On one of the afternoon after the home visit, my GP said he would nip back home for a while to get some soup, so I followed. My jaw dropped when I saw his house. It was the perfect house really. Big and beautiful in a guarded community in the middle of a breathtaking countryside. The kitchen looked like Gordan Ramsay house's kitchen on television. I was just quietly admiring all the bits that I could get a glimpse of while drinking my soup. I can see why they say that doctors who have reached the peak of their career are be the top 2% of the wealthiest of the nation. I have been to quite a few people's houses (mostly ordinary people) while I am here and I have never been to one like this before. I think he deserves it because he works very hard (7am until over 8pm everyday) and cares for his patient very much. He and the other GP supervising me both told me on separate occasions to treat my patients like how I would like my own parents and my own children be treated, and I guess that was what made them so successful.
I didn't choose medicine because of the money that I would earn. I hope you are not rolling your eyes because this is the truth. My GP asked how much would I earn as a doctor in Malaysia, and I said I have no idea, and that is still the honest answer. Prior to this I have NEVER had any idea of a big house and posh cars and expensive hobbies as a result of being a doctor, and now, ashamedly I am thinking about it and I think it'd be nice to have all these to look forward to as I progress further in my career. At this stage, life is hard for me and all of my fellow medical student friends. Most of us are living independent of our parents for the first time in life with quite limited money to spare. The basics are all we can afford, I don't even wander over to the luxurious range corner of the store. Free lunch in hospitals tends to make us very happy because then we don't take to spare that precious £3 on food. In addition to all these, I feel I am not like many other people. I get only the allowance from my scholarship with no supplementary income from my parents (because I don't need it unlike my friends who are rich and are always overspending). Last year I was pickpocket and I was so devastated because there was about £350 inside. Doesn't sound much but that would have been all I'd spend in a month. I am brought up to spend on only what is absolutely necessary, and I'm glad. I don't have 10 shoes or make up accessories or night out dresses like most other girls. I don't feel that I need them. So I feel quite inferior after seeing my GP's house, feel like we are a world apart, and I just cannot see myself like that in 20 years or however long time.
Just another surprise that my GP commented that my English is much better than the other two Malaysian students he's had previously who drove a Volvo and obviously not needed a grant (scholarship he meant). I told it as a really nice complement!
Something to like about eh...
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Saturday, November 21
Sunday, November 8
I just downed three mug full of expresso strong coffee and swallowed 5 chocolate digestive biscuits. Am very very HYPER now. Have to get off my chair to star jump every few minutes.
Am about to write an email to explain why I am have been such a lazy procrastinator. I am ashamed of myself. Hope that person won't be too angry at me...
Continue working!!!
Just broke my favourite pink bowl when cooking. Is that bad? Hope they still sell it at BMS because I really really love the bowl. :( Don't ask me why I am cooking at this hour.
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Am about to write an email to explain why I am have been such a lazy procrastinator. I am ashamed of myself. Hope that person won't be too angry at me...
Continue working!!!
Just broke my favourite pink bowl when cooking. Is that bad? Hope they still sell it at BMS because I really really love the bowl. :( Don't ask me why I am cooking at this hour.
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Wednesday, November 4
Challenge me!
When I went to a facilitation training session 2 weeks ago, we were asked to list things that we do well + why do we do well and also things we don't do well + why. It was an interesting exercise, I learnt quite a lot about myself in just two hours.
One of points raised in the discussion was rather interesting. Many people felt that many a times, they are not able to do things to their maximum potential because they haven't been challenged. I know, I know. Medical students are supposed to be all self sufficient and self motivating and self challenging. But sometimes we just come to a point where we don't know which way is forward.
I think this has happened to me in my fifth year. I thought this year started badly with an unstimulating placement in the specialist cancer hospital. I wouldn't even call it a placement because I was hardly ever in. I spent less then 20 hrs in total in that hospital over the four weeks placement. We were not working under a named firm. We were not even allowed to take self initiative and turn up to clinics or wards - we were to strictly follow the time table. We had plenty of lectures and seminars - hardly challenging sitting on my arse for most of the time in the hospital. My only non-lecture based activities on my time table were a clinic and a bedside teaching. That's it. Two half a day of patient contact over the four weeks period.
Then I moved geriatric medicine in my usual teaching hospital. I am glad to say that because they were always short of medical staff and that there wasn't a house officer in the ward, I was usually the acting junior doctor. I still had to use my initiative quite often - constantly asking if there was a job I can do. Gradually they just give me jobs without me asking and I get things done without being told. Being involved in their continuing care, I knew every single patient in the ward well and felt quite happy making clinical judgement, ordering investigations, making referrals and to give information to patients and relatives. I knew that those jobs were well within my capabilities as I have been doing them since my fourth year. I guess working in a team is my strength and trying to build a good working relationship with my colleague just wasn't going to be a challenge at all. So in summary, extremely satisfying placement but perhaps not stimulating enough.
Now in GP land, I am having a great time with the doctors. The two GPs supervising me are fantastic teachers. I am finally feeling challenged by having to see my own patients. I have no problem doing the history, examination and diagnosis, but have never really ventured into informing patients about my diagnosis and management plan (mainly because I don't feel confident enough. Silly yee yen!), and now I am forced into doing that. I mean, if a consultant ask me quesions like 'What do you think the diagnosis is' or 'What is your management plan', I'd never ever say 'I don't know' because that'd make me look very stupid. A wrong answer is better than no answer. However, I am not so sure with patients, so on my first week I just resorted to saying 'I'm not sure, see what the doctor says' to everyone I see. But then I found that I have been right most of the time. So why not just discuss my thoughts with the patients? And I find that quite difficult. If all they need is prescription, that's easy. But if not, for example if they need lifestyle change, then I've got to explain things from how does the illness arise to how lifestyle changes can ease the problem. It's something that you'd think I ought to know, but I'm not very good at it. So I'm glad that I've found something to challenge myself for the remaining two weeks.
(This bit is not important)
Finally, I'd just like to moan about sitting in with nurses. In general, I don't think fifth year students need 'sitting in' with practice nurse anymore. Sitting in with the GPs is fine because there are clinical problems to solve and a high expectation is expected of me that I should be as capable and knowledgeable as a qualified doctor. On the other hand, nurse doesn't. The practice nurse that I am asked to sit in with is the friendly and lovely. But she just thinks I don't know anything. She talks about obesity and hypertension being a major problem in the community, and then showed me the immunisation schedule. (Great. Actually I am in my fifth year and I know and have already been examined on these before...) And she's never offered to let me do anything (and to be fair I haven't really asked except for today I asked if I could do a smear, she asked 'Have you been trained?' and later the answer to my question was no). But then you'd think even if I haven't been formally taught these skills, shouldn't it be her responsibility to teach and let me observe then try doing it under supervision? I dread sessions with her as they are just so boring. They are mainly just chronic disease review which consists of filling in template questionnaires. So she asks the patients the same questions off the computer and perform the same tests/examinations, followed by the same advice on smoking, diet and exercise. It can't get more ROUTINE than this. Talking about challenge - this is plain zero challenge. I might as well be in the library reading. Which is why, this Friday as there is no GP in the surgery to supervise me, I have asked to have a day off being I don't think it's worth the time sitting in with the nurses. I don't do day off normally. But I think I just have to take change of my own education and stop doing things that are not beneficial to myself. I hope I don't see anymore of this 17th century practice of passive 'observation' teaching. Sorry, I'm feeling irked.
.
One of points raised in the discussion was rather interesting. Many people felt that many a times, they are not able to do things to their maximum potential because they haven't been challenged. I know, I know. Medical students are supposed to be all self sufficient and self motivating and self challenging. But sometimes we just come to a point where we don't know which way is forward.
I think this has happened to me in my fifth year. I thought this year started badly with an unstimulating placement in the specialist cancer hospital. I wouldn't even call it a placement because I was hardly ever in. I spent less then 20 hrs in total in that hospital over the four weeks placement. We were not working under a named firm. We were not even allowed to take self initiative and turn up to clinics or wards - we were to strictly follow the time table. We had plenty of lectures and seminars - hardly challenging sitting on my arse for most of the time in the hospital. My only non-lecture based activities on my time table were a clinic and a bedside teaching. That's it. Two half a day of patient contact over the four weeks period.
Then I moved geriatric medicine in my usual teaching hospital. I am glad to say that because they were always short of medical staff and that there wasn't a house officer in the ward, I was usually the acting junior doctor. I still had to use my initiative quite often - constantly asking if there was a job I can do. Gradually they just give me jobs without me asking and I get things done without being told. Being involved in their continuing care, I knew every single patient in the ward well and felt quite happy making clinical judgement, ordering investigations, making referrals and to give information to patients and relatives. I knew that those jobs were well within my capabilities as I have been doing them since my fourth year. I guess working in a team is my strength and trying to build a good working relationship with my colleague just wasn't going to be a challenge at all. So in summary, extremely satisfying placement but perhaps not stimulating enough.
Now in GP land, I am having a great time with the doctors. The two GPs supervising me are fantastic teachers. I am finally feeling challenged by having to see my own patients. I have no problem doing the history, examination and diagnosis, but have never really ventured into informing patients about my diagnosis and management plan (mainly because I don't feel confident enough. Silly yee yen!), and now I am forced into doing that. I mean, if a consultant ask me quesions like 'What do you think the diagnosis is' or 'What is your management plan', I'd never ever say 'I don't know' because that'd make me look very stupid. A wrong answer is better than no answer. However, I am not so sure with patients, so on my first week I just resorted to saying 'I'm not sure, see what the doctor says' to everyone I see. But then I found that I have been right most of the time. So why not just discuss my thoughts with the patients? And I find that quite difficult. If all they need is prescription, that's easy. But if not, for example if they need lifestyle change, then I've got to explain things from how does the illness arise to how lifestyle changes can ease the problem. It's something that you'd think I ought to know, but I'm not very good at it. So I'm glad that I've found something to challenge myself for the remaining two weeks.
(This bit is not important)
Finally, I'd just like to moan about sitting in with nurses. In general, I don't think fifth year students need 'sitting in' with practice nurse anymore. Sitting in with the GPs is fine because there are clinical problems to solve and a high expectation is expected of me that I should be as capable and knowledgeable as a qualified doctor. On the other hand, nurse doesn't. The practice nurse that I am asked to sit in with is the friendly and lovely. But she just thinks I don't know anything. She talks about obesity and hypertension being a major problem in the community, and then showed me the immunisation schedule. (Great. Actually I am in my fifth year and I know and have already been examined on these before...) And she's never offered to let me do anything (and to be fair I haven't really asked except for today I asked if I could do a smear, she asked 'Have you been trained?' and later the answer to my question was no). But then you'd think even if I haven't been formally taught these skills, shouldn't it be her responsibility to teach and let me observe then try doing it under supervision? I dread sessions with her as they are just so boring. They are mainly just chronic disease review which consists of filling in template questionnaires. So she asks the patients the same questions off the computer and perform the same tests/examinations, followed by the same advice on smoking, diet and exercise. It can't get more ROUTINE than this. Talking about challenge - this is plain zero challenge. I might as well be in the library reading. Which is why, this Friday as there is no GP in the surgery to supervise me, I have asked to have a day off being I don't think it's worth the time sitting in with the nurses. I don't do day off normally. But I think I just have to take change of my own education and stop doing things that are not beneficial to myself. I hope I don't see anymore of this 17th century practice of passive 'observation' teaching. Sorry, I'm feeling irked.
.
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