Work Experience in a Hospital – day five

I shadowed a Consultant on a ward round this morning, noticing their extreme patience when speaking to an ill patient who demanded to leave the hospital, wanting to return home. The Consultant remained calm and collected, explaining the severity of the patient’s condition and  why hospital, surrounded by healthcare professionals, was the best place for the patient until they became stable. The Consultant calmly stated that the move home could easily be arranged, as long as the patient understood that there was an extremely high chance that they would die or be admitted to hospital again in an emergency.

I went on to learn about two predominant types of pneumonia; legionella and mycoplasma. Legionella presents symptoms such as a persistent cough bringing up phlegm and flu-like symptoms which can be cured by erythromycin or clarithromycin. Mycoplasma is very much more serious, presenting itself in a dry cough and fever and it can damage the heart or central nervous system in extreme circumstances. Mycoplasma pneumonia is far more contagious than that of legionella so could cause an epidemic.

I saw that the Junior Doctors were tired, stressed and frustrated as they followed Consultants making accurate recordings of observations, medicines and dosages whilst being questioned by the patient’s families and nurses for help. This in turn frustrated the Consultants as they did not believe the Junior Doctors were completely focused on what was supposed to be written down on the ward round. I believe this is very important for all people going into medicine to see as we must have a realistic understanding of the stressful, and at times frustrating, profession that we are potentially going in to.

During the afternoon I went to a teaching of ‘wellbeing’ to medical students in which a lecturer spoke to students about the role of diet and exercise in maintaining a healthy mind and body. The lecturer spoke of the fact that most medical students are perfectionists so have extremely high expectations of themselves leading to severe burnout. Burnout can lead to depression, heart disease and a weakened immune system which is reflected in patient care, decreasing patient satisfaction and increasing recovery times. The lecturer focused on resilience as an extremely important quality of a doctor saying that it is a natural quality of people which can also be taught throughout time at medical school. I learned about foods containing sugar, caffeine, nitrites and salt and how they affect sleeping routine, perception and increase risk of diseases.

Emily Buchanan

Work Experience in a Hospital – day four

I was in a respiratory clinic again this morning with an inspiring Consultant where I learned more about qualities of a doctor. I noticed their reassurance and truthfulness when telling a patient about the severity of their illness – approaching the subject politely and respectfully whilst always reminding the patient the negative consequences of their condition.

I was reminded today of the disastrous impact of smoking when meeting people with extreme reduction of lung capacity – the lowest was 11% (measured using a spirometer). I try to prevent many of my peers from smoking and would love to expand this to the wider community in the future. I noted the patients’ responses to finding out that they have poorly functioning lungs. A particularly interesting response was thinking that they could easily get a new pair of lungs from a donor. This is incorrect as there is a shortage of donors and if there is a donor, the lungs will go to a child with cystic fibrosis due to them having a greater need. I noticed the doctor’s calm response to their patients, explaining clearly the plan for their future relief of breathlessness using medication. Patients often forget about the large risks associated with replacement of vital organs which could completely change their quality of life (for example after the operation they may be bed bound meaning they have a high reliance on other people, or if the organ is rejected they may die in extreme cases).

I found that by using the number (in a percentage) of lung capacity the doctor was able to show the extreme severity of this patient’s lung condition in order to tell them a truthful prognosis so that they completely understood that they were in a bad state.

As a doctor is it extremely important to have a strong relationship with your patients in order to be able to talk to them about anything – even if a little embarrassing in the eyes of the patient. The doctor advised about depression and the effects of being overweight to their patients using knowledge to comfort them whilst telling them about the best medicinal decisions for their future. Telling people they are overweight is sometimes extremely difficult and therefore whether it is acceptable is being debated at the moment within our NHS due to extra bodily weight leading to health conditions in itself, for example type 2 Diabetes.

I saw a hernia which was the intestine sticking out due to intense pressure around the lungs – hernias can be found all over the body. I will be writing another blog about a condition called Sarcoidosis as this condition particularly interested me in the clinic today.

Structure and function are the key to understanding every disease. Structure is determined by doing a scan eg. X-Ray, CT scan, MRI and function is determined by tests eg. blood tests, lung capacity test.

I was particularly interested in hearing about a new innovative surgery which allows patients to have less invasive surgery of the heart to fuse arteries by a small incision in the side of the body (a new type of keyhole surgery).

In the afternoon I spent my time in the AMU ward with a Consultant where I saw lots of patients with respiratory problems. I enjoyed looking at and learning how to interpret CT scans and X-Rays and listened to the Consultant advising Junior Doctors about which treatment to use for which patients. Everyone respected the Consultant’s wishes for their patients as the Consultant was leading the way for the chance of a healthier future for everyone.

 

Emily Buchanan

Work Experience in a Hospital – day three

This morning as I sat in a respiratory clinic at the hospital, I was greatly inspired by the Consultant that I shadowed. They were intelligent, compassionate and clearly respected by all of their fellow doctors and members of the healthcare team. Junior Doctors constantly came to the Consultant asking questions and for second opinions about treatments and the best plan for their patients, while nurses were extremely happy to support them in any way they could. It appeared that the Consultant made their patients feel comfortable, relaxed and positive even when the prognosis was not so positive. Whilst they always showed that they were in control to their patients, once they leave the room the Consultants were extremely busy answering calls whilst looking at other patients’ test results and giving second opinions for Junior Doctors. I learned that a doctor must be able to multitask to a high enough standard that they can be focusing accurately on more than one patient at the same time. The Consultant approached talking to their patients in a very different way to the two Consultants that I shadowed on Monday as the Consultant today explained what they thought was their current problem and history, allowing the patients to correct them, whereas on Monday the Consultants would let their patients do the talking then prompt with questions. Both methods seemed to please the patients.

As a doctor you must explain everything that you are doing. The Consultant was very empathetic when they delivered less positive news – always concerned about questions that may be in patients’  heads, so the Consultant always explained their decisions of medication to them so that the patient was not concerned or confused. The Consultant attempted to explain patients’ conditions without them feeling awkward, embarrassed or less able, speaking scientifically and empathetically appearing to understand exactly how the patient was feeling. The Consultant also offered them professional psychological help due to their frustration of the disease.

Many illnesses affect peoples’ state of mind due to it causing a lower quality of life. An example of this is when patients are unable to walk due to not having enough energy (from lack of oxygen) when their legs do in fact work perfectly. Patients often explained that this not only had a negative effect on them but also on their families who they were extremely reliant upon to transport them from place to place.

Today I also learned about drugs that may be able to replace antibiotics in the future. These drugs are a much lower dose of antibiotic to boost your own immune system to fight the pathogenic bacteria that has infected your body cells. I hope that more doctors use these drugs as it will reduce antibiotic resistance, although I have to say that I am not educated in the knowledge of their side effects and I was told by the doctor that they currently only work in very select cases.

During the afternoon I shadowed a fourth year medical student in the Acute Medicine ward (AMU). I was interested to hear a heart murmur which was confirmed by a Junior Doctor after the medical student hypothesised the specific type of heart murmur. I noticed how knowledgeable the medical student was when they explained in detail everything about the specific heart condition to the Junior Doctor.

It was interesting to see the dynamic in the ward with students reporting to Junior Doctors and Junior Doctors reporting to Consultants. There was clearly a hierarchy in amount of experience but everyone respected and supported each other, concerned about one another especially about those who were on call last night.

I encountered patients who suffer or have suffered recently from bronchiectasis (had also had had a thoracotomy) causing wheezing and coughing after having a lung tumour removed, lung scars causing nodules to appear on their CT scan,  recurring chest infection, osteoporosis, chronic asthma, polymyalgia rheumatica, exercise induced desaturation causing breathlessness, pulmonary embolism, lung collapse, breast cancer, severe emphysema, low T Killer cell count and a heart murmur.

Emily Buchanan

 

Work Experience in a Hospital – day two

Today I was fortunate to experience a meeting in which Consultants met with other Consultants (over the internet) to discuss current patients to ensure that everyone agreed about the plan of their future treatment. I was particularly interested to see that there were also representatives from a sister hospital as some procedures take place there as opposed to in the hospital where I had my experience.

In this meeting, one doctor whom I assume was the most senior led the discussion and concluded it by giving the best solution using all of the present doctors’ advice.

A question frequently asked in hospitals is whether to give frail elderly patients invasive surgery or whether the risk carried with the operations is too high. Doctors make decisions on the basis of amount of risk. Medication and surgery all come with risks and the decision to prescribe medicine or carry out surgery is done on a basis of severity of the patient’s condition and therefore whether it will improve the patient’s health in the long term. The lead doctor suggested that surgery must be the least invasive but most informative as possible. In the meeting I also noticed cost was a significant factor when deciding whether to allow multiple scans for the same person.

After discussing all current respiratory patients, the doctors went on to talk about the meeting of NHS deadlines. I was discouraged that they said that it was physically impossible to reach the NHS’ deadline to release results of CT scans when checking for lung cancer within 3 days. They announced that there was not enough money in the budget to employ another staff member to improve quality of service so they were forced to move their patients to other hospitals where they may receive a better quality of care.

I also visited the respiratory ward where I shadowed a Consultant and a Junior Doctor on their ward round. I was told that a ward round happens twice a day to check progress of the patients in order to ensure medication is working and therefore to advise the nurses about changing dosage or type of medicine being given to the patient. I noticed that Consultants were completely reliant on their teams of Junior Doctors who were prepared to check up on all other cases that the Consultant did not get round to seeing, and the nurses to give attention and medication where needed. I saw the doctors as kind, understanding, encouraging, intelligent and trustworthy.

I was interested to see that a teenage patient was brought to the adult ward even though their age suggested that they should be in the paediatric ward as the doctors from the paediatric ward believed that this was the best place for them due to the severity of their condition. I noticed a dynamic change in behaviour of healthcare professionals when the nurses failed to confirm with the Consultants and Junior Doctors about bringing young patients to adult wards. This is a growing issue in the NHS as mentioned in the program Hospital by BBC where they raise the debate about whether an empty intensive care bed in the children’s ward can be given to an adult if there are none left in the adult ward.

I enjoyed speaking to patients about quality of care in a private ward and feel that I improved their days by giving them my time to listen to their medical story – something which I enjoy doing weekly at the care home I work at. I loved speaking to them after my hectic time in the non-private respiratory ward as it felt more relaxed and enjoyable – it is a shame that every person cannot afford this quality of care. From talking to these people I learned the complexity of some people’s illness can stem from a simple lifestyle choice from many years ago which is most commonly smoking.

It is impossible for me to remember every condition I saw today however the most memorable thing was seeing the draining of the lungs into a transparent glass jar. It was so fascinating and the doctor explained to me that all the liquid is infection between the lungs and pleural membrane.

I look forward to my day in clinic tomorrow.

Emily Buchanan

 

Work Experience in a Hospital – day one

This week I am extremely fortunate to be gaining work experience at a hospital working with doctors, nurses, healthcare assistants and foundation-year doctors in the respiratory department. Over the next week I will be documenting what I learn from my experience, using my blog as a diary. Every day I am scheduled to be visiting a different area of the respiratory department including clinics, meetings, ward rounds, as well as sitting in teaching of radiology, respiratory and wellbeing to medical students.

Today I sat in a respiratory clinic with two doctors, both very different in their approach to dealing with patients. The first doctor was a very good listener, allowing their patients to explain their concerns and then prompted them in order to understand the background of their problem. The Consultant then went on to ask about timescale, dosage and medication whilst using the words better, worse or the same to measure improvement or deterioration in a patient’s illness. Once the doctor had listened to the full background of the condition from the patient’s point of view, the doctor told them the scientific reasons for their discomfort (even taking the effort to draw a diagram of the heart in one circumstance) and concluded with their plans for their medication now and for the future, then asked if they have any questions.

It was very interesting that the doctor had not previously seen these patients even though they had visited the respiratory ward many times before, as the doctor was covering for another doctor who was on a ward round. I believe that this lack of continuity of doctors is unacceptable for a patient’s care as the doctor had to rush to read the patients’ history as they waited outside for long periods of time – the doctor said that they felt they must hurry as they did not want grumpy patients. I also felt uncomfortable with the fact that the Consultant could not prescribe a drug for more than 28 days even though some patients had long-term conditions so were required to come into the clinic every month to get a new prescription, using doctors’ time. The patients could not get their medicine from their GPs due to the GP surgery not being allowed to prescribe the drugs due to lack of demand in the area so the cost was too great.

I noticed that there was two healthcare professionals in the room at one time, the nurse guiding the patient to use the spirometer and helping with paperwork and the doctor who analyses the results of tests and puts together a healthcare plan for the patient whilst listening to their requests and concerns. I was pleasantly surprised to hear that often there are two doctors in one clinic as a patient’s condition may overlap with two specialities, although none of these appointments were taking place today.

I also noticed the encouragement of exercising to all patients, proving the importance of exercise in improving respiratory conditions due to it being more efficient (and cheaper) than using drugs. One scheme that was recommended to more than one patient was a pulmonary rehab program in local gyms that consists of exercises from Physiotherapists to do in-session and at home. Unsurprisingly most people that came into the clinic were smokers or past smokers and I was pleased to hear that all but one patient had given up smoking within the last five years – I believe this is a success on the NHS’ part as smoking has become less fashionable.

Good care is essential for every patient, shown through equal treating of all people, whether the person is able bodied or disabled. From my work in a care home and at this hospital I learned that some wheelchair-bound people prefer being greeted sitting down in order to make them feel comfortable and at ease. Whilst this is true for all people and patients I have greeted, it is important to check with the person for their own personal preference. I would describe doctors as gentle, kind, welcoming, open, trustworthy, organised, knowledgeable, empathetic and reassuring.

Some medical conditions that I witnessed today were a heart murmur, respiratory tract infection, systemic sclerosis, heart strain causing leaky valves, arthritis, COPD, lung clots, glaucoma, post infective hypersensitivity, severe asthma and scarring on the lungs.

 

Emily Buchanan