One down, three more to go

Just decided to pop back in, as I've just finished my cardiology rotation. The past six weeks have, in general, been pretty awesome, but it is interesting to see how people progress throughout the rotation.

As somewhat expected, towards the end of the rotation, people started doing things less. The number of students attending the morning 8am handover meetings steadily decreased. The number of students going home at 1pm (or earlier) steadily increased. And yet I soldier on. Woo, go me.

Cannulations are still tricky, my histories and examinations still aren't perfect, and sure, I don't think I'm ace at cardio now - but I've been encouraged by my supervising doctors, who have been brilliant in doing what they do and trying to accommodate us at the same time. Although we are exhorted to be part of the team and thus help the team, we're still a hindrance in terms of time - except when we do discharge summaries, which I actually haven't done since the fourth week, thanks to a very efficient resident that joined our team.

Whilst I'm here, for those who haven't got a clue as to who's who, here's a brief glossary of people you see in the hospital:

Intern - Post-graduate year 1 (PGY1) - they know the practicalities of being a doctor but definitely still need to be supervised. We actually didn't have an intern during our rotation.

Resident - PGY2 and above, aka RMO/MO (for Medical Officer) - good people to hang around, as they teach you many things.

Registrar - PGY3+, in a training program to become a specialist. These can actually be really great resources as well - the registrars I've come across have inspired and taught me a great deal. They're also quite up to date with details, seeing as they have to study for exams.

Consultant - completed fellowship of a post-graduate college; if they're not a staff specialist (i.e. employed by the hospital on a full-time basis) then you see them quite sporadically.

Nurses - come in a multitude of flavours; you'll mostly come across enrolled nurses (EN) and registered nurses (RN), as well as some clinical nurse specialists (CNC) and some nurse educators. They run the wards, love to let you try your hand at cannulas.

Allied Health - physios, OT (occupational therapists), speech therapists, social workers, pharmacists, dietitians - they're the main allied health professions on the ward and you see them very frequently. Important people, especially when aiming to discharge patients - which seems to be the main goal of the hospital.

Others - there's a number of other people, such as the ward clerks, jan itors, and of course the support staff at Blacktown Clinical School. Love those people ;)

So I'm heading off to my second rotation in Endocrinology/Geriatrics, they seem to be a lot busier than Cardiology, so I may not post back until the end of that. Meanwhile, apparently everyone has exams around this period - I would like to take this opportunity to say "SUCK IT!" - it's a rare occasion when medicine is able to trump other courses on workload, so I savour every opportunity that comes along.

On that note, I would like to reflect on something that's popped up quite a lot. There's obviously a great number of med hopefuls around Australia and even abroad, looking to study in Australia as a medical student. Over the last month or so, I've noticed a couple of situations where doctors begin to stress and agitate over the workload, physically and mentally, placed upon them. These are invariably the junior doctors (interns and MOs); we don't see enough of the consultants to observe anything like that (and anyhow, they've reached the end of the tunnel and are out the other side), and the registrars seem to be somehow dealing with it okay. However, to see the junior doctors with a vacated expression during a half hour lunch break, or to break down during ward rounds, or become frustrated with a difficult patient - I mean, we know it's not an easy profession to go into, but it still hits me hard. The overwhelming sense of everything crashing down upon you is something I've personally only experienced very rarely, and I don't wish it upon anyone, yet in the short space of a month I've already witnessed this. Support services for junior doctors are certainly an important aspect in this, but I don't expect that even brilliant support and continuous lobbying will stop these incidents from happening, it appears to be a part of the workforce - a 'just live with it' attitude. This is happening in a country where our health system is comparatively tame and standards, thanks to bodies such as the AMA, have been established to prevent burnout and, worse, mistakes being made - what about doctors in countries that aren't in these situations? The overseas-trained doctors that I've talked to all mention how Australia has beyond world-class standards for working hours and conditions of junior doctors - which makes me think what world-class actually means.

I'm no specialist in these kind of issues, so I don't really want to say anything more about this, but just thought I'd share this with people. A number of med hopefuls may also be members of forums or have talked to doctors, and have wondered, maybe, if the negativism that sometimes exudes from others stems from trying to prevent people from trying out to get into medicine and basically being self-serving by making out doctors to be messiahs and self-sacrificing members of society, of which no other profession comes close. I believe that it's not - it's out of a wish to open the eyes of those who have not had experience, and not to dissuade them, but, in some way, to encourage those who enter medicine to strive and work for what they believe in. To walk into medicine, knowing that these things exist, makes for a better student and a better doctor, and a better person, as objectiveness allows people to prepare for situations and make the best hand out of the cards they're dealt. I also want to say that this is not unique to medicine - I met recent law graduates who are undergoing the same thing; and in fact, worse - the attitude and culture is exactly the same; live with it. I've heard the same for business and finance as well - and especially important is the difficulty in hunting and securing that first job, which we thankfully do not have to worry about much.

So, we who are not working - enjoy, savour, treasure the time we have as students. For those who are living with parents, enjoy the fact that you only contribute partly (or, even not at all, as I did for the last couple of decades, I will admit) to the running of the household. Procrastination is fine, but use this time to grow in other aspects, find out where you want to go and what you plan to do, and be hungry to learn, not just the contents of your course, but skills and abilities that you want to pursue - because there is no better place or time to do it, than now.

And with that, I shall head off to bed - off to another rotation, and looking forward to it, the experiences and relationships with patients and staff I will soon acquire, whatever it may bring :)

P.S: The experiences I've mentioned do not happen every single day. Nor to every single doctor. In addition, everyone else is not immune - although I've yet to see anyone else besides the doctors in emotionally charged situations, possibly because I'm following the doctors around. And yes, they're true, I'm not exaggerating.

Keen as keen can be

I just finished my first week of my clinical rotation in cardiology.

It was the most freaking awesome week I've ever had.

The first couple of weeks in the first clinical year are where you find all the super-keen students; everyone itching to learn the mundane tasks of writing in notes in ward rounds, learning how to do discharge summaries and *gasp* cannulating patients! Except they are far from mundane right now; everything is new, and everything is exciting. Write in the next patient's notes? What a privilege! Asked to interpret the patient's ECG? Wouldn't miss it for the world! Want to hold the patient's charts? I could hold it all day and night!

Okay, so I'm probably just a little bit abnormal. But the buzz of starting the hospital rotations has not really left, and I sure hope it continues for a good few weeks. This honeymoon period is what I need to catch up on my laziness in the last couple of years, making it up by focusing all my efforts on learning what I need to understand to best understand the patients now under my team's care.

There are of course a few things that I've garnered from this first week. The most important thing was that I realised I would've benefited an enormous amount if I had exerted as much effort studying in the pre-clinical years as I am sure to do this year. This is, in hindsight, quite a difficult thing for me to have done because there was not really as much stimulus to study (i.e. no patient list to care for), but nonetheless, I keep thinking about all those hours gaming away and feel it's just a little bit lost. Oh well. This is one of the reasons why I don't like super notes (which are like condensed study notes produced by students in the years above) for PBL cases (and subsequently never used them); it takes away the (imaginary) patient's role in stimulating learning, and I think that is one of the key advantages to a PBL-centred course. It doesn't last very long, true, but I think that part of the reason is because classmates begin to use supernotes, so discussion begins to be a little bit hampered by the fact that, in essence, the PBL tutorials are rendered accessory and auxiliary. The second thing I realised was that it would be difficult to then revise all that pre-clinical stuff if it was never really absorbed well, since the clinical side has now taken over and many questions to registrars are along the lines of why or how questions, as opposed to the what. The third thing I've realised is that, paradoxically, I'm now playing more piano than I ever was. Random, yes. Applicable, well... I consider piano-playing to be a form of productive procrastination, like wikipedia (as opposed to, say, eBay, or watching toddlers pinch each other). So my procrastination (if any) seems to now take a more productive form. Which is a nice thing to happen. It's a phenomenon that many may experience throughout their periods as a student; the more pressure there is to complete a task in a limited amount of time, the more likely it is that the amount of time devoted to that task is increased. A rather curious phenomenon indeed - but something I'm going to take advantage of; 50-hour weeks are shrinking my potential study time by a good amount.

Oh, and I've still got extracurricular roles back at Campbelltown campus and UWS in general. Well, at least I don't have to cook.

Back to School...

Well it's been a relatively uneventful but (as usual) very quick holiday, even though this one lasted a whole month. My call for extra temporary students for my little part-time tutoring thing pretty much failed, helped by my site's web server downtime (a week or so), and managing to hit one interested person, but not having his message until a few days ago (and thus pointless, because by then I had things arranged for the last few days of the holidays). I spent most of my holidays away from medicine, trying movies (a korean mystery named Mother), music (Adele's 19 album) and even going back to some books (John Marsden's Letters from the Inside is, in my opinion, worth a mention). One thing I did not stray away from was stethoscopes. Worrying about which stethoscope to get is probably equivalent, in med school, to worrying about which pens to buy for the HSC. But, frivolous as it was, I spent hours upon hours doing as much research as possible into the little pet topic of interest amongst med students. And finally, after all the blood, sweat, toil and tears, I made a decision: the Australian company 'Cumpers & Robbins' Trikoph (??) Cardiology (!) Stethoscope (a very important point to note) in Navy blue colour (an important decision, or so I heard, which I made in about 10 seconds). At $160, it certainly wasn't cheap (found a 10% discount voucher - 'Supporter5' for the store, Medshop Australia, which dropped the total cost plus shipping to $151) but it was certainly within my price range. Amongst others, I had the Littmann Master Classic II (single-head, single-lumen, standard diaphragm), Spirit Cardiology (single-lumen and standard diaphragm) and the good old Littmann Classic II SE, for which I was particularly enticed when I saw the 'FREE PENLIGHT' offer at Medisave.

Some key pointers from people I asked (doctors, cardiologist registrars and a few others) and what I gathered online about stethoscopes:
- Soft ear-tips apparently make a world of difference.
- They last a while. A long while. But they often 'grow legs' when unsupervised.
- One of my cousins is doing well as a doc with a Littmann Classic II.
- Brand-name appears to have minimal effect on steths, but Littmanns are far and away the most popular (by which reasons, I have not found out)
- The cheapest cardiology steths (from a decent brand) are better-sounding than the most expensive classic steths. I'm not too sure about this, and it will be one of the key things I'll be testing for with my steth.
- Single lumen vs double lumen tubing - contradictory anecdotes about this, but double lumens are quite standard in cardiology stethoscopes (although mine doesn't.....)
- Floating Diaphragm, Tunable Diaphragm, Floating Tunable Diaphragms, Bells, Paediatrics Diaphragms and Bells, etc etc. - Apparently, only C&R and Littmann have floating diaphragm factories. Hmm... this allows you to vary the frequencies of sounds you hear depending on the effort you push on the head of the steth. Once again, contradictory anecdotes found on the net regarding whether this is a good or a bad thing (having zilch experience, I'm sitting on the fence in regards to this)
- Length of tubing - Once again, contradictory anecdotes, some say longer allows you to not invade the patient's 'private space', whilst others say shorter allows you to hear better - I would side with the shorter team, since 22 inches (relatively short amongst all the 27 inch ones) is pretty much the length from your ears to the slightly bent arm anyway. Having said that however, I don't think it is a crucial difference - its hard enough to find 22 inches as it is.

I found that there was virtually no information for brands other than Littmann or Welch-Allyn, so, in the spirit of the medical student guinea pig, I will be reporting the results of my Trikoph stethoscope, and see whether it measures up to others (via the help of some colleagues).

You may ask 'why a stethoscope in the middle of the year?' to which I would reply 'because I didn't need it in the first semester', to which you may reply 'you don't need it in the second semester either' to which I would reply 'my friend said we did, and I want to get one soon anyway'. I was also shopping for books and might get a penlight - not just for med, but for computer repairs and upgrades (quite handy to see where jumpers are without taking out the disk drive - if you don't know what jumpers are, ignore this whole thing). But for now, am looking forward to another exciting semester of hard-core medicine, so sayonara holidays!