Sometimes sitting in with GP can be very frustrating. For a start, I resent the university forcing us to attend the GP every monday throughout the whole of the fourth year. That's a fifth of the time spent at the GP. And it has to be a full day - I was told off for going back to the hospital one monday when the GP let us off at lunch time. I'm not saying that there is nothing to learn in GP surgery. I just feel that our time as medical student is limited, I much rather be learning and seeing as many specialised things that I might not see again until I qualify as possible. For example, I spent the last four weeks attached to Neurology and I am still not sure if I am absolutely confident diagosing and managing neurological disorders. I thought four weeks were simply not enough to grasp everything in such a massive specialty - and this is worsened by compelling us to spend bloody 20% of the time seeing cough and cold, sick note, medication review etc. The community medical education advocates argue that the common things are what we are expected to face most of the time when we qualify. But people expect doctors to know not only common things, but also a breadth of weird and wonderful disease. Whether it's rare or common, it's irrelevant. I mean that's what people go to doctor, isn't it? Every sensible parent know sore throat in children is quite normal and may well be aware that bit of calpol, fluid and rest will suffice, but they see the doctor 'just to get it checked out'. I certainly want my doctor to have at least seen some very ill patient, so when he sees one himself, if he cannot diagnose it, he would at least think about it. There's an old saying in clinical medicine 'if you don't think about it, you'll never find it'. One day I must compile a statistics on the proportion of time we spend on each specialty throughout medical school.
GPs are not all bad. When I do get enthusiastic tutor, the day can be rather enjoyable, sometimes to the point of inspiring me to contemplate a career in GP. When I am allowed to do stuff, like taking history and examination, apply plaster, dip some urine or play with baby for example, I'd be even more elated as oxygen fills my dying brain. Unfortunately, medical students are shoved to the corner for the entire surgery most of the time.
This semester, the GP is a let down. He's alright - he goes through the PBL case with us before the start of surgery every morning. But he just rambles on and on. I like to talk and demonstrate my knowledge but I hardly have the opportunity to open my mouth. He's so patronising. We are fourth year now and he talks to us like first year students. More often than not, my monday morning freshness is killed just 10 minutes into his incoherant lecture. With the patients, his listening skill was awful (doesn't surprise me - it's all about him talking). And my goodness, the way he drags his sentences drive me up the wall! However, the good thing is that he does arrange patient with conditions relevant to our PBL case for us to meet each week. So PBL wise he's been quite helpful.
To be continued.
Monday, September 29
Sunday, September 7
Gloom
Sorry about the somber post. Don't know why am I feeling so gloomy and grumpy lately. Maybe it's the weather. Manchester weather has been terrible!
Rain rain go away
Come again another day
Ah Yen wants to go out and play!
.
Rain rain go away
Come again another day
Ah Yen wants to go out and play!
.
Monday, September 1
Guilty conscience
I am beginning to doubt if I have made the right decision to work in this profession. I am a perfectionist, by nature and nurture. I hate mistakes. It used to take me very long to get over a tiny thing although I'm getting better at the art of ignorance (or any better word for it?).
There were many times when I have done things the wrong way and have result in some damage. I am going to give three examples:
1. Tanjung Rambutan visit while I was in college
It was a work experience visit in the forensic psychiatric ward. I found it extremely interesting talking to rapists, murderers and other offenders about their illness, One particular guy showed me the various long scars of self harm across his neck, tummy and wrists and how stigma from his family meant that he had to be locked up in the unit for the rest of his life eventhough he was cured (since his family was not prepared to receive him back home which was one of the conditions for discharge).
Then we went on to observe some consultations with the house officer. A guy was trying to convince us about him hearing voices from Erra Fazira (a local singer) and that they were getting married. I distinctly remembered that all of us - the doctor, the medical assistant and us the three students burst into laughter and couldn't stop laughing for another 5 minutes. The patient was reduced to tears that we thought it was a joke, and the medical assistant threatened to put him in seclusion if he was to throw a tantrum.
I didn't actually think it was unprofessional until recently when I thought back and realise how horrible was that for the patient. We were encouraging him to keep to telling his 'wedding plan' while continuing to laugh uncontrollably, as if watching a comedy. Sure, I can blame the more experienced staff for not setting the right example. But I wasn't coerced into following the crowd. I was genuinely amused with the patient's story and wasn't giving any thought about he would feel in response to my behaviour. Perhaps that was one of the early signs to suggest that I lack the human quality required of a good doctor.
2. Old man who loved his sago pudding
I don't know much about this old man's history as the ward doesn't give handover to auxillary nurses. After spending a few minutes with him, it was obvious that he was bed bound and he was trying hard to talk but I didn't understand most of what he said. Dysarthria? Could it be stroke? Anyway from his body language I could tell that he wanted the unopened sago pudding in front of him. So I opened it and put a spoonful in his mouth. It was quite a watery bowl of sago pudding. He seemed to enjoy it. Only that as soon as he tried to swallow, he coughed and made some gurgling noise. I instantly felt uncomfortable and hesitated. Before I could think, he was making gestures to want another spoonful. I looked around his table to see if there was any powder to thicken the fluid. There wasn't. So I gave him another spoon. The same thing happened again. He struggled to swallow. So I told him that I didn't think it would be a good idea to carry on. But he wouldn't take any of that. He really wanted some more, and was making more vigorous gestures for more of the pudding. I gave in. Then he choked again. Only then I decided that I must insist to stop and I explained to him why I did it. He looked really disheartened. I rarely see hospital patients with such good appetite. I felt sorry for taking away the pudding that he loved so much. I told his staff nurse what happened after that.
A few hours later I walked pass this old man, and I heard something funny. He was wheezing so loudly that I can hear it without a stethoscope. Shit - I've definitely given him aspiration pneumonia. Shit shit shit!
But there was more bad news to come. I was allocated to the same ward again a few weeks later when the staff told me that he has succumbed to a nasty chest infection and that he was dying. They are just trying to keep him as comfortable as possible. My heart sank. I was swamped with a terrible sense of guilt. I wanted to read his medical notes but I couldn't bring myself to. What if it really was me that made him go downhill to the point of disrepair? I tried to redeem myself on that shift by giving him good patiance and care. But in my heart I knew the damage has been done. I am really sorry.
3. The ligature made of paper towels
I was at a young people's unit of a psychiatric hospital. I hate working here. I have never heard more alarms going off or seen patients being restrained more often anywhere else. I find it awfully difficult to get through to teenagers, even for a normal conversation. On that occasion I thought it was not going to be too bad because I knew all of the patients having worked here not too long ago.
I shouldn't have been complacent at all. I brought a girl into the toilet. We were supposed to supervise them but I wasn't clear if I should have a clear view of them all the time. 'TURN AROUND', she shouted at me. I thought it was understandable to give her some privacy. She then went to the sink and washed her hands when she finished and we went out. I didn't notice anything suspicious.
About an hour later, one of the staff asked me if I saw her taking any paper towel out of the toilet. I said I didn't but I did admit that I wasn't really looking.
I was just walking along the corridor after dinner when I saw that girl with her hoodies over her face and upper body. She wouldn't answer anything I asked, and wouldn't let me see her face and neck. So help was summoned and four people were needed to restrain her to take the hoodies off her. It turned out that she had made a ligature by tying knots from several paper towels and she actually had the ligature around her neck!
Again, I was overcome with a deep sense of guilt. Given that she was able to physically resist four people while trying to remove the ligature, she probably wasn't dying in any way then. Yet I just can't get over the fact that (had we not caught it in time) she could have been died, and the reason would be me: because I didn't watch her properly in the toilet. Things like that really knock my confidence off. I don't think I would be going back to any young people's unit to work again. I can't bear to see things like this happening.
___________________________
I think I have been extremely naive to believe that to be a doctor is to help alleviate human suffering. Patients are always physically, mentally or emotionally vulnerable when they come into hospital. They often have lost independence and are at the mercy of the staff to help them around. And what do we do with this more often than not? We use to our advantage for our own convenience. It's just so easy for us to do harm, to be negligent, to make mistakes, to be ignorant. I always pride myself as patients' advocate. I know no one is perfect. But sometimes I find it hard to forgive myself. If a person dies because of me, what amount of forgiving is going to bring back someone's daughter or granddad or good friend? After all the things I have done do I still deserved to be trusted?
One of the GPs told me even after 30 years of experience, things like missing cancer diagnosis still happen to him once every two or three weeks. Does this mean that I HAVE to ACCEPT that mistakes just happen? Because I don't think I can practise medicine knowing that there is a chance that things will go wrong because of my incompetence. Maybe I should consider doing histopathology or something like that - that way at least I know that I am not directly responsible for a person's life.
Sorry if this piece doesn't sound coherent. My brain is churning.
.
There were many times when I have done things the wrong way and have result in some damage. I am going to give three examples:
1. Tanjung Rambutan visit while I was in college
It was a work experience visit in the forensic psychiatric ward. I found it extremely interesting talking to rapists, murderers and other offenders about their illness, One particular guy showed me the various long scars of self harm across his neck, tummy and wrists and how stigma from his family meant that he had to be locked up in the unit for the rest of his life eventhough he was cured (since his family was not prepared to receive him back home which was one of the conditions for discharge).
Then we went on to observe some consultations with the house officer. A guy was trying to convince us about him hearing voices from Erra Fazira (a local singer) and that they were getting married. I distinctly remembered that all of us - the doctor, the medical assistant and us the three students burst into laughter and couldn't stop laughing for another 5 minutes. The patient was reduced to tears that we thought it was a joke, and the medical assistant threatened to put him in seclusion if he was to throw a tantrum.
I didn't actually think it was unprofessional until recently when I thought back and realise how horrible was that for the patient. We were encouraging him to keep to telling his 'wedding plan' while continuing to laugh uncontrollably, as if watching a comedy. Sure, I can blame the more experienced staff for not setting the right example. But I wasn't coerced into following the crowd. I was genuinely amused with the patient's story and wasn't giving any thought about he would feel in response to my behaviour. Perhaps that was one of the early signs to suggest that I lack the human quality required of a good doctor.
2. Old man who loved his sago pudding
I don't know much about this old man's history as the ward doesn't give handover to auxillary nurses. After spending a few minutes with him, it was obvious that he was bed bound and he was trying hard to talk but I didn't understand most of what he said. Dysarthria? Could it be stroke? Anyway from his body language I could tell that he wanted the unopened sago pudding in front of him. So I opened it and put a spoonful in his mouth. It was quite a watery bowl of sago pudding. He seemed to enjoy it. Only that as soon as he tried to swallow, he coughed and made some gurgling noise. I instantly felt uncomfortable and hesitated. Before I could think, he was making gestures to want another spoonful. I looked around his table to see if there was any powder to thicken the fluid. There wasn't. So I gave him another spoon. The same thing happened again. He struggled to swallow. So I told him that I didn't think it would be a good idea to carry on. But he wouldn't take any of that. He really wanted some more, and was making more vigorous gestures for more of the pudding. I gave in. Then he choked again. Only then I decided that I must insist to stop and I explained to him why I did it. He looked really disheartened. I rarely see hospital patients with such good appetite. I felt sorry for taking away the pudding that he loved so much. I told his staff nurse what happened after that.
A few hours later I walked pass this old man, and I heard something funny. He was wheezing so loudly that I can hear it without a stethoscope. Shit - I've definitely given him aspiration pneumonia. Shit shit shit!
But there was more bad news to come. I was allocated to the same ward again a few weeks later when the staff told me that he has succumbed to a nasty chest infection and that he was dying. They are just trying to keep him as comfortable as possible. My heart sank. I was swamped with a terrible sense of guilt. I wanted to read his medical notes but I couldn't bring myself to. What if it really was me that made him go downhill to the point of disrepair? I tried to redeem myself on that shift by giving him good patiance and care. But in my heart I knew the damage has been done. I am really sorry.
3. The ligature made of paper towels
I was at a young people's unit of a psychiatric hospital. I hate working here. I have never heard more alarms going off or seen patients being restrained more often anywhere else. I find it awfully difficult to get through to teenagers, even for a normal conversation. On that occasion I thought it was not going to be too bad because I knew all of the patients having worked here not too long ago.
I shouldn't have been complacent at all. I brought a girl into the toilet. We were supposed to supervise them but I wasn't clear if I should have a clear view of them all the time. 'TURN AROUND', she shouted at me. I thought it was understandable to give her some privacy. She then went to the sink and washed her hands when she finished and we went out. I didn't notice anything suspicious.
About an hour later, one of the staff asked me if I saw her taking any paper towel out of the toilet. I said I didn't but I did admit that I wasn't really looking.
I was just walking along the corridor after dinner when I saw that girl with her hoodies over her face and upper body. She wouldn't answer anything I asked, and wouldn't let me see her face and neck. So help was summoned and four people were needed to restrain her to take the hoodies off her. It turned out that she had made a ligature by tying knots from several paper towels and she actually had the ligature around her neck!
Again, I was overcome with a deep sense of guilt. Given that she was able to physically resist four people while trying to remove the ligature, she probably wasn't dying in any way then. Yet I just can't get over the fact that (had we not caught it in time) she could have been died, and the reason would be me: because I didn't watch her properly in the toilet. Things like that really knock my confidence off. I don't think I would be going back to any young people's unit to work again. I can't bear to see things like this happening.
___________________________
I think I have been extremely naive to believe that to be a doctor is to help alleviate human suffering. Patients are always physically, mentally or emotionally vulnerable when they come into hospital. They often have lost independence and are at the mercy of the staff to help them around. And what do we do with this more often than not? We use to our advantage for our own convenience. It's just so easy for us to do harm, to be negligent, to make mistakes, to be ignorant. I always pride myself as patients' advocate. I know no one is perfect. But sometimes I find it hard to forgive myself. If a person dies because of me, what amount of forgiving is going to bring back someone's daughter or granddad or good friend? After all the things I have done do I still deserved to be trusted?
One of the GPs told me even after 30 years of experience, things like missing cancer diagnosis still happen to him once every two or three weeks. Does this mean that I HAVE to ACCEPT that mistakes just happen? Because I don't think I can practise medicine knowing that there is a chance that things will go wrong because of my incompetence. Maybe I should consider doing histopathology or something like that - that way at least I know that I am not directly responsible for a person's life.
Sorry if this piece doesn't sound coherent. My brain is churning.
.
Subscribe to:
Posts (Atom)
