Wednesday, 27 June 2012

Ideas, Concerns and Expectations, Baby

I've seen this wonderful video/song via Wishful Thinking in Medical Education, about asking ideas, concerns and expectations (ICE) of a patient in an exam. It often seems contrived, and though this video is about exams for general pracctice trainees, it's so true for medical school finals too. It's definitely on my mind given the final OSCE in a few days, though I find myself running out of time before asking it.

Also, I've been told the real skill is not about whether you ask ICE, but how you respond to it.

I would love to know the guys that put this together... they must have more interesting characters than some GPs I know!

Sunday, 24 June 2012

This is what an anti-rape and anti-sexual abuse campaign looks like

via Khale at whose wonderful "I do not have an eating disorder" comic I've mentioned previously.

This is an anti-rape campaign that places no blame, and no responsibility (except on the perpetrator), but encourages bystander intervention. It is amazing. Men Can Stop Rape, an American organisation, also seem amazing.

Did I mention I'm a feminist? It shouldn't come as any great surprise, as I hope this blog has so far made clear that I'm no doormat. TTBAMS is what a feminist looks like.

                        "I only know that people call me a feminist whenever I express                        sentiments that differentiate me from a doormat"
                                                                                        - Rebecca West 

Before anyone thinks, I do know full well that this kind of campaign does not prevent every rape or sexual assault or abuse. But maybe it makes a difference, starfish-wise.


I knew from the beginning that if I were to write a blog that included my experiences of medicine, and possibly some of my experiences with patients, it would need to be anonymous. I've mentioned this briefly before but it does need a post of its own to explain this.

Posts like this one, and one in my head about a patient I saw die, seem to require anonymity to protect the patient's identity as well as my own. Of course I do everything I can to protect the patient's identity anyway (changing identifiers etc), so that even the patient themself wouldn't necessarily recognise themself in my blog. But it's easier to ensure nobody recognises the patient if they don't already know which hospital, city or even area of the country the patient was seen in, or which medical student or doctor they saw.

There's also the issue that I don't particularly want my future patients to read this and know that it's their doctor, looking after them, who wrote it*. They could easily lose faith in me or not want me to be their doctor. It's not that I'm lying to them, but my doctor-face that I present professionally is confident and professional, and different to my blog-face and the things I share on here - my fears and failings, along with some potentially more contraversial thoughts.

I talked to a (non-medical) friend recently, and told them I had to re-take an exam and only narrowly passed a few others; their response was "I'm glad you're not my doctor" - I can see why. But once I have passed, I am deemed safe and competent enough to practice, and I'm no different to any other doctor. I hope my patients would see that, but some wouldn't and there's no need to tell them all and make an issue out of it.

I don't necessarily want all my colleagues to know that this is me, I don't want my consultants to know my fears and failings - if I did, I could tell them.

My posts about my medical school have sometimes been far from positive, but I don't want to bring them a bad reputation, just because I blog negatively about this medical school and people may not about others. And you never know, they could pull me up on things I've posted - it wouldn't be the first time a student had been reprimanded for things they'd put on the internet.

Since my posts about my family aren't always complimentary, I don't want them to see this blog and know that it's me, either.

If this blog weren't anonymous, I'd need to censor it and be more careful of what I wrote and how it could come back to bite me in the future.

I'm aware that other medical students don't always blog anonymously. The medstudent in the link implies that being proud of what she writes is part of why she doesn't blog anonymously. That's not to say I'm not proud of what I've written, I am to some extent (the mopey and despairing posts, less so), but I think the reasons for anonymity far outweigh the reasons against.

I hope that doesn't make me a coward - I don't think it does, but I'm sure it could be suggested.

If you know me personally and want to share this blog, feel free to but I'd prefer it if you don't blow my cover. Please do share it, it would be nice to have more people read it, but please don't share it in connection with my name or identifiers. This post has been a long time coming, and it's because of this bit that I haven't really felt able to share this blog with people I know until know. Apologies to people I know who've come here, you've got 34 posts to get through if you want to read this blog!

*If you don't know me, and you've read this, would you want me looking after you? Really?

Like a little piece of charcoal

I woke up on Monday with so much dread for the week ahead and the work required that it suddenly came to as I was lying in bed: I am burnt out. On the one hand, that's horrible and means that I have no energy to do any work at all. But on the other hand, it's greatly relieving. It means I'm not lazy and useless, it's not all my fault that I haven't done enough work, it's just that I've done so much work and been so stressed for the exams in January and May that I just don't have enough energy left to keep going.

It felt so good to put a name on how horrendous I've been feeling about this exam and having to work for it. Burnout is a recognised concept, and a friend of mine had it after the January exams. I contacted her on Monday and she gave me some advice, including: get away from everything, go for a run even if you don't like running (which I did, briefly), burnout usually means you've done enough work already (yes, I did enough work in May, but unfortunately not for this re-take), to go easy on yourself (definitely), and to make a list of all your achievements, to push you on through this last one. I like that list of achievements idea - I haven't done it, but I have been thinking a little more about good things I've done, and that this re-take is really just to put the cherry on the cake. Except you can't have the cake without the cherry on, it is essential.

I realised that if I don't have enough energy to keep working through this revision period to the exam (which I don't), then the solution is to use other people's energy. Leech off them to get me through it, and work with others.

Which is what I've been doing. The only self-directed work I've done alone all week is to listen to a few podcasts whilst out walking places. So far, so good. Boo for burnout, but massive hooray for recognising it and getting through it.

Saturday, 16 June 2012

Breaking the stereotype?

At the medical school's graduation ball last night, for medical students/soon to be doctors and their guests, and some faculty, most of whom are doctors, there were some speeches and presentations made. By far the biggest applause of the night, with a standing ovation from the whole room (about 170 people), and two giant bouquets of flowers, were not for any doctors at all, but for two nurses.

Two nurses who were both previously intensive care nurses and are now clinical skills facilitators, and teach us so much of what we need to know, and if any of us save the life of someone who's seriously ill in August, it will be thanks to them. In fact for many of us, passing all the exams and becoming doctors at all is thanks to them. Especially for us re-takers, as one of the two nurses oversees the re-take program and eggs us on through this tough few weeks.

They completely deserved their applause and flowers and all our thanks, and it made me think because doctors and nurses don't traditionally have the best relationship, and sadly the culture is still one were some doctors look down their noses at nurses, but last night there were over 100 new doctors with more gratitude and respect for two nurses than they've ever had for any doctors.

Hopefully we'll take that gratitude and respect with us into our many different hospital workplaces, and whenever we meet and work with other nurses, and particularly if we're frustrated or challenged by them, we'll remember the gratitude and respect we had for the two nurses who got us there.

The (hopeful) graduation ball...

Last night was the graduation ball. The re-take is in two weeks, so I don't yet know if I'm graduating. I remain fairly convinced I won't be - I've bought the guest tickets and am wondering about what to wear, but all in a "just in case the unimaginable happens and I am actually supposed to be there" kind of way, not in a way that I expect to be there at all.

I'd originally decided that I wouldn't go to this ball for this reason, but friends persuaded me, and I did half want to go, especially since I was so gutted that for my original graduation ball - the one I would have gone to had I not intercalated for my BSc for a year and then taken a year out - my friends forgot to (or decided not to) tell me about it or invite me. The photos of every single one of my original medical school friends at the ball without me were a little tough to see.
Anyway, I decided to go. My main trepidations were that it would take time away from revising and would be difficult to go to before having finished exams. I didn't pay attention to the idea that at the grad ball everyone else would know they were graduating, and I wouldn't. Well, about four other people there don't yet know, but since there were over 170 in attendance...

Going to the grad ball before knowing I'm graduating was very very odd. Much as the other half kept reminding me that I had as much right to be there as anybody else, it didn't feel like it at all. I felt like a spectator rather than a participant.

The worst was walking in to the dining room in the fancy hotel to take our seats for dinner. All the place names said Dr so-and-so for everyone graduating. That was hard. There was one at my table place saying Dr TTBAMS, which on the one hand is lovely because it means the guys who made them believe I'll pass, but on the other hand it's bloody horrible because I am not yet Dr TTBAMS. It all got a bit too much for me... I couldn't really hold it together and started crying. Everyone at the next table were taking group photos with everyone holding their little Dr place name, which made it worse. Thank goodness for waterproof make-up (yes me, in make-up), and for dinner jackets requiring a silk hanky in the pocket (or maybe it's just that other half does these things properly - it did match his bow tie). Thank goodness also that our table was in the corner, and that no one else had yet arrived at the table - my friends were pushing fashionably late to the limit. Thank goodness also for the wonderful other half, who reassured me that I do deserve the place name, but tactfully turned it away and moved it out of my view for the rest of the evening.
I regained my composure, but it wasn't the best way to start the night. I don't think I was great company all night really, conversation dried up where it wouldn't usually.

In retrospect I should have given a little more thought to the difficulties I might encounter during the evening, other than my bad my nail varnish skills were. And I should have approached it with dignity in mind. I think focusing on celebrating other people's achievements, rather than dwelling on my own lack thereof, might have helped.

Friends have said we'll have a celebratory get together, with the sweets (goody bags), glowsticks and lottery scratchcards from last night, but I don't know if it will happen as I get my results after term is over and people will have gone on holiday.

In conclusion: it wasn't a great night. But I don't regret going, really, I regret not being better emotionally prepared. If I hadn't gone, I would have regretted it.

Other half told me last night he's saved my place name, ready for when I am Dr TTBAMS. I'll have a party all of my own when the time comes. Whenever that may be...

Wednesday, 13 June 2012

I keep my visions to myself

Guess the song lyrics title at the bottom....

The night before last I dreamt that I'd found a patient, a rather mad lady who clearly needed some help, just outside a hospital (that looked a bit like Berlin Tegel airport somehow), but I couldn't get any phone signal to call an ambulance. So I had to take the patient into a hospital waiting room while I got some help, and I couldn't find any. I was upset that I couldn't help her. Somehow much later on someone pointed out that I could take her to Accident & Emergency, and I was so relieved, but also very worried at how I'd managed to forget that A&E existed....

Last night I dreamt there was a very special revision lecture happening. I spent a long time trying to find out who was giving it, trying to track them down, and find out where the revision lecture was. This somehow related to a wall hanging. But I couldn't find the lecture, or who the lecturer might be (I was looking amongst friends and acquaintances, rather than anyone who actually is a lecturer), and I got very stressed about it.

If I carry on like this the nights for the next few weeks will be very interesting. And stressful. Why I didn't feel at all able to help the patient in the first dream I don't know, maybe it reflects my lack of confidence. And maybe the fact that I was so desparately searching for the revision lecture reflects my lack of sel-motivation and need to have people teach me rather than me learning anything for myself.

I hope I get some more sleep than this in the next few weeks though, I'm going to need it.

Dreams, by Fleetwood Mac. Who are wonderful (and were not in anyway murdered or destroyed by Glee - in fact that episode reminded me how amazing Fleetwood Mac's music is and made me dig out my old CDs)

Saturday, 9 June 2012

There are no laurels to rest on

Nice as it was to learn that I'd passed all of my recent exams, that silver lining had a cloud. Yesterday I was given my exact marks for the exams, and discovered that my two recent practical exams were very, very narrow passes. By 4 or 5 marks, and since the overall exam has over a thousand marks, that is tiny. I scraped through both exams, and it was very very close. Too close, there's no margin for error.

The day of the big exam was a "good day". I'd done a load of confidence building and affirmations, put my positive mindset on, and got in the best frame of mind. Nothing at all went wrong, and I was the best I could be for almost all the exam (although towards the end of the three hours I did get pretty tired, everyone does). So if my absolute best is to scrape through with the tiniest margin of error, what happens if I'm not at my absolute best next time? I might have a streaming cold, a headache, too much nerves, a grumpy examiner - anything that could lose me those 4 or 5 marks.

This has at least put the frighteners on and given me a considerable kick up the rear to get me back into revising and not sitting around beinig complacent, but for a good 24 hours it pushed me too far. I think there's a scale of:
complacent, unmotivated, not working enough ----to---- motivated, hard-working, slightly scared but in a healthy way -----to---- panicked, totally terrified, unable to work, so convinced of failure what's the point in working
and I went from the left end to the right end, completely bypassing the healthy middle. An email from a friend, an email from a mentor, and some time with the other re-takers later, I'm feeling a bit less chicken-heady (I am no longer running around with my head chopped off, which I was mentally doing this morning). I'm towards the right of the middle and it would be good to get even further towards the middle.

It would be easier if I knew what I was actually doing wrong in the exams and had some idea of what to improve, but no, that would be too easy. Medical school is a cryptic crossword. It's very frustrating to have a station which I thought went amazingly (patient/actor clearly liked me, I asked all the questions for the diagnosis and all the others to rule out a differential diagnosis, I answered the viva questions brilliantly - I am not a show-off, but I thought it was my best station of the day), the examiner gave largely positive feedback comments, with the only negative that I was "a little slow to get through all the points" - this does at least suggest that I got through all the points, to fail the station getting a little over 50% of the marks. How does that work?!

So in the absence of really having an idea of what to improve, I just need to spend the next three weeks becoming the most incredible doctor all-round that there could possibly be. I will dazzle and amaze all the examiners. A tall order but who knows what could happen...

And I will not spend the next three weeks wondering whether these horrendous results suggest that actually I'm not really ready to be a doctor, and it would be much safer for me and the general public if I did re-take the year, learn how to be a good doctor, and make a better attempt next year when I actually know something. That is not productive thinking. But it is tempting.

The above is yet another reason why this blog is anonymous. My patients don't really want to know how much I've failed, or how close I came to failing. At least, they don't want to know that and then continue to be treated by me. And I will want them to continue to be treated by me - it would be embarassing for me and problematic for the hospital if not. Much as medicine is trying to break with the tradition of paternalistic "the patient doesn't want to know X [often that they had cancer]", I feel it's appropriate here if only for my own peace of mind. I want my patients to have confidence in me. If I pass, I've passed and I am good enough to be their doctor. If they knew the numbers this may be less obvious.