d done it, I got to, um, I got a packet of sweets and a teddy bear AND a sticker

Child 5: When I broke my arm, I had this cast and, when I put it on, I barely felt a THING. So I didn’t have to hurt, so I didn’t FEEL anything. But I absolutely screamed!

Child 1: I dropped a brick on my toe and the doctor cut my toenail off.

 

5.What’s your least favourite part of going to the doctor’s?

Child 4: Going!

Child 2: Operations. (me: Have you ever had an operation?) No.

Child 5:The wait in the waiting room cos it’s scary.

Child 3: When you just sit down, staring at the teacher. I mean doctor!

Child 1: Sitting in the waiting room waiting for them to come, cos when you see them, they have a great ugly voice (?!) I don’t like when they call out our name cos they say it wrong.

5.What are you tips for a doctor?

Child 1: not to do anything, but to just give you sweets and tell you bedtime stories and give you a kiss good night.

Child 2: I’ve got one! If they gave you medical sweets.

Child 5: Actually be helpful. (me: What have they done that isn’t helpful?) umm…

Child 4: To be as kind and nice to people as they can to make them feel not scared.

 

I interviewed the children with the intention of getting an insight into their perspective, which will be key in order to empathise with future patients. The overall consensus was that going to the doctors was something to be feared, although it was interesting to note that many thought this could be reduced by the way the doctor treats them. Although often there may not be time to read a patient a bed time story, the importance of kind words and actions cannot be underestimated, when helping people who are on-edge just being in a healthcare setting. I also found it interesting that for the first question one of the children said “they know everything”. While doctors are highly specialised I’m sure we’d all agree that they do not know everything, but this serves to illustrate the highly privileged position of being a doctor, as it is a respected profession.

 

The one response that really resonated with me was when I asked, what do doctors do, and received the response “they help you”. Although this does not encompass all the aspects of a doctor, such as being a scientist and scholar, it highlights the fundamental basis of the role in that you get to help people when they are most in need. I would love to use my life for this end!

 

Work experience at Bournemouth Hospital

From the 11th to the 13th of April I completed some work experience in the eye department of Bournemouth hospital. This involved shadowing a consultant in surgery and in the eye clinics, as well as various other healthcare professionals who took me under their wing.  All I can say is wow! It was a fantastic experience and reminded me all over again why my heart is set on medicine as a career.

My first day was a full day in theatres, which caused me great excitement as I got to be in scrubs for the morning and afternoon! I love that every bit of work experience that I’ve done is totally different and it’s great to see the contrast between surgery in England and the surgery I was able to observe in a private hospital in Cape Town in the summer. What struck me initially was the complete friendliness between the theatre staff: everyone was on first name terms and you could tell they all had total respect for each other. In a later conversation with a urologist (who I was also able to observe in surgery) it was explained to me that a lot of the ‘name hierarchy’ that used to prevail in hospitals has gone. This is good for a number of reasons: it takes pressure off the consultants if something goes wrong, as there is a recognition that the theatre team are working together, and it allows the person performing the operation to be corrected or challenged if necessary, which puts the patient in a much safer position. It also contributes to a convivial atmosphere in theatre, which creates a great working environment. That said, there is not a total lack of distinction between the staff as that would lead to anarchy! If a surgeon requires a piece of equipment, one of the nurses will happily get it.

I saw an incredible variety of operations, which highlighted that what at first could seem like a fairly narrow specialisation (eye surgery) is actually a lot broader and this opened my eyes to the reality of why it takes such a lot of training to get to consultant level. Sitting in the clinic, I was provided with asurgeon’s well-used manual of ophthalmology and was again awed with the detail and breadth of the specialisation. Perched with it on my knees, I was able to look up conditions as the patients came in, which gave me a deeper insight into what was being discussed (although to understand what’s going on there’s a whole load of vocabulary that needs to be learnt!) I got to observe operations ranging from Cataracts to Ptosis (which is the drooping of the upper eyelid) to the reconstruction of the area around the eye following tumour removal: an incredibly interesting operation, employing a lot of plastic surgery techniques. It made me aware of just how wide the medical world is and how impossible it is to get bored when there’s so much more to learn and discover. One of the operations carried out used a novel technique designed by the surgeon I was shadowing and it was a privilege to be able to see this and acknowledge that I was observing something that has never been tried by anyone else.

A lot of the eye operations were done under local anaesthetic and this coupled with observing clinics allowed me to experience a lot of patient interaction. I was impressed with how patients were dealt with and the kindness and respect they were shown. Patient contact is one of the factors that is important to me and a principle reason why I want to be a doctor. It was wonderful to see the amount of patient contact that comes with being an ophthalmologist and how personal relationships can develop with patients over the years. No two patients can be dealt with in the same way: different approaches are required for each patient and a number of variables must be taken into account, such as age and quality of life. I was told that eye surgery is more about quality of life rather than life expectancy, and I would argue that quality of life is of upmost importance. Lots of people came into the clinic just in need of reassurance and it was great to see people leaving more at peace, which is – in my opinion- the exact embodiment of what is means to be a doctor.

I also had the opportunity to sit in with an optometrist for part of an afternoon and see what other health care professionals do and how they interact with doctors and nurses; another great example of how diverse the team involved in patient care is. In addition, I shadowed a urologist carrying out a prostate operation, then watched the removal of cancerous tumours from a patient in another theatre. This was a major highlight as it allowed me to see the different dynamic between the staff in each theatre. All I can say is everyone has a different style of working, but each operation was consistent in how cohesively the staff worked together as a team in a way akin to that of an army! I was able to observe more evidence of the wider team that goes into managing every patient when I got to accompany a surgeon on his meeting with other healthcare professionals, including neurologists, to discuss the brain scans of patients, with suspected eye conditions. It was fascinating to see how brain tumours could affect the eyes, but also to experience the knowledge of the neurologists working together with the ophthalmologists to decide on the best course of action. It also became evident that you never stop learning as there were questions thrown between the two specialisations, improving understanding on both sides.

For each operation I observed I was talked through the procedures, not out of the expectation that I would retain everything but more so that I could understand the why and how as to what was occurring. This was fantastic and I am incredibly grateful that people took the time to do this. I was given in-depth explanations and endless diagrams which allowed me to appreciate the procedures more fully and deepened my interest in the science behind the operations.

Not only was the medical experience great but I was also given advice for applying to medical school. I was impressed with how interested people were in what stage I was at, why I want to do medicine and the advice numerous registrars, consultants and nurses were able to give me. I was told by one consultant that medicine as a career is not without its challenges, but that none of these problems are insurmountable. From what I already know and what I have seen this time around, I would agree wholeheartedly: like all careers there are some negatives to being a doctor, but I have had first hand evidence that none of these challenges are unconquerable and that the benefits vastly outweigh the inconveniences. Being able to help patients while constantly learning, changing and evolving as medicine develops and grows is all part of what makes it such an incredible and rewarding career. Once again, I am totally smitten for medicine and completely grateful for the privilege of being able to walk through ‘a day in the life’ with experienced medical professionals.

ASIDE: If I could have taken pictures of the surgical procedures I would have, but patient confidentiality deemed this impossible. It’s probably best to spare you as I discovered that discussing pus leaking out of eyes, including graphic descriptions, does not make for best dinner-time conversation. So, you will have to cope with some pictures of me in scrubs instead!

 

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Cape Town part 1: Jubilee health centre

The summer just gone I was fortunate enough to do 2 weeks work experience in Cape Town, South Africa. I organised the trip, as I had managed to save up some money from working and wanted to use it to do something worthwhile in my long year 11 summer. I was also extremely fortunate because my family has friends all over the globe (this comes from being part of a wide-reaching church community) so I only paid for my flight: my food and accommodation was provided by a family’s generous hospitality.

It was an incredible experience, not just because of the medical aspects: I got to walk up Table Mountain, go shark cave diving and experience life in a bustling city, where cultures collide in awesome vibrancy. Cape town is an incredible place- the ocean is backed by beautiful mountains, but there are shops and waterfronts aplenty to satisfy the more city-oriented person. It is a place where everyone can find something they like, be it climbing, shopping, or reading, however it is also a place where there is a stark contrast in living conditions, with the extremely wealthy living just miles from stretches of shanty towns. A large percentage of the city’s population lives in poverty, with little access to good health care, so diseases that are less of an issue in developed countries pose much of a bigger problem over there.

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At the top of Table Mountain with a family friend

 

 

 

IMG_2030  Shark cage diving!

For the majority of my stay I was volunteering in the Jubilee community church health centre, which is located in Observatory. From the first day, it was clear to see that the values the clinic run on are very different from that of the NHS.  There is no hierarchy among the staff, aside from the obvious differing in titles (doctor, nurse etc) each member is valued equally and each is responsible for leading patient consultations. The health centre is completely volunteer operated, apart from a few core staff who manage it and this may have something to do with the total respect each member of the team has for each other, something which enabled me to see what working together in a healthcare team could be like. In addition, the appointments are not limited to a 10 minute slot, but rather as much time as is required is given to each patient. This means that the whole emotional and physical wellbeing of the patient is taken into account, something which the system in this country does not allow time for.

One example that really struck me while I was there was when a young man came in with symptoms typical of HIV (HIV is a major issue in Cape Town and many cases I saw in the clinic were HIV related). He was given the HIV test, as well as being offered counselling. I was allowed to observe the counselling (which happened there and then in a separate room of the building) which was completely patient focussed and compassionate. As it is a Christian organisation, the patient was then offered prayer –this is the same for all patients who come in- and a follow-up counselling appointment later on. I understand the context is very different between south Africa and England. In this country, there are plentiful additional services, such as counselling, that you can go to outside of the GP, however it was inspiring to see holistic healthcare being provided in one place and the patients leaving genuinely better off.

Another factor that made the care so incredible is the fact that they provide it for a minimal fee, so people are being given good healthcare for a fraction of what they would pay elsewhere. The care is not discriminative either: both the well-off and the poor are welcomed, with hot drinks and a play area for children available while they wait.

It all sounds incredibly idyllic doesn’t it? But it really was so staggeringly different from the experience I’ve had in England. What really impacted me is what one nurse said when I asked her about what she values about her job at the centre. She said: “I love medicine because it’s a privileged position. People value your opinion and you get to help them when they’re most vulnerable.” This to me emphasised why the healthcare delivered at Jubilee is so compassionate- the staff recognise what an opportunity they have to help those in need.

I could go on and on about everything I saw (the scared teenage boy who was treated with love, the endless coffees made for patients who had been there since 7 in the morning, the heart-breaking story of a mother who’d had 7 miscarriages) but I’ve gone on long enough! All I can say is that the experience was incredible and I can only hope to work in such a caring healthcare setting in the future. It showed me what medicine could be and brought it back to the fundamentals of being a doctor: prioritising patients and bringing  help to the sick.

(Aside from medical work experience, Cape Town is an incredible place and I would definitely recommend that you visit it if you get the chance. Here are some pictures to entice you!)

)IMG_2092 The waterfront

 

IMG_2260 (1) Boulders beach

 

IMG_2068 Watching the sunset from the beach

IMG_2358 The view while walking up Table Mountain

IMG_2183 ‘Birds of paradise’ in Kirstenbosch

 

IMG_2120 A beautiful street in the core of the city

 

 

 

 

Volunteering

Today is a Wednesday and so I went volunteering at my local hospital. I volunteer on a dementia ward for the elderly, although often there are patients who are on the ward due to a shortage of beds elsewhere, such as the stroke ward. It took months to organise the placement, but I would definitely recommend volunteering in a healthcare setting because it is an easy way to experience medicine on a regular basis.

I love helping in the hospital and it never gets boring; each week there are new patients to meet and, although my weekly tea round remains the same, the conversations I have with people continually vary. For example, today I spent about half an hour chatting to a man who was in his own side room. We chatted about his job and what I want to do in the future. Many of the patients I speak to seem unable to grasp that I am in a hospital, in a uniform, want to be a doctor but am not training, so I often get mistaken for a junior medic. Well, I’m not going to complain!

As you’ll be aware, it’s nearly Christmas and this particular gentleman was feeling low that he had not been discharged and had heard no news from the medical team. This is a problem I have encountered with increasing frequency on the ward. There’s not enough staff to meet the needs of the patients. I am not blaming the doctors (hey, I want to be one!) I am not blaming the nurses (they put in admirable hard work) and I am not blaming the cleaning staff or the physios or the any of the other vast workforce that helps to run a hospital. Rather, I wish to highlight a problem that exists in healthcare at the moment. Cuts in NHS funding has led to a lack of money in the system and I have come to realise that this has had knock-on effects throughout the whole service: lack of funding means a lack of staff, so patients’ needs are not met. This in turn means that a hospital stay takes longer than necessary and that the experience while in hospital is less satisfactory than it should be. It also means that there is a lack of carers (and I have experienced this more because I volunteer on an elderly ward) so people cannot go home because there is no one there to deliver the help they need. This leads to a shortage of beds for new patients who continue to come in, so there is a bed block-up and the cycle continues. This is, of course, my incredibly simplified take on the problem, but you get the gist! There are so many more opinions and factors to consider, and it’s not hard to realise that there is no simple answer.

As a volunteer, I am in a position to just sit, chat and listen and today the gentleman used this to offload his worries and anger at the system. My reassurance that the doctors weren’t ignoring him (a ratio of 2 doctors to 40 patients led me to this conclusion) were met with dismissal and, unwilling to provoke an argument, I let him continue to express his troubles. I like to think that conversations like this are shaping me to become a better doctor in the future: more self-aware, compassionate and resilient. But it’s hard, and, really, I don’t know how I would have reacted if I hadn’t been a volunteer. What if I’d been the poor doctor he was insulting and had to continue treating him regardless? Yet, this is what being a doctor is all about, maintaining respect and empathy in the face of resentment and continuing to put the patient’s needs first.

So I will continue to listen and I will continue to practice patience in the hope that, one day, I will be equipped to treat patients in the best way possible.