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 Summary – 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