Jan 16, 2011

The First Eight Weeks

Has its highs and lows, total exhaustion and insomniac excitements; and most important of all, was a totally new learning experience for me.
A bookworm back at school, the clinical setting was a complete stranger. We had many practises with standardized patients, seniors, and ward nurses prior to meeting our first patient, but actually meeting one is still like walking on the moon. Should I introduce my full name or just my last name? Should I reveal my identity as a medical student, intern, or just the general "doctor under Dr. What'shisname"? How should I ask about sexual history? Reason of abortion(s)? All these we ran through our minds again and again while dragging our feet to the ward.
My first history-taking in Pediatrics would be a total disaster had my senior not covered me up when I went into daydreaming mode. The second was better, but I still had episodes of "brainfreeze", my resident complaints.
Soon the routine sets in, I would grab a piece of paper, fold it into 8 equal columns, stick the uppermost corner with the patient's chart sticker, and preview his / her history. "Hello, my name is Sim Jun Yi, I'm a medical student assigned to your care." I would start like that, making eye contact and a friendly smile. I learned the importance of "relevancy" much emphasized by our Pediatrics teacher. Obs/Gyn taught us to bring along a female whenever we go, least our patient decide to accuse us of sexual harrassment when only a handsome male intern and an obese pregnant mother is in the room. Wear a mask, bring a pen-light, stethoscope, tongue blade, and we're almost ready.

Cooperation has to be earned from patients, the principle is similar to all walks of services unlike airlines or even bakeries and hair salons where they think they can bind you with a loyalty card. If my patients are easy-going, cheerful, or in the mood for more talking, I would attempt to trend into deeper waters. "Forgive me Mrs. Whoever, the following questions may sound offending but I may need to chart it down for future references. I hope you don't mind." We always try not to sound judgmental so that patients have the confidence in confiding with us. Mostly it's just empty talk anyway.
Then comes chart writing, another pivotal aspect of a clerk's job. Our teachers always say whether or not we produce good charts determine how the quality of care is given, on paper. My previous experience constructing complex sentences in English comes into good use - the dull pain at the lower abdomen was associated with intermittent cramping episodes and constipation, not radiating, cyclic, nor colicky. Information obtained from a series of questions we recite by abbreviations all squashed into a single sentence meant to pinpoint a specific diagnosis. We found out later there are many other indications for admission, such as nausea, vomiting or one episode of prolonged menstruation that I might easily take care at home with some sleep. How medical care is carried out is still beyond our learning I suppose.
These eight weeks had taught us the approach of medical care instead of the content. And I think it's equally important compared to shelves of internal medicine or pathology. The problem is, there is no book to dictate how you should pacify a screaming child while listening to his lungs or see his tonsils when he absolutely refuses to open his mouth ("look, a squirrel!"). Or how to handle a lady with schizophrenia who underwent surgery but wounds were too contaminated to be closed on the first week - she formulated a theory involving Russian KGBs working with aliens to steal her kidneys for clean, renewable energy - ok, I made that up myself.
So here we are, a bunch of young, shiny, well-dressed lads and ladies (in leather shoes and high stockings) pacing around wards asking questions in its most immature way, answering "I'll report that to the attending," to your every request, and whose visit every morning and evening finds you at your most inconvenient time. Forgive us, but please bare with us - it's for our good and ensuring the future medical quality.


--Sunrise-- said...

Hello, another fellow medical student here - stumbled across your blog while doing a random Google search for Paediatrics notes! I know the feeling of 'forgive us, but please bear with us' - there is so little med students can do! (I'm a third year medic) Most patients understand though, and are willing to help you to learn, I find.

--Sunrise-- said...

PS: Paeds is straightforward?! Since when?! lol :)

JYSim said...

Hey, thanks for your reply! I agree that majority of patients are nice enough (or too tired to reject) our requests or questions at times. That's why I think medicine is actually as humanitarian as it is scientific.
I think Peds is straigtforward because children will never hide their feelings, unlike us complicated adults who backstab, cheat, and scheme. Haha. Pretty dark eh?