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The Medic Mind

Discussion in 'Weblogs' started by The Medic Mind, Jun 27, 2016.

  1. The Medic Mind

    The Medic Mind New Member

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    I'm currently a fifth year medic, nearly about to graduate. I'll be starting work as a junior doctor this August and I'll be writing all about it on my blog: themedicmind.blogspot.com
     
    #1 The Medic Mind, Jun 27, 2016
    Last edited: Jun 27, 2016
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  2. The Medic Mind

    The Medic Mind New Member

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    To be frank, I wasn't looking forward to it. I had failed to haggle a day off before the night shift unfortunately, which in hindsight is probably fair enough. But I did manage to get a day off after. Thank goodness for small mercies. Anyway, I wasn't looking forward to Thursday night at all. By Tuesday, I could already feel a cold coming on. That tickly feeling in my throat, which was only slightly uncomfortable, was a warning of a greater doom impending. 'Please, not now', I prayed. In actual fact I could have postponed the night shift. I had just needed to do one, it was not specified exactly when. I still had one more week of the placement left to choose a night from. But I had planned it specifically for this Thursday, so that I could take the Friday off and have the weekend to recover. And I couldn't miss next Friday. So, I decided to stick to the plan.

    Now, the preparation. I had to be in on Wednesday as normal. I did the ward round, which was excruciatingly long. 4 hours of standing and trailing behind the consultant as we weaved in and out of rooms and curtains. And as it stretched out I knew I was definitely coming down with something. My body was feeling a bit achy and heavy, but not a great deal.

    Finally ward round ended. And I'd decided by then, to go home. Thinking it through, I was doing a 12 hour night shift the next day and I was getting ill. If I tired myself out now, I wouldn't be able to survive it. So I left.

    I got home and just slept, which was weird. I must have been really tired. Fast forward to 2 hours later, I woke up blurry eyed and feeling very much refreshed, ready to begin my preparation. My plan was to stay awake all Wednesday night, so that I could fall asleep Thursday morning and wake up refreshed to take on Thursday night. For this task I needed help; snacks, remote control, cups of tea/coffee, blanket, laptop. It was a long night

    The next day I woke up and got ready for my night shift.

    The beginning of the night was ok. Just a bunch of routine jobs that needed doing. I was tagging along with one of the FY doctors. He was really chilled out and funny, so we had a laugh.

    Then things went downhill pretty quickly. We were called to see someone who supposedly had post ictal confusion. I wasn't expecting anything major, I thought we would go down help out a little and be back on our merry way. When we arrived the patient was pacing around the room, rambling and shouting about someone being swapped for someone else and then repeatedly pulling at the emergency buzzer on the wall. Every time she did the whole ward would pulse with this red glow and the alarm would go off. She was definitely agitated. It was now three in the morning and we'd been there for an hour and a half at this point. Eventually the F1 prescribed some sedation. We ummed and arhed about which one would be the best, but in the back of our minds we're wandering how we will persuade her to take it. Thankfully, she required minimal restraining. We came back an hour later, to check up on her. She was fast asleep.

    'We need to take her bloods'. What? The patient was asleep, the nurses were finally getting back to their jobs, the ward was quiet and peaceful and now we were going to wake up the acutely psychotic patient and stick a needle in her arm. I was slightly apprehensive. But it went better than expected.

    The next call was to see an elderly patient who had fallen and nursing staff was querying a seizure. It was a small elderly lady who was very frail. We couldn’t feel a pulse or take a blood pressure reading so we had to put a crash call out. They were trying to take blood but they couldn't get a radial pulse, or a brachial pulse and just barely managed a femoral pulse.

    It was difficult to get a cannula in. Once they did, we all set about squeezing 500 ml saline bags as hard as we could to propel some fluids into her system. Gradually, all her observations started picking up and thankfully she improved. Her husband came to see her. We left them to it.

    By that time. The sun had risen, and was shining in all its glory.

    We did a few other menial tasks. And finished off the shift.
     
    #2 The Medic Mind, Jun 27, 2016
    Last edited: Jun 27, 2016
  3. The Medic Mind

    The Medic Mind New Member

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    How to prepare for an OSCE

    OSCEs aren't easy exams. It's a high pressured, anxiety inducing couple of hours. The best way to approach the OSCE is to have prepared for it. My OSCEs are generally made up of 16 stations/scenarios. They're 6 minutes long with 2 minutes for questions. When I practised for my finals, I used this format as well.

    I like to work in groups. Group work is more realistic. One person can be the simulated patient, one can be an examiner and another has to be the student. The 'station', which means scenario, is then timed.

    By doing this, you give yourself the chance to hear yourself in a safe setting. 6 minutes is a small amount of time and if you're not careful, the pressure of the situation might make you spurt out drivel. You need to get used to being in that mindset. Also, by practising certain words and phrases, you'll have them ready for the day of the exam. You'll also know what words actually don't sound right and you can avoid those. Say you've practised how to explain Crohn's disease. You've practised and you know what phrases sound better and what types of jargon to avoid. On the day, if you're so lucky to have a scenario like that, you'll be able to go into semi-automatic mode and perform as you've practised. You want to get into a rhythm so that it feels natural and easy.

    After the 6 minutes is over, the examiner and pretend patient will try to give honest feedback. The feedback needs to be honest or else there is no point. You don't need people to applaud and tell you how great you are. You need the truth. You need to know where you might lose marks and what you can do to gain them. Criticism should be given in a way that is helpful. You don't want to put people down unnecessarily. I adopt my medical school's approach: describe what the person did well and what they could improve on and how. Give them a few options: try say it like this or avoid this word. You don't always have to change everything, take what's been said on board, think over it and decide whether to keep it or not. If you're comfortable with the way you do something then don't change it. At the end of the day, it's someone else's opinion.

    Get the basics first and then build on it. I think it's best to know a little about a lot than a lot about a little. If you don't know how to do a certain skill, look it up. Try to find a video that closely resembles your school's method. If this is an examination, try it on a friend then on an actual patient (with consent) and have someone watch you and analyse your method. Having a doctor watch you would be the next step up. This isn't always feasible. However, if you're in a teaching session around the bedside and the consultant asks for someone to step forward and do a respiratory exam. Put yourself forward. I didn't enjoy doing it, but that sweaty and awkward feeling you get when you're being watched by people is basically what it feels like in an exam. This helped me to get used that feeling and have someone superior tell me what I need to change. Again, each consultant has their way of doing things and their way is not necessarily the right way. Just nod and smile.

    Practice when you can. Some OSCEs require you to perform skills like taking blood. Try practice these throughout the year and not just in the run up to exams. Like I mentioned before. You want to get into a rhythm of performing the skill so that it becomes automatic and you're not thinking through each step.

    Find out what's been tested in the past and make sure you've practised. Also, find out from people in the year above what examiners look for. I know that we automatically lose a mark if we forget to use alcogel on our hands in the beginning of the station. That's useful to know because I don’t want to keep losing marks at every station.

    These are some of the things that helped me get through and pass my OSCEs. They're not nice exams but I guess they're a necessary evil.

    Read more on my blog themedicmind.blogspot.com
     
  4. The Medic Mind

    The Medic Mind New Member

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    I recently published a blog post about all the things I'll miss about medical school. It's easier to think of them all now that I've finished. The last five years seem to have flown by so quickly and I'm waiting expectantly to start my new job as an F1.

    Read more here: themedicmind.blogspot.com/2016/07/becoming-a-doctor.html
     
    #4 The Medic Mind, Jul 13, 2016
    Last edited: Jul 16, 2016
  5. The Medic Mind

    The Medic Mind New Member

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    So a few weeks ago, I published a post about what I'd miss about med school and in the interest of balance I thought I'd write a few things that I won't miss about med school.

    I won't miss ward rounds. All that standing around and walking solemnly from patient to patient whilst the consultant mumbles to the other doctors, flicks through the observation charts and makes minimal changes to the drug chart gets very boring very quickly. It's hard to stay focused when they've actually forgotten I'm there. Some ward rounds can be up to 4 hours long, with no hope of rest or salvation

    I always felt like I was taking up space. Technically, I'm there to learn so there's not a great deal I add. So if I'm with the nurse whilst she's counselling a patient before a procedure and I'm just casually hovering over her left shoulder I do feel a little but useless.

    After 5 years of med school, I am so poor. Med school is not cheap. The debt I'm accumulating makes me want to cry and I'm so far in into my overdraft it's worrying. But I think I've managed to keep it together as best as I could. My car has been the biggest drain on my finances, but with some of the far off places the medical school has flung us off to, it has been my saviour.

    Bringing me swiftly to my next point: travelling. My med school loves to send us to the furthest, hardest to get to places in the name of medical experience. Some of these places can take up to a couple of hours to get to if you don't have a car. I quickly got one.

    I won't miss swapping wards every few weeks. Just about being able to remember the names of everyone on the ward and knowing where everything is, before moving on to a brand new ward and starting all over again.

    I've graduated and now I'm officially a doctor. I'll let you know how I get on.

    themedicmind.blogspot.com
     
  6. The Medic Mind

    The Medic Mind New Member

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    4 weeks in and I'm exhausted.

    My body went from 8+ hours sleep a day to lucky-to-get-6 hours sleep a day. I come back from work tired, I wake up tired, I'm yawning whilst eating lunch. I'm just generally tired.

    I think it's taking a while for my body to adjust to being a full time doctor. Or just being a full time anything. Before I started work I had a few months of taking it easy. Waking up when I wanted, sleeping when I wanted and not doing much in between. Now, most of my day is spent on my feet. I'm standing at the computer, at the bedside, running after consultants, the list goes on. The drive home is probably my first chance to actually sit down.

    I'm hoping my body will get used to this and realise that this is the new normal. The good times are over. I need to be in bed by 11 and awake at 6. And if I'm not in bed by 11, tough, I still need to be up by 6.

    I've started to depend on coffee now. I'm not a big coffee drinker but I've been hitting them pretty often nowadays. In the morning or at lunch time. Just something to stop me yawning whilst the nurse is trying to talk to me.

    It's not just that the work is physically demanding; it's also mentally draining. Especially, when patients need to vent their frustration and you get the full brunt of it all. You have to answer for someone else's decisions or the NHS's shortcomings. It's not easy to shake that off when you get home. I know for me it spins round and round in my mind for hours, weighing me down and then I feel even more exhausted.

    Social life is hovering at 0. If I'm lucky to get home at 6, I'm wiped out. Those few hours after work, I feel like a zombie. Barely any energy to actually feed myself. Anything that requires a good level of concentration I can't do. It's probably why I end up just laying on my bed scrolling through Facebook. Swiping down with my thumb requires very little brain power and I'm getting some social interaction from the comfort of my bed. It honestly feels like I step in at 6 and time starts to fast forward. Before I know it, it's 10 pm and I can't understand where the last 4 hours have gone. I blink, it's quarter to 11. I go to brush my teeth, I come back and it's 11:30. Sleep, wake up and it starts all over again.

    It gets worse when there are long days and nights. Then there's only a couple days to recover and then back to the 9 to 5 grind.

    Which reminds me, I have a set of nights coming up. Fantastic.


    themedicmind.blogspot.com
     
  7. The Medic Mind

    The Medic Mind New Member

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    I like change (to a degree). I don't like monotony, doing the same things over and over again with little or no difference in results. So for me, I'm looking forward to the new placement: a new team, a different workload, a different set of skills to learn. It keeps work interesting and keeps me on my toes.

    I don't think I've mentioned properly that I've been on a cardiology ward all this time. We treat the same things MI's (heart attacks) and heart failures. All. The. Time. It was interesting and new to me in the first couple of months but now it's becoming tiresome.

    Read more at: http://themedicmind.blogspot.com/2016/11/change-over.html
     
  8. The Medic Mind

    The Medic Mind New Member

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    So, I've moved my blog to a new space. Find me at Mind The Medic!!
     
  9. The Medic Mind

    The Medic Mind New Member

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    I planned to post something different but reading on from my last piece, I thought an update would be more appropriate. I sort of left it on a cliff-hanger and I haven’t yet talked about my current placement (which is funny because I’m a few weeks away from my next placement).

    It’s been a tough placement for me. Not tough in the way the previous one was. In comparison, my current workload is way more manageable and easier, plus I don’t have as much responsibilities. It’s just been really hard to adjust to. 3 months in and I still don’t feel like I’ve become a part of the team. The other day, I was asking for study leave from one of my consultants and he offhandedly replied that it didn’t really matter because I was a ‘supernumerary’. It struck me that that is how I’ve been feeling through the whole time I’ve been here.

    The last three months have taken a hit on my confidence. By the end of my first placement I’d built myself to the idea that I was a good F1, or I had the potential to be. The feedback I’d received had all been positive and I felt more empowered to get better. And now, it’s been different. I’ve been told off, constantly criticised and questioned to the point where it’s left me feeling quite vulnerable and ostracised from the team. I hate that I feel like the odd one out and I don’t feel included. It sucks that I’ve not felt as close to this team as I was with my last one. I am a people pleaser and to realise that people aren’t happy with me, it honestly puts me down. I understand people not liking me for my personality but it’s unusual for me to have a lot of criticism in a work place environment. I can only describe it as having a ‘type A personality’, someone who’s always aiming for As and A*s on homework and test papers. All of that contributes to a pleasing mentality, so all of a sudden I’m getting Ds and Fs (figuratively speaking) and I’m panicking because I’m not used to it.

    When anyone asks me how my placement is going. I want to smile and put a positive spin on it, but that part of me that always likes to blurt out the truth, gives a pained smile instead and I don’t have the energy to lie.

    In short, the placement has been painful for me but the end is so near. At least the experience has highlighted some of my shortcomings and to be honest, I couldn’t expect every placement to be plain sailing. There’s a lesson to every experience. I’m ready to take the lessons and move on as quickly as possible and hopefully make the next placement 100x better.

    Mind The Medic
     

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