My First Week in Clinical Medicine
It was October 2016. I was nervous. Perhaps more nervous than I had been my whole life. I was about to begin my second year of Medical School and, the last time I was there, I was a patient in the psychiatric unit. Now, I was about to make the shift back. I was scared of all the questions people would ask me. Scared of if the same would end up happening to me that time round. Petrified of all the whispering that would undoubtedly be following me.
Fast forward 11 months.
September 2017. I was excited. More excited than I had been in a long time. I couldn’t believe – and still can’t – just how much things managed to improve for me in one year. Mental health is something that we all have, but it is only when it becomes damaged in some way where we realise how important it is. I was now about to start clinical Medicine. That is, actually being on the wards and training to become doctors. Not reading stuff about the science of the human body anymore. Well, not as much – we learn about it everyday.
If you are interested in the progression of my mental health, have a look through my latest blog posts. I documented how I was feeling there from time to time – there should be a gradual shift from negative to positive. This blog post, however, will focus more on how I have found clinical Medicine so far.
Note: ALL patient details here, including their age have been altered. None of these are real patients but the lessons I learnt are what I’m trying to get at.
On the first few days, we were taught how to perform some basic examinations. These included examining the cardiovascular system, respiratory system, cranial nerves, upper and lower limbs and the musculoskeletal system. We will also be taught how to examine the abdomen in due course.
In learning the examinations, a consultant would firstly demonstrate on a healthy volunteer (who we were all very grateful for having) the procedure. We would then split up into groups where a junior doctor along with the rest of the group would watch us perform the examination.
It was very easy recalling to someone the procedure for each system. However, to actually go and do it ‘live’ in front of everyone else was anything but easy. Everyone was really supportive but it was difficult to feel completely at ease with lots of eyes staring at you. Nor was it easy to recall in our heads. It was bloody difficult, in fact. And rather embarrassing when we would try to find the heart, only for the junior doctor to sigh and go: “The heart is on the left side of the body usually!”
(We do actually know that, but it’s surprisingly difficult to coordinate yourself for the first time)
The difficulty of approaching ANYONE on the wards
It is difficult to feel as though you belong as a Medical Student. We are just learning, after all, so we are of practically no use to anyone. We still suck at examining so most of our practice is simply to make sure we put our hands and stethoscope in the right places rather than trying to feel to see if it’s normal or not. Nor have we yet been taught many clinical skills that are of use either, so we aren’t yet allowed to cannulate or take blood. Well, we are allowed – but none of us want to try it without practising on plastic arms first.
Most people on the hospitals seem so busy too. Introducing myself with: “Hi, I’m a third year Medical Student!” to a healthcare assistant or junior doctors often lead them to looking at us with a blank expression and going: “Ah, OK” and turning their backs to us. I’m not even exaggerating – some are genuinely like that. Some are also very polite, however, and start conversation to help us feel at ease. But then their bleep or something goes off and I end up feeling bad for having wasted their time.
Then there are the patients. Having had lots of experience of being a patient myself, albeit in a psychiatric setting, you’d think I’d be good at this. However, I am always so bloody scared of saying ‘hi’ to them. What if they end up thinking I’m a doctor and get mad at me when they realise I’m not? What if they just shout at me for no reason at all? And if they ask me something I don’t know? All these thoughts go through my head before I eventually pluck up the courage to go and speak to them. Most are absolutely lovely, however, and smile when seeing us.
‘Go and take a history and examination from Mr Y!’
One day when nothing was going on in my ward, I decided to do something that was equally brave and stupid: I decided to go to A&E. I thought I would learn quite a bit there.
I loitered around for a bit in the bay of doctors and nurses. Then, plucking up the courage, I went up to two doctors and introduced myself. One scowled at me a little and seemed annoyed to see me. The other smiled and said they would help me out. They asked what my objective was of the placement and, to my embarrassment, I had no idea. I just mumbled something about wanting to practise taking histories and doing examinations.
To my horror, he told me to get the file for the next patient on the waiting list. ‘Go and perform a history and examination on him!’ he said to me. ‘Don’t take the file with you, mind you – the senior doctors will want to see the patient too so you can present your findings to them.’
What have I done, I thought to myself? I smiled, pretending to be brave and walked up to the cubicle of the patient. His file said he had come in with chest pain. I wasn’t sure if I should go in assuming that I knew that, or if I should assume I knew nothing. After being scared that the man may be very angry to see me, I plucked up the courage and walked in.
He looked at me curiously. I felt like sinking in a giant hole. I then introduced myself as a Medical Student as bravely as I could and explained what I had been asked to do. The man seemed delighted, and I asked about his presenting complaint. I knew how to assess pain, so I could do that in my history. Or so I thought. It turns out the acronyms they teach you are never told to you in order by the patient. (Obviously!). You therefore need to work out what has been missed and ask about that.
The patient was speaking again but I realised my mind had gone blank suddenly. What on Earth do I ask him next? While thinking that, I suddenly realised that I wasn’t listening to a word the patient said. Great…what are they talking about? But what do I ask them?
Eventually, the history was done. I examined the patient and that went a little more smoothly, but that’s not saying much. The patient smiled at me and said, “Thank you. I feel much more calm now after having spoken to you.” I had no idea what I had done – my history got practically no information and nor did my examination. Maybe I just seemed to do it confidently even though it was rubbish.
I much prefer this environment of Medicine compared to pre-clinical years. Perhaps it’s because my mental health has improved so much, or perhaps it’s because I’m not getting to practice what I’ve always wanted to do. It’s like playing doctor when we were children – except now things seem much more real. Thankfully, we all know our competencies and would never act outside them.