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.

Back to Basics

There are times when it feels so good to review the sheer basics of medicine when you know there’s no upcoming quiz or assessment. 

Lately, I’ve gone back to basics  and I’m reviewing the simplest concepts of all. It’s amusing how much I never really understood in med school. I guess I understood enough to get by, but not enough to be able to apply the basics to the big clinical picture. 

All with time I guess. 

Pamper Me Silly

Medical school is officially behind me! No more classes! No more clinics! Not as a medical student anyway.

Thursday was my last day of classes. We had clinics in the morning, followed by an afternoon final exam for the course, and then a presentation afterwards. Since then, we’ve gone out as a class and celebrated. Then again we celebrated. And we celebrated some more. I’m exhausted.

Today I finally had enough motivation to get back to the gym for a solid workout. I was on a week-long lazy trip; half-assing workouts here and there. I was also finally motivated enough to clean up my room and clean out quite a bit of trinkets here and there that I don’t need anymore.

I also sold my bike! I’m so saddened by it. My little companion made travel around the city so easy! Now I’ll have to get used to walking again from place to place (like to breakfast tomorrow).

To cheer myself up, I decided to get my nails done. It’s actually been a really long time since I’ve had any sort of nail care in a salon. I used to get acrylics, which looked really pretty but damaged my nails to badly. I tried those UV nails today. I must say that I’m quite impressed so far. But we’ll see how I feel once it’s time for them to come off – apparently, I can’t just use nail polish remover…

I’ve also made an appointment to get my lash extensions refilled. And tomorrow once that’s done, I’ll make another appointment for a pedicure.

It’s time I pampered myself a bit after so long!

And who knows, maybe I’ll even end up buying this ridiculously-priced dress just because I deserve it.

March is Match Month

It’s currently the time for all final year medical students to start finding out what specialty and where they will be working come mid-summer. The Canadian Match occurred this past Wednesday, so I’m glad to all my friends that are now able to start planning the next few years of their lives.

I didn’t participate in the Canadian Residency Match this year. I’ve actually grown quite fond of Europe and the European lifestyle, so I only applied to the UK Foundations Program. My match results will be out this coming Monday. So 3 more days!

I feel like the last half year were a lot less stressful for me than for others who applied to the Canadian and American systems. My application was short and sweet. I didn’t have to worry about personal statements, reference letters, and whatever other paperwork was necessary for the process. I’m in awe of those who went through that though, while doing international electives at the same time; flying out for interviews; etc.

A week after my match, the bulk of my class will find out their US Residency Match results. And then I feel that most of us will be able to relax until we all graduate in May. There’s just over two months left for most of us to enjoy Europe.

That’s currently one of the only interesting things going on in my life right now. I’m hoping to hear good news on Monday, and then I can start planning my life for post-graudation.