Acute Medicine

Despite the fact that I don’t particular have an interest in internal medicine, I do have to say that I am learning a lot already on my placement. Everyone is nice and eager to teach. And there is a lot to learn as well.

I do need to brush up on some of my internal medicine knowledge, as well as on interpreting ECGs. But the registrars and consultants actually take the time to teach in a way where you’re able to connect the patient’s complaints with the investigations that were carried out, and the rationale behind them.

I might actually have something educational to blog about eventually. Don’t get me wrong, I do love surgery, but my breast and endocrine surgery placement was very heavy with administrative duties. Now I feel like I’m doing a lot more clinical tasks, and I feel like for the first time in 8 months, I need to use my brain again.


Goodbye Surgery, Hello Medicine!

I am now officially done with surgery for the next four months. Coming up is nothing but medicine. There are two months of being in the AMU, which is basically a gateway between A&E (the ER) and being placed on an appropriate ward (or getting discharged back to the community). Finally, my last two months will be ward based. I haven’t been ward-based all year, so it’ll definitely be an experience for me.

Luckily, I’ve only got two weeks of nights – first one in coming up! And I’m only on for two weekends, having the rest off.

What I do need to do is brush up on is my general internal medical knowledge. So I will try to throw up some useful bits of information in a way that memorable to remember for other doctors and medical students.

And now that I’m officially done with surgery and done for the day, I’m off to attend the mess pay-day party and get my share of the free booze.


How to Report an ECG

  • Rhythm and rate
    R-R interval
    (large squares)
    Heart rate
    1 300
    2 150
    3 100
    4 75
    5 60
    6 50
  • Conduction intervals
    • PR interval (normal 120-220ms; 3-5 small squares)
    • QRS complex (normal 120ms; 3 small squares)
  • Cardiac axis
  • Description of the QRS complexes
  • Description of the ST segments and T waves
  • Description of U waves (if present)
  • Interpretation

Example 1

Normal ECG

Sinus rhythm, rate 75bpm
PR interval 140ms
QRS complex 120ms
Normal axis
Normal QRS complexes
Normal ST segments T waves
Interpretation: normal ECG

7 More Shifts

I didn’t actually think that I would be counting down the days until I’m done with surgery and looking forward to medicine, but it’s happened. Mind you, I still love surgery, but the job I was on was very … administrative. I felt more like a secretary than a doctor over the last four months, and I have to admit that I’m actually looking forward to dealing with acutely unwell patients with regards to diagnosis and management. There really wasn’t any of that here on breast and endocrine surgery.

My favorite days on the firm were Thursdays and Fridays because that’s usually when I spent the entire day in the OR. Sometimes, the surgeries would go on until about 8PM, but I didn’t mind. I enjoyed all the opportunities I got to work hands on. And I’m glad I did more than just hold retractors. This is what I will miss dearly for the next four months. But at least I’ll be back in another surgical firm come August.

The shifts were long, but change is coming once again. With that, I still need to get all my ePortfolio items signed off before next weeks, so that’s just one extra thing I have on my plate. I’m finally giving myself a deadline of Friday to get everything completed.

A Week of Being On-Call

I’ve realized that being “on call” at my hospital as a first year doctor is different than what my other friends are doing in the UK, and it’s a whole lot different than what my friends in North America are doing. In North America, being on call usually means you are supposed to be around and available for 24 hours, if not longer. My other friends in the UK are usually on until 10pm, and if they’re on call, it means they’re on call from 8am-10pm, or something along those lines.

For me, being an on call first year doctor in surgery, means that I only answer my pager from 5pm until 9pm. I come in in the morning and work with my regular team from 7:30 until 6pm. At 5pm, I pick up the on call pager and I have an hour overlap between both jobs, which is usually manageable.

Since most of the surgical teams work until 6pm, I don’t often get paged anyway, unless it’s a nurse from one of the wards that needs medications prescribed. I really enjoy being on call because it’s where I get to pick up a lot of my practical skills.

This week in particular. I’ve successfully taken ABGs and analyzed them. I’ve perfected my cannulation skills. Taking bloods is a breeze. And this week, I’ve changed my first suprapubic catheter. These are things I don’t often do when I’m not on call, as breast and endocrine surgery usually has relatively stable patients that don’t stay in the hospital for long.

And now after a Monday-Friday of working from 7:30 to 9pm, I am off for a full week. Hello vacation =)