Family Medicine to Emergency Medicine

So I’m due to start a family medicine residency in August – but I’m currently working in the emergency department and I LOVE this job. The hours are awful, other specialties can give me shit when referring patients, and patients often want more than what I can offer them, but I love the pace of the job and the work I do.

I’ve abandoned the thought of training in a surgical specialty because it requires a minimum of 5 more years of training (and most train for 7 years before becoming attendings). And speaking to my senior colleagues makes me realize that training is not as simple as keeping a surgical logbook and attaining specific surgical skills at different levels of training. In this country, it’s all about your tick-boxes: audits, audits, and more audits; research and publications, but not just in any journal – it must be a peer-reviewed journal; teaching, with “evidence” that you’ve taught; conference presentations and poster presentations. And you’re strewn all over the country at times. And they have almost the same requirements to get into the surgical training post as well – those who meet the tick-box requirements get in. There are no reference letters highlighting whether you’ve got the surgical skills to make it in the job. You don’t get “points” for being able to be a proficient first-assist in a laparotomy. The structure of the system is flawed.

I am now at the point where I’ll be entering general practice, and this also comes with its own set of requirements during training, one of which I’m particularly not looking forward to – reflections. Every week, a requirement is to two at least two reflections either about a patients encounter or on something you’ve learned from. Personally, I’m not one to reflect – in a blog, yes. But in a portfolio – no. Especially since I know it will be read and assessed by my supervisor. In that sense, I feel my reflections will be very superficial and I won’t be as honest as I truly feel. But, whatevs.

My other thought is what if I abandon general practice and try to jump into emergency medicine training. I’d be more satisfied with my job. But training would again be another  years. The option I’m set on now is to endure the three years of general practice and then get a fellowship in emergency medicine and remain there. The options are endless. My career path is not a fluid one. The only path that’s certain for me with work is my return to Canada. My aim: return in a maximum of 3 years, if not earlier.

My First Ward Round

Way back after my first year of medical school, we were required to do a medical observership/attachment. Our school wasn’t too specific about where and in what specialty to do it, so I ended up shadowing/observing a general surgery attending in Toronto. I remember sitting in on his clinics in the beginning of the week, and scrubbing into surgery in the latter half. I was enthralled! I was excited! I’m trying to think back, and it may have very well been my first time scrubbed in the OR.

There was a peculiar thing that the surgeon would do each day as well – his secretary would print him off a patient list and we’d leave the office or OR and see patients in the hospital. Just me and him. He’d find the patient, have a brief look through the patient’s notes, pop in the patients room and say hi, find out how they’re doing. Then he’d leave and scribble a line or two in the notes. Then we were off to see the next patient.

He didn’t say much during this time, but I now realize that we were rounding on all his post-op patients. I think my perception of rounding was jaded by TV shows where an entire group of doctors goes from patient to patient presenting relevant details and the attending makes a plan while a scattered intern scribbles everything down in the patient’s notes. Where the attending asks relevant medical questions to pimp out the residents. There was none of that here.

ward round

And in reality, having a morning ward round for nearly two years now, I can still say that it’s nothing like what’s depicted on TV. Maybe it’s because I’m practicing in the UK where their system is a bit different. I’ve been on specialties that approach reviewing patients in different ways. In the ED, we gather in a seminar room every couple hours (during shift changes) to catch up on all the patients via a computer screen – who’s been seen, who’s been referred, who still needs a referral, who’s likely going home, and what the plan is for each patient. And in ED, your patient is basically your patient. A senior doctor will give their input or advice, but it’s your job to make sure all the investigations are done and checked, and a referral or discharge plan is acted on.

When I was on breast surgery, I was working under four different attendings. If one of them showed up in the morning, they only rounded on their patients; if they came at all. A lot of the times, I would round on the patients myself – check for any post op complications, check drains, make discharge decisions, write discharge letters.

When I was on acute medicine, there would normally be two ward rounds during the day, and every day it was with a different attending and a different set of patients because of the high turnover of the unit. On the opposite hand, when I was on acute geriatrics, the attending would only round on Tuesdays and Fridays, and it was up to us young residents to manage the patients every other day – mind you, there was nothing acute about the specialty because these patients were treated very quickly and then spent the next several weeks having physiotherapy and occupational therapy assessments.

When I was on Urology, a different attending led the ward round every day, and we would see all the patients under the urology team – this was probably the most problematic type of ward round because on Monday, we would have one plan in place for a patient, and the next day’s attending would make a different plan the following day.

The parts of the ward round that remain consistent between each different specialty I’ve been on include plenty of writing and creating a jobs list so that when the round was over, I’d be able to get to work with sorting out scans, X-rays, CTs, discharges. And perhaps it’s just the way the UK system works, but there hasn’t been much teaching during this time. Many times the attending tries to finish everything off before 9 to run to the OR or to clinic. A lot of the times, they’ll only see the sickest patients and then leave the senior resident to continue with all the other patients. There’s almost never any “pimping.” And when questions are asked, they’re asked usually to all residents. And a lot of the time, we’ve become so ingrained in creating a jobs list and working through those jobs for the rest of the day that we fail to make connections between our medical knowledge and its application to the patients. We forget the basics. And even worse, I feel we lack the motivation to later go on to educate ourselves on the facts we’ve missed out on.

This is why medicine involves lifelong learning. It’s simply not enough to show up to work to present a patient’s vitals and recent blood results when we can’t make the connection between why a patient in kidney failure has persistent hyperkalemia on routine bloods despite treatment. My knowledge has been somewhat refreshed after spending the last 6 months studying for the MCCEE. But since the exam, I’ve fallen back into being lazy. I come home, watch TV or waste time online, and go to sleep. It’s an easy trap to fall into, but it’ll eventually catch up and reflect in your work. I experienced that earlier in the week when dealing with a patient. So now, I’ve had that kick in the ass I needed to get back into gear.

Life is always going to be busy. You’re never going to have enough time. The important thing is to learn to manage your time wisely. Spend some of it enjoying yourself, and spend some of it educating yourself.

Company’s Coming! 

Last week, I finally wrote the MCCEE. Results coming out in about 8 weeks.

Coming up next week is the tortuous deadline for having all my work -related tick boxes filled in and completed by the appropriate people. This is one of the worst and most useless things of the Foundation Program – the dreaded ePortfolio. In theory, it’s a great concept; but in reality, there’s so much useless shit associated with it that it really does end up being just a tick box exercise at the end of the year. But enough about that.

My good news this week came from one of my closest friends who lives in Scotland – she got accepted into the same GP program as me and we’ll be spending the next three years working together!!! She started looking for a place to live and she’ll be coming down to visit in a few weeks to check out the area. Can’t wait 😉

Two Weeks

A lot ishappening over the next two weeks. 

I’ll find out how my GP interview went and I will likely be offered a job. I’m not doubting this at all -I just want to know where in the country it’ll be. 

I’ve got a good friend dropping by to visit next weekend. V and I made sure we were both free for the weekend. Now we just need to plan some activities to keep our guest entertained. 

I will finally find out what happened with my core surgical training interview and whether I will get a job offer or not. This I’m less certain of than the GP situation. And if I do get an offer but am forced to move, will I take it if at the same time I’m offered a GP post located where I am right now? Does that make sense? I hope so. 

Finally, within two weeks from now, I’ll be in Canada with friends and family I haven’t seen in a few months! Can’t wait!

Phone Obsessed

I was obsessed with Candy Crush and Soda Saga previously. So I deleted the apps off my phone. Thought it better to get rid of games and spend my time on social media. 

Then I realized I still had solitaire and briscola on my phone. So now I go between playing those in my spare time. It might actually be time to delete them as well. 

I am just obsessed with being on my phone… Too obsessed. 

Goal for the week is to stop looking down and instead look around to see what’s happening around me.