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Showing posts with label studies. Show all posts
Showing posts with label studies. Show all posts
Titanic, numbers, medicine
Coming to the end of study week creativity, and blog wars (which I clearly won, muhaha).
During study week, I spent more time on numbers, than I did on medicine. Mean, median, life tables, cumulative incidence, incidence rate, binomial distribution, normal distribution, and so on. Statistics. Yawn? I thought it would be. But it was fascinating, the assumptions and stories behind these ways we use to summarise information.
One set of data really caught my attention. Survival of passengers aboard Titanic (see more detailed figures and analysis). What a story numbers tell!
"Those poor poor people," my friend said. Indeed, it does not take long before you feel the injustice seeping through the page (computer screen). Were the rich informed first? Were the poor systematically excluded from the lifeboats? Was wealth a measure of how much a person's life was worth? There are even journal papers discussing these questions.
The numbers tell a more noble story too, of how women and children were preferentially saved. It's sad - picturing these agonising decisions of who should live, and who should not. The rush, the terror, the scramble to safety, before your ship sinks out in the middle of a cold, cold ocean. Chilling too to wonder, when it comes down to it, would I not also push people out of the way to survive?
Would the movie Titanic be more powerful than these numbers, in impressing these images and emotions within me? I have never watched Titanic by the way, so I could find out, if I wanted to.
Working out answers to mathematical questions recaptured a period of time before university when I really enjoyed learning. The type of interest which consumed you, as much as a good novel you were reading, or a drawing you were working on. Not that maths was my favourite, but I have always enjoyed working out problems, doing questions to learn (like physics). Rather than areas which relies heavily on descriptions, and a good memory (like biology, which I didn't take up for that very reason). When I can and do study, the week before exams is usually one of my favourite weeks of the semester - sleep, eat, procrastinate, study, repeat. But I think, the contrast between intriguing Titanic figures and preparing for exams, has reminded me once more of why I don't find the subject of medicine very exciting.
I have come a long way from first year where I truly fell asleep through almost an entirety of one lecture, every single day. Sometimes I didn't understand the words they used, other times I couldn't see how I was supposed to remember step by step, what goes on in some long and boring biological pathway. Then somewhere during clinical school, I realised to my delight that understanding and problem solving was part of medicine too. Having not much knowledge of the details, you can still work out a basic history to ask, physical exam to perform, investigations to perform, or management issues to consider, for any condition or presentation.
You can get by with that, but it can only get you so far. You will always have those random lists which don't make sense. Obscure symptoms and signs which are barely logical, eponymous names which collect symptoms which should not even exist together, specific terms for radiological findings, associated conditions - some which feel associated, but most which feel unrelated, criteria for scoring for diagnosis or prognosis, staging systems for malignancies. Then drugs, with their hard to pronounce names, side effects which affect every system, dosages which can sometimes vary with brands, even for the same generic medication. Or expected values for this and that blood test. Or fanciful bacteria and parasite names, or body parts in full glorious Latin. And so many acronyms and mnemonics, that I might remember something amusing like I GET SMASHED (aetiology of pancreatitis), but barely remember what each letter stands for.
To be more than mediocre, you do need to remember tiring terms, long lists and fantastic figures. Physician training, or most areas of medicine really, seem to favour people with good memories. Which I lack; I would say, in general people don't get excited about an area that they are not good at. So I wonder at times, would I better utilise my strengths elsewhere, or would there be a suitable area in medicine? Or, would that matter less when you spend more time working and learning, rather than reading and learning? Would people be interesting enough that it wouldn't matter how interesting or disinteresting anything else was? I don't know, but I guess we will know, in time.
During study week, I spent more time on numbers, than I did on medicine. Mean, median, life tables, cumulative incidence, incidence rate, binomial distribution, normal distribution, and so on. Statistics. Yawn? I thought it would be. But it was fascinating, the assumptions and stories behind these ways we use to summarise information.
One set of data really caught my attention. Survival of passengers aboard Titanic (see more detailed figures and analysis). What a story numbers tell!
"Those poor poor people," my friend said. Indeed, it does not take long before you feel the injustice seeping through the page (computer screen). Were the rich informed first? Were the poor systematically excluded from the lifeboats? Was wealth a measure of how much a person's life was worth? There are even journal papers discussing these questions.
The numbers tell a more noble story too, of how women and children were preferentially saved. It's sad - picturing these agonising decisions of who should live, and who should not. The rush, the terror, the scramble to safety, before your ship sinks out in the middle of a cold, cold ocean. Chilling too to wonder, when it comes down to it, would I not also push people out of the way to survive?
Would the movie Titanic be more powerful than these numbers, in impressing these images and emotions within me? I have never watched Titanic by the way, so I could find out, if I wanted to.
Working out answers to mathematical questions recaptured a period of time before university when I really enjoyed learning. The type of interest which consumed you, as much as a good novel you were reading, or a drawing you were working on. Not that maths was my favourite, but I have always enjoyed working out problems, doing questions to learn (like physics). Rather than areas which relies heavily on descriptions, and a good memory (like biology, which I didn't take up for that very reason). When I can and do study, the week before exams is usually one of my favourite weeks of the semester - sleep, eat, procrastinate, study, repeat. But I think, the contrast between intriguing Titanic figures and preparing for exams, has reminded me once more of why I don't find the subject of medicine very exciting.
I have come a long way from first year where I truly fell asleep through almost an entirety of one lecture, every single day. Sometimes I didn't understand the words they used, other times I couldn't see how I was supposed to remember step by step, what goes on in some long and boring biological pathway. Then somewhere during clinical school, I realised to my delight that understanding and problem solving was part of medicine too. Having not much knowledge of the details, you can still work out a basic history to ask, physical exam to perform, investigations to perform, or management issues to consider, for any condition or presentation.
You can get by with that, but it can only get you so far. You will always have those random lists which don't make sense. Obscure symptoms and signs which are barely logical, eponymous names which collect symptoms which should not even exist together, specific terms for radiological findings, associated conditions - some which feel associated, but most which feel unrelated, criteria for scoring for diagnosis or prognosis, staging systems for malignancies. Then drugs, with their hard to pronounce names, side effects which affect every system, dosages which can sometimes vary with brands, even for the same generic medication. Or expected values for this and that blood test. Or fanciful bacteria and parasite names, or body parts in full glorious Latin. And so many acronyms and mnemonics, that I might remember something amusing like I GET SMASHED (aetiology of pancreatitis), but barely remember what each letter stands for.
To be more than mediocre, you do need to remember tiring terms, long lists and fantastic figures. Physician training, or most areas of medicine really, seem to favour people with good memories. Which I lack; I would say, in general people don't get excited about an area that they are not good at. So I wonder at times, would I better utilise my strengths elsewhere, or would there be a suitable area in medicine? Or, would that matter less when you spend more time working and learning, rather than reading and learning? Would people be interesting enough that it wouldn't matter how interesting or disinteresting anything else was? I don't know, but I guess we will know, in time.
University classmates
I've always found it awkward, to not see my classmates for years, then see them again. Then not for months, then again at internship talks and career related events, then not for more months, then again at exams, then not, then again at graduation and celebrations.
I guess, I never liked them much, and don't hold any sentimental attachment towards my cohort. In those preclinical days, I didn't like the fact that all the students from local high schools had their gangs, those from residential colleges were close to one another, those on the same train line got to know one another well, those from an Indian background had their own group, as did the exclusive Singaporeans who rarely associated with anyone else, and as did a group of Indonesians who were always so talkative. I didn't enjoy associating with those who were smart but arrogant, or obsessively competitive until they lived biochemical pathways and breathed anatomy notes. Nor did I share much in common with those who boasted about how many times they had sex in a day, those who were more interested in having a drunken good time than learning medicine, or girls who treated every day at school as a fashion show or beauty contest to win.
Maybe I met some nice people too, but I can't recall many. I disliked medical students altogether and avoided associating with them. Truth is, I probably felt that way because I felt sad and rejected about not fitting into their conversations, their backgrounds, their interests, their lives. I guess now my views towards the medical community have shifted, after encountering memorable friendships, friends who I'm thankful for, both at my clinical school and outside that too, with those from other cities and countries around the world. Nevertheless, being back each time reignites some of those negative feelings.
During our long wait in the holding area, as we held small chit chats with those seated around us, I wondered, what makes two people click, and another two get along awkwardly every time they meet? Is it that the other person is awkward (but they don't seem to have issues getting along with mutual friends), or that I'm awkward, or is it just something between us that will never change? On the other hand, how is it that another person may be socially awkward, but be one that you can get along with easily? What makes one person warm, and another cold as frost? How is it that you can laugh and joke with some people in one setting, and not know what to say to say to them, when the setting changes? Why do I feel hated and snubbed every time I interact with some people, or am I hypersensitive and misinterpreting their sentiments towards me? What is it about an interaction that makes two people want to get to know each other, make an effort to be friends, and how do people decide who are the individuals they will politely greet but are happy to never see again?
It's so complicated. My head hurts.
I guess, I never liked them much, and don't hold any sentimental attachment towards my cohort. In those preclinical days, I didn't like the fact that all the students from local high schools had their gangs, those from residential colleges were close to one another, those on the same train line got to know one another well, those from an Indian background had their own group, as did the exclusive Singaporeans who rarely associated with anyone else, and as did a group of Indonesians who were always so talkative. I didn't enjoy associating with those who were smart but arrogant, or obsessively competitive until they lived biochemical pathways and breathed anatomy notes. Nor did I share much in common with those who boasted about how many times they had sex in a day, those who were more interested in having a drunken good time than learning medicine, or girls who treated every day at school as a fashion show or beauty contest to win.
Maybe I met some nice people too, but I can't recall many. I disliked medical students altogether and avoided associating with them. Truth is, I probably felt that way because I felt sad and rejected about not fitting into their conversations, their backgrounds, their interests, their lives. I guess now my views towards the medical community have shifted, after encountering memorable friendships, friends who I'm thankful for, both at my clinical school and outside that too, with those from other cities and countries around the world. Nevertheless, being back each time reignites some of those negative feelings.
During our long wait in the holding area, as we held small chit chats with those seated around us, I wondered, what makes two people click, and another two get along awkwardly every time they meet? Is it that the other person is awkward (but they don't seem to have issues getting along with mutual friends), or that I'm awkward, or is it just something between us that will never change? On the other hand, how is it that another person may be socially awkward, but be one that you can get along with easily? What makes one person warm, and another cold as frost? How is it that you can laugh and joke with some people in one setting, and not know what to say to say to them, when the setting changes? Why do I feel hated and snubbed every time I interact with some people, or am I hypersensitive and misinterpreting their sentiments towards me? What is it about an interaction that makes two people want to get to know each other, make an effort to be friends, and how do people decide who are the individuals they will politely greet but are happy to never see again?
It's so complicated. My head hurts.
Prestige
Towards the end of high school, we flipped through a huge phone directory sized job guide, which has now become fully electronic. Abattoir worker, actor, aerobics instructor, agricultural engineer, analytical chemist, anthropologist, archaeologist. We have barely begun in covering the range of jobs starting with "A". By the way, anthropology was the one that sounded the coolest at the time. Oh well, maybe I will go back and do that BA one day.
At that time, I couldn't understand why training as an apprentice chef, was considered a "lower" job than say, an accountant. Or, why three years of university education was considered so much more worthy than a three year TAFE course. Or, why was it that, the higher a score that was needed to enter the course, the more students wanted to get into the course. Again I thought about the question, whilst working as a kitchen hand, alongside those who were a similar age to me, most who did not attend university, and many who did not complete high school. But, if you work hard at what you do, contributing to society in a meaningful way, what does it matter what you do? Even now, I'm not sure I completely understand the way our society ranks different occupations and careers.
In the same way, I don't understand why medicine is so prestigious. The expression of respect, especially but not exclusively within Asian circles, that becomes evident when one hears that you are studying medicine. Wow, you must be really smart. Uh, thanks? Not infrequently, I have had others misinterpret "studying medicine" to mean that I am going to be a nurse, or a pharmacist. It's when I feel the twinge of irritation of, no I'm going to be a doctor, that I realise, I have also adopted the attitude that we are smarter, better and simply superior. We joke about this so often and perhaps, one by one, we really start to believe it, if we didn't already upon entering medical school.
Elitist. Being in an old and well established university, our students are known for being stuck up, often making snide remarks about the incompetence of students studying on the other side of town. What, you are at a rural hospital for clinical school, you couldn't possibly have chosen to be there. Where are you going next year? Congratulations on your internship destination, largest is the best, the hardest places to get in, so you must be really good! Er, no I'm not, how do I explain that neither my marks nor my life achievements are amazing. I feel uncomfortable that my extended family is more excited about my internship destination than I am - uncomfortable, because I know they are happy because they love prestige. Anyway, how does older and bigger automatically equate to a better place to work and grow?
It just doesn't stop here. Which specialty training program are you in? The enthusiastic "wow" for someone on the R.O.A.D. to happiness (radiology, ophthalmology, anaesthetics, dermatology), or training in a much admired field such as neurosurgery, is such a stark contrast to the "oh" someone training to be a general practitioner often receives - oh, why don't you want to specialise? Just like when we were in high school and choosing what to study in university, we equate more "difficult" entry requirements, to a better specialty, and a better person. Not just academically, but smarter, richer and more important. Therefore, we treat them with special favour. Or should we?
Good marks and hard work are fine in themselves, and indeed, many of those in highly sought after specialties are talented, committed, and deserve the respect that they have. But it really bothers me, the obsession of prestige and achievement that surrounds this profession. How across every level, from medical students to consultants, we are judged, and in turn judge one another, based on rank, specialty, place of training and other such criteria. Not only professionally, but just as much in personal and social interactions. And how we judge those outside medicine to be just... well, not as good. Why aren't you dating someone in medicine - or conversely - of course my parents will be happy with my sister's new boyfriend, he's going to be a doctor!
Perhaps, most troubling, is when this occurs in fellowship. Attending a medical Christian event over the weekend, we were asked to add our year level and university, or specialty for graduates, to our name tags. I thought, does this really matter, and pondered whether it would affect the way we talked and interacted with one another. More than a year ago now, I attended a talk at Christian medical event where I clearly felt the hospital hierarchy in the room. I happened to be seated next to registrars who seemed to want to make it clear that they were registrars (not intern or residents), and seemed to change their manner when they talked to fellow registrars, and when the medical students talked to them. Or it could be purely my interpretation; or, they were shy and not very talkative anyway.
The speaker in front was the head of the endocrine unit at this hospital, and the director of that very prestigious specialty college. During the talk (on a topic which I have now forgotten) I wondered whether at times the speakers were not speaking more as consultants to their junior doctors, on how to do medicine and life, rather than humbly sharing God's words and God's work in their own lives. Considering how important connections are, in turn, I wondered how many students were using refreshment and mingling time as career networking opportunities, rather than seeking genuine fellowship and spiritual growth. Maybe I was being over cynical, but certainly, the thought of focusing on the networking aspect did not escape my mind.
So in Christ Jesus you are all children of God through faith, for all of you who were baptised into Christ have clothed yourselves with Christ. There is neither Jew nor Gentile, neither slave nor free, nor is there male and female, for you are all one in Christ Jesus. - Galatians 3:26-28
At work, we should respect those in authority, including brothers and sisters in Christ. However, it was disappointing to see hospital heirarchy, reinforced by junior and senior doctors (and students) alike, permeating into church life and ultimately, hindering fellowship and taking the focus away from God. Recognising that we are all sinners, and recipients of God's grace, why should one (no matter who they are in the medical profession) exalt themselves over another? Perhaps that experience made me reluctant to join the medical fellowship events in M. Until recently that is, when I was once again reminded of the importance of being inspired by, encouraging and being encouraged by other Christians in medicine. Just as those who are proud stand out, there are of course, many who are marked by faith, having lives which point clearly to God.
Do nothing out of selfish ambition or vain conceit. Rather, in humility value others above yourselves, not looking to your own interests but each of you to the interests of the others. In your relationships with one another, have the same mindset as Christ Jesus: Who, being in very nature God, did not consider equality with God something to be used to his own advantage; rather, he made himself nothing by taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself by becoming obedient to death — even death on a cross! -
Philippians 2:3-8
What's wrong with being elitist? What's wrong with loving prestige? What's wrong with having an elevated view of our profession, our university, our hospital, our specialty, our rank? It matters what we value first and foremost. We lose perspective when self becomes bigger and more important than God. We forget who we trust in, who we should be thankful towards for all that we have. We compare with others, begin to focus on collecting trophies, aiming for what is "best" and most prestigious, to serve our pride and desire for recognition. In doing so, we lose sight of our purpose, and become distracted from working for God, and living to love others. Jesus, king of kings, did not exalt himself but came to serve. How each of us, not least myself, should be constantly reminded to do likewise!
At that time, I couldn't understand why training as an apprentice chef, was considered a "lower" job than say, an accountant. Or, why three years of university education was considered so much more worthy than a three year TAFE course. Or, why was it that, the higher a score that was needed to enter the course, the more students wanted to get into the course. Again I thought about the question, whilst working as a kitchen hand, alongside those who were a similar age to me, most who did not attend university, and many who did not complete high school. But, if you work hard at what you do, contributing to society in a meaningful way, what does it matter what you do? Even now, I'm not sure I completely understand the way our society ranks different occupations and careers.
In the same way, I don't understand why medicine is so prestigious. The expression of respect, especially but not exclusively within Asian circles, that becomes evident when one hears that you are studying medicine. Wow, you must be really smart. Uh, thanks? Not infrequently, I have had others misinterpret "studying medicine" to mean that I am going to be a nurse, or a pharmacist. It's when I feel the twinge of irritation of, no I'm going to be a doctor, that I realise, I have also adopted the attitude that we are smarter, better and simply superior. We joke about this so often and perhaps, one by one, we really start to believe it, if we didn't already upon entering medical school.
Elitist. Being in an old and well established university, our students are known for being stuck up, often making snide remarks about the incompetence of students studying on the other side of town. What, you are at a rural hospital for clinical school, you couldn't possibly have chosen to be there. Where are you going next year? Congratulations on your internship destination, largest is the best, the hardest places to get in, so you must be really good! Er, no I'm not, how do I explain that neither my marks nor my life achievements are amazing. I feel uncomfortable that my extended family is more excited about my internship destination than I am - uncomfortable, because I know they are happy because they love prestige. Anyway, how does older and bigger automatically equate to a better place to work and grow?
It just doesn't stop here. Which specialty training program are you in? The enthusiastic "wow" for someone on the R.O.A.D. to happiness (radiology, ophthalmology, anaesthetics, dermatology), or training in a much admired field such as neurosurgery, is such a stark contrast to the "oh" someone training to be a general practitioner often receives - oh, why don't you want to specialise? Just like when we were in high school and choosing what to study in university, we equate more "difficult" entry requirements, to a better specialty, and a better person. Not just academically, but smarter, richer and more important. Therefore, we treat them with special favour. Or should we?
Good marks and hard work are fine in themselves, and indeed, many of those in highly sought after specialties are talented, committed, and deserve the respect that they have. But it really bothers me, the obsession of prestige and achievement that surrounds this profession. How across every level, from medical students to consultants, we are judged, and in turn judge one another, based on rank, specialty, place of training and other such criteria. Not only professionally, but just as much in personal and social interactions. And how we judge those outside medicine to be just... well, not as good. Why aren't you dating someone in medicine - or conversely - of course my parents will be happy with my sister's new boyfriend, he's going to be a doctor!
Perhaps, most troubling, is when this occurs in fellowship. Attending a medical Christian event over the weekend, we were asked to add our year level and university, or specialty for graduates, to our name tags. I thought, does this really matter, and pondered whether it would affect the way we talked and interacted with one another. More than a year ago now, I attended a talk at Christian medical event where I clearly felt the hospital hierarchy in the room. I happened to be seated next to registrars who seemed to want to make it clear that they were registrars (not intern or residents), and seemed to change their manner when they talked to fellow registrars, and when the medical students talked to them. Or it could be purely my interpretation; or, they were shy and not very talkative anyway.
The speaker in front was the head of the endocrine unit at this hospital, and the director of that very prestigious specialty college. During the talk (on a topic which I have now forgotten) I wondered whether at times the speakers were not speaking more as consultants to their junior doctors, on how to do medicine and life, rather than humbly sharing God's words and God's work in their own lives. Considering how important connections are, in turn, I wondered how many students were using refreshment and mingling time as career networking opportunities, rather than seeking genuine fellowship and spiritual growth. Maybe I was being over cynical, but certainly, the thought of focusing on the networking aspect did not escape my mind.
So in Christ Jesus you are all children of God through faith, for all of you who were baptised into Christ have clothed yourselves with Christ. There is neither Jew nor Gentile, neither slave nor free, nor is there male and female, for you are all one in Christ Jesus. - Galatians 3:26-28
At work, we should respect those in authority, including brothers and sisters in Christ. However, it was disappointing to see hospital heirarchy, reinforced by junior and senior doctors (and students) alike, permeating into church life and ultimately, hindering fellowship and taking the focus away from God. Recognising that we are all sinners, and recipients of God's grace, why should one (no matter who they are in the medical profession) exalt themselves over another? Perhaps that experience made me reluctant to join the medical fellowship events in M. Until recently that is, when I was once again reminded of the importance of being inspired by, encouraging and being encouraged by other Christians in medicine. Just as those who are proud stand out, there are of course, many who are marked by faith, having lives which point clearly to God.
Do nothing out of selfish ambition or vain conceit. Rather, in humility value others above yourselves, not looking to your own interests but each of you to the interests of the others. In your relationships with one another, have the same mindset as Christ Jesus: Who, being in very nature God, did not consider equality with God something to be used to his own advantage; rather, he made himself nothing by taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself by becoming obedient to death — even death on a cross! -
Philippians 2:3-8
What's wrong with being elitist? What's wrong with loving prestige? What's wrong with having an elevated view of our profession, our university, our hospital, our specialty, our rank? It matters what we value first and foremost. We lose perspective when self becomes bigger and more important than God. We forget who we trust in, who we should be thankful towards for all that we have. We compare with others, begin to focus on collecting trophies, aiming for what is "best" and most prestigious, to serve our pride and desire for recognition. In doing so, we lose sight of our purpose, and become distracted from working for God, and living to love others. Jesus, king of kings, did not exalt himself but came to serve. How each of us, not least myself, should be constantly reminded to do likewise!
The hardest things
Assignments. Midsemester tests. Exams. Assessments. Tutor marks. Not being able to answer questions. Not knowing doses of medications. Not remembering pathophysiology. Not being sure of clinical signs.
A classmate was saying that the thought of the physician training exams terrifies him, because of what he had heard about the low pass rates. I laughed and replied, you can always take it again, and if you fail too many times, maybe you're really better suited to doing something else. I hear of students in science, pharmacy, arts, architecture, engineering, law, each talking about how stressful it is to have weekly assignment, midsemester tests, or exams coming up. Each, including medical students, sighing and not so subtly implying that their course is harder than everyone else's.
I guess I don't completely understand. Not that I don't feel the stress of assessments. But for many years that type of anxiety has not progressed beyond a useful prompt to open my textbooks and get on with work. So with a tad of arrogance, and disdain, I frown in scepticism when people around me rant about how hard everything in university is. I can't help wondering, which part of writing an essay, even if it's several thousand words in length, is difficult when you only have ten contact hours a week? Which part of medical school is difficult, and how much does that first class honours really count, especially when, being old and grey one day, you look back at your life? How are clinicals overwhelming? We keep learning, and have many years ahead to learn. Plus with so many iPhone apps (what a serious disadvantage, not having one yet!) what does it matter if we don't have encyclopaedic knowledge on every topic?
Lately, in my possibly excessive hours of self reflection, I found that the hardest things in university, in medicine, in hospital rotations, have little do with the studies, or even the clinical work itself. Not saying there isn't much to be learnt as a junior doctor. But, being a scribe/secretary/PA/intern for a team during ward rounds, writing scripts, filling in pathology slips, making phone calls - these are not difficult tasks, and hardly deserve the respect bestowed by the "Dr." title.
Rather the hardest things are to wake up to an alarm clock, or worse still, long before the alarm clock sounds. Day after day, after day. It's waiting for trains on a chilly morning, or cold afternoon, and attempting to use the vending machines at the platform to barricade against the wind, only to realise that it's impossible to do so because the wild wind constantly blows where it wills, in multiple directions. It's uncomfortably shifting weight between the collapsing arches of two feet in uncomfortable shoes, and pouncing on opportunities to sit on ledges, lean on benches, kneel on the floor whilst leaning on patient beds to write notes on. It's driving home at night blinking constantly, feeling like there is glue trying to close my eyelids shut. It's being too tired to asleep, or when insomnia lingers. It's when too many early mornings make the days of the week blur into one another, until I score a patient wrong on the mini mental examination, when it was really me who had the days and dates mixed up.
It's being easily upset, fiercely angry, and excessively sad and teary. It's wondering whether it would be better if I live alone forever so that no one else needs to deal with these emotions. It's when the monsters pay frequent visits, when gradually the sorrows of the night spill into the morning, yet there is still the obligation to get ready for the day, be functional, and deal with the grief of others. It's when grief spills into the unconscious world, manifesting in restless dreams with deaths of loved ones, hurtful words, being attacked with a ballpoint pen, lost friendships - waking up with palpitations, elevated heart rate, hearing my own voice cry out, and starting the day with a discomfort that is difficult to describe. It's when, working next year, staying home to sort myself out for non physical illnesses is no longer an acceptable option. It's being physically unwell and feeling guilty for resting at home for a minor illness. It's being disheartened at the room with suitcases, bits of paper, bags, shoes and clothes strewn over the floor. It's at the end of a day, being reluctant to be at home amongst another family's world of hidden but palpable sadness, conflict, uneasiness, which I feel for almost as much as if it were my own. Yet having no real alternative, unless I wish to wander from restaurant to restaurant, bubble tea to bubble tea stores, taking long strolls around the city, or purposely making the train journey home longer, every evening.
In writing I realise, perhaps it's not that I hate medicine, but that I use it as a scapegoat. What is hard is the weariness of functioning reliably, and managing the difficult feelings that come with daily life, both personal and those which arise from clinical encounters. I think that's what my Boggart would be shape shifting into, if there was a physical, tangible, pictorial representation of that fear. I shouldn't scorn at others for what their Boggarts turn into, for them finding their greatest fears, the hardest things, to be other aspects of life.
Day by Day
Day by day, and with each passing moment,
Strength I find to meet my trials here;
Trusting in my Father's wise bestowment,
I've no cause for worry or for fear.
He, whose heart is kind beyond all measure,
Gives unto each day what He deems best,
Lovingly its part of pain and pleasure,
Mingling toil with peace and rest...
God, help me to walk with you through each day, through everything I find difficult. In toil and rest, pain and pleasure, finding strength and purpose in you.
A classmate was saying that the thought of the physician training exams terrifies him, because of what he had heard about the low pass rates. I laughed and replied, you can always take it again, and if you fail too many times, maybe you're really better suited to doing something else. I hear of students in science, pharmacy, arts, architecture, engineering, law, each talking about how stressful it is to have weekly assignment, midsemester tests, or exams coming up. Each, including medical students, sighing and not so subtly implying that their course is harder than everyone else's.
I guess I don't completely understand. Not that I don't feel the stress of assessments. But for many years that type of anxiety has not progressed beyond a useful prompt to open my textbooks and get on with work. So with a tad of arrogance, and disdain, I frown in scepticism when people around me rant about how hard everything in university is. I can't help wondering, which part of writing an essay, even if it's several thousand words in length, is difficult when you only have ten contact hours a week? Which part of medical school is difficult, and how much does that first class honours really count, especially when, being old and grey one day, you look back at your life? How are clinicals overwhelming? We keep learning, and have many years ahead to learn. Plus with so many iPhone apps (what a serious disadvantage, not having one yet!) what does it matter if we don't have encyclopaedic knowledge on every topic?
Lately, in my possibly excessive hours of self reflection, I found that the hardest things in university, in medicine, in hospital rotations, have little do with the studies, or even the clinical work itself. Not saying there isn't much to be learnt as a junior doctor. But, being a scribe/secretary/PA/intern for a team during ward rounds, writing scripts, filling in pathology slips, making phone calls - these are not difficult tasks, and hardly deserve the respect bestowed by the "Dr." title.
Rather the hardest things are to wake up to an alarm clock, or worse still, long before the alarm clock sounds. Day after day, after day. It's waiting for trains on a chilly morning, or cold afternoon, and attempting to use the vending machines at the platform to barricade against the wind, only to realise that it's impossible to do so because the wild wind constantly blows where it wills, in multiple directions. It's uncomfortably shifting weight between the collapsing arches of two feet in uncomfortable shoes, and pouncing on opportunities to sit on ledges, lean on benches, kneel on the floor whilst leaning on patient beds to write notes on. It's driving home at night blinking constantly, feeling like there is glue trying to close my eyelids shut. It's being too tired to asleep, or when insomnia lingers. It's when too many early mornings make the days of the week blur into one another, until I score a patient wrong on the mini mental examination, when it was really me who had the days and dates mixed up.
It's being easily upset, fiercely angry, and excessively sad and teary. It's wondering whether it would be better if I live alone forever so that no one else needs to deal with these emotions. It's when the monsters pay frequent visits, when gradually the sorrows of the night spill into the morning, yet there is still the obligation to get ready for the day, be functional, and deal with the grief of others. It's when grief spills into the unconscious world, manifesting in restless dreams with deaths of loved ones, hurtful words, being attacked with a ballpoint pen, lost friendships - waking up with palpitations, elevated heart rate, hearing my own voice cry out, and starting the day with a discomfort that is difficult to describe. It's when, working next year, staying home to sort myself out for non physical illnesses is no longer an acceptable option. It's being physically unwell and feeling guilty for resting at home for a minor illness. It's being disheartened at the room with suitcases, bits of paper, bags, shoes and clothes strewn over the floor. It's at the end of a day, being reluctant to be at home amongst another family's world of hidden but palpable sadness, conflict, uneasiness, which I feel for almost as much as if it were my own. Yet having no real alternative, unless I wish to wander from restaurant to restaurant, bubble tea to bubble tea stores, taking long strolls around the city, or purposely making the train journey home longer, every evening.
In writing I realise, perhaps it's not that I hate medicine, but that I use it as a scapegoat. What is hard is the weariness of functioning reliably, and managing the difficult feelings that come with daily life, both personal and those which arise from clinical encounters. I think that's what my Boggart would be shape shifting into, if there was a physical, tangible, pictorial representation of that fear. I shouldn't scorn at others for what their Boggarts turn into, for them finding their greatest fears, the hardest things, to be other aspects of life.
Day by Day
Day by day, and with each passing moment,
Strength I find to meet my trials here;
Trusting in my Father's wise bestowment,
I've no cause for worry or for fear.
He, whose heart is kind beyond all measure,
Gives unto each day what He deems best,
Lovingly its part of pain and pleasure,
Mingling toil with peace and rest...
God, help me to walk with you through each day, through everything I find difficult. In toil and rest, pain and pleasure, finding strength and purpose in you.
What I think about during clinic - part three
5. Children
Children are often such a clear reflection of a stable, or dysfunctional family. A little girl with neatly brushed hair and clean clothes, comes in coughing, politely covering the mouth with hands or elbows. Her mother is educated, concerned, but not overly anxious. A young boy comes in, with his alcoholic mother and father who can't keep a job because he often doesn't bother to rock up for work. The mother warns the doctor about how he may swear profusely whilst the local anaesthetics injection is being administered.
There are patients who really struggle with life. Then some have kids, and lots of them. It's stressful because sleep is disrupted, the kids need to be ready for school, somebody needs to care for them when you are at work, kids get sick frequently, and so on. If parents are barely managing to care for themselves, or have one unstable marriage or relationship after another, you can't help wonder, why have so many children? (I wonder sometimes for myself too, whether I have enough mental stability to be a parent.)
On a brighter note, I'm almost always more awake when I see a child. It doesn't matter what they come in with, even if it's URTI after URTI. I don't tire of playing peekaboo twenty times in a day or sticking my tongue out at the child (only if the doctor and parents are busy talking to each other). I'm happy to lend my stethoscope as a toy. I remember how five year old C always loved to listen to bowel sounds, then would pull up her own shirt and say with a sweet smile, "do you want to listen to my tummy?" Sometimes I want to pick kids up for a cuddle but I guess that's not really part of the job of being a doctor. I did once though, and quickly realised that I should be careful with my dangling earrings and hair that isn't tied back, as naughty little babies pull at anything they see.
For years I've always said that if I wanted to do paediatrics, I might as well have done veterinary science. Like pets, children are uncooperative, plus they scream, growl, vomit and even bite you. Before my children's rotation earlier this year I had the following conversation with C.
C: Children's hospital (reading my rotation timetable on the computer screen). Do you like kids?
W: No.
C: Aww, but you like me!!
W: Yes, but I only like you!
I guess that's not so true. Although C, I only like kids because you're such a beautiful, lovely, bright, happy, funny, little girl. I only like other kids, maybe because I really miss you when I don't see you for months and months.
6. Aging
When a child pouts and throws a tantrum, or lacks insight, it's acceptable. But in a full grown adult, or elderly patient, it's distasteful. Even if the maximal mental and emotional capacity in that person, is the same as a child's. Life's not fair, is it?
The circle of life is a running theme in general practice as you see children, teenagers, young adults, progress through stages of learning to walk, run, work, drive, live on their own, be married and have children. And in the same room you see the elderly, gradually becoming unsteady on their feet, losing their memory, unable to drive, being widowed, needing to go into care because they are no longer coping. An interesting medical interpretation of Ecclesiastes from a fellow student, which made me laugh when I heard it:
Ecclesiastes 12:3-5
...when the keepers of the house tremble, (unsteady hands)
and the strong men stoop, (kyphosis)
when the grinders cease because they are few, (less teeth)
and those looking through the windows grow dim; (sight)
when the doors to the street are closed
and the sound of grinding fades; (can't remember, stopping work?)
when people rise up at the sound of birds, (insomnia)
but all their songs grow faint; (hearing)
when people are afraid of heights
and of dangers in the streets; (fear of falls)
when the almond tree blossoms
and the grasshopper drags itself along (impotence)
and desire no longer is stirred...
From dust we came, to dust we return. Entropy, sickness and death overcomes all. And seeing that each day in clinic is unsettling and frightening, knowing that neither I nor the ones I love, can escape.
(continued from Eccl 12:5)
...Then people go to their eternal home
and mourners go about the streets.
But seeing life and death is also a constant, and perhaps a much needed reminder that this is not home. Which forces us to reassess how we're spending our short life, and about exactly what we're chasing. I fell in love with this song when I heard it for the first time recently, on the way to clinic:
...Cause what if your blessings come through raindrops
What if your healing comes through tears
What if a thousand sleepless nights are what it takes to know you're near
What if trials of this life are your mercies in disguise?
When friends betray us
When darkness seems to win, we know
That pain reminds this heart,
That this is not, this is not our home
It's not our home
Children are often such a clear reflection of a stable, or dysfunctional family. A little girl with neatly brushed hair and clean clothes, comes in coughing, politely covering the mouth with hands or elbows. Her mother is educated, concerned, but not overly anxious. A young boy comes in, with his alcoholic mother and father who can't keep a job because he often doesn't bother to rock up for work. The mother warns the doctor about how he may swear profusely whilst the local anaesthetics injection is being administered.
There are patients who really struggle with life. Then some have kids, and lots of them. It's stressful because sleep is disrupted, the kids need to be ready for school, somebody needs to care for them when you are at work, kids get sick frequently, and so on. If parents are barely managing to care for themselves, or have one unstable marriage or relationship after another, you can't help wonder, why have so many children? (I wonder sometimes for myself too, whether I have enough mental stability to be a parent.)
On a brighter note, I'm almost always more awake when I see a child. It doesn't matter what they come in with, even if it's URTI after URTI. I don't tire of playing peekaboo twenty times in a day or sticking my tongue out at the child (only if the doctor and parents are busy talking to each other). I'm happy to lend my stethoscope as a toy. I remember how five year old C always loved to listen to bowel sounds, then would pull up her own shirt and say with a sweet smile, "do you want to listen to my tummy?" Sometimes I want to pick kids up for a cuddle but I guess that's not really part of the job of being a doctor. I did once though, and quickly realised that I should be careful with my dangling earrings and hair that isn't tied back, as naughty little babies pull at anything they see.
For years I've always said that if I wanted to do paediatrics, I might as well have done veterinary science. Like pets, children are uncooperative, plus they scream, growl, vomit and even bite you. Before my children's rotation earlier this year I had the following conversation with C.
C: Children's hospital (reading my rotation timetable on the computer screen). Do you like kids?
W: No.
C: Aww, but you like me!!
W: Yes, but I only like you!
I guess that's not so true. Although C, I only like kids because you're such a beautiful, lovely, bright, happy, funny, little girl. I only like other kids, maybe because I really miss you when I don't see you for months and months.
6. Aging
When a child pouts and throws a tantrum, or lacks insight, it's acceptable. But in a full grown adult, or elderly patient, it's distasteful. Even if the maximal mental and emotional capacity in that person, is the same as a child's. Life's not fair, is it?
The circle of life is a running theme in general practice as you see children, teenagers, young adults, progress through stages of learning to walk, run, work, drive, live on their own, be married and have children. And in the same room you see the elderly, gradually becoming unsteady on their feet, losing their memory, unable to drive, being widowed, needing to go into care because they are no longer coping. An interesting medical interpretation of Ecclesiastes from a fellow student, which made me laugh when I heard it:
Ecclesiastes 12:3-5
...when the keepers of the house tremble, (unsteady hands)
and the strong men stoop, (kyphosis)
when the grinders cease because they are few, (less teeth)
and those looking through the windows grow dim; (sight)
when the doors to the street are closed
and the sound of grinding fades; (can't remember, stopping work?)
when people rise up at the sound of birds, (insomnia)
but all their songs grow faint; (hearing)
when people are afraid of heights
and of dangers in the streets; (fear of falls)
when the almond tree blossoms
and the grasshopper drags itself along (impotence)
and desire no longer is stirred...
From dust we came, to dust we return. Entropy, sickness and death overcomes all. And seeing that each day in clinic is unsettling and frightening, knowing that neither I nor the ones I love, can escape.
(continued from Eccl 12:5)
...Then people go to their eternal home
and mourners go about the streets.
But seeing life and death is also a constant, and perhaps a much needed reminder that this is not home. Which forces us to reassess how we're spending our short life, and about exactly what we're chasing. I fell in love with this song when I heard it for the first time recently, on the way to clinic:
...Cause what if your blessings come through raindrops
What if your healing comes through tears
What if a thousand sleepless nights are what it takes to know you're near
What if trials of this life are your mercies in disguise?
When friends betray us
When darkness seems to win, we know
That pain reminds this heart,
That this is not, this is not our home
It's not our home
What I think about during clinic - part two
3. URTI
URTI (upper respiratory track infection ie the common cold/coughs/sore throats). URTI. URTI. URTI. Repeat script. URTI. INR. Script. URTI. URTI. URTI.
"My throat is really dry and sore. I feel yucky and cough up this really gross... stuff." The patient would pause for dramatic effect and frown in disgust. Perhaps not realising that the doctor just heard this twenty times that morning and has switched into autopilot mode.
"Look, there's no temperature today, your throat is fine, ears are fine, lungs are clear, it's a probable viral infection and should just clear up by itself in a few days. Plenty of rest, fluid and Panadol. Wait, oh, I didn't check your throat yet." I giggle silently and think, I knew it was a scripted response!
(By the way, doesn't it make you feel uncomfortable to think that the bored medical student, sitting at the edge of the examination bed, gazing out of the window, half reading a handbook, stifling a yawn, is quietly but surely observing and critiquing each word and action, and maybe even sensing your feelings and thoughts during the consult? I think I would feel quite self conscious if the roles were reversed.)
Instead of typing the same notes again and again, slowly with your two finger method, why not use a copy paste template for URTI notes? Would it not be better use of a doctor's training and health care resources to have URTI clinics run by community nurses? Only problem would be that occasionally, the presumed minor illness may be the start of something more serious.
OHCS makes me laugh. In regards to minor illnesses the first paragraph reads "...GPs do not have a sufficient monopoly of this to justify being called 'triviologists'"
4. MC
The only reason many URTI patients go to a GP is for a medical certificate (MC). Several weeks ago, if not for that precious piece of paper, I wouldn't have driven in a half awake state, waited in a clinic (not for very long), and have a (very lovely and comforting) doctor diagnose something that anyone off the street could diagnose.
Whilst medical certificates are probably needed for year 12 students who are unable to sit major exams, or for prolonged inability to attend work due to a more serious medical condition, our society seems to be obsessed with them. A seven year old child's mother asked for one because the swimming instructor required a medical certificate for non attendance. Surely for primary aged children, a note or explanation by a parent is sufficient.
It's as if schools, organisations, workplaces assume that a doctor's signature automatically makes an illness and off days legitimate. Which is untrue. If you're keen, it's easy to fake symptoms. Even for an URTI the GP decides arbitrarily how long you should rest for - maybe a day, maybe a week. Regardless of whether you offer a convincing story or not, if you visit the right GP, or enough GPs, you will find someone to happily print an MC for today's, or even last week's illness - if you're lucky. The huge emphasis on producing medical certificates for everything means that GPs spend large amounts of time on unnecessary paperwork, rather than clinical medicine. Again, poor use of health care resources.
URTI (upper respiratory track infection ie the common cold/coughs/sore throats). URTI. URTI. URTI. Repeat script. URTI. INR. Script. URTI. URTI. URTI.
"My throat is really dry and sore. I feel yucky and cough up this really gross... stuff." The patient would pause for dramatic effect and frown in disgust. Perhaps not realising that the doctor just heard this twenty times that morning and has switched into autopilot mode.
"Look, there's no temperature today, your throat is fine, ears are fine, lungs are clear, it's a probable viral infection and should just clear up by itself in a few days. Plenty of rest, fluid and Panadol. Wait, oh, I didn't check your throat yet." I giggle silently and think, I knew it was a scripted response!
(By the way, doesn't it make you feel uncomfortable to think that the bored medical student, sitting at the edge of the examination bed, gazing out of the window, half reading a handbook, stifling a yawn, is quietly but surely observing and critiquing each word and action, and maybe even sensing your feelings and thoughts during the consult? I think I would feel quite self conscious if the roles were reversed.)
Instead of typing the same notes again and again, slowly with your two finger method, why not use a copy paste template for URTI notes? Would it not be better use of a doctor's training and health care resources to have URTI clinics run by community nurses? Only problem would be that occasionally, the presumed minor illness may be the start of something more serious.
OHCS makes me laugh. In regards to minor illnesses the first paragraph reads "...GPs do not have a sufficient monopoly of this to justify being called 'triviologists'"
4. MC
The only reason many URTI patients go to a GP is for a medical certificate (MC). Several weeks ago, if not for that precious piece of paper, I wouldn't have driven in a half awake state, waited in a clinic (not for very long), and have a (very lovely and comforting) doctor diagnose something that anyone off the street could diagnose.
Whilst medical certificates are probably needed for year 12 students who are unable to sit major exams, or for prolonged inability to attend work due to a more serious medical condition, our society seems to be obsessed with them. A seven year old child's mother asked for one because the swimming instructor required a medical certificate for non attendance. Surely for primary aged children, a note or explanation by a parent is sufficient.
It's as if schools, organisations, workplaces assume that a doctor's signature automatically makes an illness and off days legitimate. Which is untrue. If you're keen, it's easy to fake symptoms. Even for an URTI the GP decides arbitrarily how long you should rest for - maybe a day, maybe a week. Regardless of whether you offer a convincing story or not, if you visit the right GP, or enough GPs, you will find someone to happily print an MC for today's, or even last week's illness - if you're lucky. The huge emphasis on producing medical certificates for everything means that GPs spend large amounts of time on unnecessary paperwork, rather than clinical medicine. Again, poor use of health care resources.
What I think about during clinic - part one
1. Typing
"I hate not being able to type properly. It was such a disadvantage during the fellowship exams. I took double the time. Could hear all the other candidates tapping away..."
Touch typing should be compulsory, my classmate commented. The variety you see is amazing. Hunt and peck, with one or two fingers, index or with the middle finger. Or even touch typing with the left hand but pecking away with one finger on the right. Okay, if you're eighty and coming to the end of your career it's not so important. But for everyone else in the practice (doctors, nurses, receptionists) this should be part of professional development. Think of all that time you can save.
At least medical students can be helpful in something, eh? Typing out notes as the clinicians dictate, or helping a nurse to discover, with much delight, that keyboard shortcuts exist for copy, paste, underlining, and bolding text.
2. Consent
Being a female student, I didn't have a single patient refuse consent for a long time, even during the rather awkward gynaecology clinics. But there seems to be an average of one patient each day at this clinic who refuses to see students simply on a whim. Or the patient who comes to the appointment half an hour late and writes on the form:
"Student okay, but wants doctor to do everything." For a straightforward cough and cold. I don't think the person realises that although less experienced, students are taught to be thorough. And even the doctor is more likely to take less shortcuts, and think properly about your case, when he or she is teaching.
I'm happy to sip hot tea and milk in the tea room, munching on an apple or the occasional pumpkin seed, surfing the net on my phone. But whilst waiting, I also began to form strong opinions about consent in regards to seeing medical students.
Firstly, it all depends on how consent is obtained. Some sessions I get a run of several patients refusing consent and I can't help wonder what the reception staff is saying to the patient. No wonder some of my male classmates had difficulties getting into delivery suite when the midwife, with a frown, said tentatively:
"Well, there is this male medical student... would it be okay if he attends the birth? You can say no, it's okay to say no..."
Scenario one - written consent needs to be obtained for every patient (as it is in this practice). Scenario two - displaying clear signs in the waiting rooms that this is a practice with medical students, and if patients have an issue with having one in their consultation, they can speak to reception to opt out. I'm sure the number of patients who say "no" would differ. A lot.
Coming to the end of my time as a student, I can't help think, well in a few months time I can't refuse to see you in the emergency department, in outpatients clinic, simply because I don't feel like it. Certainly, a patient should be able to opt out of seeing the student if there is a legitimate reason - for example, if the student was a family friend and the patient needed a sensitive examination, or wanted to discuss serious mental health issues. Or if they need to be somewhere by a certain time, and can't be in with the student for half an hour before the doctor sees them. That's okay. But it shouldn't be for no reason.
"I hate not being able to type properly. It was such a disadvantage during the fellowship exams. I took double the time. Could hear all the other candidates tapping away..."
Touch typing should be compulsory, my classmate commented. The variety you see is amazing. Hunt and peck, with one or two fingers, index or with the middle finger. Or even touch typing with the left hand but pecking away with one finger on the right. Okay, if you're eighty and coming to the end of your career it's not so important. But for everyone else in the practice (doctors, nurses, receptionists) this should be part of professional development. Think of all that time you can save.
At least medical students can be helpful in something, eh? Typing out notes as the clinicians dictate, or helping a nurse to discover, with much delight, that keyboard shortcuts exist for copy, paste, underlining, and bolding text.
2. Consent
Being a female student, I didn't have a single patient refuse consent for a long time, even during the rather awkward gynaecology clinics. But there seems to be an average of one patient each day at this clinic who refuses to see students simply on a whim. Or the patient who comes to the appointment half an hour late and writes on the form:
"Student okay, but wants doctor to do everything." For a straightforward cough and cold. I don't think the person realises that although less experienced, students are taught to be thorough. And even the doctor is more likely to take less shortcuts, and think properly about your case, when he or she is teaching.
I'm happy to sip hot tea and milk in the tea room, munching on an apple or the occasional pumpkin seed, surfing the net on my phone. But whilst waiting, I also began to form strong opinions about consent in regards to seeing medical students.
Firstly, it all depends on how consent is obtained. Some sessions I get a run of several patients refusing consent and I can't help wonder what the reception staff is saying to the patient. No wonder some of my male classmates had difficulties getting into delivery suite when the midwife, with a frown, said tentatively:
"Well, there is this male medical student... would it be okay if he attends the birth? You can say no, it's okay to say no..."
Scenario one - written consent needs to be obtained for every patient (as it is in this practice). Scenario two - displaying clear signs in the waiting rooms that this is a practice with medical students, and if patients have an issue with having one in their consultation, they can speak to reception to opt out. I'm sure the number of patients who say "no" would differ. A lot.
Coming to the end of my time as a student, I can't help think, well in a few months time I can't refuse to see you in the emergency department, in outpatients clinic, simply because I don't feel like it. Certainly, a patient should be able to opt out of seeing the student if there is a legitimate reason - for example, if the student was a family friend and the patient needed a sensitive examination, or wanted to discuss serious mental health issues. Or if they need to be somewhere by a certain time, and can't be in with the student for half an hour before the doctor sees them. That's okay. But it shouldn't be for no reason.
General practice
Throughout these years, I don't know how, or who is responsible for this, but more or less we all have a picture of the general practitioner really knowing their patient and family, talking in depth with them not only about the physical ailments but having abundant time to explain results and addressing their concerns. An epitome of work life balance, family friendly hours, and just a healthier working environment than hospital medicine.
Week one and two. In, out, in, out, an endless list of patients, one after another. I don't see how there's more time in these clinics than a public general medicine or surgical clinic. I don't see how churning people in and out, quickly dishing out the necessary paperwork, scripts, eyeballing a wound, performing a quick minor procedure, is any less fast paced than working in the emergency department. Consulting at a rate of six patients per hour for the entire day, skipping lunch, working until the sun sets, isn't my idea of work life balance. But it depends who you sit with, and clinicians do choose their working hours. Unfortunately they don't allocate medical students half days.
Seeing so many within a short span of time, I have noticed something completely new, and unfortunate within myself. I get sick of people, sick of talking, sick of engaging in small talk, and especially talking behind a mask, a persona. The time waiting for the doctor to finish with their patient before entering the room is agonising. It's the training grounds for random chit chat. Of course I love what I'm doing, of course I'm enjoying my rotation, of course graduating soon is so exciting! I muster up an unusual (and if you know me, unnatural) enthusiasm and smile; oh, how could I answer otherwise with those genuine smiles and innocent eyes looking at me expectantly?
"Do you want to specialise in anything? Are you planning to study after graduating? Or just be a GP?" Do general practitioners get tired and frustrated with the public perception that somehow specialists are GPs but more senior, more qualified?
Then I tune out, and spend more time typing away into the computer program than listening to what the patient is saying. Which doesn't look as rude as it sounds, because I am simply imitating some of the clinicians at work. Never mind that I actually disapprove of this. It's just easier, mentally, to float in and out of the conversation. At times, I know without patients saying outright, and without asking, that they have a particular topic they want to discuss, which was the real prompt for their visit today. The underlying concern which we were always taught to ask about and address. But I ignore what I sense because I don't want to talk, or be engaged. Sometimes during the consultation, I feel a tug of guilt and am prompted to turn around, face the patient, lean closer, looking at them, and ask "how is that headache?" But the rest of the time goes something like this. Sorry I don't think I will be a very good doctor.
"Yes well, I had the sore throat and two days later I started the cough."
"Sorry, when did you say you started coughing? Did you say you had a sore throat?"
"I catch up with the doctor every few weeks or so. Just to update him on how I'm going." She said elusively, as I asked her what she was in for today. I've always been the last one to dismiss "health practice" and "ethical practice" as useless arts subjects, or scoff at a patient's multiple psychosocial issues. But perhaps the sheer ratio of non-medical to medical cases strains on my ears, and my sympathy.
He's a charming man to be sure, just the right dose of intelligence, wit, friendliness, and warmth. By the way, the doctor goes from being your standard doctor doing a conventional shoulder exam, cutting out skin cancers, to one who wields acupuncture needles from head to toe, blows a small piece of charcoal and places it on a woman's abdomen to focus the energy, or flicks muscle to work with fascial planes. He knows better than I know that they're not coming for healing with conventional medications, and not even the alternative medical treatments he offers. That afternoon there were a whole string of mostly female patients who were, I'm sure, drawn to something about being able to talk to someone, anyone, about their week. Being cheered up, and having their aches and pains magically fixed by a smile and a positive energy. Someone to flirt with, even if it's done within appropriate social bounds.
What a lonely society it is, an African doctor had commented. I agreed. The idea of a big fat Greek and Italian families, the classic Asian culture of filial piety, or the necessity of having many family members visit an Indigenous patient at the hospital is often ridiculed. Living with extended family members, or supporting and living with aging parents is often seen unfavourably, an intrusion, in an individualistic world. Yet the freedom and self sufficiency our society encourages comes at its own price. Since when has the doctor been the first and best point of call for emotional and social issues - at home, at work, with children, with spouses, with in-laws? For sure, we should be sensitive to those issues and there is a time for pills and treatments. But it seems that some people see doctors as an automatic solution, a healer mystical powers to charm away the weariness, pains and sufferings of life on Earth. I wonder if we roll our eyes and groan at "non-medical" presentations, not only because we are not called to utilise the little ability we have in aiding physical illnesses, but also because we are baffled at the enormity and impossibility of being a healer for the emotional and social sicknesses of our world.
I have a terrible attitude, and I don't mean to be so negative. I had always loved clinics, and had waited in anticipation for this rotation. I am trying to find some positives. The doctors are nice and I even came across an old friend. The endless supply of mixed dried fruits and nuts, simple stocks of tea, coffee, fresh fruits, bread, tuna, cheese, milk and crackers is absolutely delightful. I am really only less than ten minutes away from the clinic every morning. I could even nap for an hour every lunch time, but I don't. Putting clinical skills and the knowledge we've gained over the years into something useful, is good. Finding out that I can't suture neatly is, not so good. Children are adorable. The town is one of my favourite places, exercising here and only here is fun, fellowship is refreshing.
But I'm resentful. For the ringing of an alarm clock. For not having enough time to do all the things I planned to do after last semester was over. For being kindly lent the textbook but not having the opportunity to open it. For wanting to switch off every time I come home, then indulging too long in the world of my novel, and paying the price with not enough sleep. For having to quickly whip up a simple dish instead of cooking something which makes my eyes and heart light up. For leaving most days when it's too dusky to hit a tennis ball accurately, and becoming too dark to enjoy a walk around the beautiful swan filled lake. Not being able to sit down and write out these thoughts though I've been itching to do so since I started the rotation. Let alone create new posts for the food blog.
I hate it. Not general practice itself - I haven't crossed it off my potential career pathways list. But because I feel trapped, like a rat (any creature really, just arbitrarily chose my favourite), wearily then angrily pawing at the confines of its cage. I'm turning into a monster with evil red eyes, sharp claws and bared teeth. Worse still, knowing that the confines will only grow smaller, have less breathing space, be more inflexible, as this year rolls onto the next. It's frightening. How can you run, run, as fast as you can? And where, oh little rat, will you run to?
Week one and two. In, out, in, out, an endless list of patients, one after another. I don't see how there's more time in these clinics than a public general medicine or surgical clinic. I don't see how churning people in and out, quickly dishing out the necessary paperwork, scripts, eyeballing a wound, performing a quick minor procedure, is any less fast paced than working in the emergency department. Consulting at a rate of six patients per hour for the entire day, skipping lunch, working until the sun sets, isn't my idea of work life balance. But it depends who you sit with, and clinicians do choose their working hours. Unfortunately they don't allocate medical students half days.
Seeing so many within a short span of time, I have noticed something completely new, and unfortunate within myself. I get sick of people, sick of talking, sick of engaging in small talk, and especially talking behind a mask, a persona. The time waiting for the doctor to finish with their patient before entering the room is agonising. It's the training grounds for random chit chat. Of course I love what I'm doing, of course I'm enjoying my rotation, of course graduating soon is so exciting! I muster up an unusual (and if you know me, unnatural) enthusiasm and smile; oh, how could I answer otherwise with those genuine smiles and innocent eyes looking at me expectantly?
"Do you want to specialise in anything? Are you planning to study after graduating? Or just be a GP?" Do general practitioners get tired and frustrated with the public perception that somehow specialists are GPs but more senior, more qualified?
Then I tune out, and spend more time typing away into the computer program than listening to what the patient is saying. Which doesn't look as rude as it sounds, because I am simply imitating some of the clinicians at work. Never mind that I actually disapprove of this. It's just easier, mentally, to float in and out of the conversation. At times, I know without patients saying outright, and without asking, that they have a particular topic they want to discuss, which was the real prompt for their visit today. The underlying concern which we were always taught to ask about and address. But I ignore what I sense because I don't want to talk, or be engaged. Sometimes during the consultation, I feel a tug of guilt and am prompted to turn around, face the patient, lean closer, looking at them, and ask "how is that headache?" But the rest of the time goes something like this. Sorry I don't think I will be a very good doctor.
"Yes well, I had the sore throat and two days later I started the cough."
"Sorry, when did you say you started coughing? Did you say you had a sore throat?"
"I catch up with the doctor every few weeks or so. Just to update him on how I'm going." She said elusively, as I asked her what she was in for today. I've always been the last one to dismiss "health practice" and "ethical practice" as useless arts subjects, or scoff at a patient's multiple psychosocial issues. But perhaps the sheer ratio of non-medical to medical cases strains on my ears, and my sympathy.
He's a charming man to be sure, just the right dose of intelligence, wit, friendliness, and warmth. By the way, the doctor goes from being your standard doctor doing a conventional shoulder exam, cutting out skin cancers, to one who wields acupuncture needles from head to toe, blows a small piece of charcoal and places it on a woman's abdomen to focus the energy, or flicks muscle to work with fascial planes. He knows better than I know that they're not coming for healing with conventional medications, and not even the alternative medical treatments he offers. That afternoon there were a whole string of mostly female patients who were, I'm sure, drawn to something about being able to talk to someone, anyone, about their week. Being cheered up, and having their aches and pains magically fixed by a smile and a positive energy. Someone to flirt with, even if it's done within appropriate social bounds.
What a lonely society it is, an African doctor had commented. I agreed. The idea of a big fat Greek and Italian families, the classic Asian culture of filial piety, or the necessity of having many family members visit an Indigenous patient at the hospital is often ridiculed. Living with extended family members, or supporting and living with aging parents is often seen unfavourably, an intrusion, in an individualistic world. Yet the freedom and self sufficiency our society encourages comes at its own price. Since when has the doctor been the first and best point of call for emotional and social issues - at home, at work, with children, with spouses, with in-laws? For sure, we should be sensitive to those issues and there is a time for pills and treatments. But it seems that some people see doctors as an automatic solution, a healer mystical powers to charm away the weariness, pains and sufferings of life on Earth. I wonder if we roll our eyes and groan at "non-medical" presentations, not only because we are not called to utilise the little ability we have in aiding physical illnesses, but also because we are baffled at the enormity and impossibility of being a healer for the emotional and social sicknesses of our world.
I have a terrible attitude, and I don't mean to be so negative. I had always loved clinics, and had waited in anticipation for this rotation. I am trying to find some positives. The doctors are nice and I even came across an old friend. The endless supply of mixed dried fruits and nuts, simple stocks of tea, coffee, fresh fruits, bread, tuna, cheese, milk and crackers is absolutely delightful. I am really only less than ten minutes away from the clinic every morning. I could even nap for an hour every lunch time, but I don't. Putting clinical skills and the knowledge we've gained over the years into something useful, is good. Finding out that I can't suture neatly is, not so good. Children are adorable. The town is one of my favourite places, exercising here and only here is fun, fellowship is refreshing.
But I'm resentful. For the ringing of an alarm clock. For not having enough time to do all the things I planned to do after last semester was over. For being kindly lent the textbook but not having the opportunity to open it. For wanting to switch off every time I come home, then indulging too long in the world of my novel, and paying the price with not enough sleep. For having to quickly whip up a simple dish instead of cooking something which makes my eyes and heart light up. For leaving most days when it's too dusky to hit a tennis ball accurately, and becoming too dark to enjoy a walk around the beautiful swan filled lake. Not being able to sit down and write out these thoughts though I've been itching to do so since I started the rotation. Let alone create new posts for the food blog.
I hate it. Not general practice itself - I haven't crossed it off my potential career pathways list. But because I feel trapped, like a rat (any creature really, just arbitrarily chose my favourite), wearily then angrily pawing at the confines of its cage. I'm turning into a monster with evil red eyes, sharp claws and bared teeth. Worse still, knowing that the confines will only grow smaller, have less breathing space, be more inflexible, as this year rolls onto the next. It's frightening. How can you run, run, as fast as you can? And where, oh little rat, will you run to?
Favourite paeds resources
Edit: how could I forget! I shouldn't forget to thank Wikipedia and Google Search for their invaluable contribution to my education in medical school (and beyond).
Before I delete them from the "Favourites" bar!
1. Pedscases: cases, podcasts, quizzes and MCQs. Cases were my favourite - you answer MCQ/select options questions about what to do next and read a digestable chunk of clinical reasoning before moving to the next part.
2. Merck Manual of Patient Symptoms: there's really good paediatric ones on common conditions (constipation, cough, diarrhoea, fever etc)! Clear, concise, always the same format every podcast so it's great repetition.
3. University of Arizona - Podcasts: a few more paediatric podcasts. Less medical (but still relevant) topics such as injury prevention, interviewing adolescents.
4. The Children's Hospital at Westmead - Fact Sheets: an alternative to parent information pages from RCH.
5. RCH Clinical Practice Guidelines: last but not least. It reflects well on a hospital to provide good CPGs that are widely used. RCH does a much better job with theirs than RWH does for women's health.
Before I delete them from the "Favourites" bar!
1. Pedscases: cases, podcasts, quizzes and MCQs. Cases were my favourite - you answer MCQ/select options questions about what to do next and read a digestable chunk of clinical reasoning before moving to the next part.
2. Merck Manual of Patient Symptoms: there's really good paediatric ones on common conditions (constipation, cough, diarrhoea, fever etc)! Clear, concise, always the same format every podcast so it's great repetition.
3. University of Arizona - Podcasts: a few more paediatric podcasts. Less medical (but still relevant) topics such as injury prevention, interviewing adolescents.
4. The Children's Hospital at Westmead - Fact Sheets: an alternative to parent information pages from RCH.
5. RCH Clinical Practice Guidelines: last but not least. It reflects well on a hospital to provide good CPGs that are widely used. RCH does a much better job with theirs than RWH does for women's health.
Paed's scribbles
Happy paediatric pictures.
Behavioural problems. Temper tantrum, food refusal, sleep problems:
Behavioural problems. Temper tantrum, food refusal, sleep problems:
Delicious MacBook cover:
Vaccinations!!!
And our favourite game - draw something. Else.
There are more scribbles and more draw something pics too.
Women's scribbles
Sorry, women's isn't very inspiring. Unlike psych and children's. Scribbling in class, or during sermons (which has been my recent outlet for scribble energy) is a high compliment. It means I am really paying attention, and interested, in what you're saying. Really.
Ziph this is my new creation after I got tired of drawing kidney man (what an awesome year & how fun it was to see you guys every day, I miss B) and uterus woman:
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Hello, I am your friendly gynaecologist:
.JPG)
Unhappy heart and a disturbing fetus:
.JPG)
Oops it's a bit messed up anatomically, and not very women's related. I think the correct term is "abstract". Go ahead and psychoanalyse me:
.JPG)
Mostly medical
Conversations had, or heard in the past week.
Holding on
A: so we've been learning about constipation in kids. It becomes this cycle of them holding on and not going (etc). I had a thought in the shower, you know the song "Keep Holding On"?
B: yeah? *hums*
A: keep holding on... just stay strong... there's nothing you can say, there's nothing you can do... *giggle giggle*
Self introduction
A: hi, my name is Dr A
B: hi I'm his mum, and just to clarify, I'm also the referring GP involved with this case
Students (muttering to each other): gee that's weird
Sewing techniques
A: I need to sew the button back, you know how to sew right?
B: maybe, we learnt during high school
A: I guess you can do surgical sutures, it shouldn't be too hard
B: true, so next time when I'm fixing a hole in my pants I'm going to use the simple interrupted suture
A: what, that's ridiculous! Can you imagine what that would look like when you walk out onto the street?
Holding on
A: so we've been learning about constipation in kids. It becomes this cycle of them holding on and not going (etc). I had a thought in the shower, you know the song "Keep Holding On"?
B: yeah? *hums*
A: keep holding on... just stay strong... there's nothing you can say, there's nothing you can do... *giggle giggle*
Self introduction
A: hi, my name is Dr A
B: hi I'm his mum, and just to clarify, I'm also the referring GP involved with this case
Students (muttering to each other): gee that's weird
Sewing techniques
A: I need to sew the button back, you know how to sew right?
B: maybe, we learnt during high school
A: I guess you can do surgical sutures, it shouldn't be too hard
B: true, so next time when I'm fixing a hole in my pants I'm going to use the simple interrupted suture
A: what, that's ridiculous! Can you imagine what that would look like when you walk out onto the street?
Study life - day one
a) Looking at FB
b) Searching the fridge
c) Thinking about useless things
d) Feeling sad, and a bit annoyed
e) Room is getting progressively messier
f) The house is so quiet
g) It's strange not to meet people
h) No class, I thought I would love it
i) Bored, disconnected from the world
j) At least there's a cat on my lap
k) A 10 minute walk, or run
l) Feel like eating, a lot
m) Three lamb chops, yum should be full
n) Another look at the fridge
o) Two oranges, a nectarine, an apricot
p) Mmm, passionfruit yoghurt
q) Maybe I'll have some of that raspberry yoghurt too
r) A packet of Shapes
s) And some raisin toast
t) Still hungry
u) Where do I eat out tomorrow
v) Check deals, and Urbanspoon
w) Elective forms, insurance forms
x) S & S - who wants to meet up?
y) Bored, tired, the songlist is getting old, screechy
z) Sleep
b) Searching the fridge
c) Thinking about useless things
d) Feeling sad, and a bit annoyed
e) Room is getting progressively messier
f) The house is so quiet
g) It's strange not to meet people
h) No class, I thought I would love it
i) Bored, disconnected from the world
j) At least there's a cat on my lap
k) A 10 minute walk, or run
l) Feel like eating, a lot
m) Three lamb chops, yum should be full
n) Another look at the fridge
o) Two oranges, a nectarine, an apricot
p) Mmm, passionfruit yoghurt
q) Maybe I'll have some of that raspberry yoghurt too
r) A packet of Shapes
s) And some raisin toast
t) Still hungry
u) Where do I eat out tomorrow
v) Check deals, and Urbanspoon
w) Elective forms, insurance forms
x) S & S - who wants to meet up?
y) Bored, tired, the songlist is getting old, screechy
z) Sleep
Conferences
Five things I realised:
1. It seems that I can wake up and be motivated to attend things without much problems if I know that there will be morning tea, coffee, lunch, afternoon tea and ice cream breaks. Yum.
2. Not that I needed to do this but - the opportunities for networking with others in the field when people meet face to face. Sure you can contact people via whatever means, but the human touch of real life interactions is irreplacable.
3. Global health, vaccines, and WHO work is interesting.
4. Talks are more about sharing ideas, ways to explore an issue, discussions, debates, inspiring better approaches, rather than purely delivering a lecture on a topic people don't know about.
5. You can have great quality data, do a good research study, or have a great idea about solving a problem. But presenting it is just as important - it just doesn't look very professional if you have your "poster" presentation as a few loose black and white, A4 sheets in the regular size 12 font.
1. It seems that I can wake up and be motivated to attend things without much problems if I know that there will be morning tea, coffee, lunch, afternoon tea and ice cream breaks. Yum.
2. Not that I needed to do this but - the opportunities for networking with others in the field when people meet face to face. Sure you can contact people via whatever means, but the human touch of real life interactions is irreplacable.
3. Global health, vaccines, and WHO work is interesting.
4. Talks are more about sharing ideas, ways to explore an issue, discussions, debates, inspiring better approaches, rather than purely delivering a lecture on a topic people don't know about.
5. You can have great quality data, do a good research study, or have a great idea about solving a problem. But presenting it is just as important - it just doesn't look very professional if you have your "poster" presentation as a few loose black and white, A4 sheets in the regular size 12 font.
Lost in translation
Ha. What a stereotypical, overused title. Oh well.
Our previous hospital was predominantly of Anglo-Saxon background, and throughout the whole year we saw less than a handful of patients who couldn't speak fluent English. This hospital, similar to other metropolitan public hospitals, has migrants from everywhere, Italian, Serbian, Vietnamese, Chinese, Greek, you name it. This time there was an elderly Asian gentleman in the wards.
"He speaks Chinese, anyone speaks Chinese here?" the consultant looked around.
I hesitated, remembering the disapproving tones we had from our tutors at the mention of students being used as interpreters. Plus the last time I spoke in Chinese was an awkward international call to organise my elective. I had said "hello", instead of "喂", and the lady handed phone to someone else saying, "她在说外国话".
But since the Asian intern didn't volunteer herself, I said, I can speak it, to some extent. They wanted to know if he knew where he was, and the day and month. Okay.
"你知道你在哪里吗？今天是星期几？现在是几月份？
Ask him if he's coping at home. That's tricky, I had to think hard, and came up with a half formed phrase (can't remember the exact wording) which he understood and replied that for small things he could handle it, but some of the more strenuous activities were difficult. He seemed happy to be able to converse and be understood properly. And we moved on to the next patient, and I reflected on the experience.
We've had many HP/EP/PD tutorials about using interpreters, and speaking to people from different backgrounds. We're always told, you should always use a trained, professional interpreter. Really? Yes I'm totally far from fluent but if you're asking about which day and month on ward round, how essential is it to find an interpreter. Or, the man in ED with his chest pain who was brought in by his daughter, are you going to wait for who knows how many hours for the only Serbian interpreter in the region, or are you going to ask the daughter who is also able to give good collateral history?
Our teaching has always focused on what can go wrong. The classic dilemma is the scenario where children are used as the interpreter, then they tell you that in their culture, it's better not to tell their terminally ill parent what is going on. See, they say, the children should never have been used to interpret in the first place. Or the example of awkward interviews, and misunderstandings with a doctor who speaks the patient's language as a second language. So the blanket rule is, always use an interpreter. Oh of course, how could people not understand that, I thought.
But now I disagree. Why do the tutors shake their heads when our classmates say they themselves, or the patient's family, were interpreting for a patient? True, there's lots of things that can go wrong in using non professionals, but there's also lots of things that can work better. It's impractical to call an interpreter for everyone who has some difficulty with English and clinician know it. If you work on those principals, how about calling an interpreter for every doctor who finds it difficult to communicate fluently in English?
In our society, it seems that having a certificate is a tick of excellence (and not having one, equals being inadequate). After working in hospitality, I realised that in some places, it's compulsory to have a food handling certificate. Before my hospital placement last holidays, I had to have a "hand hygiene certificate". Our hospital never provided one, so I searched online, answered a few MCQ's and printed myself one from the website. Do you really think there was any difference between my hand hygiene practices before and after the certificate? The point I'm making is that having a professional with a certificate every time doesn't mean you've optimised communication. Look at the interpreter who was called in, only to discover he spoke the same language but in a different dialect to that of our patient. Hmm, (nice man he was but) very useful? Or my friend's experience where the professional interpreter was interrupting the flow of the interview by cutting in, when the patient began to express herself in English. On the other hand, professionals can be great - I saw an age care assessment, and mini mental performed by an experienced interpreter, and it flowed seamlessly.
Consent for surgery, yes you wouldn't want to use someone who fumbled with the language, or emotionally involved, as an interpreter. On the other hand, ward rounds every day with basic questions, the family member can probably do a better job of helping you out with history (since they are often involved in the care too) than the professional.
Our previous hospital was predominantly of Anglo-Saxon background, and throughout the whole year we saw less than a handful of patients who couldn't speak fluent English. This hospital, similar to other metropolitan public hospitals, has migrants from everywhere, Italian, Serbian, Vietnamese, Chinese, Greek, you name it. This time there was an elderly Asian gentleman in the wards.
"He speaks Chinese, anyone speaks Chinese here?" the consultant looked around.
I hesitated, remembering the disapproving tones we had from our tutors at the mention of students being used as interpreters. Plus the last time I spoke in Chinese was an awkward international call to organise my elective. I had said "hello", instead of "喂", and the lady handed phone to someone else saying, "她在说外国话".
But since the Asian intern didn't volunteer herself, I said, I can speak it, to some extent. They wanted to know if he knew where he was, and the day and month. Okay.
"你知道你在哪里吗？今天是星期几？现在是几月份？
Ask him if he's coping at home. That's tricky, I had to think hard, and came up with a half formed phrase (can't remember the exact wording) which he understood and replied that for small things he could handle it, but some of the more strenuous activities were difficult. He seemed happy to be able to converse and be understood properly. And we moved on to the next patient, and I reflected on the experience.
We've had many HP/EP/PD tutorials about using interpreters, and speaking to people from different backgrounds. We're always told, you should always use a trained, professional interpreter. Really? Yes I'm totally far from fluent but if you're asking about which day and month on ward round, how essential is it to find an interpreter. Or, the man in ED with his chest pain who was brought in by his daughter, are you going to wait for who knows how many hours for the only Serbian interpreter in the region, or are you going to ask the daughter who is also able to give good collateral history?
Our teaching has always focused on what can go wrong. The classic dilemma is the scenario where children are used as the interpreter, then they tell you that in their culture, it's better not to tell their terminally ill parent what is going on. See, they say, the children should never have been used to interpret in the first place. Or the example of awkward interviews, and misunderstandings with a doctor who speaks the patient's language as a second language. So the blanket rule is, always use an interpreter. Oh of course, how could people not understand that, I thought.
But now I disagree. Why do the tutors shake their heads when our classmates say they themselves, or the patient's family, were interpreting for a patient? True, there's lots of things that can go wrong in using non professionals, but there's also lots of things that can work better. It's impractical to call an interpreter for everyone who has some difficulty with English and clinician know it. If you work on those principals, how about calling an interpreter for every doctor who finds it difficult to communicate fluently in English?
In our society, it seems that having a certificate is a tick of excellence (and not having one, equals being inadequate). After working in hospitality, I realised that in some places, it's compulsory to have a food handling certificate. Before my hospital placement last holidays, I had to have a "hand hygiene certificate". Our hospital never provided one, so I searched online, answered a few MCQ's and printed myself one from the website. Do you really think there was any difference between my hand hygiene practices before and after the certificate? The point I'm making is that having a professional with a certificate every time doesn't mean you've optimised communication. Look at the interpreter who was called in, only to discover he spoke the same language but in a different dialect to that of our patient. Hmm, (nice man he was but) very useful? Or my friend's experience where the professional interpreter was interrupting the flow of the interview by cutting in, when the patient began to express herself in English. On the other hand, professionals can be great - I saw an age care assessment, and mini mental performed by an experienced interpreter, and it flowed seamlessly.
Consent for surgery, yes you wouldn't want to use someone who fumbled with the language, or emotionally involved, as an interpreter. On the other hand, ward rounds every day with basic questions, the family member can probably do a better job of helping you out with history (since they are often involved in the care too) than the professional.
Living and dying
"It is better to go to a house of mourning than to go to a house of feasting, for death is the destiny of every man; the living should take this to heart." - Ecclesiastes 7:2
The times where death is in your face. I dug up a few entries from the old blog. The time we heard about the death of our high school classmate, not long after his 21st birthday. Although we weren't close, I knew his birthday well. We shared birthdays. Knowing that this car accident could have been any of us, made us think about the fragility of life. We visited the graveyard. My sister, four years old at the time, came along. I asked her, do you know what it means to die? She shook her head and said uh uh. She asked whether people get dirty when they're buried. I think she knows a little more now. She points out dead rats in the garden to me. She said to mum that she felt sad there when the family went to visit grandma and auntie's graveyard.
Eight years ago, the year dad remembers well. Being whisked away in the middle of high school to be by grandma's bedside when she had metastatic cancer. How I cried when I heard over the phone that she was in a coma. When we visited her, maybe she had a few lucid periods, maybe she teared when she saw us. Surprised that, walking out of the ward, one of the doctors in a white coat was my aunt. Later in the year, the same aunt who had long standing system lupus erythematosus, who was actually supposed to be dead when I was a toddler from bacterial encephalitis, died from bowel perforation after a month in ICU. My cousin was just over ten.
A month before you got sick I called you for the first and only time, on my own accord, with mum's international phone card. You sounded sleepy from your afternoon nap but you were so excited to hear from me. You were always very excitable, and silly. You bought me pretty clothes, and I still have them archived somewhere. I think in the older generation, you're the only one who draws, and you drew brilliantly. How could you, you missed my lovely sister by half a year. We included your name in one of my sister's Chinese name characters, and maybe she's a little similar to you. These years, I want to tell you, hey I'm studying medicine too. Like me, was your decision a last minute one too? After you died, I had a vivid dream where I met you but I woke up and realised it was just a dream and I cried. I don't think often about you, but I had a less vivid dream about you this year, and felt sad again. The first few anniversaries, the family sent emails, poems, reflections, in remembrance. Time passes, grave visits happens less, and this year is the first year that we didn't receive these emails.
Seeing death is an inevitable part of clinical school. The man last semester, who grew progressively worse from his renal failure after making the decision to stop treatment. Shadowing the palliative care consultant last week, we saw people who were alive and walking, but barely. Off colour, thin, in pain, and very tired. Without the spark in their eyes, as mum put it. The grief of the crying daughter, the concerned husband - I see their pain, and I feel incredibly sad. I see the non existent boundary between them, and us, the professionals who give an air of being immune to the infirmities of mortals. And it scares me (the process, the grief, less so death itself). I started medicine thinking, I would care, but at arms length to be able to perform the job properly. I'm not sure what made me think I would be able to do that. Sure, it's easy to switch off the emotional connections altogether, but that doesn't seem right either.
Later in a tutorial, we talked about confirming death and communicating death to family members. Would you talk to the dead person while you perform the physical exam to confirm his or her death? Our group giggled. Like a friend said, we do laugh and joke about death to be able to talk about it. The tutor asked us to say dead, D.E.A.D. She gave amusing examples of how euphemisms can cause confusion with people from different cultural backgrounds. A dead man's son who asked for his father in the hospital, after getting a phone call from the staff that "he's passed on". Since his father has moved to a few different parts of the hospital, the son had thought the father had just passed on to a new ward, hmm awkward. Another story was that of a family who were confused about the treating team coming around saying solemnly "it's only a matter of time", every day. A matter of time til what? They wondered.
Back to the verse at the start - why would a house of mourning than a house of celebrations? Knowing the endpoint sets clear direction and priorities for living. But I'll direct you to the writings of another blog writer to think about that verse.
The times where death is in your face. I dug up a few entries from the old blog. The time we heard about the death of our high school classmate, not long after his 21st birthday. Although we weren't close, I knew his birthday well. We shared birthdays. Knowing that this car accident could have been any of us, made us think about the fragility of life. We visited the graveyard. My sister, four years old at the time, came along. I asked her, do you know what it means to die? She shook her head and said uh uh. She asked whether people get dirty when they're buried. I think she knows a little more now. She points out dead rats in the garden to me. She said to mum that she felt sad there when the family went to visit grandma and auntie's graveyard.
Eight years ago, the year dad remembers well. Being whisked away in the middle of high school to be by grandma's bedside when she had metastatic cancer. How I cried when I heard over the phone that she was in a coma. When we visited her, maybe she had a few lucid periods, maybe she teared when she saw us. Surprised that, walking out of the ward, one of the doctors in a white coat was my aunt. Later in the year, the same aunt who had long standing system lupus erythematosus, who was actually supposed to be dead when I was a toddler from bacterial encephalitis, died from bowel perforation after a month in ICU. My cousin was just over ten.
A month before you got sick I called you for the first and only time, on my own accord, with mum's international phone card. You sounded sleepy from your afternoon nap but you were so excited to hear from me. You were always very excitable, and silly. You bought me pretty clothes, and I still have them archived somewhere. I think in the older generation, you're the only one who draws, and you drew brilliantly. How could you, you missed my lovely sister by half a year. We included your name in one of my sister's Chinese name characters, and maybe she's a little similar to you. These years, I want to tell you, hey I'm studying medicine too. Like me, was your decision a last minute one too? After you died, I had a vivid dream where I met you but I woke up and realised it was just a dream and I cried. I don't think often about you, but I had a less vivid dream about you this year, and felt sad again. The first few anniversaries, the family sent emails, poems, reflections, in remembrance. Time passes, grave visits happens less, and this year is the first year that we didn't receive these emails.
Seeing death is an inevitable part of clinical school. The man last semester, who grew progressively worse from his renal failure after making the decision to stop treatment. Shadowing the palliative care consultant last week, we saw people who were alive and walking, but barely. Off colour, thin, in pain, and very tired. Without the spark in their eyes, as mum put it. The grief of the crying daughter, the concerned husband - I see their pain, and I feel incredibly sad. I see the non existent boundary between them, and us, the professionals who give an air of being immune to the infirmities of mortals. And it scares me (the process, the grief, less so death itself). I started medicine thinking, I would care, but at arms length to be able to perform the job properly. I'm not sure what made me think I would be able to do that. Sure, it's easy to switch off the emotional connections altogether, but that doesn't seem right either.
Later in a tutorial, we talked about confirming death and communicating death to family members. Would you talk to the dead person while you perform the physical exam to confirm his or her death? Our group giggled. Like a friend said, we do laugh and joke about death to be able to talk about it. The tutor asked us to say dead, D.E.A.D. She gave amusing examples of how euphemisms can cause confusion with people from different cultural backgrounds. A dead man's son who asked for his father in the hospital, after getting a phone call from the staff that "he's passed on". Since his father has moved to a few different parts of the hospital, the son had thought the father had just passed on to a new ward, hmm awkward. Another story was that of a family who were confused about the treating team coming around saying solemnly "it's only a matter of time", every day. A matter of time til what? They wondered.
Back to the verse at the start - why would a house of mourning than a house of celebrations? Knowing the endpoint sets clear direction and priorities for living. But I'll direct you to the writings of another blog writer to think about that verse.
Psychiatric scribbles
Concentrating hard in class. Or maybe psych just lends itself to visual interpretations.
Many faces:
Bipolar, magic mushrooms, and the wave:
Transforming the mental exam into picture tiles:
(See the drunken rat and more...)
Shrinkery
The awkward moment in a role play when your acted role becomes blurred with your own experiences. You begin to wonder if the psychiatrist can feel that the acting is too realistic. They sound genuinely concerned (see, they are good actors, my friend commented that therapists are cheats pretending to care). So genuine, that you begin to worry if they feel that you are the patient. Then, you almost ask the psychiatrist in the middle of role playing for a corridor consult, feeling that, talking to a caring therapist is quite soothing.
How have you been feeling this week? Do you feel like you should cut down on the drugs? Yes, sometimes people self medicate to drown out the difficult feelings. Perhaps you can find some different ways to cope, how about getting out more and scheduling some activities throughout the day. Another awkward moment. The subconscious transformation of the dinner conversation from social to therapeutic becomes conscious.
The disturbing Mount Misery comes to an end as the psychiatry rotation comes to its last week. The only book I've managed to read during semester without major disruptions to my routine - reason being, I can't stand it for more than short spurts on the train, or in between waiting for patients. Freud, penis and mothers, dude, what were you thinking? Insightfully put in the narration, "the real perversion of Freud and analysis was to take the essence of something and reduce it to something else - the present to the past, love to hate, joy to misery, life to death - and to do it under the guise of understanding..."
Ah, so long, the land of slow coffee breaks, sweet normality of working hours and waiting for patients instead of patients waiting for you. Nodding nonchalantly at a patient's printed book of erotic poetry, stalking patients to their house, and calling them through their bedroom window to wake up and open the door to let you in. Goodbye shrinks with their long silences that forces you to say more than you intended, shrinks who have long buried skills in sucking blood or managing medical conditions, shrinks with a beard and long hair slightly neater than your average hobo, the ever patient shrinks who delivers care to those who slap them or threaten to kill them. Goodbye imposter parents, successful entrepreneurs, rock stars, devil's clutching hands, televisions that give special messages, armed robbers, drug addicts, arsonists, and people who blow up like balloons on medications.
I wish I could say, goodbye human suffering. But we'll just be going back to a different sort of suffering. In fact, we can't escape the groaning pains and decay as long as we are in this world. And unfortunately, I don't seem to be coping with my own emotions any better than before these six weeks began. Sad. Only thing I realised is that I do self therapy, alot. Extract from observing today's session. Now, what would you tell a friend? To take it easy. Maybe you can tell yourself that when you're feeling upset. (Tick.) What are some things you can do to feel better? Apart from eating tasty food. (Tick.) Take a hot shower? (Tick.) Maybe rubbing your arm (Tick.) or massaging your own shoulders? Next time I want you to write down what you're feeling at the time and your thoughts (Tick.)
I'm beginning to enjoy doing mental exams on anyone whose demeanor or expression catches my eye. That well groomed, unpleasant, sour faced, distracted and irritable hairdresser yesterday. Lack of insight. Damn you, you cheat, this is how people get sued. Fortunately for you, no one sues for hair because it grows back. I was offered a tailored therapy (not self therapy this time) - now, you feel that she ruined your evening, but is it true? You want to harm her? Jesus loves her. Pfft, why would Jesus love someone like her. Besides, I'm not Jesus and I hate her. But we're supposed to be like Jesus. Okay, still! Distract me.
Oops we've sidetracked. How strange it will be to go back to "real" medicine. But, the benefit is that our eyes and ears will be attuned to another layer of the patient's story. To some extent, what Roy said in Mount Misery will be true:
"Much of what I saw was psychiatric: belly pain, anxiety, phobias, depression, suicide attempts, hallucinating crazies. Before, these had been "turkeys," unfathomable and untreatable, mocked by us real docs and turfed to the shrink or back out onto the street. Now they were familiar, and easy. In a few minutes I got the feel of where this person stood in the world. I had learned something in my year of psychiatry, something about how to listen to intense feeling without flinching, how to make sense of it."
How have you been feeling this week? Do you feel like you should cut down on the drugs? Yes, sometimes people self medicate to drown out the difficult feelings. Perhaps you can find some different ways to cope, how about getting out more and scheduling some activities throughout the day. Another awkward moment. The subconscious transformation of the dinner conversation from social to therapeutic becomes conscious.
The disturbing Mount Misery comes to an end as the psychiatry rotation comes to its last week. The only book I've managed to read during semester without major disruptions to my routine - reason being, I can't stand it for more than short spurts on the train, or in between waiting for patients. Freud, penis and mothers, dude, what were you thinking? Insightfully put in the narration, "the real perversion of Freud and analysis was to take the essence of something and reduce it to something else - the present to the past, love to hate, joy to misery, life to death - and to do it under the guise of understanding..."
Ah, so long, the land of slow coffee breaks, sweet normality of working hours and waiting for patients instead of patients waiting for you. Nodding nonchalantly at a patient's printed book of erotic poetry, stalking patients to their house, and calling them through their bedroom window to wake up and open the door to let you in. Goodbye shrinks with their long silences that forces you to say more than you intended, shrinks who have long buried skills in sucking blood or managing medical conditions, shrinks with a beard and long hair slightly neater than your average hobo, the ever patient shrinks who delivers care to those who slap them or threaten to kill them. Goodbye imposter parents, successful entrepreneurs, rock stars, devil's clutching hands, televisions that give special messages, armed robbers, drug addicts, arsonists, and people who blow up like balloons on medications.
I wish I could say, goodbye human suffering. But we'll just be going back to a different sort of suffering. In fact, we can't escape the groaning pains and decay as long as we are in this world. And unfortunately, I don't seem to be coping with my own emotions any better than before these six weeks began. Sad. Only thing I realised is that I do self therapy, alot. Extract from observing today's session. Now, what would you tell a friend? To take it easy. Maybe you can tell yourself that when you're feeling upset. (Tick.) What are some things you can do to feel better? Apart from eating tasty food. (Tick.) Take a hot shower? (Tick.) Maybe rubbing your arm (Tick.) or massaging your own shoulders? Next time I want you to write down what you're feeling at the time and your thoughts (Tick.)
I'm beginning to enjoy doing mental exams on anyone whose demeanor or expression catches my eye. That well groomed, unpleasant, sour faced, distracted and irritable hairdresser yesterday. Lack of insight. Damn you, you cheat, this is how people get sued. Fortunately for you, no one sues for hair because it grows back. I was offered a tailored therapy (not self therapy this time) - now, you feel that she ruined your evening, but is it true? You want to harm her? Jesus loves her. Pfft, why would Jesus love someone like her. Besides, I'm not Jesus and I hate her. But we're supposed to be like Jesus. Okay, still! Distract me.
Oops we've sidetracked. How strange it will be to go back to "real" medicine. But, the benefit is that our eyes and ears will be attuned to another layer of the patient's story. To some extent, what Roy said in Mount Misery will be true:
"Much of what I saw was psychiatric: belly pain, anxiety, phobias, depression, suicide attempts, hallucinating crazies. Before, these had been "turkeys," unfathomable and untreatable, mocked by us real docs and turfed to the shrink or back out onto the street. Now they were familiar, and easy. In a few minutes I got the feel of where this person stood in the world. I had learned something in my year of psychiatry, something about how to listen to intense feeling without flinching, how to make sense of it."
Close to heart
Three weeks of psychiatry and I've had enough. The conditions are interesting and I wouldn't mind talking to more of the patients (consumers?) myself, but sitting in with psychiatrists during those long interviews I've come close to nodding off to sleep so many times. Which always makes me laugh because it reminds me of the referral letter I read about a patient having issues with his previous psychologist who often fell sleep through therapy.
Sometimes I go through a psych lecture thinking, I don't want to be reminded. We had the talk about suicide. Oh... is it unusual to be preoccupied with thoughts of death, and plan how you might go about it? If society made it easier to access easy, painless, non-gruesome, high "success" methods, I would be long gone. Is a risk assessment forming in your mind now? I've learnt to throw out those thoughts into oblivion whenever they appear. And walking with God these years, there isn't the thoughts of everything being empty, meaningless, weary - that is the most life draining thought of them all.
Still, when my mood and sadness overwhelms me sometimes I wonder why I have to be stuck in this world I don't feel like I can live in. It seems that small things can tip me into a dark place with this drowning sorrow and thoughts that's painful and hard to shake off. It makes me wonder how I will deal with the bigger issues in life - if I have problems with marriage, if someone close dies, if I get a serious illness. At these times I wonder, why am I going to be a doctor (or, why am I talking to psychiatric patients) when I can't deal with my issues. Physician heal thyself.
Maybe the plus side of all this is that I'm constantly conscious aware of promoting my mental health. Often reflecting to understand why I feel and respond the way I do, consider how I can interact better with other people, talking to a good listener (friend, not a psychiatrist yet), praying and fellowship, getting out of the room even when I don't feel like it, caring about other people even when I don't particularly want to care, write or draw to deal with my feelings, make sure I get enough sleep, have a regular schedule, eat something nice when the appetite comes back, don't try to use alcohol to deal with mood problems.
I recognise that they are people loved by God, they often had a tumultuous upbringing, and well, they have an illness. But I find it seriously hard to respond with compassion and patience at angry, threatening, accusatory patients. Just you wait. I'm going to kill you. I don't know how psychiatrists take it.
I can't make my mind whether I really hate Psych, or if I can grow to love Pysch. I'll have a good think about Psych's effects on my psyche at the end of the rotation.
Psych is following me around. Personification, paranoid delusions. Today's topic at Christian medical fellowship was on psychiatry. Part one covers secular and Christian models for mental illness, and part two covers psychiatric therapies from a Christian perspectives, whether voices are demonic. Part two also briefly touches the question "are Christians delusional?"
Sometimes I go through a psych lecture thinking, I don't want to be reminded. We had the talk about suicide. Oh... is it unusual to be preoccupied with thoughts of death, and plan how you might go about it? If society made it easier to access easy, painless, non-gruesome, high "success" methods, I would be long gone. Is a risk assessment forming in your mind now? I've learnt to throw out those thoughts into oblivion whenever they appear. And walking with God these years, there isn't the thoughts of everything being empty, meaningless, weary - that is the most life draining thought of them all.
Still, when my mood and sadness overwhelms me sometimes I wonder why I have to be stuck in this world I don't feel like I can live in. It seems that small things can tip me into a dark place with this drowning sorrow and thoughts that's painful and hard to shake off. It makes me wonder how I will deal with the bigger issues in life - if I have problems with marriage, if someone close dies, if I get a serious illness. At these times I wonder, why am I going to be a doctor (or, why am I talking to psychiatric patients) when I can't deal with my issues. Physician heal thyself.
Maybe the plus side of all this is that I'm constantly conscious aware of promoting my mental health. Often reflecting to understand why I feel and respond the way I do, consider how I can interact better with other people, talking to a good listener (friend, not a psychiatrist yet), praying and fellowship, getting out of the room even when I don't feel like it, caring about other people even when I don't particularly want to care, write or draw to deal with my feelings, make sure I get enough sleep, have a regular schedule, eat something nice when the appetite comes back, don't try to use alcohol to deal with mood problems.
I recognise that they are people loved by God, they often had a tumultuous upbringing, and well, they have an illness. But I find it seriously hard to respond with compassion and patience at angry, threatening, accusatory patients. Just you wait. I'm going to kill you. I don't know how psychiatrists take it.
I can't make my mind whether I really hate Psych, or if I can grow to love Pysch. I'll have a good think about Psych's effects on my psyche at the end of the rotation.
Psych is following me around. Personification, paranoid delusions. Today's topic at Christian medical fellowship was on psychiatry. Part one covers secular and Christian models for mental illness, and part two covers psychiatric therapies from a Christian perspectives, whether voices are demonic. Part two also briefly touches the question "are Christians delusional?"
