Debate Chamber Medicine Course – day two

 

We started the day learning how to intelligently guess what some medical conditions are from their names including dysphagia (dys = painful and phagia = engulf) meaning painful swelling, haematemesis (haem = blood and emesis = vomit) meaning vomiting blood, angular stomatatis (stoma = opening) meaning inflammation in the corners of the mouth, and tenesmus (tene = to hold) meaning feeling a constant need to empty the bowels.

We then went on to learn about gastroenterology. Symptoms that may show signs of a bowel condition include acid reflux, bloating, blood/mucus in faeces, increased wind, vomiting, constipation, weight loss, loose stool, hard stomach, nausea and tenesmus.

I learned how to take a patient history including finding out what is happening, what is the next plan, past medical history and family’s medical history, past and current medication, allergies, lifestyle factors, the patient’s concerns and any other relevant information. It is important to decide whether the condition is benign or pathological and chronic or acute.

In deciding treatment the following three things are considered: conservative treatment, medical treatment and surgical removal or repair.

Some common reasons for blood in the faeces or vomit include ulcers, Mallory-Weiss tear from force of vomiting, ruptured oesophagus, and dilation of veins surrounding the gut due to portal hypertension.

We also learned about clubbing of the fingers, Dupuytren’s contracture, Spider Naevil (due to build up of oestrogen), Gynaecomastia (from failure of breaking down oestrogen), Hepatomegaly (enlarged liver), Fibrosis and Cirrhosis, and IBD including Ulcerative Collitis and Crohn’s disease.

Mechanisms that can take place in a person with liver failure include fluid secreted into peritoneum presenting as a swollen belly, jaundice, coagulopathy (replacement of clotting factors lost through heavy blood loss), and a build up of ammonia in the central nervous system interrupting neurones. Symptoms of alcoholism following withdrawal include crawling skin, Delirium Tremens, seizures and hallucinations. The risk of these conditions developing is very high and therefore doctors do not recommend quitting alcohol altogether when attempting to overcome addiction. Furthermore, an interesting problem with alcoholism is that alcohol may interact with the liver and prevent enzymes being released to break down certain medications including Warfarin which is a blood thinner. If Warfarin is not broken down, the blood will become thinner until there is continual bleeding. This effect can be reversed by taking Vitamin K.

In the afternoon we learned some pharmacology including methods of administering drugs, how to assess consciousness and learning why some people fail to take their medications.

Methods of administering drugs include intravenously, orally, enema, inhaling, sublingually, through a central line, topically, by intraosseous infusion, intramuscularly and subcutaneously. The route of administration is chosen depending on time, efficiency, patient choice, location of problem, expertise of the healthcare professional, bioavailability and practicality. Positives of oral administration include its practicality and ease, however it is indirect and may take lots of time to reach the affected area. Intravenous administration can be a problem as lots of people, particularly children, are terrified of needles and there is a high risk of infection. On the other hand the drugs injected acts immediately for faster relief. Inhaling is very good for immediate lung relief, whilst intraosseous infusions have a very high infection risk, a long recovery period is needed and they are very expensive.

I learned that NICE decides which treatments are made available on prescription on the NHS. However, it is not illegal for a doctor to prescribe unlicensed drugs.

To assess consciousness of a patient, we use AVPU; alertness, voice, pain, unresponsive. It is necessary to do this to decide what immediate care must be given.

Reasons for patients’ poor compliance with medical guidelines include laziness of the patient, ethical opinions, wanting to cut down number of medications, the process can be painful, fear of the medication being painful or addictive, forget to take it, a poor patient-doctor relationship leading to the patient not trusting their doctor, denial of having the condition, worrying side-effects or long waiting times.

 

Emily Buchanan

 

Debate Chamber Medicine Course – day one

 

Below are my notes from day one of this course that I went on today.

Oncology

Definitions

Cancer – an abnormal group of cells

Benignnon-invasive = very slow growth, does not cause a problem

Malignant locally invasive = spreads to a nearby area

Metastaticinvasive = via blood/lymph to rest of body

Angiogenesis – development of blood vessels around tumour to supply it with nutrients for growth

 

How tumour cell invades an area in body

Tumour cell breaks through collagen fibres (for strength and elasticity) surrounding epithelial cells then squeezes through the gaps between epithelial cells by intravasation. This gap is left open and other less aggressive tumour cells can pass through causing more of a problem.

Cancer is a defect of DNA leading to a different sequence of amino acids being coded for.

 

Types of Cancer

Carcinoma

  • Most common
  • In epithelial cells including breast and lung

Sarcoma

  • Rarer
  • Tissues formed from embryonic mesoderm including fat, bone, muscle, cartilage
  • Lipoma which affects fatty tissue and malignant shwannoma which is cancer of the protective layer of neurones (shwann cells produce myelin for the myelin sheath)

 

Pancreatic Cancer

  • Known as silent killer due to lack of symptoms
  • Non-specific symptoms including epigastric pain, loss of appetite, vomiting, weight loss, painless jaundice, steatorrhea, trousseau sign, diabetes mellitus
  • Risk factors: genetic, age, smoking, poor diet, chronic pancreatitis
  • Low survival rate at 25% in a year’s time and less than 5% in five years’ time

 

Leukemia

  • Cancer of the blood or bone marrow
  • Caused by an uncontrolled increase in white blood cells known as ‘blasts’ crowding out other cells
  • More common in childhood
  • Bone marrow biopsy to prove, or lumbar puncture testing cerebrospinal fluids (CSF)
  • If any cells are found in CSF, the tumour is able to reach the brain

 

Genes associate with cancer

  • Oncogene – stimulate growth
  • Tumor suppressor – inhibit growth
  • Repair genes – limit mistakes
  • PSA – excess produced when prostate tumour present
  • BRCA1 – may lead to ovarian or breast cancer

 

Cancer staging

  • Gleason System for prostate cancer

A number is chosen from 1 to 5 (normal to very metastatic) so that complexity of each person’s condition can be noted

  • TNM staging for all cancers

T = condition of primary tumour (T1-T4)

N = extent of lymph node involvement (N0-N2)

M = extent of distant metastasis (M0 or M1)

Higher numbers indicate lower survival rate

  • Diagnosis

Putting information together concerning genetics, results of protein tests, scans and biopsies.

Concerns surrounding genetic screening include high cost at around £400-2000, counselling for those with worrying results, whether they are completely reliable, expensive and high-risk prophylactic (preventative) surgery may be required.

 

Scans

  • X-Rays
  • MRI
  • CT Scan

 

Treatment – usually a combination of the following

  • Chemotherapy attacks rapidly dividing cells, hence loss of hair, weight loss (gut cells) and anaemia (RBCs)
  • Radiotherapy where a radioactive source is fired at the cancerous cells
  • Operation to remove tumour eg. Mastectomy
  • Bone marrow transplant
  • Hormone treatment eg. Tamoxifem

 

Extra information

  • Spleen converts red blood cell into bilirubin and uncontrolled release of bilirubin causes jaundice
  • Ending in ‘-itis’ = inflammation
  • Theories of cancer’s cause include bacteria, viruses, genetics, immune system
  • It is possible to screen for genes that are linked with disease including DMD (muscular dystrophy), LDLR (heart disease), and MLH1 (colon cancer)
  • Measure symptoms by a change to ‘normal’, although everyone’s base line is different form one another so there is no point comparing patients’ symptoms to each other

 

Final activity

The last thing we did was to read a case study about a patient and present a summary then come up with a differential diagnosis, a final diagnosis, staging and treatment. I really enjoyed this activity as we had the chance to put the science that we learned today into practice.

 

 

Emily Buchanan

Work Experience in a Different Hospital – day five

 

To conclude my work experience in this hospital I did the daily morning ward round then shadowed a Consultant in clinic.

During the ward round I learned that it is important to figure out whether a new symptom is evidence for development of a current medical issue or a sign of a new problem. To work this out the Doctor worked through the differential diagnoses before deciding on the next part of the recovery plan. In addition I saw that a Doctor must be exceptionally organised, keeping up to date with all paperwork even when a patient is about to be discharged, in case of readmission to hospital or their GP.

I was fortunate to experience the calming wisdom from a Doctor who dealt very well with a patient who was complaining about quality of care at the hospital. The Doctor was calm, collected, professional and in control, even when the patient was very frustrated and upset. Empathy was shown by the Doctor as they explained the situation and clarified that they understood the patient’s concerns. A doctor must think with their head in terms of professionalism and with their heart in terms of duty of care.

I learned today that a lot of people in hospital become constipated due to lying in bed for prolonged periods of time. This means that laxatives are regularly prescribed to many patients, especially in the elderly as old age is a risk factor for constipation. I also learned that an obvious ‘beat’ in the dip of the clavicle is a symptom for cardiac failure. It is important to check for this as there may not be any other symptoms and it can go unnoticed.

I often hear people complaining about the organisation of our NHS and today I saw a problem with organisation that was wasting a lot of the Doctor’s time. A few of the machines were not working and this meant that the Doctor then had to go to another ward to complete some paperwork. The Doctor was frustrated and stated that their job was to look after patients, and not to fix broken machines. There is not enough time for them to do a job that another person should be doing.

Furthermore I spoke to a Consultant about delivering bad news, which is something that every Doctor has to do multiple times. It is important to warn the patient about what you are about to say by introducing the problem, then letting them know the bad news and waiting for them to respond. It is important to let them have some time to reflect about what you have just told them.

When querying why someone is losing weight it is important to investigate whether the patient has changed the amount of exercise they do, changed the amount of food they eat, if they have an overactive thyroid gland and if their kidneys and liver are working well. In the clinic I also learned about kidney stones and how they can block the ureter leading to pressure build up in the kidney and recurrent UTIs. To remove the kidney stone, a stent is put into place after the pressure is released from the kidney.

Lastly, I was very happy to hear that patients are given a 40-minute time slot with the Consultant during the clinic. This is ideal as it allows the Consultant to thoroughly examine the patient and ensure that they have enough time to come up with the best reason as to why the patient is not well.

I am so grateful for the wonderful and inspiring Orthogeriatrics team I worked with this week. The dynamic of the team is something I will never forget. I am excited to put all of the skills I have learned into practice in the future and aspire to be as kind, professional and compassionate as the Doctors I met this week.

 

Emily Buchanan

Work Experience in a Different Hospital – day four

 

Today started with the daily ward round with the Consultant where the importance of teamwork was shown again, this time between all people working in the hospital. If a patient feels that their treatment from a certain ward is inadequate, the Doctors being told about the event are obliged to apologise on behalf of the other ward to the patient, even when it is not their own fault.

I noticed the constant turn around of patients, with some leaving over night and others arriving when I am not at the hospital. This provides a lot of variation in a doctor’s career. Variation is also due to constant rotation of the medical team. It seems that every member of the team is slightly uncomfortable with the change as they are not used to the way that each other work. It takes time to learn to work cohesively as a team.

The Consultant had a way of ensuring they got all the needed information from their patients by asking questions in the same order for every patient. The conversation would begin with asking how the patient feels, then checking their observations and drugs charts and finishes with explaining the next stage of the patient’s recovery plan. The information from patients must be complete, so doctors must be organised and systematic in their approach to gaining information from their patients.

I was pleased to see that the patients with dementia were put into a separate ward that was more relaxed compared to the other wards to ensure everyone remains happy and calm. Some patients in this ward can get confused and may instinctively be violent against nurses when they may aggravate an area of the body that is sore post-op. Therefore, when the Doctor took bloods which can be painful, they made sure to have another member of staff with them to comfort the patient and prevent violent behaviour.

‘Hospital Passports’ are a very clever initiative used by care homes when sending their residents into hospital. They provide lots of information about a patient to make their stay in hospital more comfortable including likes and dislikes, current medications and conditions, and mobility. This saves the doctors a lot of time when attempting to find out background information on admission.

It is a known fact that doctors learn new concepts every day and I saw an example of this today when they were asked to stop their duties in small groups to come and see how the new needles that are going to be distributed throughout the hospital differ to those already used.

An act of kindness I saw today was the Consultant offering to move a patient to a bed with a little more natural light, after the patient made it clear that they were unhappy with the location their current bed was in.

Some science I learned was about an angiogram showing the journey of blood through blood vessels in the heart. I also learned that codeine can have some very serious side effects including dizziness.

 

Emily Buchanan

 

 

 

Work Experience in a Different Hospital – day three

 

Today I was inspired once again by another Consultant on the ward round and when shadowing the nurses carrying out routine checks in the wards.

On the morning ward round, there were two new doctors to the ward as 1st August every year is the change over date for placements. They got to straight to work learning how the Orthogeriatrics ward paperwork is filled in and what tests are necessary for every patient on certain numbers of days after their operation, following the Trust’s policy. I learned a lot about how to make myself more approachable and how to gain more rapport with the patients. The Consultant taught me that eye contact is very important to reassure the patient, as well as touching the patient’s hand or arm where appropriate to make them feel at ease. In terms of body language it is ideal if you are able to approach them side-on as this makes the situation less daunting and if there is an opportunity to get to the same physical level as the patient by sitting on a bed or a chair it should be taken to make them feel comfortable to open up to you. An introduction of who you are and listening to the patient talk about some of their non-medical history is a good way to let them feel free from awkwardness. The best doctors are good listeners as they let the patient explain what they think is going on then correct them when they are going a little off track. Doctors check that the patient is okay with what they are doing to them before they do it, for example listening to someone’s heart or prescribing new medicines.

It is surprising how important social services are to the NHS in finding places for patients to go after they have recovered in the ward. It was shocking to hear that some people had been in hospital beds for over a month, though medically fit, waiting for a place to live at a care  or residential home. (Due to the serious nature of a broken neck of femur, it is common for elderly people to lose all independence and have to move into care homes.) This is inappropriate use of finite NHS resources as hospital is a place for medical recovery and not for bed rest. These hospital beds could be used for other patients in areas where the number of patients exceeds the number of beds. The members of the healthcare team have to treat the patients as well as sometimes having to organise housing needs. The type of housing the person lived in before admission correlates with recommended time spent in hospital before discharge. This is because if the patient is living alone it could be very dangerous and painful to have to rely on themselves for everything whilst recovering, whereas if living in a nursing home there would be plenty of support available to help with recovery. This is why every orthogeriatric patient that has come from a care home is aimed for discharge after five days on a ward, whilst those striving for their independence again may take a lot longer.

Furthermore I learned that everyone comes from a different stage in their lives and has different personalities, and this means that the ‘level’ that the healthcare team want the patient to be at for discharge is very variable. Not every patient is perfectly healthy before they break their hip and come into hospital, so it would be wrong to prevent discharge of patients if other medical issues that are being monitored by their GP are under control. It is important to remember that difficult communication may not be solely due to delirium after the operation, but could be due to underlying medical issues. This is why it is very important to find out as much as you can about the patient when they enter the hospital through A&E before they have the operation and are admitted to the ward.

Taking bloods is not always easy, especially if the patient has lost a lot of blood during surgery.  This is a common problem that nurses come up against when doing observations. I learned today that nurses are the ‘doing’ of the ward in that they change the sheets, serve the dinners and water, put in cannulas and do observations, as well as giving out medication and collecting data about the patients that is reported and analysed by doctors to come up with a plan. This plan is discussed with other members of the healthcare team including Physiotherapists and Occupational Therapists in regular ward round meetings. MDT meetings are held to discuss which patients are ready to be discharged and what needs to be done for the safest possible discharge.

Learning the difference between osteoblasts and osteoclasts is important to understand the condition osteoporosis, which causes the weakening of bones and is a common reason for fracturing bones during a fall. Osteoblasts are cells that synthesise bone, whilst osteoclasts break down bone tissue for repair of the bone. If osteoclasts work at a higher rate than osteoblasts, bone is broken down faster than it is synthesised, causing weakening and osteoporosis.

 

Emily Buchanan

Work Experience in a Different Hospital – day two

 

Today I gained experience shadowing a Consultant and Junior Doctor doing a ward round,  seeing a newly admitted patient in A&E and shadowing a Physiotherapist and Occupational Therapist doing their work on a ward.

Today I really felt the sense of community at the hospital, not only among the patients but also between all members of staff. Everyone appears to support each other and it is nice to see that people from certain specialities are not afraid to ask other specialities for advice. I noticed that the Physiotherapists and Doctors always checked that they were both happy before making final decisions about patients, by having regular meetings outside the wards. This ensures that every decision made by the medical team is the best  possible decision for the patient. I noticed the importance of teamwork between the Consultant and Junior Doctor during the ward round as well as between the Physiotherapist and Occupational Therapist (OT) working together to make the exercises as painless as possible for the patients. I feel extremely grateful that all of the staff are extremely friendly and welcoming to me in the Orthogeriatrics ward where I am based, and feel that they genuinely care for me in ensuring that I am gaining as much experience as I can of all medical professions on the ward. I enjoyed hearing about the team’s jargon, helping to make writing notes and having conversations quicker.

I enjoyed speaking to a Consultant about their enjoyment and difficulties of being a doctor. I learned that whilst the job can be extremely tiring and not very financially rewarding, it is extremely emotionally rewarding to be the person to improve or prolong someone’s life. The variety of the job through meeting lots of different patients is very exciting and something I believe I would enjoy greatly. The role of a doctor is very caring and enjoyable as you can apply the science you know to a real life situation and see the results through speaking to patients and finding out how they are feeling. I love that as a doctor you are constantly learning, and even as a top consultant you may not have heard of every medicine that you come across on the job so you learn something new everyday. I also like the idea of growth of responsibility as you become more confident with clinical skills and decision making through years of practice. It is very interesting to see that doctors all have a different way of speaking to patients and this shows that medicine as a career is an art. I love the idea of teaching younger people clinical skills when I am qualified.

I learned that communication with patients can be extremely difficult especially if they do not say what they mean due to delirium or confusion, or if they refuse to speak to the healthcare team all together. This can make doctors frustrated as they do not know if the patient is in pain and if they are reacting well to their medication. It is also difficult to communicate with patients who believe they have pain but do not actually have pain as it is psychological. It is difficult for the doctor to decide whether they need painkillers.

It is important to remove as much equipment from the patient’s body as possible so that they feel like their condition is improving for a better state of mind. The Consultant was constantly looking for ways to improve the patients’ comfort including removing catheters as soon as possible. This may also encourage them to get on their feet sooner after the operation as they believe that they are fit enough to stand, decreasing the risk of them losing independence.

I learned that blood transfusions to treat anaemia are extremely risky and expensive. The cost is about £800/unit whilst there is a high risk of contracting an infection or having severe side-effects. Therefore, Doctors encourage the taking of iron supplements or injections to increase the amount of haemoglobin in the blood to carry oxygen to cells, without the risks that come with a blood transfusion.

It was inspiring to see the tireless work of the Occupational Therapist and Physiotherapist who were extremely patient and encouraging to all patients. Whilst seeing what their job entailed, I noticed that a lot of their work was talking to patients and reassuring them that they would only get better if they had the confidence to do the exercises, for example to stand up. Before this week I did not realise how important confidence is for a patient’s recovery.

An example of a member of the medical team making extra effort to ensure that patients were comfortable and happy today was when a Physiotherapist sat with a patient after they had done their exercises to fill in their food form for their upcoming meals as the patient could not reach to fill it in for themself.

 

Emily Buchanan

 

Work Experience in a Different Hospital – day one

 

I am extremely fortunate to be spending this week in a hospital gaining experience with Consultants, Junior Doctors, Physician Associates, Occupational Therapists, Physiotherapists, Nurses, the Administrative team and all other members of the healthcare team, on an Orthogeriatric ward. I will blog daily about my experiences and knowledge gained during the day.  On my arrival at the hospital, I was reminded of the rules of patient confidentiality that I am going to be very careful to not ever breach in my blogs. Patient confidentiality is taken extremely seriously by the NHS.

Firstly I shadowed a Consultant doing their ward round. During a ward round the Consultant and a Junior Doctor assess the improvement or deterioration of a patient’s condition, in order to decide the next stage for recovery. The next stage may include changing dosage of drugs, physiotherapy, scans, or any other plans to help the patient improve. The Consultant seemed keen to ensure that patients were made aware of their medical plan for the next few days as well as for the future, giving them an opportunity to ask questions at any point about their condition or treatment. I learned that it is important to explain to patients exactly what is going on and make them aware of the progress or deterioration of their condition to make them feel confident and that they are in control. The Consultant and Junior Doctors were very approachable and spent lots of time answering the patients’ questions to ensure they understood fully what was happening to them and why they were taking certain medications. The patient’s family is always made aware of the current medical situation at the request of the patient. I learned that doctors’ jobs can be extremely emotionally challenging when they are forced to deliver bad news to both the patient and the family of the patient, and that doctors must remain detached emotionally from the family in order to ensure that their mental state remains healthy for the benefit of other patients as well as themselves

A doctor must be trustworthy and caring to ensure that the patients feel comfortable so that they are open and honest about how they are feeling. This helps the doctor decide about treatments to give them. On the ward round I noticed that the Consultant always remained positive but realistic, reassuring patients that the healthcare team is doing their best to ensure they are as comfortable and medically safe as they can. This is key to making patients open-minded and positive about recovery.

An example of staff going out of their way for patients’ comfort was when a patient was distressed due to loud noises being made by another patient, so they were moved apart. Another example was when I saw nurses going to another ward to look for a reading book to help the patient to relax.

I learned that it is important to ensure that there is enough support for the patient at home for them to live comfortably before they are discharged. Lots of steps are taken to track a patient’s progress surrounding day-to-day activities, such as making a cup of tea, before being discharged home. This is to ensure that the patient will be safe and remain healthy ( to prevent another injury!). I watched a Kitchen Assessment by an Occupational Therapist during which the patient was asked to make a cup of tea in order to see what equipment they need to help them to transport the tea from their kitchen to their table and chairs at home.

I went to A and E with a Physician Associate where I saw a patient admitted with a broken hip. When first admitted into A&E, I learned that the Doctor or Physician Associate has to try to work out as much information as they can to do with how the patient fell, why the patient fell, if they have fallen before, what medications they take routinely and whether there are any underlying medical conditions that the healthcare team must be made aware of. I looked at the X-Ray and learned that it is important to check a patient’s abdomen as well as the fracture before  referring them for surgery, in case of complications with the heart or lungs. In the initial consultation it is important to find out how the patient fell and why the bone broke (whether they have osteoporosis). I also found out that everyone is treated with antibiotics against MRSA after an operation to prevent infection in the open wounds.

I learned that hip replacements have high mortality rates at 10% in the first month and 35% in the first year.

It was interesting to hear that the Doctors let an operation take place even though they did not have a bed available on the ward, so were relying heavily on someone being discharged today.

I learned some very detailed science including about rheumatoid arthritis, ECGs and chemical markers in the body, as taught to me by Junior Doctors. I saw a case of rheumatoid arthritis and learned about the role of synovial fluid in the joints as a lubricant for free movement around the joint area. I learned about the ideal ECG wave and was able to look at people’s ECG traces, identifying P, Q, R, S and T waves. I learned that an elevated ST wave or a ‘dipped’ T wave is the sign of an acute heart attack and needs instant treatment. Chemical markers tested in blood tests include neutrophils (a high number may show a bacterial infection), lymphocytes (a high number may show a viral infection), C-reactive proteins which I will research for my blog next week and Troponin T and I. I learned that blood tests are used mainly for searching for anaemia, infection, kidney trouble and thickness of blood. Anaemia must be tested for due to loss of blood during operation, infection to select the correct antibiotic, kidney function to ensure the correct amount of fluid is being given and thickness of blood to see if blood thinners are needed.

I really enjoyed my day today and very grateful for the warm welcome by all the staff at the hospital. I am very excited for tomorrow!

 

Emily Buchanan

 

 

 

 

Work Experience in a School – a week

 

I was fortunate enough to spend the last week in a school in a less economically developed area where I met people from different backgrounds. Below is a report to describe the time I spent there and to evaluate my experience.

On my first day I felt warmly welcomed when we were taken to a conference room to find out more about the school and to discover what we would be doing during the week. I was fortunate enough to then be taken on a tour of the local area exploring the newly developed areas and the areas that are still awaiting (and need) development. It was interesting to see where some of the students live in order to try to understand their background and upbringing. Visiting their estates allowed me to contrast and compare their local area with my own. It was not as different to my local area as I previously had been told and I believe we need to be careful when speaking about the students’ upbringing in order to not promote segregation and a culture of ‘us and them’. We must all work together in society to allow everyone to do their best. I found this tour very interesting. Something that struck me in the area was the prominent sense of community – everyone knows everyone as lots of people live in a small space. This is extremely special and unique to the area. The sense of community was further reflected in that the area is extremely culturally diverse and it feels like all cultures are welcome and that no one is left out. With any area there are problems and it was very sad to hear stories of the local people battling with knife and gun crime. Although I do not know much about the government’s ideas I believe that they need to do more about this issue to save innocent people who are being exposed to very violent crimes starting from a vulnerable young age. When I spoke to a boy of age 14 he explained that it is not uncommon for stabbings to happen at the parties that they attend. This is very worrying.

During my tour of the school I noticed the amazing facilities that they have on offer including an enormous sports hall, 3G sports pitch and many computer rooms. This is extremely important for the children’s education to ensure that they are well-rounded. I was very impressed with the new building which appears to almost double the size of the school and provides new, modern classrooms and spaces for the students to relax and unwind. The gardens around the school are a great place for the pupils to run around and release their energy, and also offer space for reflection.

On Tuesday, I sat in lessons for the day observing the dynamic of the school, the students’ behaviour and the teaching. I was excited to see that many of the students are extremely bright, enthusiastic and have a lot of academic potential. Whilst in most cases the behaviour was at a high standard, I also noticed that some of the classrooms were a lot noisier to what I am used to at my own school. However, I was pleased to see that discipline is recognised as a high priority at the school in order to allow the students to reach or exceed their potential. The teachers most definitely care a lot about the students, making sure that they balance conversations by talking about both academic material and life outside the classroom for the benefit of providing students with an all-round education. It was inspiring to see that many different teaching methods are used and encouraged at the school including textbooks, board work, computer work, noting, mind-mapping and games.

I feel that I learned the most on Wednesday when I sat with a class of students who were set workbooks to do whilst their peers were on school trips. They were the students who were not going on the trips but were still required to come to school in order for the school to continue to promote the importance of education. I learned that there is a great cross-section of academic ability as I saw that some of the students struggle with basic numeracy and writing skills, whilst others are aiming for high GCSE results to facilitate their applications to Oxbridge and Russell Group universities. I feel that I helped one student in particular on Wednesday as I gave him one-to-one support that he needed in order to make him focus on his work, give him confidence and not be distracted by those behaving badly around him. He had amazing academic potential and it felt great that I was able to teach him some maths and Spanish skills, which he easily understood. When I got home I made a poster of the maths topics that I taught the boy as I think that it may benefit other students of the school if it is placed on the walls of the classrooms.

On Thursday I was able to give advice to Year 10 students in small groups and speak to them about their plans for the future and any worries about GCSEs. I was surprised to hear that some of them did not know what A Levels are, so it was good to introduce this concept to them. I also promoted the idea of going into higher education including university, foundation years and apprenticeships. This made them very excited and curious to hear about my plans and goals. I hope that this gave them inspiration to put maximum effort into everything they do and take every opportunity offered to them, in order to do their very best in their exams. These sessions were successful as I managed to convince many students that GCSEs are extremely important and that anyone can succeed when they put their mind to it. I explained that I would much rather be socialising with my friends than studying but when I put my mind to it studying can be fun and is the key to fantastic grades which will facilitate me doing what I want to do in the future. I went on to introduce new revision ideas to them for which I believe they were very grateful. During the afternoon, I led a ‘Q&A’ session where the top sets of Year 9 and 10 were invited to ask us any questions about education and our futures. We also offered advice about how to handle stress.

The marketing exercise on Friday was extremely fun and allowed me to put teamwork skills into practice. We were set with the task of marketing the school leading to doing a presentation at the end. This reinforced skills of teamwork, listening and public speaking.

I would most definitely recommend this work experience to anyone looking to go into a profession working with people, or looking to gain a more-rounded perspective of the city we live in. I had an amazing time at the school and was able to reinforce skills that are key to my future profession as a doctor and I hope that the students felt that they benefited from my advice and experience. They should have confidence that their school is a great school, be very proud to go there and recognise it as an enjoyable stepping-stone to their futures.

The school is a brilliant school offering a safe, happy and fun place to learn and it was an honour to have been allowed to spend time there.

 

Emily Buchanan

Book Review – In Stitches by Dr Nick Edwards

 

In Stitches is written by a doctor who has worked in many hospitals and is training to become a Consultant. I really enjoyed this book as I learned a lot about the NHS and the reality of being a doctor. Dr Edwards covers a lot of material including NHS reforms, management, funding, certain illnesses, current problems in our population, the future of medicine and feelings about being a doctor, through case studies – ensuring that the information is always interesting to read and not just lists of NHS regulations!

Dr Edwards feels that managers are not directly at fault for the problems in our NHS, but that it is ‘unintended consequences’ of new policies brought about by the government which are to blame. He believes that some new policies have led to failures, damaging patient care and the NHS’ reputation. He talks about a brief history of the NHS including that its creation was overseen by Nye Bevan in 1948 and that underfunding appeared to start in 1997. I was interested to find out that 1997 was therefore the year that the ‘4-hour rule’ was introduced – a rule which states that 98% of patients must be seen and admitted or discharged within four hours’. Dr Evans feels that this rule is now outdated. Measures are often taken in order to ensure hospitals do not breach this rule for example by moving curtains to fake admittances, adjust figures and cancelling operations in order to increase bed space. He also expresses in In Stitches that he feels that he is ‘no longer allowed to do good-willed gestures’ as he must constantly ensure he is not breaching NHS rules. This is a shame as it means that doctors are not able to fulfil their role (‘not allowed to do the job properly’) and use the ‘gold standard skills’ that they spend a long time learning at medical school, for fear of breaching regulations. Dr Edwards talks about this leading to patients no longer receiving the level of care that they require and deserve.

Medical conditions that I read about in this book are addiction, Type 2 Diabetes, psychosis and schizophrenia, atrial fibrillation and appendicitis. Most of these conditions were linked with Cannabis, Alcohol, Cocaine and Heroin.

Being a doctor can be extremely difficult. Dr Edwards expresses that you must be ‘mentally strong’ and able to ‘cope with stress’ to be a doctor and must be able to detach yourself from patients in order to provide the best quality of care. Detaching yourself from your patients is extremely important to ‘protect’ yourself from mental health problems. In addition, I learned that it is okay to have a limit in your ability and important to understand that sometimes it is best to let ‘nature take its course’ when you have ‘treated the patient to the best of your ability’. Dr Edwards also talked about enjoyment of working with lots of different people from all cultures, and getting the ‘buzz’ from working in a high-pressure environment.

Problems of the NHS that he talks about in In Stitches are wasted funding, long hours and the postcode lottery. Dr Edwards noticed that many members of staff were often not needed at certain times including when there are hardly any cars in the car park but there are often two car parking attendants sitting around who are employed by the NHS, and when operations are cancelled due to shortage of beds but surgeons remain in work, waiting around needlessly. Furthermore, he stresses the importance for need to cut down number of hours in Junior Doctors’ shifts. Long hours leads to severe tiredness and this directly affects patients’ care negatively. Dr Edwards asked himself the question ‘Would I have treated her the same way if I had not been exhausted?’ showing that his mood was affecting his ability to work. The postcode lottery is something often discussed as a problem surrounding the NHS as it could be said that some people have better access to medical facilities than others, depending on where they live. Dr Edwards suggests that this may not actually be the case and that it is just the local area’s advertisement or lack of advertisement of the other medical facilities on offer (as opposed to just A&E) that affects the number of people using them and therefore affects the number of people coming to A&E.

Solutions offered to some problems include improving saving of patient test results as money is wasted repeating tests and preventing unnecessary admission to wards in order to reach targets. The money that these activities cost could be put to better use elsewhere for example for more personalised care for the elderly by home visits, investment into specialist units and improvement of quality of care homes.

To conclude the book, Dr Edwards assures the reader that ‘the good bits outweigh the bad bits’ but clearly believes that it is important to understand both the positives and negatives of being a doctor before applying to medical school. He then goes on to suggest that it is most important to look after yourself under the pressurising conditions of working in a hospital, in order to be the most benefit to your colleagues and your patients. The book also raised the question whether it is ethically correct to treat someone, even when it is against their wishes.

Emily Buchanan

Hospital on BBC 2 – It’s back!

 

I am very happy to say that after having a month and a half away from blogging to focus on exams and university open days, I am back to talk about the documentary Hospital on BBC 2 that has returned for a second series. I blogged about series one and have no doubt that this will not be my last blog about the program – it is incredibly inspiring and encouraging, whilst providing a realistic view of the current strains on our NHS and on our doctors.

I would like to focus on Episode 2 of this series – where private medicine’s benefits and disadvantages were discussed.

It is common to assume that it is completely unethical to encourage private healthcare as it is only available for those who can afford it. I was interested to hear in Hospital that most of the money made in private medicine goes back into the NHS to fund new drugs, new staff and new technologies – it makes up “5 percent of total NHS turnover”. This is encouraging as it means that not only those who pay for the care benefit, but also those who do not use private healthcare benefit through use of the NHS. Private medicine also releases the burden on beds in wards as patients are placed in separate private wards. The beds in the private wards are also often used when NHS wards are completely full – allowing extra space for sick patients to come and receive as high quality care as in NHS wards, even when the NHS section of the hospital has reached full capacity. On my work experience in a hospital I noticed that the Consultant that I was shadowing in the NHS respiratory wards also spent some time in the private wards so the point that private patients receive better care may not be true. Private work also means that doctors can make more money, which may encourage them to stay in the job for longer, helping to prevent a shortage of doctors.

However, some medications are only available for those who are willing to pay which brings up an ethical debate as people question whether it is is fair that people can “buy more life” whilst others, who do not have as much money, can not. Some people argue that condoning the private medical sector leads to unfair mistreatment of people who do not pay for their treatment at the point of use as doctors are more likely to spend time on private wards where they receive higher pay. Some people that were interviewed in Hospital stated that in private wards you get a more comfortable area to convalesce and more personal care. This is worrying as everyone should be treated equally – whether you have more or less money, and people should not be given a higher chance of survival than others due to economic advantage.

I found it sad to find out that some people are forced to sell all of their belongings in order to have a chance to fight for survival against a traumatic disease, such as cancer. People feel that they must sell all that they own in order to afford new treatments that are not available on the NHS due to fears that they are not tested very well nor are proven to work, to attempt to increase their chance of survival. It was also interesting to hear that rules vary from region to region so some drugs are allowed to be prescribed in certain places that are not allowed to be prescribed in other places – a postcode lottery. This means that some patients are forced to travel long distances for care that others may get on their doorstep.

In this episode of Hospital I also learned again that some imaging options or invasive surgery are not necessarily the best option for people with an already bad quality of life. Doctors must assess whether they believe that the risk of dying from surgery is greater than if the person is left untreated. This is often a difficult ethical decision as it is most kind for the patient to die in as little pain and suffering as possible.

I look forward to watching tonight’s episode on catchup tomorrow.

 

Emily Buchanan