Wednesday, 17 February 2010
Patient stealing and reaching the end of general medicine rotation
Been a bit overdue in posting this as have been a bit busy over the last week and a bit, for once this was mainly in a social way as its been my 21st this week - yay for legal USA drinking should I ever go there. Medicine has also been busy as this week is my last on general medicine so have been trying to complete my logbook (logbooks are the bane of a 3rd year medics life at my medical school, we have to get signatures to show we have attended particualar sessions, met various multiproffesionals and been observed practising various clincal skills).
The problem with our logbooks is that you have to get the signatures and as a result end up missing sessions that may be more useful educationally in order to get a signature. For example this morning I went to see the hospital Chaplain to find out about his role so that I could get my 10th and final "Multi Proffessional" experience signature. But as he couldn't do it any other time I had to see him rather than going to an additional teaching lecture, as that was optional and did not require a signature. It was admittedly interesting finding out what the chaplain does and how the chaplancy service at the hospital works (and I suppose will be useful to some medical students so that they know in the future they can refer patients there, but to be honest I already knew it existed so Im not sure I gained that much) but I'm sure my future patients would prefer I'd attended the lecture this morning by the famous visiting Clinician. That said I suppose logbooks do stop some people just skiving off.
Last tuesday I had my last "on take" to do and it proved to be a very annoying experience. I learnt the hard way that you can not always just trust other medical students with what you tell them as sometimes their competitive streak takes over their sense of fairness which is a real shame. During the morning on take I managed to find a patient that my consultant agreed could be a good CBD (case based discussion) patient - these are patients that we have to follow up throughout their time in hospital and then present (and be examined on) them at the end of the rotation. Anyway I spoke to this male patient and took his history just after he had been admitted and he was very easy to speak to and furthermore was unlikely to be in hospital too long which makes it easier as its a bit worrying when you don't know if your patient will be discharged in time for your CBD. He had chest pain which the doctors felt was ?PE and was exactly the kind of condition I was looking for - lots to talk about without being overly complex. However in the afternoon I made the mistake of telling another student on my firm (medical team) that I had found a cbd patient at last and the other student asked his name. Before I knew it this other student was running off to find the patients notes himself and also planning on using him for his CBD. :O! Now whilst we are not technically prevented from using the same CBD patient I think it is a bit frowned upon because really your CBD patients are meant to be people you clerked in when they came to A+E and then have seen ever since then. It is really meant to be an independent thing of finding a patient for yourself then following them through their admission. I didn't actually clerk this patient in but I did re take his history very shortly afterwards. What really annoys me is that this student didn't have the courtesy to ask if it was ok with me if he used the same patient but just did. Also Ive checked our examination timetable and I am doing my CBD after the other student in the same room - which means if the consultants don't change over in between then its going to look like I am the one who stole his patient and this could affect my grade unfairly. All in all very annoying.
I had more annoying times on this particular afternoon about patient stealing but not to the same extent. Not many patients were coming in for ages so I had to wait around in the MASU office for a while with nothing to do. On the plus side this meant that when patients did arrive, the registrar gave me one to go clerk in and my name was written up on the clerking sheet as seeing that patient (meaning in theory no one should go see the patient until after I have presented the clerking to them and then a junior doctor will review them with me). However when I found this patient in A+E her curtains were pulled and when I came in I discovered two other students on my firm already clerking her having seen her name on the A+E board as a new medical firm admission. This in itself was annoying when I had waited so long for a patient to clerk but then when I went back to the registrar and explained why I couldn't clerk them I gained a rant from him about how annoying it was when medical students didn't do things the proper way. He told me I had to tell my collegues the proper system but when I did so I'm not sure it came across the best way because it was hard not to show that I was a bit annoyed myself that they nicked my chance to do some clerking (and by this get some vital clincal skill logbook boxes signed off!). A tough day.
I had a better day yesterday managing to get a teaching ward round, gi history and mini cex (this is like a practise CBD but done from just one time seeing a patient) all before 1pm which was pretty awesome. I had previously had trouble finding both a GI history (as patients with GI problems always just seemed to be due to come in when I have been on take but have never emerged) and a mini cex so it was great to finally get these done (and both on the same patient as I used a GI problem for my cex!) The patient was lovely, she was happy to let me re take her history and examine her even though she knew it was just for my benefit and she was feeling very nauseous (she was actually sick whilst I was in there but then encouraged me to continue afterwards when I was a bit unsure whether I should continue putting her through it). Lovely lady and then I had the fortune to present her to a very nice registrar so got better marks for my cex than I feel I strictly earnt. Good times!
Thats all for now as I need to work on my CBD (and to be honest watch an episode of house I'm currently streaming!) Sorry its been a bit of a rant this week, its probably because it gets a bit stressful when your trying to get your last signatures (which are usually the hardest ones to get hence why you left them till last!) so its particulary annoying when things stop you from getting them! Still only three more signatures to go now (and they are all sessions I'm timetabled in for wooo!) and then logbook completed :D. Have a lovely week.
\p.s. Apolagies for the wierd paragraphing - it won't let me make gaps today without a \ for some reason!