MWOP – Day 5, A&E

On my fifth and final day at MWOP, I observed the work of the health professionals in A&E. I found this day extremely eye-opening as I had never previously properly experienced what goes on in this department.

One thing I noticed from the outset was the amount of paperwork that has to be done in this specialty. Because A&E are seeing patients for the first time, and are one of the first points of contact with the hospital, the health professionals have to make sure they are documenting everything properly and accurately. Nothing can just be left or put to the side for later. The documentation is vital to ensure the best delivery of healthcare and to enhance the communication as the patients interact with different departments.

Another aspect of this department that I observed was the fast pace, as there is a constant flow of patients coming into the department, and the doctors have to deal with them all quickly and efficiency, making sure they are still treating them to the best of their ability. The specialty comes across such a range of cases, from a sprained ankle to a brain tumour.

I accompanied a doctor to break some bad news to a patient. The patient had come in because they’d fallen over, and by that afternoon it was discovered they had a tumour in their brain. Being there and observing as the doctor broke the news to the patient and their family was such a new situation for me, and made me really appreciate the demanding aspects of medicine even more, as I understood how hard it must be to have to deliver such life-altering, saddening news to someone.

Something else that was made even clearer to me on this day was the severe impact of people’s lifestyle choices on the NHS and healthcare in general. The majority of the admissions into A&E were drug and alcohol related, and so many staff and resources were needed to help treat and save those individuals. It really made me think more about how people’s life choices are not only affecting them, but the health care system too, and highlighted how important it is that awareness is raised of the impacts of such choices.

Overall I had such an amazing time at MWOP, and will forever be grateful for the opportunities I was given and the eye-opening experiences I had. All the consultants and patients I worked with were so welcoming and I really felt like part of the process. I found out so much about the career and the whole area in general, and it intensified my passion to become a doctor even more. It really made me see how there is no other career that I would rather be in.

 

 

MWOP – Day 4, My Day in Theatre

On my fourth day on MWOP, I had the amazing opportunity to observe surgeons in theatre. It filled me with such a sense of awe seeing how seamlessly a number of professionals worked together to carry out life-altering surgery in a matter of hours!

The surgery that I saw was in the Maxillofacial department. Being in this department was fascinating because I’d never fully appreciated what this specialty entailed. In order to specialise in this area, you need to have a dentistry degree as well as a medical degree, and the specialty focuses on the head, neck, face and jaw.

Performing the surgery was the maxillofacial consultant who was in charge, and then also helping was a registrar and two junior doctors. There was also a scrub nurse, who was vital to ensure the smooth running of the surgery, the anaesthetists, and a few other nurses who all helped to prepare all the correct equipment, make sure everything was in order, and prepared the theatre before surgery. Seeing the number of people involved, and the important roles each of them had, really made me think more about how vital the coordination of all the different health professionals is, and how the unity and efficiency of them all together is so vital to ensure the best possible patient care.

The surgery I watched was a right partial glossectomy with right neck dissection on a patient who had tongue cancer. This surgery involved part of the patient’s tongue being removed, followed by the removal of their lymphatic system from their neck. The patient needed to have this surgery because they had tongue cancer. The tumour had already been removed, however under the NICE rules, the surgeons needed to remove a bigger proportion of it to ensure all of the tumour was removed. The rules also stated the removal of the lymphatic system was needed to reduce the chances of the cancer spreading.

The surgeons explained how they used harmonic sears to remove the large parts of tissue from the patient’s neck, as it doesn’t singe the tissue. It uses hydrogen gas to vibrate the tissue then sears it off.

I was so fascinated watching this surgery, and was so grateful for the time the surgeons spent explaining what they were doing so I could understand the process as much as possible. It really resonated with me how demanding the work of a doctor is and how intricate and challenging it can be,. However, the idea that they were performing a procedure that would completely change this patient’s life for the better, and possibly even save their life, made it even clearer to me that being a doctor is the profession I desperately desire to be in.

 

MWOP – Day 3, Catheterisation Lab

On my third day at MWOP I observed what went on in the Catheterisation lab (Cath lab). I found this day very interesting because I’d never fully realised what Cath lab actually included or, in all honesty, what it was. However after observing this area on the third day, it made me understand a lot more about the work done here, and the variety of things that they see.

For anyone who isn’t sure what the Cath Lab is (which included myself before I went on this work experience), it is a clinic in a hospital where diagnostic imaging equipment is used to visualise and look at the arteries and chambers of the heart, and then they work to treat any abnormalities that they find.

In the Cath lab, there were two radiology rooms where all the procedures would take place, and then in the middle was a room where the consultants, doctors and nurses would look at all the images. In the procedure rooms, a catheter, which is essentially a long thin tube with a camera on the end, is fed into the patients heart through a vein, and then those images appear on a screen that the doctors will then look at. They will then look for any abnormalities and see if the problem is significant enough to warrant a procedure. For example, they may look for where the artery walls are too thin, pinched or blocked, and whether it is serious enough for a stent to be inserted to widen the artery.

I saw one patient being rushed in because they were extremely unwell on their ward. They found that one of his arteries was extremely thin which was affecting the oxygen delivery to his heart. They therefore needed a balloon pump to help the heart pump the blood. A balloon pump is a catheter with a balloon on the end of it, and it was inserted into the patient’s aorta. It is just a temporary solution and patients who have it are waned off it over time. So for example, it may inflate for every beat of the heart to start, but then it’ll do it every other heart beat, every three etc, and it is just to aid them until they are ready for surgery.

Something else that is involved in the Cath Lab is deciding when patents need stents in their arteries, to widen them to help oxygen delivery. I was actually able to see quite a few stents being inserted into a number of patients, and it was extremely interesting seeing how they did it, and understanding the different times when one may be required or not.

Overall I found my time observing at the Cath Lab extremely interesting and I learned a lot, as it was a specialty I had not fully recognised before, or understood to its full extent. Therefore I found it really insightful seeing what was involved there. One thing however that I did feel on my morning there was that there wasn’t as much patient contact involved in this specialty, as a lot of it is procedures and looking at the images of the heart. However there was still a lot of variety within the area, as there were a number of different specialities all working together in the same room including radiologists and cardiac surgeons, which shows how that overlap and cross over really does occur across all areas of medicine.

MWOP – Day 2, Respiratory Ward Round

On the morning of my second day at MWOP, I had my first clinical activity and I was on ward rounds. The ward I was observing was the respiratory ward, and I found out so much from my morning there. I must admit I’d never really thought much about that area, and so it was something that I’m so glad I got the chance to see, and it really made me see a bigger and wider side to medicine that I hadn’t properly thought of before.

Whilst I was there, I was shadowing the consultants, and observing what they were doing as they went round the ward talking to each patient individually seeing how they were and discussing the plan of action for them. I was also lucky enough to stand in on their board round that all the consultants, doctors, physiotherapists and nurses undertake before the ward rounds begin. In this they go through each patient and discuss how they are, when they are likely to be able to go home, and what the next step for them is. This is also where they brief each other about any new patients that have come in over night that some of the staff may not yet have met. It made me realise even more how key communication and team work is to medicine, and how things must be explained and discussed with all the appropriate people properly, to make sure all are aware and to create the most effective work.

One thing one of the consultants explained to me that I found extremely insightful as I’d never properly stopped to consider it before, was the social care side of medicine, and the difficulty of getting people home when there are external factors such as funding and care packages to be put in place. This is especially prevalent where patients need continuing care or have a chronic illness, which is something that will need medicating for the rest of their lives, or at least for the long term. For example, the consultant explained how there was one patient who was in hospital for 300 days, but the actual medicine side was sorted in a week, but because of funding issues with social care and ongoing medication they would need, they could not be sent home. It is a very common issue, and is something doctors have to deal with daily, which I had not properly realised before and so was invaluable information to me.

Something else I learned on the respiratory ward was the overlap in medicine, with both the cross over between specialties, and also the overlap between illnesses where one problem can cause/affect another.

I saw these overlaps with how their was one patient who had lung cancer, which caused breathing problems. But the cancer had also spread to their bones which caused the bones to crumble, which compressed a bundle of nerves at the base of their spine, meaning they had trouble with mobility and moving their legs. This made me realise how one problem can cause so many others, and how many different specialist doctors can be involved in the treatment process. For example, this certain patient may have required a respiratory consultant, an oncologist and physiotherapist among many other specialised doctors and nurses. This opened my eyes to not only the overlap with illnesses, but also how closely different specialties can work together, and how there are so many different people who are all key to a patient’s recovery and getting them the proper treatment.

The other thing that surprised me was the range of different respiratory-related illnesses there were, and the range of causes there was for it. The main issue seemed to be because of people’s social choices, for example smoking, their diet and how active they are. The consultant explained to me how this itself creates issues, as even after the doctors have done all they can, if the patient isn’t willing to adapt or change their lifestyle, the problem is likely to recur and so the patient may need treatment again in the future.

Overall, I found the second day of MWOP extremely fascinating, and it opened my eyes and mind to so many different aspects of medicine that I had not fully considered before. Seeing those aspects has now made me appreciate the role of doctors and consultants, and all health workers in general, a lot more and made me see how much variety and overlap there is, and not everything is so black and white as people may at first think.

MWOP – Day 1

Every day at MWOP was split into two sections. We would have a clinical observation every morning and then a lecture-based activity in the afternoon. However, on the first day the morning consisted entirely of an induction which was extremely interesting, and of course very important. They went over the essentials such as hand washing, fire safety, confidentiality, time management and the basic rules of conduct in a hospital environment. Seeing as most of us had not been in such a situation before, it was information that was invaluable to us and is something that applies not only to medicine but to general life, and will come in handy in the future.

In the afternoon we did some small clinical workshops. We were taught about cannulation and how to correctly insert a cannular into a patient. We were also taught how blood is taken and were able to practice on dummies! We were taught CPR and the correct way to deal with a situation outside of a hospital environment when someone is unconscious and may require CPR. I found this especially interesting as it is something that could be needed at any time and we could come across at any point in our lives, and could mean saving someone’s life. We also were taught how to suture, and were able, again, to practice on dummies, and it felt amazing actually trying some of the practical medicine, as it’s something I’ve never had the opportunity to do before.

We also looked at different parts of the anatomy on a 3D screen, where we were shown what different organs and parts of the body looked like, and their position in relation to one another.

Overall I found the first day was a vital opening introduction, and allowed us to understand the professional side and reality of working and being in a hospital environment. It also gave us valuable time to get to know each other, as we would all be working together for the week, and so it helped to build out team work and communication skills which are so vital in not only medicine, but also day to day life in general. We were also able to develop our problem solving skills on this first morning as we were given certain activities to do in a group throughout the day which was extremely interesting and useful to learn.

 

 

Medical Work Observation Programme (MWOP)

From the 17th of July to the 21st July I had the amazing opportunity of attending the Medical Work Observation Programme (MWOP) 2017 at Cardiff Heath Hospital. I had such an eye opening week there, and was able to shadow doctors and see what type of work they do on a day to day basis. I was also able to get an insight into the variation that exists within medicine and also the overlap between different specialties and areas. I found this extremely interesting as I feel it’s something that is not recognised as much, as people often think specialists work only in one area and that they only see one specific thing, but that actually within medicine there can be overlaps with almost everything, and doctors can come across people will illnesses that cross a number of different specialities, not just the one they are in. Seeing how the doctors and surgeons deal with that, how medicine is affected by it, and how the different specialties work together was really interesting to see.

My time at MWOP made my passion to become a doctor even more intensified, as I found the work that all the doctors did so fascinating, and it really made me realise how much I would appreciate the role. I found it so admiring how hard all the staff of the hospital worked and how much they had to do, and also how there are a lot of external and social factors that come into medicine, that I had perhaps not fully appreciated before.

I wrote a short diary entry for every day that I spent at MWOP, which will be featured shortly following this post, where I go into more detail about what areas of medicine I was lucky enough to see, and what I learned and discovered from my time there.

Pharmacy Work Experience

During my week of half term I did work experience at a Pharmacy, and it has been so interesting, and it has honestly been one of the best experiences of my life. I did it at Central Pharmacy in Cardiff, and I worked from 10am to 4pm. The people there were so lovely and treated me so well and I learnt so much!

During my time at the Pharmacy I was observing what the pharmacisits and workers do on a day to day basis. I was watching how they deal with tricky prescriptions, how they process them and check they’re accurate and also what can and cannot be sold over the counter at a given time.

I also got heavily involved, taking people’s prescriptions and handing them to the pharmacists for them to make, and then giving them back out, ensuring the right ones were going to the right person. I helped to file repeat perscriptions too, and was able to take orders from people who wanted to put in a new order for their repeats. Furthermore, I was shown how to dispose of unwanted or out of date medication safely, for example if patients had brought spare medication back, and so I now know how they should be gotten rid of safely and effectively. I was on the till quite a lot as well, so customers could buy over-the-counter medication and any beauty products etc that the Pharmacy sold. I found all of this extremely useful and interesting as not only did I learn all about the medical side of things such as the processing and handing out of the prescriptions, what can and can’t be sold together and over the counter and how to dispose and handle medication, I also was able to learn more ways of how to deal with people, patients and customers, as there were so many different people I would encounter every day at the pharmacy. I was also observing the whole workings of the Pharmacy in general whilst I was there too, and that in itself was so interesting and useful to me.

At least two times a day the Pharmacy would always receive a delivery of the medication needed for the prescriptions for the patients, and this would need to be unloaded and restocked ready to give to the patients, and often people would return the same day after 3pm to collect it, so all of this had to be done quickly and efficiently, and I found this so interesting to observe.

There were often challenges that the Pharmacy would face. For example, if someone got the wrong prescription, and I was able to observe how they dealt with that and what had to be done. They would usually have to contact the surgery to get the correct information, as I learnt they could only give the patient what their doctor/surgeon had prescribed them, and nothing else.

Something else I learnt is that regular patients have to have a yearly review with the pharmasist to make sure they understand what they need to be taking, why and how they should be taking it. I found that extremely interesting as I never realised that had to be done before.

I learnt that when someone orders a repeat prescription it usually takes about 4-5 days for them to receive it, and when that time comes they get contacted for them to come in, unless they’ve asked for it to be delivered. However, in some cases such as if the patient is running extremely low on their medication and they need it, or they are going away and so need to stock up, then orders can be brought in earlier. I also got the amazing opportunity to go along to the surgeries too with one of the workers, which they do every day to pick up the prescriptions for that day that had been ordered 4-5 days previously. I saw how the pharmacists sit down and cross reference all the prescriptions with the doctors to ensure that everything was correct, and for the doctors to tell them if there had been any queries about any of the medication that had been prescribed, for example if too much or too little had been prescribed.

I cannot express my gratitude enough for being able to have this opportunity! It was so valuable and interesting and I know it has helped me so much. I truly believe it has also helped me on my journey to medicine because I was able to see another side of medicine, the pharmaceutical and drug-based side and it interested me so much. It was so eye-opening seeing how the Pharmacy works with the surgeries and GP’s and how they all interlink, and there was so much more to it than I ever thought.

Volunteering at Dragonflies, an after school club

Whilst I was in year 10 I volunteered at a children’s after school club, in Lakeside Primary School, called Dragonflies. I helped there for 6 months. Dragonflies is a place where the children can go after school when their parents are working and cannot pick them up straight away at the end of the school day. I went once a week after school for an hour and helped to look after the children who attended the club, and made sure that they were happy and having fun, whilst ensuring they were behaving and learning at the same time.

There were a range of activities that we did with the children on a regular basis including drawing, playing outside, cooking, playing group games or anything to that effect.

I learnt a lot whilst volunteering at Dragonflies. I developed my team work skills hugely as I was working with the other workers to ensure that the children were playing safely and behaving whilst also having fun. We had to organise games and activities and make sure that it was always noted who exactly was there and what time they left as there were children being picked up all at different times. This therefore greatly improved my organisational skills as I helped make sure all of that was being recorded and that all was safe and in order.

I also developed skills with how to deal with children and know the best possible ways of helping them to understand what to do, make sure they are happy and ensuring they stay well behaved. I tried to develop bonds with them in order to make them feel comofortable around me so they knew they could come to me for help and if they needed anything, or even if they just wanted a chat, as the whole purpose of the club was to make sure they were happy and having fun.

Caution and risk assessments had to be undertaken as activities such as cooking were undertaken, to ensure that the children were safe and any possible hazards and risks were dealt with. Also, as we were providing food and snacks for them we had to ensure that any allergies or food requirements were noted and that the children with those requirements were getting the right treatment and food, which required organisation, caution and communication.

Irritable Bowel Syndrome

Irritable bowel syndrome is a common disorder that affects the large intestine. It is a long term condition that has to be dealt with by the sufferer as part of their every day lives as it will effect them in the long run. I have taken an interest in this condition as we thought that my sister had this at one point, but it ended up being bruising of the colon. However this has made me want to know more about the condition and what people who suffer from it have to go through.

What are the symptoms?

The symptoms of Irritable Bowel syndrome vary from time to time, being worse at some times than others, for example when you are under a lot of stress. The key symptoms are:

  • cramping
  • abdominal pain
  • bloating
  • gas
  • diarrhea
  • constipation

People with IBS can often also experience times of depression and anxiety as it can be very tough on people’s lives and can very painful and debilitating.

These symptoms are not usually constant and can be relieved by going to the toilet, and therefore easing your bowels. They are usually aggrevated at different times, when people experience flare ups, and that can be caused by a number of things.

Causes of IBS

Although the official cause of IBS is unknown, there are lots of triggers that can aggravate it and make it worse. These include:

  • Stress
  • Diet
  • Female Hormonal Triggers*
  • Medicine Triggers*

*Female Hormonal Triggers – In my research I found that women are much more likely to suffer from irritable bowel syndrome than men are, and that it is particularly bad for women  when they have their period, which suggests that it is hormones that women have and men do not that can often cause flare ups.

*Medicine Triggers – If you are taking certain tablets, painkillers or antibiotics then these can make IBS worse, trigger it or give you some of the symptoms.

What are the treatments?

Although the condition is a long term one, it can improve and become less of an issue over time. It’s not clear what causes irritable bowel syndrome and therefore there isn’t really a known cure for it, however there are treatments that can be used to give some relief and ease the pain. The best way to deal with the condition is find ways to relieve stress and making changes to your lifestyle and diet. Here are foods that can help to ease and prevent the symptoms:

  • Getting rid of/reducing amount of high-gas foods (carbonated drinks and certain vegetables and raw fruits)
  • Getting rid of/reducing amount of gluten (wheat being a key one)
  • Exercise Regularly
  • Discover and eliminate any stress triggers

The best option is to talk to your doctor and they will be able to advise you on the best things to avoid and the best things to eat to target and help your own version of the condition, as different people will react differently to different types of food and methods etc.

This post was just a brief overview of irritable bowel syndrome and the symptoms, causes and treatments of it, and I hope you have found it interesting and enjoyed reading.

What Have I Learnt?

For me, something I have learnt which I never knew before was that women are more likely to get IBS than men are, and it may be hormones they have that aggregate it. I feel like learning all of this has really helped me understand the condition more, and although this wasn’t what my sister had, I can see what she went through more and what other people with the condition have to go through experience.

Sources of my research:

http://www.nhs.uk/Conditions/Irritable-bowel-syndrome/Pages/Introduction.aspx

https://www.buscopan.co.uk/irritable-bowel-syndrome/do-you-have-ibs/causes-of-ibs/

Arthritis

Another condition that I have always been interested in, and causes an issue with lots of people, is Arthritis. I’ve known lots of people who have had Arthritis and it can affect people of all ages and in lots of different ways.

What Is Arthritis
What Are the Symptoms of Arthritis
Arthritis in Children
Causes of Arthritis
Treatments for Arthritis

What is Arthritis

Arthritis is a common condition that causes pain and inflammation in a joint. In my research I found that 1 in 5 people aged over 18 get arthritis and almost 300,000 babies and children have arthritis or a rheumatic condition. Having arthritis can stop you from doing basic things such as holding things, walking up stairs, or walking in general, depending on what type of arthritis you have and what part of your body it affects. It’s a life changing disease and I cannot even begin to imagine how hard life must be for someone with the condition.

You can get arthritis in any joint and there are lots of different types of arthritis that you can get, but the two most common types are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is the most common type of arthritis and usually affects people aged 40 and over. It’s especially common in women and tends to have a history of effecting family in the past. This type of arthritis makes movement extremely difficult and can cause a lot of stiffness and pain as it damages the cartilage that lines the joint.

Rheumatoid arthritis most commonly affects people between the age of 40 and 50, and in my research I found that women are three times more likely to be affected by this type of arthritis than men are. It occurs when the body’s immune system targets affected joints, which leads to pain and swelling and it can cause bone and cartilage to break down. People with rheumatoid arthritis can also develop problems with other tissues and organs in their body.

What are the Symptoms

There are lots of different types of arthritis that you can get, and the symptoms vary depending on which variation you have.

Here are some of the general symptoms of Arthritis:

    • Early morning joint stiffness
    • Fatigue
    • A general feeling of being unwell
    • Weight loss
    • Mild fevers or night sweats
    • Skin rashes
    • Joint pain
    • Inflammation in and around the joints
    • Restricted movement of the joints
    • Warm, red skin over the affected joint
    • Weakness and muscle wasting

Arthritis in children

As you can see, arthritis seems to be most common with people aged 40 and above, but it is common for young children to have it too. The types that tend to affect children more are known as juvenile arthritis. This type of arthritis occurs when there is inflammation of the synovium. The synovium is the soft tissue that lines the spaces of diarthrodial joints, tendon sheaths, and bursae.

Bursae – small fluid-filled sacs that cushion a joint

Tendon Sheath – a membrane around a tendon that permits the tendon to stretch

Diathrodial Joints – The most common and movable type of joint

Juvenile arthritis is an autoimmune disease, which means that the immune system attacks the body causing the condition to occur. Although there is no known cause for juvenile arthritis, in my research I found that many believe it is related to a mixture of genetics, certain infections, and environmental triggers.

There are four main different types of Juvenile Arthritis. These are:

  • Oligo-articular (most common)
  • Polyarthritis
  • Systemic onset
  • Enthesitis-related arthritis

Oilgo-articular – most commonly affects the knees, ankles and wrists. One major risk of this type of arthritis is that the child may develop eye problems.

Polyarthritis – This type has similar symptoms to that of adult rheumatoid arthritis. Some symptoms include rashes on the skin and high temperatures.

Systematic – This type has quite a few symptoms. It starts with rashes, fever and a sense of lethargy and tiredness, and then can develop into the swelling and inflammation of joints.

Enthesitis-related arthritis – Most commonly affects older boys and teenagers. The symptoms include pain in the sole of the feet and around the knee and hip joints.

Causes of Arthritis

Although not all causes of arthritis are known, the potential causes include:

      • Injury
      • Abnormal metabolism
      • Inheritance
      • Infections 
      • Immune system dysfunction
      • Smoking
      • Occupations which are very physically demanding

Treatments of Arthritis

At the moment there is no known cure for arthritis, but there are lots of different treatments that people with arthritis can have in order to try and relieve the symptoms and make day to day life easier for them. Some general suggestions for treatment for arthritis include the following (although treatment does depend on the individual’s type of arthritis and the symptoms they have individually):

  • Painkillers
  • Non-steroidal anti-inflammatory drugs
  • Joint replacement
  • Joint fusion
  • Cutting and re-aligning the bone
  • Physiotherapy
  • Exercise
  • Disease modifying anti-rheumatic drugs

Overall, in my research about the condition I have found out a lot about arthritis, and it is such a complex disease which can affect so many people in many different ways. Personally, something I learnt that I’d never known before was that children could get arthritis as well, and I learnt about the different types of arthritis they can get and how it affects them. I hope this post has also helped you to learn more about the disease as well, and I hope you have found it interesting. Thank you for reading 🙂