Monthly Archives: July 2017

Work Experience – Day 2

Continuing my work experience placement at the QEH, I had another really interesting and insightful day. I began my day following the consultant on the TSS/MAU ward round, what I found particularly interesting was looking at chest x-rays, and listening to the sounds of patients’ lungs. For those with crepalations (crackling noises), looking at the X-ray reinforced the probability of infection, due to the amount of ‘white space’ seen. One particular patient with heart failure and pneumonia had an especially fascinating X-ray, with white areas appearing in lines – as if down each bronchiole. The consultant explained to me that because of the heart failure, not enough blood and thus oxygen was reaching the span of the lungs, causing the infection to occur in this manner.

I saw a variety of patients, from the elderly with infections and some heart failure, to a young man who had overdosed on drugs, a woman with seizures and another with jaundice, explained to be due to her liver failure. The young man who had overdosed, was my first experience of a rude and unpleasant patient, who could not understand how the doctors could not spend their entire day with him. However, he was dealt with calmly by an F1 doctor, who explained that his requests were underway and some pain relief would be along shortly. I was however, occasionally disappointed at how doctors would sometimes walk away from patients when they were speaking to them, and in one case, left a frail elderly lady confused about the future of her treatment.

In the afternoon, I sat in a diabetes clinic, listening to consultations with a diabetes nurse, nutritionist and endocrinologist. Here, I was surprised at how well the nurses knew their patients, but also how medicines were not relied upon. While diabetes is managed by insulin, I also learnt that diet (carb counting) and exercise where really important in managing diabetes. Encouraging their patients to learn about how their diabetes and insulin works, and it being explained on a one to one basis seemed really effective, in giving patients the tools they needed to control their diabetes with less (expensive) medication. As the diabetes nurses had a very niche area of work, it meant that they could see their patients frequently, and give them small ‘snippets’ of information to take away at once. Not overwhelming them, I was told that this made large changes to occur in small intervals.

I have really enjoyed my time at the QEH so far, gaining an insight into both the positives and negatives of working as a doctor, and the hospital environment as a whole. I am certainly looking forward to what the rest of the week will bring.

Work Experience – Day 1

This week, I am lucky enough to have a placement at my local hospital, on the MAU and TSS wards. The MAU ward is the medical assessment unit, where patients are examined and then referred to specialisms, sent home, or moved to other wards. The TSS unit stands for the Terrington Short Stay Unit, and was where I was placed today. Here, many patients are admitted due to a fall, problems with diabetes or problems which come through A&E which aren’t life threatening. The aim for a maximum stay at the TSS unit is 72 hours, however today I have seen the stresses and strains of the unit, and how this is not always possible.

Surprisingly, while not one of my first experiences in a healthcare setting, today was one of only a couple of times I have been on a hospital ward. My family and I are lucky enough not to fall ill very often, so it was a hugely eye opening experience. It is a tough environment, bright lights, loud noises and machines, ill patients and lots of people who need help, however I found I quickly found my feet and the ward became much less daunting.

I began my day following two F1 students and a consultant doing the ward round, seeing just under 30 different patients. I saw a number of fascinating conditions, including sepsis, jaundice and been able to listen to an abnormal respiratory sound –  ‘crackling’ and compare it to a healthy lung. From looking at the scans of the patient, I then saw that what was supposed to be a black area (lung) was patched with abnormal white areas, causing the crackling. This was explained to me to be fluid, which needed to be monitored incase it worsened. I learnt a lot medically, from simple abbreviations, to little pieces of knowledge about diseases and illnesses, however a key part of this for me was patient interaction. The consultant led the ward round, asking the F1 students questions and for their opinions, however, he spoke differently to each patient, both making himself easy to understand and the patients as comfortable as possible. Nobody wants to be in hospital and I’ve seen today how a friendly doctor, who listens to the stories a patient has to tell, can really improve a patients’ experience.

What I didn’t like about the TSS ward, was the emphasis on discharge. There seemed to be rush to get people out as someone was always waiting for a bed, and the F1 students were being pushed to discharge patients quickly by the nurses. It is a ward with an incredibly quick turnaround, and on speaking to one of the F1 students I shadowed for the rest of the day, she told me that she wished she had more time to follow her patients’ stories and really get to know them, rather than just treat them and send them on their way. This has really made me consider which aspects of medicine I might like to pursue, as I feel that this following of a patient and their story – both medical and personal, is an aspect of medicine really important to me, and one that you might not get in a ward such as TSS or A&E.

Having said this, I really enjoyed my insight into medicine today, as packed full of paperwork and stress as it may be. I saw both what I consider to be good and bad practice, and both upbeat and unhappy patients – a reality of medicine. Perhaps one of the loveliest and most heartwarming aspects of today was husband and wife, on adjacent wards just the other side of the wall from each other. The husband of the couple just wanted to sit and hold his wife’s hand, and this was facilitated for as much as possible by the TSS team, as they obviously appreciated just how much it improved their stay.