Saturday, January 26

A&E placement

Simply amazing!

It was not just that I have learnt so much stuff in a week. It's the whole pleasant atmosphere of being there. It was a district general hospital I was attached to and the the department is divided into the ED and the Urgent care centre (UCC). I usually spend half a day at the UCC and the other half at the ED.

Here are the summary of stuff I've learnt:
Monday
- Abdo pain (child), Ortho exam (foot) and intepreting x-rays
Tuesday
- ECG (T invertion and bigeminal rhythm), Heart failure (cause and management), Convulsion (febrile), Bronchiolitis (infant), Unstable ankle fracture and reducing it, Trop-i increase (causes), D-dimer, Assessing bone/joint injury/pain, Assessing pleuretic pain, Assessing trauma to chest wall
Wednesday
- Plastering, Cardiac arrest, Apical pansystolic mummur in anaemia, Bad practices, Severe abdo pain, Inserting femoral line, Checking BM
Thursday
- Assessing painful arm and shoulder, Pain relief in A&E, Inserting venflon and taking blood, Swollowed foreign body (management), Log roll, Positioning for x-ray C7 view, Scalp laceration, Tonic-clonic seizure (causes), Haematemesis, Bad discharge, Causes of faint/collapse, Allergic reactions, Common causes of infection in elderly, ECG (Supraventricular tachycardia), Sudden onset of 'unwell'
Friday
- Foreign body in the eyes, Trauma to shoulder and chest, Whiplash injury, Performing 12-lead ECG, Triage, Fractured neck of femur (external rotation and shortening), Fractured pelvis, Managing seizure, Hypovolaemia (signs and symptoms), Stem cell transplant (inflammatory reaction)

So you see I've seen quite a bit, and I've still got so much to learn! I must say I was rather apprehensive at the beginning because the only system in the body that I am well versed in is the GI tract and the genitourinary system; whilst at A&E patients pop in with all sorts of problem. But after my first day, I know I need to learn to examine all the major systems in the body, which will be quite overwhelming. In addition, I get to see the patient before the doctor does, write up the history and examination finding, discuss possible diagnosis and suggest investigations and further management for the patient.

On my second day two registrars gave me some tips:

'If you have a bad experience here, don't take it as a representation of the speciality' - that's probably quite useful because the department is extremely busy most of the time, and we always have managers harassing the medical staff, telling doctors what to do.

'Ask lots of questions, don't hide around the corner' - that's what I've been trying very hard to do. It was understandably difficult for the first few days and I did feel a little neglected. But I realised that, like placement anywhere else, I've just got to look interested and offer to do anything for the doctors and nurses. Otherwise people just won't notice me, or won't even realise who I am after four weeks in the department if I keep on shying away.

And one of tips from a consultant: 'Learn anything. Anything you can lay your hands on or anything you can observe. Even with things like adjusting the bed's cot side.' - That is quite helpful because as a student there isn't much I can be very helpful at and it's only these very simple things I can do to feel a little useful.

There is only one thing. A consultant said I need to wear a white coat. Ever since he told me that, he asked me everyday where is my white coat. I kept on saying 'next week'. So from next week onwards I will have to wear a white coat. I'm going to look so weird...

Wednesday, January 9

Campaign dilemma

I'm really annoyed with myself because really, I should be studying! So many chapters and notes to read and memorize and yet I can't help blogging away here...

Anyway I just want to talk about the issue of the right to healthcare among the immigrants in the UK. In Manchester, Gemma, a friend of mine and I started a student group called Crossing Borders, which addresses healthcare issues among refugees and asylum seekers. The main reason I was involved was because I had experience working with the refugees community and kind of understand what problem they face. In our group we have about 10 enthusiastic members. Just before christmas, we successfully hosted a peer education workshop about refugees and healthcare for medical students, which was very encouraging.

At a national conference with the same student group from other medical schools in the UK, we agreed that we would take up the campaign of defending primary healthcare for asylum seekers. Just a background information: the government is expected to come up with a regulation to put a stop to failed asylum seekers accessing NHS primary healthcare services. This would mean that failed asylum seekers will not be allowed to register with a GP, not receive antenatal care, not get immunisation etc. When I first learn about it, I thought this is wrong, and no doubt the I would get people to sign up for the campaign.

Then over time I swayed. The public response generally doesn't favour our stand. Many people put up comments like 'why are we paying for their healthcare?', or 'why are these people not deported in the first place?', which was not pleasant, but I can see some truth in them. I tried to convince myself - these people had fled to the UK to seek refuge, not to take advantage of the welfare system here.

Then what this consultant told us about her encounter with some dialysis patients who came to the UK for free dialysis treatment really shoke my belief. She said normally these patient would be transported from the airport straight to the hospital with symptoms of severe ureamia. They dialyse them, then the doctor breaks the bad news 'I'm sorry but you have kidney failure'. The patient would appear as though they were not surprised by the news, but denied that they knew that they've got the condition. A few weeks into dialysis, it would transpire that they actually knew that they have renal failure before arriving and coming to the UK is literally a gamble on their life, either they are going to receive dialysis and live, or they will be deported and die. Now this is really a difficult dilemma. If you have to know, as the saying goes back at home, living with kidney failure is not an option the poor, because the cost of treatment is just so ridiculously high. For a person to undergo haemodialysis for a year, taxpayers would have to fork out a whooping £35,000! Is it fair to the british taxpayers to be funding the treatment of these foreigners when some of the british patients don't get their life-saving cancer drugs which is just about the same price? And when a patient is on dialysis, their almost always would be put on the transplant list as having a transplant is much cheaper in the long run generally speaking. Yet, this would only make the waiting list longer than it already is, and making the british patients wait even longer for a donor and face higher risk dying while more time is spent 'waiting'. Is it fair that the british patient who has contributed to the economy die while the foreigner, though arguably to survive, who is here to take advantage of the free health service here live for another 10 years with improved quality of life with the transplanted kidneys? The answer is obvious. It isn't fair. But as doctors, who are we to turn away the patient to let him literally just, die? I hate to think about what will happen to this girl http://news.bbc.co.uk/1/hi/wales/7178416.stm.

So back to the campaign, I actually felt that I would be very naive indeed to be saying that the goverment is being heartless, cruel to the vulnerables; and to gain public sympathy telling some sob stories. The group of students working on this campaign nationally are very passionate about the issue, but I think the shortcoming of the way they work was that there was no debate. All they do was lobbying the politician and look out for people who said something against their stand, and come up with argument to rebute them. What about the other side of the arguement? Why can't they acknowledge the legetimacy of the simple fact that the NHS has limited budget and can't be pleasing everyone in the country, let alone outsiders? If this is how campaigning is like then I don't think I'll ever be involved in any kind of campaign ever again. I don't mind signing a petition, but I'm not prepared to be the lead advocate and refusing to understand from alternative angles. Maybe I'm a born fence sitter. And I much prefer doing something more direct and practical like volunteering.

Today is Yee Leng's birthday - Happy 21st birthday!

Monday, January 7

Doctors to be: 20 years on

'Doctors to be: 20 years on' is a BBC production tracking down doctors from the time they had their interview to get into medical school 20 years ago until the present time. It's really inspiring to watch because I can relate to the character in the documentary. Particularly at times like this when exams is around the corner, when there's so much to read and take in that I almost always feel like giving up, wondering if there any point to even try to read through this enormous amount of stuff. And the bad news is medicine is a profession of examinations, pretty much at all stage until we get to the top. I do want to end up as a successful hospital consultant and it doesn't matter how much hard work it takes. But I'm far from there. Very long road ahead indeed, that it's just very difficult to convince yourself that all these effort will be all worthwhile after all. Watching the consultant on the documentary who went through exactly the same thing as I am facing now kind of put some perspective back into me.

I've also realised that medicine is truly a profession of lifelong learning. I've learnt so much over the last 12 weeks, and yet there are so much more that I don't know. I'm not alone. The junior doctors know a hell lot of medicine. I'm always at awe about how much they know when they teach us medical student practical medical. Yet there are always things that they are not sure of, and would need to ask their consultant about, and it's not uncommon to see junior doctors listening along as a consultant teaches the medical students. And the consultants - at the first sight you would think that they were just walking encyclopedias of the speciality. They speak so eloquently on their subject matter and command so confidently in day-to-day medical practice you would think that there's nothing that they don't know. Yet sometimes even the consultants get stuck. That's why there is so much research going on. Thanks to the complexity of the human body, the thirst for knowledge in medicine will stay alive as long as we are in the profession. One last thing about medicine being so unique is that everyone learn from each other all the time. Most of the time knowledge does get passed down from the seniors to the juniors, but that doesn't mean that the seniors necessarily know more than the juniors about everything. Although we endeavour to learn everything under the sun, we simply cannot, and we rely on each other to fill in our gaps of knowledge all the time.

Despite feeling that I was going to fail every time I sit for an exam, I've managed to pull it through so far. I hope the same will happen this time. Fingers crossed.

Sunday, January 6

My neighbour

My neighbour is so annoying! She's a second year medic and she's been staying over for christmas holiday as well. She's a lovely girl. And a very hardworking one as well. I know that because when she revises, she reads aloud at the top of her voice! I can hear it from my room all the time. That's so annoying because neither can I sleep nor can I concentrate with my studies.

I seem to be annoyed with many things nowadays... not a great start for the year. I need some quiet meditation.

Saturday, January 5

Surgery

Yesterday was my last day of the four weeks attachment on the general surgical firm. Overall I have really enjoyed it. I love learning about the surgical diseases. It's refreshing to see the surgical approach of managing a patient. And it's useful to know that surgeons don't just operate on people. In fact, a large proportion of their time revolves around thinking how they can avoid operating on patients. The doctors have been absolutely amazing.

One thing I kind of did not enjoy was being in theatre. I despised wearing the oversized scrubs (which was often the smallest size left). I hated the crocs as they are so uncomfortable. I don't really like watching the operations. Most of the time in theatre I just felt bored and uncomfortable, like I didn't belong there. Also doing laproscopic surgery is like watching the surgeon trying to get around winning the playstation game, and I can't imagine myself ever being good at that.

But besides that all is well. The wards are just like any other medical wards, except that overall the patients looked better. As always I love talking to patients. I felt that I have learnt abdominal examination properly during this attachment, and can take focused history when a patient presents with an acute abdomen. My whole experience could have been much better if I get along better with my group. I have described my views about my group in my previous posts. And I have come to terms that I cannot change them if they are not willing to change themselves. So for the last week I have not really spoken to any of the people in the group. I've actually felt like I don't want to even see the sight of them or hear their voice for one second. I actually thought of throwing away a christmas present that I got from the group secret santa we played last christmas. That's awful isn't it? I don't know how come I can be so nasty. But I just couldn't stand their behaviour. Last week all of them again decided that a teaching would not be happening and hence we should all go home. It's not all of them that I disliked. Some of them were alright. Nevertheless I'm so glad that we will be splitting up next week.

Tuesday, January 1

$20

An ex-teacher of mine emailed this to me. I found it very true.

A well known speaker started off his seminar by holding up a $20 bill. In the room of 200, he asked, "Who would like this $20?". Hands started going up. He said, "I'm going to give this $20 to one of you but first, let me do this". He proceeded to crumple up the $20 dollar bill. He then asked, "Who still wants it?" Still the hands were up in the air. He replied, "What if I do this?" And he dropped it on the ground and started to grind it into the floor with his shoes. He picked it up, now crumpled and dirty. "Now who still wants it?" Still the hnads went into the air.

No matter what was done to the money, people still want it because it did not decrease in value. It was still worth $20. Many times in our lives, we are dropped, crumpled and ground into the dirt by the decisions we make and the circumstances that come our way. We feel as though as are worthless. But no matter what has happened or what will happen, we will never lose our value. Dirty or clean, crumpled or finely creased, we are still priceless to those who love is.

Happy New Year! May all of you have a wonderful year ahead.