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.