Monday, June 23, 2008

Everything comes down to...

I think JD and Turk sang it best:

I just finished my 4-week placement in Gastroenterology. Loved it!

Apart from finding it very interesting, it was a great placement because of the doctors on the service. The registrars were so willing to teach - it was really refreshing. Even more refreshing was that the consultants were the same (we just didn't see them as often as the registrars). Each week we (myself and the other 2 students on the placement) were required to present at least one long case to one of the consultants, which was extremely valuable.

And yes, there was a lot of poo. I even saw melaena for the first time. But the weird thing is, I didn't smell it! In fact, although I saw a shitload of poo (hahaha), I don't recall smelling it once. Perhaps I trained my nose somehow? I dunno.

  • Best moment: Every morning, the registrar gave us each a new patient to clerk. We had to take a history and do an examination, and then do a short case presentation to the registrar. It was good to get practice doing short cases, because you have to pick the key information to present, leaving out the extraneous stuff that would come up in a long case. It's similar to how we'll need to present cases when we're working as interns. The other good experience was the outpatient clinic, where we saw new patients who'd been referred to the Gastro team. Again, we took a history and did an examination (and wrote in the patient's notes), and then presented to the registrar or consultant on duty.
  • Weirdest moment: A patient came into the outpatient clinic after some rectal bleeding. I'd finished the history and was about to start the examination, when she said, "I took a photo of it - do you want to see?" How could I say no? She then whipped out a camera phone to show me several photos of a blood-filled toilet bowl.
  • Worst moment: The patient with a blocked biliary tree due to pancreatic cancer, with only weeks to live. However, he didn't know this because his family didn't want to tell him, and he didn't speak English. Big ethical dilemma! The registrar didn't approve, but had respected the family's wishes so far. One of the family members had been doing the translating - the registrar told them that if he felt his words were being mistranslated at all, he'd arrange for an independent translator. Also, he told them that if the patient asked specifically about whether he had cancer, then he would tell him. A very tough situation indeed...
I started my 6th placement today - Cardiology. It's a lot busier than Gastro, but so far very good. I'm going to get a lot of practice taking blood, reading ECGs, and doing long cases.

And how nice is this: the Gastro registrar found out that I was doing Cardiology next, and offered to give me a tutorial on the Cardio examination. Those sorts of offers don't come along very often, so of course I took full advantage of his kindness.

14 weeks till the end of third year!


BrisMedStudent said...

I did a bioethics in undergrad and we touched on this very topic. It's all very tricky and gets into the whole sordid world of ethical relativism. Whilst the patient has a right to know the diagnosis, they also have a right not to know; the principle of respect for autonomy doesn't require inflicting unwanted information of people. It does require finding out what kind of info they want to know and respecting their wish. The conclusion I came to (I'm not sure this is practical) was that before the test is done, ask the patient themselves whether they want to know the results. The other point of course is that they can (probably) often guess the diagnosis by the way people act around them.

We've been told to use the official translators whenever possible to avoid those kind of problems.

KT said...

Yes, it's very tricky. I think it's arrogant for us to assume that the patient wants to know what's going on, or that the patient doesn't already have an inkling of what's going on (as you said, by the way people act around them). I was surprised that official translators weren't used.

I'm writing an ethics essay about this soon...

Dragonfly said...