Almost Automatonophobia

Hi,

Back on the weekly posts now, and it feels good. This week there is a ward round in the stroke rehabilitation ward, where patients are looked after post-stroke and health care professionals do their best to help them improve their function. The real fun comes from my GP day, where I see a number of strange cases, the strangest of all was a 18 year old lady who was applying to be a nurse, but who had what she said was a crippling fear of CPR dummies which would stop her from realising her dream.


The ward round around the rehabilitation ward for stroke victims was an experience. Many of the patients were really quite ill, with serious problems meaning they couldn't function normally. They may have physical problems, such as the inability to walk or feed themselves (whether through problems with arms or inability to chew and swallow) and may have cognitive problems, such as the inability to form words or recognise objects. All of these are equally debilitating, but the people with cognitive impairments seem a lot more interesting from a medical perspective. It is very easy to understand why someone may have problems moving a limb, but a lot harder to understand why a person may no longer be able to recognise and name objects such as a pen. The consultant on this ward round was fantastic, taking plenty of time for each patient and talking slowly and clearly to make sure they understood perfectly, crouched down on her knees to get to eye level with them. Some patients stay in this ward for months and months as they slowly improve, to try and get them functioning as well as possible, but she would still take a decent amount of time to ask them how they were and see how things were going. While the area of medicine doesn't appeal to me all that much, if I am going to be a doctor, I would definitely like to be a doctor like her!


Medical school lectures and seminars are not usually the most interesting of times. Don't get me too wrong, you learn a lot and the subject matter can be fascinating, but there are not usually a lot of laughs bouncing around. This changed in a seminar this week on prescribing, though. We were being taught about how to prescribe, and were looking at the BNF (effectively the bible of drugs), going through drugs that are given for infections in different systems of the body. The atmosphere among the ten or so students there was very strange. Not really sure how to explain in, but just one of those strange buzzing sort of atmospheres that seem to be waiting for something to happen, almost like that  before a storm... The GP tutor said 


"This section of the BNF can be used to help you see which drugs to use for infections to different areas of the body. For example, for skin"... 


There was a second of silence as she caught her breath, then the guy next to me let out a snort of laughter, which he was clearly trying to contain and 'whispered' to me "Forskin!". This was definitely not a whisper, and the whole room was giggling away for a good minute. Fortunately the GP tutor saw the funny side as well. Its a little scary how many similarities there are to primary school with us fourth year medical students...

My day at the GPs surgery this week involved a huge variety of patients, some of who were really interesting! Being a GP has never been an appealing idea to me, as it seems as though it may become a bit boring, but these days in GP surgeries definitely make it seem like quite an appealing job! One of the patients who I saw today was a definite hypochondriac, who came to see the GP almost weekly, and had used her own money to pay for many investigations that she didn't need, such as a full body MRI scan. She had had a small lump on the inside of her cheek, which while it wasn't visible, and didn't irritate her in any way, she had wanted it removed. Most people she had talked to had said it didn't really need doing, so she had gone  privately. Unfortunately the private doctor who she saw used the equipment in the operation incorrectly, and turned up the diathermy too high. This ended up with her having a large hole in her cheek. A young shopkeeper, she was very unhappy with this result from what was an unnecessary operation, and now had serious health worries. Its important to remember that all operations carry a degree of risk!

This is a child, and a different hole, but you get the idea...

The GP was very busy due to a number of complex patients she needed to see, and I ended up seeing a couple of patients on my own, with the intention of reporting them back to her and making her talks with them shorter. This would hopefully help the waiting times, and give me practice as well. This was, unfortunately, when the most complicated patient turned up, when I was left alone. This wasn't the typical 'complex' patient, with lots of medical problems - just someone that we had definitely not been taught about in medical school. This was an 18 year old, who wanted to be a nurse, but said she had a crippling phobia of CPR dummies. She was afraid that this phobia would hinder her in her training, and wanted it to be cured. How do you approach a patient like that? I have heard of a fear of puppets (Automatonophobia) but never this, though I assume it is similar. It was clearly worrying her, so I tried to be as serious as possible while I got the GP involved, to help me out. In the end it was decided that perhaps she could try CBT to help her out. The GP first suggested 'flooding' by putting her in a room full of the dummies and locking the door. Fortunately she was joking, I don't think that dying from a dummy-induced-heart-attack would look very good. Once home, the internet tells me that she isn't alone, I mean look at the first poster on this facebook page! Some of the things that GPs see and hear about can be really sad, but others can be fantastic!