Thursday, March 29

Easter Holidays

UK universities seem to have a rather unique term system. The 2nd semester is much long than the 1st (Jan to May, compared to Sep to Dec). Year 1 medical school is pretty generous with their breaks. I'm currently having 3 weeks easter holiday, a much needed break after continuous mugging. Thereafter, 3+ weeks of project work, without any other lessons. Then another 3+ weeks of study break before a barrage of exams...

So technically, year 1 cirriculum has finished. And it ended off on a good note.

My last lesson was a ward session. In pairs, we headed out to our assigned wards, to our allocated patients, to practice all the clinical skills we have learnt thus far.

It was my partner's turn to take the patients history, and it flows like this:
Presenting complaint
History of presenting complaint
Past medical history
Drugs & Allergies
Family History
Social History
Systematic enquiry
Ideas, concern, expectations

Our patient was so chatty that I didn't get a chance to do the 2nd part, physical examination. Unsatisfied, i headed back to the hospital after our debrief, while my classmates strided off into the early spring for their holidays.

B.S was sitting in the vascular wards, her left foot bounded up. A visible black marker drawn across her shin, though the ulceration and red tender skin was creeping superiorly. Her ulcers are progressing upwards. Now with all the time i had, i pulled a chair beside her bed, and started chatting with her. She shared the hardship and adventures of her life. And like a jigsaw puzzle, piecing the stories together in my mind, she felt like more than just a patient, and more like a friend.

We spoke till the sun was no longer shining through the windows, and the seagulls were back to their routine and irritating squawkings. It was time to go. So i wished her all the best; afterall, that's all i had to offer.

Medical school has loads to offer. But admist all the structured learning and clinical session, we need to know how to recognise and sieze an opportunity when it arises. B.S was my patient, but through the additional time i had with her, she unknowingly become my teacher. There is so much information u can gather from simply observing and listening, rather than diving straight into clearing the checklist for history taking, and the procedures of physical examination. For example:

When she shook my hand, her grip was loose and her fingers cringed - Osteoarthiritis
As she spoke, she occassional pause to catch her breath. The muscles in her neck and shoulder tensed, meaning she needed additional effort. - Chronic obstructive pulmonary disease
Swollen ankle - Heart failure? Vein blockage?
Large number of bruising - On steroid medication? blood-thinners?
Cloudy rim around the iris, and excess skin deposits around the eyes - Corneal arcus & Xanthelasma = High cholesterol

I'm grateful that Aberdeen medical school starts clinical from year 1. Clinical skills require time to develop. In the end, that's what makes us doctors.

1 comment:

  1. Its lovely how the initiative you took may lead to your patient becomes your teacher. :)

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