Life of a medical student

Mi Familia

Life of a medical student part 9: April 2019

Current activity: Relaxing on an outside bench at my friend's farmhouse. (A game farm with wild animals: Kudu, impala, giraffes, etc.)

Pro: This is my first proper weekend off this year (I'm not on call and don't have any work shifts scheduled).

Con: I am in such a beautiful place but I keep falling asleep throughout the day. I think the lack of sleep has final caught up to me.

Music track: La Boulangerie 2 - Tourment d'Amour (Saneyes) by La Fine Equipe & Friends (Such a cool blues sort of vibe. Makes you want to jam.)

I have just completed my Family Medicine rotation and to honest I was taken by surprise by how much I enjoyed it. I already know that theatre is for me – I feel completely in my element there – hence me being slightly apprehensive before starting family medicine as it is the complete opposite. Its main element is patient interaction...full time patient interaction. And surprise, surprise I'm actually pretty good with that. I was placed in a district hospital with limited funds and resources. The whole experience was insane, amazing and oh my word there was a never ending list of patients. Clinic days just did not end. One after the other...so much so that doctors forget to eat and drink which is not okay. You have to set time aside, even 15 min, in the day to sit and eat in your own space (the doctor's tea room) otherwise you just get caught up and everyone needs you all the time.

The cool part of working in a district hospital is that when working in casualty there are no specialty departments available on hand so you get to be first hand exposed to all cases: neurology, orthopaedics, trauma, gynaecology, obstetrics, etc. You are basically a doctor in all specialties and have to do a full history, examination and stabilization of the patient before you can even think about calling for a referral as most referral dates are available in a month or two. As a student I must say this set up was perfect for me. To be thrown into a system where you take any patient (you are not picky) and you figure it out while you are there. Then you really start to become aware of what elements of your knowledge and confidence are lacking. As a student you are still required to present to senior doctors who agree or disagree with your diagnoses, sign off on all special investigations and prescriptions. So even if you are completely wrong you are corrected on the spot. Furthermore, it is nice to have back up in the sense that a lot of clinical signs I have only read about and not seen in real life so I often doubt my own clinical detection of these signs and end up asking the senior doctors if I am imagining things or not. For example I detected Argyll Robertson's pupils for the first time (this is when a patient's pupil can accommodate but do not react to light). This clinical sign can be seen in patients with syphilis and interestingly enough those who are on opioids (which I did not know) so it helps to check what medication the patients are on before making diagnoses. As I mentioned above you also realise your shortcomings. Here is one example when I presented one of my casualty cases to a senior doctor: "Hello Doctor. I have a 68 year old female who was referred from clinic due to a hypertensive emergency with a blood pressure of 229/109. She is a known hypertensive on treatment, diabetic on treatment and has dyslipidaemia. I did a full physical examination. No symptoms or signs of hypertensive complications such as stroke or myocardial infarction both clinically and on history. I wanted to do a fundoscopy to check for hypertensive retinopathy. I took her to the side room and then realised I don't actually know how to do a fundoscopy. We were never taught and I've only seen pictures. Can you please assist?" True I may have sounded like a complete retard but hey...guess who got taught how to use a fundoscopy? I did. And guess who doesn't remember how to do it a second time. Correct again – me. I will have to hunt down another doctor another time. Oh well practice makes perfect I guess.