Hospital

I’m in my second year at medical school and spend 2 days a week in hospital on placement. We are there from 8-4pm. It’s a long day and when you’re not used to the early morning starts and the long days constantly on your feet, it can be tiring. But we are all slowly getting used to it. I love hospital. It is my favourite 2 days of the week. I look forward to it and don’t mind the early morning starts. I remember before the clocks changed I’d get up at 5.45 am and it’d be cold and pitch black when I left the house. One of my housemates would tell me she’d hear me get up that early and would feel so sorry for me going out in the cold. Most people complain about it and sometimes if I went to bed late, I too would feel like crap the next day. But usually when my alarm wakes me up, I jump up and get ready thinking of what I may see and learn that day.  

We have a log book with a list of 30 cases and 18 KCEs that we have to get signed off. KCE stands for key clinical experiences and that includes clinics that we have to sit it on. The cases are a list of symptoms. They include jaundice, difficulty passing urine, shortness of breath and chest pain. We have to meet patients who present with these symptoms.

The aim of our placement is to meet and speak to patients, take their medical history and perhaps if suitable carry out a clinical examination relevant to the appropriate system. We then have to find a doctor to present the history to, outlining what investigations we would carry out, differential diagnoses and potential treatment options. A differential diagnosis is a list of diseases that the patient could have that accounts for their symptoms and the purpose of the investigations is to eliminate all the things it cannot be and to confirm your diagnosis. We then get feedback on our history and then the doctor discusses the case in more detail with us.

This is my favourite part of the course. I love meeting patients and taking histories. We are put into firms (groups) that we go around in and at this stage they want us to take histories in groups of 2/3. That way we can feel more comfortable and allows us to learn from each other. In my firm, there are 5 of us - 2 guys and 3 girls. The 2 other girls like to work together and I work really well with the 2 guys. I think we all balance each other out. I ask the probing conversational questions and the guys are to the point and can direct the conversation and get the most out of the patient in an efficient way. One of the guys in my group isn’t the best communicator. He doesn’t have a warm or friendly manner with patients and often asks blunt to the point questions when taking histories. He cam’t wait to finish and just often appears bored. He’s not at all like that with us though. He is so funny and charming and has a warm cheeky sense of humour. He just doesn’t portray that amazing side to him with the patients. I love to have a chat with patients and I always come away from the consultation having learnt something. Whether it’s a bit more about life for the working classes or how different people reflect and deal with their diagnoses. I always feel so inspired about the strength of humanity in general and often feel my eyes well up with emotion. For example I met a wonderful man recently, who had just been told he may have an adenocarcinoma of the bowel and he just took it on his chin. He said that’s life and we just have to get on with it. What’s the point in worrying and getting upset, he said. I always come away from some histories feeling like life isn’t nearly as bad as it seems when there are people who have much bigger worries. Patients are always inspiring me and to me the satisfaction and joy you see when you give them good news is what you live for.  

I also love the diagnosis element to medicine. I love how you can have a list of symptoms and you have to put it together to work out what’s wrong. You use all the knowledge that you have learnt and are constantly learning to make a diagnosis and plan what investigations and treatments you’ll carry out. The guy I mentioned is amazing at this! He is just so smart and retains so much information and can access it so quickly and efficiently. He is just such a born clinician and I am always learning from him. We take most of our histories together and realise we have a great working and personal relationship. Everyone has such different skills and we should all learn from each other so we can be the best we can be.