New year, new ways to avoid revision

Well it is here, 8 days into final year at Med school, only 150 something to finals. One Five Oh...................as in 5 months.............as in argh!

Anyway Block 9, at least I think it is 9, or maybe Year 5 block 1 - yes that is easier, is GP. GP blocks have a reputation for being very boring, very quiet and drinking lots fo tea, much like Psych but with less depressed people. My block is turning out to be anything but...I am on an island for starters, which means no ferries after about 7pm until 7am. This means no ambulances to big A&E and city hospitals. Thus the helicopter (more later)!

This also means that there is no GEMS/Deputising service for Out Of Hours - so the duty GP covers GP emergency, A&E, Minor Surgery, OOH cover and Maternity, as well as Police Surgeon duties. All these have my phone number so I am wondering how many 1am phone calls there will be......

The practice is the only one on the island and covers about 7000 people, 25% are elderly, 14% are kids, and almost 50% appear to have a long term chronic disease of one type or another. So all in all life is not exactly super-quiet here, except after work..... the rush hour is very proportional and seems to focus around ferry arrival and school start / finish times. After about 7pm, the town gets very quiet and up where I am staying, I can hear cars passing on the road about 100 yards away. I can even hear the cows in the adjacent field, though I have not yet noticed the deer which apparently roam the field behind my accommodation.

The practice staff are all friendly, the nurses and receptionists slightly more so than some of the medical staff, who due to their work patterns haven't really seen me much - the on call person ahs the enxt day off, so I only saw my supervisor one day last week - hoping to catch up with her tomorrow to arrange some Phleb sessions with the reception staff on 'study' mornings or where my timetabled stuff doesnt start until 10 or 11.

Considering staying over here for part of a weekend to see how busy A&E is. But looking at diary, doctor on duty rota etc, the only possibilities seem to be staying this Friday night, or coming back on Sunday afternoon this week.

Anyway this week is a right mess. I am back at Depcat hospital to present my SSM research stuff on Wednesday so I need to (gale force winds permitting) head back to the city tomorrow, then meet registrar (who has moved to anotehr hospital) on Wednesday morning, then onto depcat to present the findings, meet Mum and Dad for a carvery meal, then back to the Island on Thursday (5.45am start) til Friday night or Saturday morning.

Introducing Suburban Seaside Hospital

This weekend is the Monday Holiday in the Health Board where i am currently on placement, so a 4 days weekend!

I utilised today by a period of meditative activity (i.e. a long lie) then started to scout out my next placement location. From Depcat Hell, I will be at the Suburban seaside hospital. Well it's not on the prom, but its a darn sight closer than my flat is.

I decided to find someone with some knowledge of the area I'd be going to, and indeed who knows the road very well. Step forward the ubiquitous Butcher Boy. the tattooed drinker also knows the area well, but he had films to see and drink to drink. We set off shortly after lunch and had a good journey down, despite the obsessive changing of the speed limit every 5-10 miles, The trip takes about 50 minutes, so is almost commutable - although we do get accommodation at the hospital if we choose to use it.

The biggest surprise was the fact that there's no two ways about it, the hospital is bright yellow. Most around here are Concrete or Stone. This one is yellow brick and looks both quite nice and quite odd at the same time.

We then went for a rather nice lunch in the Boot of the old town, near the courthouse and beach, before heading for the 'burbs, where I dropped butcher Boy at his parents house and he did some carjacking, and I drove back up to the big smoke.

Who said public holidays were restful?

Do you mind if I examine you?

As mentioned here and here, today was my first day on my easter holiday clinical skills placement. It was bright sunny morning, if chill, and the train was even on time. The walk to the GP's was nice, past a park and sports ground and not at all what I expected that area of the city to be like. Maybe my exposure to UPA's in Edinburgh has coloured my views on what they are like?

The format of the clinical skills bit is that there are 2 students, and we get 30 minutes with each patient. We take it in turns to lead each consultation, and take a brief history, then do an appropriate examination, then the other person does the examination, then we get feedback from the tutor.
I was observing consultations 1 & 3 and leading consultation 2.

The first one was a man who was diagnosed with lung carcinoma 4 years ago, but the tumour has not developed in 4 years and the GP thinks it maybe carcinoma in situ. Either that or this was one of the 5% that deos respond to chemo and radio therapy and survives 4 years. He was breathless at rest, but surprisingly mobile for his age (80) and breathlessness!

The second one was one I was leading. The man had had breathlessness on holiday, then 7 days later woken feeling funny, and was admitted to hospital with an MI. He was also found to have a calcified aortic valve and AF (the 3 main causes of which are heart ischaemia, thyrotoxicosis and valvular problems - see I do listen in plenaries sometimes). Hew as quite difficult to pin down on history and was quite vague. On examination he had a quite striking ejection systolic murmur.

The 3rd patient had MS, and so we did a neurological work up, where I managed to miss quite a few of the reflexes...

Then we had 2 normal patients on whom we did BP while they were in seeing the gP. These were not planned patients, and so teh history was often very short - History of Presenting Complaint, a bit of local enquiry, and social habits, then hand them over to the GP.

The GP tutor is very friendly, so hopefully these sessions will mean that I go into the OSCE more confident than I feel now. Especially as I passed last year with a satisfactory, and this year the OSCE is twice as long as it was last year, and although I only need a formative pass, I would hope to do better than I did in 2007.

Due South, on Tuesday

Following on from my last post, I was looking at a map trying to work out teh ebst way to get to my clinical skills GP on Tuesday. The GP is in Pollok, next to a big roundabout.

It looks like I need to get a train, then walk through the Socialist Republic of Tommy Sheridan-ism, until I get to the roundabout where the GPs is. This involves walking past the local (huge) sports complex, always a haunt for Neds, however as yet I haven't been able to find a high school on the map, so either they are bussed out, or no such beast exists. However there are many (large) primary schools on the map. Google earth-ing the area is also quite good fun...

Roughly equidistant, as the train station, from the GPs are Ross Hall (private hospital), Leverndale Hospital (huge psychiatric unit) and Silverburn (huge shopping centre).

In the opposite direction from the train station is Bellahouston Park, where I spent a week in the summer of 2004, working in a tent....

GP Visit (9)

The GP's this morning was a waste of time!

3 hours not getting to examine people followed by free lunch and a talk of anti-impotence drugs, and a free sample of drugs (from an anti-histamine company, not from the anti-impotence company!!!!).

Then this afternoon was a trip to see my patient who is subject of my essays - the flat was full of cats and dogs, and the stench ion the stairway up to it was awful. Once in the flat it wasn;t so bad but it was clear that the cats used the stairs as a toilet. Lovely.

Elective falls through

As part of our course we do junior and senior electives which take place after the end of years 3 and 4. Each is 4 weeks long. For various reasons both these elective periods happen at the exact same time of year, so there is certain competition as 500 students all want electives in the same 8 week period.

Basically my plans have fallen through. I emailed my potential supervisor in February and was told "Yeah. it is fine, we will email you nearer the time"; well we now need to send a form to the Med School Office proving that we have a supervisor etc. This needs to be in by 1st May to give them 8 weeks to check details etc before we start the electives at the end of June. I emailed my erstwhile supervisor on Tuesday and today got a reply from one of his colleagues saying that they already had a student working with them, and I should have made my application earlier than the end of April. So clearly they have had some internal communication issues(!) Maybe I should have pushed earlier, harder etc.

So now I have Friday and Monday to organise a replacement elective, around ******** - can't afford 4 weeks anywhere expensive, since this is viewed as outline the teaching time and thus not eligible for Student Loan / Student Support. Thus I need to be able to keep on my part-time job at weekends / evening as well as being on elective 8-5, since the mortgage and food bills won;t pay themselves.

So I need to find a specialty, supervisor and project within 96 hours, get agreement, get the form filled in and returned to Faculty and all this while writing two 2,000 word essays about community-hospital interactions in the management of a patient i have studied, and revising for the written papers, and the OSCE's.

Ain't life great, excuse me while I go for a long walk off a short pier!

Old men falling over..

My GP visit today was quite good - we sat in on about 15 consultations across the 3 hours, and got to hear a different set of problems to the one's we had heard before. We even managed to diagnose a new presentation (ie the condition wasn't listed on the PC already..) It was an older tee-total guy who walks everywhere but had been falling over a lot, and sometimes blacking out as he fell. There was no history of epilepsy, and no dizziness or feeling woozy. We successfully managed to diagnose a postural hypotension by measuring his Blood Pressure when sat down and after standing for 3 minutes - he had a 30 mm Hg drop in his systolic BP.

After morning surgery, our GP let us go at 1pm, in order to focus on our Community coursework this afternoon, which I failed to start.

Oh well.

Thoughts on Assessment

Week 23 is turning out to be a fun week.

• Monday was a holiday, and I slept for a lot of it. This did not help my revision.
  
• A visit to my GP on Tuesday morning meant that I missed Hospital clinical practice, but my neck was really painful and stiff, but as expected I got advised that it would ease up, and to take 'brufen (or Ibuprofen as the rest of the world outside Glasgow calls it).
  
• In the afternoon, we had out clinical skills session on breast examination - having now had about 15 clinical skills sessions, all of which are examinable in the OSCE I am getting very scared as I can't remember how to do some if not all of them. The session was good because for once we only had about 4 of us per manakin. Thankfully most clinical skills videos are available on the net or DVD.
  
• Today we had the excitement of our OSCE briefing from a lecturer who thinks he is funny, but sadly isn't. His jokes were very lame and the rest of the talk consisted of telling us the lists of possible topics that could be covered in the OSCE. Since my GP isn't keen on practicing examinations beyond CV and respiratory, I'm very worried about the OSCE, almost as worried as I am about the real exam and especially bones....
  
• However, tonight someone sent me a list of past exam questions which I can at least practice with. Not sure if they are all from our Uni, but at least it gives me something to practice with.
• Also just remembered that we have coursework due in 2 weeks, so that will be fun. I got BB for the first piece this year, so hoping for a similar result this time.
  
• Dr Amy my colleague at work, who is in the year below me at Uni has asked to see my project from Year 2 as she has know idea what to write for hers. Due to them being based on different patients, she can't use my info, but I hope the essay helps her, looking at it now, everything in it seems both obvious and complex!! How did I ever understand public policy and sociocultural medicine?