Clinics

Hi,

Firstly, happy Easter weekend to all those out there, and I hope you are enjoying whatever holiday you get (if any). This week was pretty 'run of the mill', but I realise that a run of the mill week working in hospitals is still a lot more varied than in many other career locations. What a wonderful profession to go into - where each week is full of variety and interesting little things. Diseases are very varied, and people even more so - so whether you are spending your time chatting away with a 25 year old constant re-offender admitted from prison, or a tottering 90 year old lady who wants to talk about her cats by name as though they are people, its always interesting to go in every day. I suppose I look forward to it in a sick sort of way (whether that cancels out the early early starts we need sometimes is another matter) but its much more fun than the lectures from the past 2 years!

Some good news for you all. I am currently applying to intercalate at a few external universities and have got offered a place at one of them, and had two interviews at another two, awaiting results. That's not really good news for you, it is more my good news to tell you I suppose, but what can we do. I am pleased anyway - definitely intercalating externally on a nice looking course, but my first choice is one of the institutions I had an interview at. Just a waiting game now.

Down to business - I could ramble on all day otherwise. We are assigned our set rotations (as I said before, I am on a gastroenterology rotation) but if we just stuck to these we wouldn't learn nearly enough, as we would miss out on other rotations such as 'endocrinology' or 'renal' based rotations. I have been chopping and changing quite a lot recently, there is only so much you can learn about livers. Correction. I am sure there is an absurd amount you can learn about livers, enough to fill lifetimes of work with hepatic wonderfulness, but there is only so much I want to learn about livers at this current point in my training. I would rather focus on the common sorts of things like asthma, diabetes or heart attacks that the gastroenterology rotation doesn't give that much exposure to. As of such, I have had a very chop-and-changed week floating around different departments in the hospital and trying out different things. One of the best of these trials this week was a morning in an endocrinology clinic, so I will stick to that. No need to waste too much of your day with this post!

In the clinic I spent time in, we were being taught by an amazing consultant. All doctors seem to have very different attitudes towards teaching and the formality/informality of the teaching position. Obviously, doctors who want to teach are worth being with a lot more than doctors who do not want to engage with the students at all, and want you to sit in the corner, out of sight and out of mind. Both 'formal' and 'informal' teaching styles teach plenty, and its always worth being with a doctor who wants to teach, but in my opinion the informal doctors are a lot more fun, and enjoying yourself surely helps learning! Back on track (again) this clinic was headed by a very knowledgeable, interested in teaching, informal consultant. Not that all consultants aren't knowledgeable, but the other two are not prerequisites of the job. As well as learning about all of the conditions we encountered (a wide variety, from hypothyroidism to suspected Turner's syndrome to the rare pheochromocytoma) we also got a good general education. Sorry, to clarify, when I am referring to we here, I am referring to myself and the other medical student I found waiting in the general department, so we paired up. Most doctors only want a maximum of two medical students in their clinics, which is fair enough, as otherwise it makes quite a crowded room. Two medical students seems to give a better experience as well, as  perhaps the doctor puts more effort into teaching if there are two of you (and you both benefit as you are there) - and any hard questions you can hope that the partner knows the answers if you do not!

The general education we were gaining from this clinic was pretty broad. We were asked questions such as what country 'Chisinau' was the capital of (Moldova, if anyone was wondering). It seems that medical students are expected to have a broad knowledge base. Personally I don't think I have heard of Moldova outside of the Eurovision song contest, but perhaps I am the exception. When the consultant told this specific patient (who was from Moldova) about his questioning, she did ask if we had got the question right. A neat turn of phrase got us out of trouble with her by giving the impression we had, getting the response "Well, they are medical students, they should be smart".

1) It was a lie. I had no idea about this capital. Moldova? They made the 'Numa Numa' song with the strange lyrics, right?

2) Bit of a wake up call really. The public perception of medical students seems to be split into two camps from what I have found. We are either seen as a smart group of hard working genii in the making, or seen as a group of 'work hard, play harder' people who work a bit but go out on some heavy nights out as well. The further you get in your medical education the more people are going to expect you to know about medicine and different things in general. I used to be able to fob off friends and relatives in the first 2 years. "Oh, you say you have a tear to your anterior cruciate ligament? Sorry, I haven't done arms and legs yet, if it was a problem with your heart, I might have an idea". No such joy any more. It is always nice if people ask you something though, even if you don't have an answer (or have to make one up). Makes you feel respected and trusted.

As well as asking us (and teaching us) about a wide range of different topics, while patients were not in the room I add, the consultant also told us an alarming amount about his personal take on life. Again, this was most definitely when patients were not in the room, while he was jokingly friendly and beautifully informal whilst we were in the room, all professionalism and seriousness when patients were there. As it should be. I would like to be like that. Anyway, we learnt that our consultant has a real hatred for monkeys, and one of the worst things he could imagine would be having sex with one of these said creatures, how this came out I am not sure, but I wonder how patients would react should they find out. The consultant also finds 'muscular women a real turn off'. Again, how this came out is beyond me, but yet more information I didn't want to know. Muscular women (and I think he means really muscular here) came above, but only slightly, monkeys on the sliding sex scale. Not sure how comfortable my female partner was during this conversation, but all carried out in the consultants crisp Irish accent, it was a joy to listen to. One of the biggest turn off's about muscular females is, we heard, that if you came home and the dishes were not done, you couldn't ask her to do them because you have been at work all day, you would just get punched in the face. While this sort of conversation is most definitely inappropriate, I think it is this sort of things which keeps some people going in the very PC and polite world we have to live in now. A joke to the wrong person can wind up very badly, so venting away and acting the fool (even if you are a 50odd year old respectable consultant) around people when you can is necessary for a normal life! The consultant did get one of one of the patient's kids to have a chat down the Dictaphone whilst dictating a letter for his secretary to type up. I would love to have a secretary to do work for me! One reason to aspire to be a consultant I suppose.

I digress from what should be the focus of this blog. The patients. But I have talked for some time already, and have many things to do (as usual). In the clinic all of the patients we saw had some form of endocrine problem. The most common by far was hypothyroidism (people with diabetes go to a specialist clinic, as this is the most common endocrine disorder in the population) but this seems like a relatively dull disease to manage, with follow ups basically consisting on checking that the patient is fine. The more exciting conditions we got to see I mentioned before, because they are exciting! There was a patient with a suspected pheochromocytoma, a type of tumour growing in the adrenal glands, releasing adrenaline when it shouldn't be.  This is a rare diagnosis, though, and will need further testing, but it is one of those 'exciting' conditions to come across... perhaps.

Another patient we met that day was a woman who, back in the UnPC days of yore, may have been described as a FLK (funny looking kid). While she had come in for a completely unrelated diagnosis, she was very short and just generally a little abnormal looking. It sounds offensive, saying something like that, but I think being on the outlook for such things is an important part of medicine. After she had gone, the doctor decided that it was possible she had Turners Mosaic, (Turners being where instead of having XX chromosomes, females only have one X) - Turners mosaic females have some cells with XX and some with only one X (XO) due to a defect when they were in the embryonic stage. This means that she would still have gone through normal development (such as starting having periods) which someone who had Turners would not have. It can only be confirmed by genetic testing, though, and does the doctor want to say to her, next time she is in for a check up "Hey, you look a bit odd, perhaps you have a genetic defect, can I test for it please?"

That might be taken as a little offensive.

Happy Easter once again.