In my team, it is not compulsory for HO to present the patient in ward round. When the medical students were around, they presented all the patients. And when they were gone, the registrars would present all the cases. Nevertheless, every weekday morning is a stressful time in my team because there is a daily grand ward round. So sometimes, when few registrars have gone on leave, she/he in th ward would not have seen all the patients before the specialists arrive (at 8am). When no one is volunteering to present, the house officer has to step up and say something (although my fellow HO Amy was lucky enough to not have to present a single patient since she started working in this ward).
Presenting in the morning grand round is an intimidating affair. Four specialists scrutinize every detail you say and would jump at the chance to attack you, sometimes with clinical mismanagement, other times with the way you present or would simply ask question that you cannot answer. It is not only the house officer. The medical students and registrars get plenty of that as well. Shouting and scolding are the norm in the daily grand ward round.
Today was such a morning. Started with a patient who has been leaking and started Prostin induction yesterday, and was due for a review vaginal examination (VE) done at 5pm, which I had done and informed the registrar. Usually the registrar does these Prostin review VEs. When I told the oncall reg about my findings, he said he would review the patient himself later after the ward round (at 10pm) as he was not going to put in a second Prostin so late in the day. That was why I didn’t write down my 5pm findings. The specialists said I should have documented the things that I have done and that the registrar should have been called to insert a second Prostin at 5pm. I do feel bad for this because if I had insisted for the reg to come and put in the second Prostin at 5pm, the woman may not have been left leaking for so long (which put her and the baby at increased risk of infection).
Later on, I presented a case of hyperaemesis gravidarum rather smoothly, with only one point missed on the scan. (Prof S asked ‘Is it a viable pregnancy’ inpatiently). And when I finished, she said ‘Continue same’ and moved on. Phew.
Then I kept on being attacked on my handwriting – apparently too small. ‘Can you write any smaller?’ Dr L kept on shouting at me as we moved from one patient to the next. ‘Do you have Parkinson’s? Write smaller. Yes, just keep telling her to write smaller’ Dr N joined in the bombardment. At least my writing was neat and legible, although admittedly small. The thing is: the more stressed I am, the smaller my handwriting becomes. Specialists ought to know that.
The last straw came when Prof A (who had finished round on the other side of the ward) rejected a letter to a patient’s employer that I have written because I had just addressed it ‘to whom it may concern’ and rather than the employer specifically (and drew big circle around like a school teacher correcting someone's essay. The other four specialists read the letter out loud and agreed Prof A's point in unison. ‘What if she brings this letter to claim insurance? A big responsibility for someone as young as you to shoulder isn’t it?’ Prof S’ final words of advice, and left. Malu-nye...
‘Why do I keep on getting shot at today?’ I asked Amy, the other HO. Right after the round, we went down to the canteen and ate away our resentment.
Actually despite all of these, I do like presenting because we always get feedback on the way we present, clinical management and get asked difficult questions. I much prefer to learn this way than the British – ‘well done’ always because we pick up things much faster. I have learnt so much and have become more confident with each case that I’ve presented. I am an aduIt, I don’t take scolding and critism personally, and I have never been made to feel less than human, which is good enough for me.
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