Monthly Archives: August 2017

Work Experience – Day 5

Friday was the final day of my work experience at the QEH, and its safe to day that despite my hectic and busy week I definitely didn’t want to leave.

Again, I spent the morning doing the TSS ward round, but this time with a consultant, two F1 students and two ‘soon to be’ F1 students. There were a few patients I had seen every day of the week, showing that despite the aim for patients to leave TSS after 72 hours in the current situation of the NHS and QEH, this just wasn’t possible as beds, clinics and homes were not available for them to go to. The consultant had a very busy day, so the ward round was completed quickly, with lists and lists of jobs for the F1’s to do before they went home. After discharge letters, taking bloods, requesting scans and looking at X-rays, I spent the afternoon in a gastroenterology clinic.

The clinic was a different environment to that of the ward, and reminded me much more of a GP surgery. There were a variety of patients with different symptoms and illnesses, some losing weight unexpectedly, some gluten intolerant, some with IBS. In the same way as symptoms and illnesses varied, there were patients form all walks of life, elderly, a young mum with her 3 year old, a teenage girl, an alcoholic who appeared to have been drinking already. Again, each was spoken to differently despite the same questions being asked, depending on if they were nervous, experienced in controlling illness, alone or with family. There were two cases which stood out for me, the first a young anorexic girl, who was being investigated as the cause for her anaemia was unknown. The consultant realised when she was alone, that this would be a difficult consultation as she had nobody to support her – calling in a nurse to ‘chaperone’ eased and relaxed the environment, meaning there was comfort for her when she broke down in tears. This was a difficult conversation as she was worried the consultant would tell her GP her weight, missing her parents (who were on holiday) and worried about her future. The consultant was reassuring, never rushing or pushing her and making time for all their patients, something which is easily lost in a busy afternoon.

Breaking bad news is, I’m sure, something every doctor dreads. Unfortunately, the end to my work experience placement was not a happy one. The consultant I had been shadowing had to break the diagnosis of lung cancer to a patient. During an ultrasound of her liver, shadows had been found, and later scans showed that these were also found into her lung. While it seemed the patient was almost expecting this diagnosis, it was still an incredibly difficult conversation, again with a nurse present . The doctor was very clear that he wanted to keep the patient in the loop, as many decisions and discussions were taking place behind their back. The important aspect of this conversation was making the patient aware of the support network available for them, the opportunity to ask any questions and to write any down when she thought of them to ask later.

I had an incredible, eye opening week during my work experience. I would recommend it to anyone considering medicine, as it has shown me both the highs and the lows of life in  a hospital. I have realised the sometimes mundane tasks of an F1 doctor (sometimes they felt like secretaries) and how doctors are seemingly always rushing from one place, clinic or ward to another. Most importantly, it has shown to me that its a tough career, busy, with a lot of responsibility and hard work, but if you truly enjoy and love what you do (as everyone I met did) it is definitely worth it.

I am definitely excited for the future, and everything it may bring.

Work Experience – Day 4

Thursday was a very exciting day at the QEH, as it was the day the new F1 students began shadowing for their placements which began last week. Therefore, after the TSS ward round in the morning, I joined in learning about the computer systems, request forms and how the ward generally runs. the security of the NHS became apparent when I was told every website/system had to have a different password, and each be changed every month.

The systems for looking at blood results, X-rays, booking scans and researching patient histories were all shown to me, alongside the referral forms and blood book. After this, I enjoyed speaking to the two new F1 students on TSS, one of which trained in Malta and the other in Plymouth. It was interesting to hear their views on gap years, reapplying and their own university experiences, as well as the challenges they have faced along the way. I was particularly impressed by one of the students, who I couldn’t help but think I would love to be my own doctor. She always had her eyes on the patients, walking them back to their beds when they got confused and speaking to them when they were obviously bored or distressed. A particular moment was occurred when watching a lumbar puncture, where a (scarily) large needle is inserted between the vertebrae to remove fluid. This fluid also circulated the brain and so can be used to detect small bleeds. The patient was a young woman who was obviously distressed during the procedure. The F1 student brought her tissues and water, reassured her and told her to squeeze her hand through the pain. For me, this was the best and most impressive piece of practice I saw all week – all be it the most simple.

I spent the final part of the afternoon back in endoscopy, watching procedures and learning again about how the equipment (air and water) worked. Seeing how different patients were spoken to and experienced the procedures was interesting, as it was an unpleasant experience for everyone. It was a really interesting and insightful day, surrounded by the excitement of the new F1 students and it definitely confirmed that medicine is the only career I want to undergo!

Work Experience – Day 3

Continuing the reflection of  my work experience at my local hospital, the end of the week was just as exciting as the start. Wednesday began with the TSS ward round again, where I continued to learn how to interpret chest x-rays, and followed the treatment of many patients I had seen before. The lady with jaundice due to her liver failure was still smiling despite her deterioration, however the ward was also filled with new patients we had not seen before. A particularly memorable case was a drug overdose, a young woman with a suspected tear in her oesophagus who was reluctant to undergo any treatment, but after speaking to a doctor relaxed into the hospital environment and was much more willing to cooperate. Perhaps the highlight of my day were an elderly couple who warmed everyone’s hearts – she was desperate to have him home. After speaking to them for a while, ‘just a touch of heart failure and pneumonia’ wasn’t going to worry them, and in her words was nothing they couldn’t handle. Her positivity and supportiveness of her husband was endearing, and I couldn’t help but smile at her excitement towards his discharge.

I spent the afternoon at the endoscopy unit with a consultant, watching and learning about the  procedures he undertook. The first of which  was a colonoscopy of a young and cheerful (slightly drowsy due to the medication!) male. It was particularly interesting to see the tiny ulcers in his colon, and how small biopsies and photographs could be taken using the equipment. As he was an outpatient, he was given steroids to take home to and reduce the inflammation. The second procedure I witnessed was a stark contrast to the first, a frail, elderly man who was an inpatient. He had a gastroscopy, which was used as a diagnostic procedure, hoping to find the source of a bleed. By this point the blues had stopped, but the end of the oesophagus was inflamed with ulcers. However, this was a particularly interesting case as the consultant made me consider whether this invasive procedure was a good thing for patient, who was so frail and elderly. The possibility of over investigating was an interesting and complex one, and led me to believe that if it was my grandparent, I wouldn’t want the procedure done unless they were in serious pain, or it was urgently life threatening. These procedures are simple with relatively few risks, but they are also unpleasant and undignified.

Wednesday definitely opened up my eyes to the harsh realities of medicine and the unpleasantries of certain procedures. I really enjoyed learning and speaking to patients on ward rounds and finding out about their own hospital experiences.