My first week on the new rotation, and I am now on a respiratory medicine firm. It was sad saying goodbye to my old rotation, and I made them a cake as a thank you for putting up with me for the last month. The new set of doctor's whose task it is to look after me seem nice, so hopefully this month will be just as good. I tend to spend most of my time with the junior doctors helping out on the ward, and don't come into too much contact with the consultants who tend to run things from their offices or do clinics, apart from a few days a week when they lead ward rounds. This is very different from previous years where we tend to be attached to consultants in hospitals and clinics. Perhaps this is intended to teach us the knowledge in the earlier years (consultants know a lot) then teach us how to work as junior doctors now. In my opinion, the younger doctors are much better teachers. They have a good idea about what we need to know to pass exams (what we are interested in now) and the correct level to teach things at. The junior doctors will teach about how to recognise pneumonia or a pneumothorax on a chest X-ray, while consultants tend to tell us about things such as CT guided biopsies and other procedures we wouldn't be doing unless we were a consultant. I am sure these things are a lot more interesting, but just much less relevant to us.
And medical students...
Anyway, complaining over, its been a busy week. The most interesting parts were a crazy on call night in the hospital with a 'celebrity appearance', and a number of controversial decisions based around the Liverpool care pathway.
The Liverpool care pathway (LCP) is a way of treating patients in the last days of their life. The decision to put someone on the LCP is not taken lightly, and only made when it seems that they are going to die in the next day or two. It is often used in the very end stage of chronic diseases such as cancer. One of the patients on the ward was very ill, and the decision was made by one of the registrars to put him on the LCP. The man couldn't communicate, seemed to be mostly asleep all of the time, and could barely breath. The LCP involves 'supportive' care, meaning that they are given drugs to try and make them more comfortable, rather than treatments aimed at 'curing' them (as by this point a cure is impossible). it also means that the family expect the death, and can visit the patient at any time, rather than just in visiting hours. The next day, the patient seemed to have perked up a little and seemed a bit more restless. This day the consultant was doing his ward round and decided that it was inappropriate for the patient to be on the LCP as he seemed to well. I am told that sometimes patients can seem to perk up a little once put on the LCP, as stopping the regular medications and trying to treat their symptoms only can help. Either way, the consultant spent some time berating the registrar for putting the patient on the LCP, talking about how inappropriate it was, and finally making her cry. Certainly not appropriate behaviour, especially as he hadn't seen the patient the day before. The consultant then went and told the family that the LCP was being stopped, and the patient could be back on normal treatment. The next day, after the patient had been put back on his regular medications, he died. The family were clearly upset about this, and the death now looks unexpected as the patient wasn't on the LCP, meaning it should be looked into further. Despite all of this fallout, the consultant isn't anywhere to be seen, running clinics this day instead, and leaving the less senior staff to sort out the ward. Now, I don't mean to be consultant bashing at all, as they do fantastic work, but this is pretty poor practice.
On more positive note, the on call I did this week was crazy. There was loads going on, including a child who had a cardiac arrest from an asthma attack (but it all turned out well, with her being successfully resuscitated). The most exciting part was when the rumour circulated the doctors that Johnny Depp had been admitted into one of the wards. Excited, and dreaming of some sort of romantic encounter, the junior doctor I was attached to hurried to the ward with me in tow. This rumour had obviously spread quickly, as there seemed to be most of the hospital's night staff hurrying to the same place. On arriving, we found a plump middle aged man, inexplicably dressed as a pirate and confused about all the attention he was getting. A wicked rumour!