No rest for the wicked, fourth year UK placements begin!

Foreword! I started this blog post literally a couple of months ago now on my first week back in the UK, but didn't *quite* finish it as everything was super manic then - moving back into a student house near the hospital, trying to get back into the swing of UK medicine etc etc, and now before I quite realised it I have gone months without posting. Well I'm going to catch up now, starting with this blog (the rest on here was written at the time) and then retrospectively catch up with more blogs about whats being going on for me back in the UK. Sorry for the prolonged delay!

31/10/11: Still more elective posts to come, but they are only written enough so far to be a memory jog for me about what I did each day, not in blog form yet! However as of last friday I am back in the UK and didn't want to not write anything about my placements here just because I hadn't finished my elective blogs; will rearrange blog post order later :).

So back in England as of last friday, moved into my unfurnished house on Saturday, straight into lectures as of Monday...Hectic! The unpacked/confused mess of my bedroom is testiment to a busy week, albeit mostly because I have been catching up with various people and training/playing university sport (and after many months away, am in serious need of training!).

I am starting on a 6 week placement on Oncology but we also have GP visits and a research project to undertake and these take up a couple of days a week, so really my oncology placement is only 3 days a week (so just 18 days in total...which really doesn't sound that much when I think of it like that!). Furthermore one of these days is often only half a day.. I suppose this is why all the major specialites like surgery and medicine are done in 3rd year or we really wouldn't know that much about them!

So far it seems like this rotation is going to be a lot less clinical experience and a lot more lectures than 3rd year. I'm not sure how I feel about this, on one hand clinical experience is easily the most interesting part and I don't know how well I concentrate in lectures particulary when they are back to back - I try but am a bit too talented at accidently going into prolonged daydreams and realising I've missed a chunk of lectures! On the other hand though, it means everyone learns more or less the same thing and so no one misses any core information, the downside educationally of clinical experience is that it is so varied that you can learn very different things from your peers and accidently miss things. So swings and roundabouts really!

One of our lectures this week was all about being careful how we portray ourselves on social media sites such as facebook and blogs... The BMA has produced guidelines (you can get them from here if you are interested) on what doctors and medical students should and should not do on these sites after numerous doctors and nurses were suspended after pictures of them "planking" in a hospital were put on facebook. Personally think its a bit harsh that they got suspended, guess sense of humour is a bit lacking in that trust! As long as no patients saw/complained I really think that was just a harmless bit of fun, clearly I'm going to have to be careful what I do in the hospital myself!

Its quite scary how policed our social lives are already, and I don't understand why people can't see that doctors and medical students are human too and entitled to their own lives; but I suppose we have known from day one (literally, I'm pretty sure our first "fitness to practise" talks occured on the first day of medical school!) what we had signed up for. As a blogger the social media talk definately made me a bit paranoid, but I'm pretty sure I change enough minor details and am anomynous enough that I am not breaking patient confidentality. Just to clarify if you think a patient I talk about sounds like you, its very very very unlikely to be, I change basic things like gender and age (slightly) and I never use any specific details that would make a patients identity obvious. And on that note, time to talk about the patients I've seen this week....

The patient that had the biggest impact on me was a man in his early 20's that I saw in a Melanoma clinic. Now the melanoma clinic was an interesting experience because on one hand it was absolutely amazing prinicipally because the consultant I was sitting in with was wonderful and exactly the kind of doctor I aspire to be one day. She was both amazing with the patients and even though she was really busy she took the time to teach me an examination I did not know (how to examine the axillary lymph nodes) and explained patients to me. After the experiences we have had with doctors in the Tanzanian hospital it was a breathe of fresh air to be with not only a doctor who seemed to really know her stuff but one who also seemed to geniuneally care about her patients and did her best to explain things to them and reassure them (where as in Tanzania the doctors barely communicated with the patients and didn't ever appear very empathetic). On the other hand though it was a very depressing experience because the majority of patients we saw were palliative only (it is no longer possible to cure their cancer and now doctors are just treating to minimise their symptoms). Furthermore I saw quite a few palliative patients who were very young - maybe it shouldn't make any difference to my feelings whether the patient is 80 or 30 but whilst I felt sorry for both types of patient it did feel even more horrible with the younger patients because if it wasn't for the cancer they would probably have had years left and instead were having most of their life stolen away.

Accordingly the sadest patient was also the youngest and was roughly my age but had metastatic (the cancer had spread) disease. The doctor was trying to get him onto clincial trials which were looking at a new treatment for his form of cancer (although even this treatment was palliative but may give him longer) but unfortunately as if one form of cancer was not bad enough for a twenty year old, it had been found since that he had another form of cancer. Two cancers in an under 30 year old?? Possibly he has some genetic susceptibility which predisposes him to cancer, but it wasnt discussed. The other cancer itself would be treatable but unfortunately its presence means he is not eligible for the trial for his melanoma.

He seemed remarkably philosophical and optimistic considering the horrific luck that has been thrown his way. I think I would be completely unable to function in his position but he was just getting on with his life. It does worry me a bit though that he was so optimistic because he had not fully understood his prognosis rather than because he is a very strong/resilient person but hopefully this is not the case.

So a very sad clinic all in all but also one where I saw some fantastic medical practice in terms of empathy and really caring about patients, so definitely a clinic I am pleased to have experienced. I hope that one day I can be that good a doctor myself.

Halfadoc xx