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.