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!