Sunday, September 27, 2009

Identity theft

I've just remembered some things that particularly struck me during my Paeds rotation.

On ward rounds, the doctors would always say hi to the parent/s (usually mother, but sometimes father) - but instead of greeting them by name, they'd say, "Hi Mum, how's little Johnny going today?" I saw this time and time again - in fact, I never once saw a parent referred to by their name. I felt bad for the parents. Sure, the child is the one who's sick and needs attention, but it's damn hard for parents to give up work, or caring for their other children, to spend time in the hospital. And on top of all that, they lose their identity and are reduced to the generic "Mum" or "Dad".

I also felt bad because the parents often have no idea how long they'll be staying in hospital - that's par for the course, as it really depends on how quickly the child recovers. But for a parent who's never experienced this before, it must be so frustrating and daunting. Each day they wait for a visit from the doctors - sometimes first thing in the morning, often not before midday - to discover their fate, and often they're disappointed to find that they're stuck in the hospital for another day, or a weekend if it's Friday.

A couple of patient encounters particularly bugged me:

  • One 3-year-old child had been in hospital for weeks, and his poor Mum looked frazzled. I ended up taking a detailed history from her, and found out that she also had a 4-month-old child, had recently split from the father of the second child, and was going through a bitter legal dispute with him (he had assumed custody of the child). She had to sit there and entertain her sick, bored and cranky child each day, while also trying to deal with these legal and relationship stresses. I don't know how she did it. In the child's notes I was pleased to see that these issues had been identified, and that the social worker was involved.

  • During my farcical week of surgery, we went on a lightning quick ward round. One mother was confused because two groups of doctors had been to see her. Who was in charge? Who should she believe? It was clear that she had questions, but the doctors blew her off and she was left floundering. Another student and I trailed out of the room behind the team, and he said to me, "How would you evaluate that patient encounter?" I said, "Possibly one of the worst I've ever seen." He agreed. It was tempting to go back into the room and have a chat with the mother, but who were we to do that? We didn't have the information she needed. I wish I'd spoken up, but I'd only just met the doctors on my team - in fact, they hadn't bothered to give us their names, and never asked for our names. (That's a pet hate, by the way - it happens all the time.)
So endeth my random observations.

Friday, September 25, 2009

Kids! I don't know what's wrong with these kids today...

I've finished my Paediatrics rotation. It kinda sucked. I loved the kids and could easily see myself working with kids, but my weekly placements within the rotation sucked, and that ruined it for me.

My first week was spent with the Renal team, and I was looking forward to solidifying my renal knowledge, and learning about kid-specific things too. But it was dull - with only one or two inpatients, there wasn't much for me to do. Clinics were the main part of the week, but it really gets dull sitting there, not interacting, hour after hour, day after day.

My second week was General Medicine. Two or three students are attached to each team, and we basically spent the whole time walking around on ward rounds that lasted several hours. Sometimes, if we were lucky, we got to write in the notes. Mostly we were ignored.

My third week was in the Child Development Unit. I'd already heard that it was pretty cruisy (finishing at lunchtime each day), and that was fine with me. But the time I spent there was pretty useless. One day I had to sit behind a one-way mirror to observe a session with an autistic kid, but they hadn't bothered to check whether the audio equipment was working, so I sat in silence and ended up playing with my iPhone for an hour. Then I was told that the doctors would be on a conference later in the week, so I really only experienced three half-days of questionable value.

My fourth week was Anaesthetics. I specifically requested it, and I'm glad I did. Everyone was friendly and they let me do lots of stuff, including cannulation and intubation. And during the operations I chatted to the anaesthetists about the pros and cons of their chosen career. Finally, a good placement!

My fifth week was General Surgery. It was SO frustrating. We had to be there at 7am for ward rounds. But the rounds never started before 8am - one day we waited until 8:30am! Not happy after getting up early to drive a considerable distance to be there on time. Also, on the first morning the registrars on our team told us that there was only one day of theatre that week because all the doctors would be at a conference. That also meant they wouldn't be admitting any patients, so there was absolutely nothing for us to do. They had three or four neonatal inpatients, so the ward round was over really quickly - and then later in the week, the NICU was closed because of a pertussis outbreak! While it was good to have spare time so close to exams, it was ultimately disappointing.

The other weeks were made up of lectures and exams. I passed the exams, but gave myself a bit of a scare. I had a brain freeze during the written, and ended up passing by one mark. I was convinced I'd failed. Similarly, I stuffed up one of the stations in the OSCE - I knew I'd failed that station, but had to pass the other three stations to pass the OSCE. Luckily I scraped through, but only just. I spent three days sick to my stomach with worry, constantly in tears - not the best when I was supposed to be studying! The annoying thing was that all of the exam questions (written and OSCE) were from past papers, so it should have been a breeze. I really need to get over this exam anxiety already.

Apart from Paeds, I've been continuing with the yearbook. We've collected profiles from most students now, though some are being particularly difficult about it. We've even got some "conscientious objectors" who don't want profiles in the yearbook. WTF? We'll be editing all the content over the next couple of weeks. It's slowly coming together...

And in my massive amount of spare time (yeah right), I'm helping to organise a Vietnam fundraising dinner and my friend's hen's night. I am mental.