Back into the normal run of medical school, and enjoying the fact that I am relatively free from work a the moment, while the weather is also lovely. Usually it seems that the amount of sunshine is directly proportional to the amount of work I have to do, and thus the amount of time I have to spend inside on a computer. Not any more! I can enjoy a cycle to and from the hospital to learn there, and enjoy my time away as my own time... At least until the exam and presentation in a little over a month. Still, they can wait!
This week I spent some time in infectious disease outpatient appointments, and infectious disease ward rounds, and some more time in the sexual health centre, where a somewhat familiar face made a visit.
Clearly, because of confidentiality, I am not going to say anything about the B-list celebrity who was coming in for a sexual health screen, but it is interesting to note that these poor people have to live their whole lives in the public eye, with all these people they have never met knowing about intimate details from their lives. I am sure some use these details for their own publicity, carefully cultivating certain images, but its sad to know that others just want to get on with things and not have rumours fly around about them. Anyway, celebrity or no - everyone should have regular sexual health check ups! Apart from this unexpected visit, the sexual health clinic was pretty similar to previous times I have been there. I would talk to the patient on my own, present them to a doctor or nurse, who would then come in and do an examination with me. There were a large number of teenage boys who had come in with lumps on their penises which had been there for some time. All of these were diagnosed as Fordyce's spots, a harmless feature which just occurs on some penises. Strange that so many came in in one day for these lumps. Perhaps it was sex-ed week at school... Doctors often comment that patients seem to come in clusters of disease, where you won't see something for some time, then a number of that particular condition will come in in one day. I suppose its like buses...
Sexual health clinics are slowly losing the stigma that people have attached to them... Come one come all, they have free sweets!
Other than the time in the sexual health clinic, which I am still really enjoying, I got to join some outpatient sessions and ward rounds with the infectious disease doctors. As I did an intercalated year based around infectious disease last year, I was hoping that my amazing knowledge of all things infectious and puss-filled would come in useful, but it has turned out that I actually know basically nothing about clinical infectious disease. Who could have guessed that having to learn each of the proteins that make up HIV and how they are put together would not have any real-world use. (I use real-world here to mean clinical doctor. I am sure most of the things I learn have little use outside of medicine...)
Despite my astounding lack of knowledge (as in, I know the same for infectious disease as I did for the other specialities) I really got into the infectious disease clinics. Most specialities have 'bread and butter' cases which make up most of their work load, e.g. endocrinologists see a LOT of patients with diabetes and thyroid disease. This has always put me off of specialities, as I can imagine that the lack of variety would lead to it getting boring (for me, at least). Not so with infectious disease, it seems. The clinic consisted of a huge range of diseases from serious cellulitis, to endocarditis, osteomyelitis and HIV. From just one clinic this was a good range of disease, and there was a lot of detective work to be done as well. Many patients are referred to the infectious disease team with problems like PUO - a long standing fever, or generalised lymphadenopathy. The diagnosis is often not easy to find, as many of the tests are nowhere near 100% accurate at picking up the disease (such as TB) so clinical judgement is important.
One of my favourite things about the infectious disease clinics was all of the patients who have caught weird and wonderful infections while abroad. Obviously the problem-solving and diagnostic side of things is very interesting for these people, as they can be rare diseases, but hearing about their travelling stories (one was distributing free text books through Sub-saharan African slums) is fascinating. Made me want to go back on my elective (until we looked at the lump under the next patients skin, caused by botfly larvae growing under there before becoming flys...)
All in all a great week, and perhaps I will become an infectious disease doctor... Despite the fact that I saw some pretty nasty infections in the sexual health clinic this week, the worst things in medicine (in my opinion) are still those chronic ulcers in the vascular wards, with that necrotic smell from the dying tissue that fills the ward...