My GP placement

Some of you might be wondering why the long silence. The answer is simply laziness, specifically the post-exam laze, although at the moment it seems ages ago since I've had my last OSCE. Time really flies....

I'm now on the third week of my SSC attached to a GP practice. Unlike ordinary practices, we specialise in providing primary care for asylum seekers only. In February this year when I volunteered in an event organised by the Manchester Refugees Support Network, I met this GP (who is now my supervisor) who works here and I asked if I could do a placement with her, which she happily agreed. I was naturally looking forward to this placement as (many of you might have know) I am passionate about issues surrounding refugees.

It couldn't have been a better placement. We see lots and lots of patients with post traumatic stress disorder. Although it was quite boring for me to see the GPs prescribe antidepressants after antidepressants, I enjoyed listening to their stories. It was extremely rewarding to see a patient who started off obviously unable to trust anyone and almost mute, to start to give bits of eye contact on the next visit, to start talking, to joke and finally to trust us enough to tell us their horrible ordeal. I have seen the most terrible scars from torture while examining these patients, yet it is often the unseen scar deep in the heart which is even more worrying. The sufferings that the asylum seekers face make the biggest problem in my life so minute, so insignificant. Similarly, because the close knit staff here know what's more important in life, they never complain about petty things. They are the nicest people ever, like the buddha, they are always calm and smiling and I get along with all of them very well.

I don't mind the heavy emotion involved, instead I usually get quite excited about it. But I can't help but notice that many of the patients see the doctor not for medical reasons. Many of them come in for a letter from the doctor for various reasons, eg to support an legal appeal, for a bus pass, to complain against the housing provider, even to report a hate crime etc. I mean some of these things are not even a doctor's job, but I have never seen the staff here refusing to help a patient. These asylum seekers are really desperate people. Besides having to deal with the stress from previous trauma and leaving home, they have to deal the the painful process of applying for asylum in the UK, at the same time not able to speak English and not allowed work. If we don't help them they just have no where to turn to. Thus the staff in this GP practice spend lots of time making phone calls and writing letters to sort out logistic/practical day to day things for the patients. I have helped a patient write a complain letter and another patient write a claim letter for compensation of lost item in the post. They were just tiny favours but the patients were extremely grateful, which gave me much satisfaction in helping them. Medically, I learn a few useful stuff not seen in ordinary GP practices in the UK. For example in unexplained anaemia I have to think about tropical diseases like tape worm, which is a deviation from the standard differential diagnosis; or in generalised myalgia before I write off one as a heart sink patient I would remember to exclude vitamin D deficiency.

At the end of the placement I need to submit an essay related to a chosen topic. I thought about the people I have seen and helped, and I thought about why I became so passionate about refugee issues since the college days. It was because I have a great family, and a warm home, a place I can seek shelter in and feel secure no matter what happens. And I think everyone should have a good home No one should be left homeless. And if you must know, the house that asylum seekers in the UK are provided with are often of the lowest standard. So I have decided to write an essay on the housing problems faced by asylum seekers and how their health are affected.

Exam

The much dreaded year-end OSCE is next week. I'm glad that I'm finally feeling a little panic. Clinical OSCE is not an exam I've sat for many times, so there's a worse fear of failing compared to sitting the other written test that I've grown quite accustomed to.

Yesterday I've finally found the jasmine tea that I've missed so much in the supermarket. I'm loving it!

The Apprentice

My favourite quote from the apprentice in this series was from Lucinda. Being one of the three candidates on the firing line in the board room, Sir Alan Sugar asked Lucinda who is a risk manager by profession 'What's the risk of you getting fired?', then she coolly answered 'The probability of me getting fired is one out of three.' That's such a genius answer! British Apprentice is so much better than the American version, probably because it's much more authentic as the BBC doesn't censor off all the swear words...

Presentation

Every friday, we have a session called Clinical Debrief. The a few of us from the two PBL groups usually take turn to present and discuss interesting cases we've encountered throughout the week. Our tutor have been quite open to suggestion in terms of what to do in these sessions. The activities range from heated debate on ethical and philosophical issues to OSCE practice. Last week I asked the tutor if he could teach us basic fundoscopy. Neither he nor the rest of the group looked keen, but just mumbled some websites and library books that I'd find useful. I don't like fundoscopy, but in view of the coming OSCE, I really want to take this opportunity to understand the common things properly. So I decided to prepare a surprise presentation to the group in the next session on diabetic and hypertensive retinopathy.

Throughout the week after the progress test, I researched on the internet and made sure I know the stuff myself. I put togather a power point consisting many different fundi pictures. Because it consisted of about 38 slides, I wanted to make sure that it doesn't drag on so I practised and practised in my bedroom.

And I did it today. It went really well!

'Did you said last week that you wanted to do some fundoscopy because you weren't very confident in it?' My tutor asked.
'Yes.' I said.
'And now you're speaking like an opthalmologist!'

And feedback from my friends had also been incredibly positive. From the quiz I put on later on people were definitely more knowledgable about the two conditions than they were before.

I know I'm not the most chatty person and I can be quite a boring geek. But I'm glad that I was able to contribute something to the group. And also on making presentation, I know I can present well even in front of large and critical audience provided that I prepare well before hand.

All in all, it was a really happy day for me.

Arrogance

Last week, I was in the ward with two other final year medical students. I like being with them. They are so busy catching up with revision and I get to learn stuff essential for exams. One of them was really nice, teaching me lots of mnemonics and loved playing the teacher, quizzing me on various things and enthusiastically predicting the OSCE stations that may come up in my end of year exams. The other one was alright I thought, but he became more annoying as the day went. He didn't really want to engage in conversation with me and the other nice guy. And then later on, he observed my cannulation technique and kept on telling me all sorts, building up the pressure, and finally I thought he was quite happy that I failed so he could have a go. The nice guy said he's over the top, sometimes feeling that he's better than everyone else. He jokingly said that I would be like that in two years time.

Which really made me wonder. I could actually turn out to be arrogant like the other guy when I reach his stage. I don't want to turn out like that. But, really, can what should I do to avoid it? What should I do if I already know more than I should? I sometimes try to keep quiet to give others a chance and to not show off too much. But sometimes others may see that as arrogance. I have clear weaknesses too - everyone who knows me can tell that I can't make idle conservation easily and I rarely attend social events, which makes others misjudge me.

In a recent portfolio review, I told the tutor that I feel bad for taking extra initiative to learn more than I am expected to. And she told me that's nonsense. My most enjoyable placement was the SSC in A+E, not only because it was a great learning place, but also because I don't have to lower my standard according to the ability of the medical students of my year group. It's complicated.

At the end of the day, I don't want to be better than anyone else. I just want to be a good doctor, a doctor who knows my stuff well. I don't know how is it like to practise medicine in Malaysia. But I would expect less senior support given the shortage of doctors in the rural areas. So when I am alone in the deep jungle of Sabah treating the indigenous people, I don't want to make mistake on my patients because I haven't learn enough in medical school.

I need a diary. Blog is good but sometimes I really need to vent. And there are things that I can't write on the blog. I'm stressed at the moment. Boiling from inside. But I shall maintain my calm exterior.

Next year

A while ago, I have decided that I don't really want to be too actively involved in Medsin next year, although I'll probably still continue coordinating a project and do some training occasionally. But last week a friend said I should go for the post of Manchester Medsin president next year. Then I had a rethink - it's nice to know that there are people who think that I can do it. But, no thanks. For two reasons really.

Firstly, I have underestimated the time commitment necessary in the clinical years. It's true to an extent that most of the firm allows medical students to 'do whatever you want'. However that's exactly my problem - I love medicine so much that I don't mind being in hospital from 9-5 everyday, in fact I really want to. That makes me thoroughly satisfied but perpetually exhausted, leaving me with no energy to deal with attending meetings, sending and replying emails, chasing up with what's happening with the other student projects.

Secondly, I thought I really want to have a life of my own, specifically a get away from medicine. I've always wanted to join the choir, drama group, dance classes, learn foreign languages etc, but I choose medically related extra curricular activities over those for the past years in university. Next year will be my last before my final year, and I don't really want to leave university regretting because of not doing things that I've always wanted to do. And being the vice president for Medsin as well as a medical student this year (and coordinating Crossing Borders Manchester and working as a part time auxillary nurse), I just find myself really struggling to do anything properly. I have no social life at all - all my spare time is spent on catching up with some rest. So next year I just want to enjoy myself, not take on more responsibility than what I can cope with.