*disclaimer: this is going to be quite a sensitive post, so please do not ask me for more information regarding specific details in the following account. i do not wish to damage any person or organisation’s reputation in this account but rather, to draw attention to an unpleasant experience and to get some stress reduction through verbal diarrhoea.*
1. do you think it’s appropriate for a patient to be visited four times during one single morning ward round? by four groups of people? to be probed and pressed and squirm in pain each time round?
NO, i don’t think so. i’m aware that in some hospitals, patients can be visited twice during each ward round, because the team sometimes splits into smaller groups so that they can finish seeing all their patients in time. at times, a patient has a more difficult diagnostic/management problem and the other team will visit as well, i feel that this is a justifiable situation.
it is NOT justifiable when a patient is first visited by a HO and another doc (probably MO), gets asked some questions and probed… then he’s visited by a registrar, who asks the same questions and probes some more, and then he’s visited by a different HO, an MO and a SIP student where he’s asked more of the SAME questions and probed once more! and finally, the consultant joins this last gang of docs, asking more questions, and NOT EVEN TOUCHING the patient?
the patient actually said: “When is this all going to end manz… and why isn’t anyone telling me what’s wrong with me???”
i do not think that a patient who is in pain should be pressed and probed so many times when it’s so obvious that there WILL be pain. have you docs not elicited tenderness before? or is it such an interesting and rare sign that you have to do it again and again?
2. i was unhappy with the team because two DIFFERENT docs on the team had given DIFFERENT management plans. what does this show of the team?
- a lack of cooperation and communication within members of the team
- a lack of organisation
how are we to trust such a team? how can we entrust our loved ones to people who give confusing and varied reactions to the same case?
3. i was extremely unhappy with the two HOs on call that day.
you do NOT clerk a patient, write up his notes and IGNORE the family right after clerking, especially if one of them was heading towards you, with the look on the face that says: how is the patient now? i felt like slapping the bitch. especially after she started treating me nicer when she found out that i was a medical student. WTH… bitch!
4. the patient was extremely pissed off by the consultant. he complained that the consultant did not treat him like a patient, did not greet him and totally ignored him while explaining the course of action to take with the junior docs. for eg. the consultant did not even tell the patient he was going to be sent for a scan! i suggest the consultant be sent for COFM make-up posting.
5. the patient was aghast when the attending surgeon, while talking to him, implied that he had operated on the patient, but that it was not his diagnosis or decision to operate. the patient was shocked and really concerned. through his words, the doctor had given the impression that he was desperate for a patient to practise operating on, and then he somehow absolved himself from all blame, should anything go wrong in the post-operative period. a chilling thought indeed. shouldn’t whoever it was that operated on the patient take some share of responsibility in what happens after the operation? in addition, by showing how ‘desperate’ he was to operate on the patient, it really shook the patient’s confidence in him.
6. this is just an issue of concern… i really wonder on the sense and wisdom of doing a CT scan for something that normally is based on a clinical diagnosis? apparently, the other doctor agreed with me regarding this point, but i suppose, there are always doctors who go in for the new gadgets… nevertheless, by then, the signs had progressed to the point where a clinical diagnosis was pretty certain. which made me wonder, was a CT really necessarily? what if it was a patient with financial difficulties? would the other doc still have ordered a CT?
THE GOOD
On the other hand, we were impressed and the hospital stay was made pleasant by the wonderful staff nurse and some other nurses manning that ward those few days. they were always cheerful, gentle, helpful and comforting to the patient. they made eye contact while speaking to you and went out of the way to help the patient. i say kudos to them!
The reg on call that day was a wonderful person. of all the docs, he was the only one who greeted the patient AND the patient’s family. He also introduced himself properly. Shame on all you other docs! He even offered a hand to shake. (I notice usually only professors do such a thing.) He was courteous, friendly and reassuring, both to the patient and the family. Now, THIS is what i call the model doctor!
I hope that i’ll bear this unpleasant experiences in my mind and learn from them. I should constantly remind myself that i must not become as snobbish, uncaring and unfeeling in the future.
1. Do you think it’s fair that medical students visit the same patient over and over again asking the same questions doing the same examination? We all still do. Ask over and over again, touch the same thing over and over again. Does it make it better that we all go at the same time? Well some of us don’t even bother to ask the rest along and just do it ourselves. If that is the culture we are brought up with? Do you think anyone would change that mentality?
2. As medical students, we never share information, we rarely share notes with others, we rarely share cases or little gems of knowledge we picked up along the way. During tutorials we all pretend to play dumb while some unsuspecting one among us becomes the “unfortunate one”, the ones among us who have the knowledge never share, nor do we discuss our concepts of the topic, how do you expect us to function as a team, if that is the way we behave as we work together as students. Let alone as colleagues with work politics abound.
3. How many among us only do bother to capture the essence of the case medically or clinically, do we actually bother to appreciate them as individual or as cases? With such underlying notions is it really possible to do 10,000 COFM postings and still become that doctor you speak of?
5. Doesn’t that doctor sound the exact medical student we all are, always wanting to find that most interesting case to clerk or examine, just for the experience, do we ever bother to be responsible for our behaviour? that we may have distressed the patient preventing the rest from learning from the patient too? with that sort of selfish mentality it’s rather hard to blame the surgeon for wanting to practise on someone, sounds exactly like a typical medical student.
6.Well if we continue to forget to share or rather refuse to share our clinical gems with our fellow peers, we will spiral into a system where each of us have our own brand of “cook book” medicine. No homogenity at all. We will never straighten our misconceptions and misunderstandings and merely exact them on patients. On our 1st day of call we will realise when forced to work as a team, we are mere individuals pretending to be together as a team. To really play as a team, we need to start thinking about who we are to the team. Good luck!
Comment by Medical Student — January 7, 2006 @ 12:45 am