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 =)

Job Satisfaction

The other first year house officers I work with despise the job! Like, they genuinely loathe breast and endocrine surgery. And I would normally understand because they have no interest in surgery at all. But now I’m starting to realize that they don’t hate the job because they don’t like surgery, but it’s because of the type of work we’re doing.

We’re not learning. We’re not managing patients. We’re often doing odd jobs that could be considered secretarial. Hence why we started calling ourselves glorified secretaries. We’re calling bed managers to arrange beds for patients. We’re calling couriers to deliver patient notes between hospitals. We’re calling secretaries from other hospitals in order to have operation notes from a surgery in 2013 faxed over for our consultant. I guess it can be stressful, but my two colleagues seem to stress over it a whole lot more than I do.

And at the same time, I guess they’re failing to realize that there is plenty of opportunity to learn and gain experience. We see patients twice a week during our own pre-op assessment clinic. While they focus on co-morbidities and ordering every appropriate test they can think of to make sure the patient is clear for surgery, I spend my time taking a full history and conducting a thorough physical. So a person has diabetes, but they’re not on insulin and it’s relatively well controlled just on oral metformin. I’m not going to freak out and email everyone about this patient asking whether they are to come in a day early.

And so what if I get yelled at by a senior doctor?! I take this as a natural process that it supposed to happen during your career training, and to be quite honest, Brits are super, super, super nice when they’re telling you off. It’s absolutely impossible for me to be offended by anything they say. Maybe it’s my thick skin? But I’m able to take getting yelled at with a grain of salt and learn from it. And luckily, I don’t get told off too much either.

Overall, I am somewhat satisfied with my job. There are a lot of things to learn, and it’s not the medical knowledge I’m talking about, it’s the practicality of the job – what to do and when; when to call for senior advice; who to call for senior advice. I’m fairly confident that I know my limitations on the job. And every day is a time to learn. Unfortunately, agreeing with my house officers, there isn’t much opportunity to learn patient management on this job unless you’re on call because we barely have ward patients with breast and endocrine surgery. And when we do, they’re (thankfully) complication-free.