A bit more optimism

Apologies for the outpouring of self pity the other day. I've perked myself up and accepted that whatever will happen, will happen and there's no point moping about it. I've pretty much come to terms with the fact that I could be resetting the year, so if I do pass it'll be a pleasant surprise, but if I don't hopefully I won't be too disappointed, although it would suck a lot.

I'm currently working another 15 hour locum shift today. It's been pretty busy up until now so it's nice to have a bit of quiet time. If I do pass the exams, then I've found out that my first proper clinical rotation will be in Orthopaedics and Anaesthetics. We have a 3 week community learning placement and then we go straight into proper rotations. Orthopaedics is probably my most dreaded speciality, probably because I don't have a massive interest in it, and MSK is my worst topic. If I knew that I'd passed exams I could be revising in preparation for it now, but I can't help but think that I'll be jinxing myself if I did now, so I'm refraining. I really wish that I have passed the exam as I'm so looking forwards to the time where I can go into the hospitals instead of lectures. Going back to lectures and group work full time again will be so hard.

As an aside, why do people leave it until 10pm on a Saturday to take action after running out of their prescription? Last Saturday at 10.30pm we had a flurry of people coming from the GP on call centre awaiting faxes of their regular prescription to be sent over. Except that the fax machine was broken, but as the patients all kicked up a fuss about needing their medication tonight, I had to try to contact all the different on call GP's to organise emergency supplies. If their medication is so important, why didn't they order it a week ago when they saw they were nearing the end of their supply, or even ask the Pharmacy to sort it for them on the Friday, or even come in on Saturday day time. Most of the medications were things that the patients took in the morning, so why didn't they take action on the Saturday morning, when we may have been able to get a script from their GP? Why Saturday night at 10.30pm????? It reminds me of when my sister (who's a nurse in A&E) had a patient call up an ambulance on a Friday evening and came into A&E by said ambulance because they'd run out of their regular medication..... Patients drive me crazy sometimes.

Lots of neuro

As is the constant theme in the run up to exams, my life isn't really consisting of anything interesting outside of revision hell at the moment. I've currently got half an hour left until the FIFTEEN hour locum shift I've worked today is over. The morning/afternoon was pretty busy but this evening's been DEAD (as in, there's been one patient come in, in the last 4 and a half hours...) so I've taken advantage of this and got lots of uni work done. My brain's no longer concentrating though so I thought I'd update this to use up the last of the time until I can go home to bed. I'm looking forwards to bed so much!

This week was the last week of my radiology SSM. Instead of going to shadow people in the radiology department, we just had a short neuro imaging lecture and then we all we had to give a short presentation on "whatever we wanted, as long as it related to radiology" to the rest of the group as part of our final assessment. My presentation was pretty boring  and I'm not great at presentations (nerves cause me to forget how to talk coherently) so I'm not expecting a great mark for that. It doesn't count for much though, we basically just have to pass it. In the neuro lecture the radiologist got out a model skull to show us. I thought it was just a bog standard model of a skull, but NO it was actually a 3D printed skull showing the exact fractures a patient had sustained from a gunshot wound! I didn't even know that was possible!

I've also given in the last of my other bits of coursework for the term, so all I've got to concentrate on now is revision for exams (which are getting very close, very quickly). One of my downfalls last term was the fact that MSK was hard, the lectures were too long and detailed and I couldn't figure out a good way of writing up notes for it, so I just didn't... (a friend has since given me a copy of his very good notes which I am extremely grateful for). Neurology this term could very easily have gone the same way, but I've made a concerted effort to put a lot of time and energy into getting my head around it and making good notes. I'm almost up to date with it all now which I'm very pleased about as it's taken far longer than any of my other modules. Hopefully it'll pay off for the exams.

Exam worries

Oops, it’s been a while since I’ve last posted. This term is just going really fast and I don’t really know where the time goes! It’s just over 6 weeks until my big scary exams. 6 weeks really doesn’t seem like much revision time at all, especially when these exams aren’t just on this term’s work, but on everything we’ve covered since the start of med school and we don’t finish this term’s teaching until 2 weeks before the exam! It doesn’t help that every weekend seems to be taken up by working locum shifts or with visiting parents or friends. I’m trying to do as much work as I can in all my free time, but it never feels like enough. I had a bit of a freak out a couple of weeks ago that I’d never be able to learn everything in the time, and that everyone else in my year is far smarter than I am, and I just felt really disheartened. I’m feeling a bit better now, but I still have occasional moments of self doubt and panic. I really, really don’t want to have to re-sit these exams (and I don’t even want to think about the possibility of repeating a year). Having to re-sit the summer exams was enormously stressful and took up a big chunk of my summer holiday, and I don’t want a repeat of that. If I pass these exams then I’ll get to enter the clinical phase of the course, which by all accounts sounds a bit more relaxed than the pre-clinical phase, and I wouldn’t have to sit another exam for a whole year! Additionally, we also had to chose a clinical partner a few weeks ago, which we’ll be placed with in clinical rotations, and I’d hate to mess mine about by failing these exams. So all in all, my stress levels are pretty high at the moment.

A little while ago I wrote about being offered a 15 hour locum shift that I turned down. I worked a 10 hour shift at that pharmacy a few weeks ago, and as it turned out to be a really quiet, nice pharmacy (I spent a lot of the shift just doing uni work it was that quiet), I’ve agreed to do a few 15 hour shifts, starting with one this Saturday. I was worried that it was going to be really busy for the whole of the 15 hours which is why I originally turned it down, but now that I know that the majority of the time will likely be really quiet, I don’t feel unsafe working it. I was correct in my previous post in saying that a pharmacy open such long hours in it’s location isn’t really necessary, but I found out it’s because there’s another pharmacy situated a few doors away from it. Regulations mean that new pharmacies opening close to existing pharmacies are only allowed to open if they’re 100 hour opening pharmacies. Pharmacy’s tend to be pretty profitable so I’m sure they’re still making money, even though they are paying a pharmacist and a dispenser to just sit there a lot of the time during the extended hours.

Tales from the pharmacy

These are several stories that happened to me whilst working recently which I thought I’d share (any identifying details of the patients below have been changed!).

• It was the middle of a busy shift when one of the healthcare counter staff came up to me and told me that there was a patient requesting to see me who was having an asthma attack. I went out to see her, and she was indeed having an asthma attack and at that point was really struggling to breathe. There are certain prescription medications that Pharmacists are allowed to give to patients in emergency situations without a prescription or the patient being known to the pharmacy, so I took the patient into the consultation room and gave her a salbutamol inhaler. After several puffs she started being able to breathe again, which I was very relieved about. I stayed with her to ensure she recovered fully, and after 5 minutes or so she’d recovered enough to be able to talk again. At that point she got pretty upset as I think the attack had given her a shock. I comforted her and stayed with her for a while until she felt ok to leave. She thanked me a lot and claimed that I’d saved her life (probably a slight exaggeration!), but it was nice to think that I’d made a difference in that women’s life that day.

• On another occasion, 2 sisters came into the pharmacy I was working at, both with prescriptions for the morning after pill. I asked them if they knew how to take it, and as they didn’t seem to know much about it, I took them into the consultation room to counsel them on it. I said that I could talk to them separately, but they were happy to come in together. As part of the counselling I always check how long ago the unprotected sex was to ensure that the patient is still eligible to take it, and to advise them on approximately how effective it will be. When I asked the question to these sisters, one of them said the early hours of the previous day and the other one nodded in agreement. I didn’t probe further but I couldn’t help thinking about what on earth had occurred? Had they both just happened to have had unprotected sex with different men at the same time, or had it occurred in some big orgy?! I’m glad I did talk to them though as the doctor didn’t seem to have told them anything about how to take it (or else they’d forgotten everything the doctor had said), and hopefully they’ll have good outcomes from it.

• Lastly, I was doing a medicines use review with a patient and talking to her about her medication. She had recently been prescribed a cream, so I asked her what she was using it for. It turned out that the patient is a naturist and was using the cream for a shaving rash “down below” from a recent naturist holiday! She didn’t need to tell me so many details surrounding the need for the cream, but it was interesting to hear about and the patient seem to mind telling me about it! 

Recently my locum agency wanted me to work 25 hours in one weekend at the end of September – a 8am to 11pm shift on Saturday and a 9am to 7pm shift on the Sunday. I agreed to work the Sunday shift but not the Saturday one. I know that in the future as a doctor I might have to work long hours, but as I currently have the liberty of refusing shifts, I’m taking full advantage. I just wouldn’t have felt confident in still being clinically safe to work after 15 straight hours, plus when I’m in uni full time Mon-Fri and have work to do outside of lectures, I need time off at some point! How much need though is there for a Pharmacy situated on the outskirts of a small town to be open until 11pm on a Saturday? It seems a bit pointless to me.

Back to the real world

I’ve just come back from a 9 day holiday in the countryside of France. It was such a nice break!

(photo taken by me)

Back to the grind tomorrow though. I’m doing a locum shift with a company which requires all their locums to perform 2 Medicine Use Reviews and 1 New MedicineService every day. These are essentially services where the pharmacist sits down with the patient and reviews their medication with them. Sounds good in principal, but setting targets means that in reality pharmacists often end up doing the services on patients who don’t really require the service in order just to reach targets and earn the company money (the pharmacy gets paid approx £27 for every one carried out). Some days you just don’t get the patient’s through the door who match the minimum criteria to allow you to carry out the service on them, or the patients just don’t agree (are often too much in a rush) to sit down with you, so trying to reach targets can be pretty stressful.

This is the main reason why I dislike community pharmacy – it’s a business with the main priority of making money. Patient care is secondary and there’s always going to be conflict. I’m glad doctors still work for the NHS where making money isn’t the primary aim.

Pharmacy and exams

Another reason why I'm glad I'm giving up Pharmacy to do Medicine (if I manage to pass med school that is....):

http://www.which.co.uk/news/2013/05/can-you-trust-your-local-pharmacys-advice-319886/

This report is flawed in many ways (the very small sample numbers, only looking at one source of advice instead of the wide range of services pharmacies offer etc.), but the results do ring true to a certain extent in my personal opinion. There are many excellent pharmacists and pharmacies out there giving an excellent service, but on several occasions I've been a customer in a pharmacy and have been given poor or no advice (when ideally I should have been given counselling considering I was a new patient taking a blood pressure lowering drug (I take it for migraine prophylaxis)), or overheard bad advice being given to other customers. I also know that I went to university with several people who I wouldn't trust to advise me on medical related matters, who are now working as pharmacists (this may be unfair and is only my opinion). Many people don't seem to respect pharmacists as much as they do other health care professionals ("glorified shop keeper"), which whilst unfair, I don't see changing significantly in the foreseeable future, especially with reports like the above.

(Note: I don't feel the same way about hospital pharmacists. Hospital pharmacists do further diplomas and training, and every hospital pharmacist I've ever known has had an excellent knowledge base and regularly prevent unsafe prescribing/make sure the best medication is prescribed to patients in hospitals).

On a different note, my second exam on Friday went better than Thursday's exam, but I still don't think that I've done enough to pass overall. I'm doing a little bit of revision everyday to prepare for resits, whilst also preparing for my OSCE exams next week. We found out the OSCE stations today which we're going to be examined on. Most of them seem ok, but there's a few I'm a bit unsure about. There's going to be one station on ECG which I presume will be to interpret an ECG but I really don't know what to expect from it. I also haven't had that much ECG practice, so I definitely need to do a lot of work for that one. There's also stations on infection control and male anatomy which I'm not too sure of what to expect and a station on mini mental state examination, which I know is quite straightforwards but we've never actually practiced it before! Luckily my boyfriend has agreed to be a practice patient all week (when he's not at work) as practicing on a real person is definitely more effective than just running through the motions by yourself.

Exam results

So we got the exam results back, and………….. I passed!

It’s not a big celebration though as I only just passed, but considering I knew I hadn’t done enough/the right type of work I’m pleased. On my first exam I only passed ¼ questions, but that was the exam where I had a bad migraine the day before and got myself pretty worked up and panicky for it, whereas I was a lot more calm for the second exam, and for that exam I passed 4/4 questions. I have used this as an impetus to change and so far this term I’ve been staying a few hours after uni each day and at weekends, writing up my lecture notes and doing extra reading each week. I feel a lot better about my revision and my grasp on the teaching topics than I did last term.

The one exception to this is my musculoskeletal module.  For all my other modules I’ve been typing up revision notes for each lecture, but I’ve found that this hasn’t worked for musculoskeletal as these lectures are mostly just pictures. I also find musculoskeletal very hard as I did absolutely no anatomy in my previous degree and I find it really difficult to remember the plethora of names of things in the body that we have to learn. Before I started med school I honestly thought that there were only a few key muscles in your limbs, I didn’t have a clue about all the little things in there as well! I think I’m going to have to buy some anatomy flash cards (such as these), but other than that I don’t really know how best to revise this subject. If anyone would like to share how they revise anatomy/musculoskeletal or give me any tips I’d be very grateful!

Other than getting my exam results, nothing too exciting has happened recently. At hospital this week we saw a man with an inguinal hernia which was interesting to examine. I also met up with my special study supervisor and we decided on my study topic: elective caesarean sections. I’m really excited about this as it should be really interesting and will help consolidate some of the topics we’re studying at the moment. I’ll be going in to observe the caesareans which I’m really looking forwards to, but I’m also slightly nervous as I’ve never seen an operation before and I’m hoping I don’t do something embarrassing like get in the way or faint! It was also really embarrassing in the meeting, as we were discussing different topic areas and then once we’d decided on caesareans I had to fill out a form for my supervisor to sign documenting this. The only thing was, in that moment I couldn’t for the life of me remember how to spell “caesarean”, so I just wrote an approximation of it in scrawled handwriting and hoped that my supervisor wouldn’t notice! He didn’t say anything, but maybe he was just being polite. So embarrassing!

I had a really horrible locum Pharmacist shift last weekend. It was really busy (which wasn’t the problem although I didn’t get a chance to have a drink all day, let alone stop for lunch), but pretty much every other patient who came in had a problem or a complaint (about things from earlier in the week which I didn’t have anything to do with but I was still the one to get shouted at). There were also loads of people coming in claiming that we should have their repeat prescriptions made up, and that they didn’t have any medication left, but when I looked the prescriptions had only come back from the doctors late the night before, so shouldn’t have to be ready until the Monday, or just weren’t back from the doctors at all. This meant either hurriedly making up their prescription and keeping them waiting, or else having to do emergency supplies. This caused the patients to be grumpy and more often or not this was taken out on me. It was just annoying because all of the problems and complaints came from the regular staff not doing their jobs properly and poor store procedures, but it was me who ended up looking bad and incompetent. Grrrrr. I’m going home again for another locum shift tomorrow. Hopefully this one will be a little better.

Exam 2

Exam number 2 went far better than my first exam. The questions were on things I knew about, and the few questions I wasn’t too sure about, I felt that I at least could put down a sensible answer. I don’t know why this exam went so much better than my first exam; maybe I just got lucky with the questions or maybe the extra day and a half’s revision actually made a difference. For this second exam, I actually felt as though I might have passed all 4 questions on the exam, which would mean that I might actually pass the exam! I would love for this to happen, but I’m not getting my hopes up as I’m not sure how picky they’re going to be with their marking.

I came out of the second exam pretty happy, thinking that the second paper was far nicer than the first, but most of the people I spoke to afterwards seemed to think the exact opposite! I think it might be because the majority of the people on my course seem to have some sort of Bioscience degree, and therefore find the bioscience molecular questions pretty easy, of which there were more on the first paper than on the second. I’m the opposite however, my degree involved a minimal amount of bioscience, and in much less detail than we’re covering now, and therefore I find the bioscience questions the hardest. The bioscience people seem to have a slight advantage at the moment, but I’m hoping that come the clinical years and our pharmacology module, my degree will be of benefit!

I’m currently typing this on the train. I went home for the weekend to do a locum shift today. It was quite a nice shift, not too busy but not too quiet, but there were a few things I found a bit more difficult. I had several people requesting my advice about various ailments, including two mothers with young children. One of the children had what appeared to be conjunctivitis, and the other had come out in a horrible rash with no obvious cause. I think I gave sensible advice about treatments and made sure to tell the mothers to go to the doctors if things didn’t improve/symptoms got worse or certain symptoms appeared, but giving advice is still really stressful, especially with young children who can decline really quickly. I realise that this is pretty much what being a doctor entails, but I’m hoping that with practice comes confidence.

The first day of second term is tomorrow. I think it’ll mostly just be introductory stuff to our new modules, but I’m looking forwards to it. Some of the modules that we’re doing this term look really interesting (and difficult..) and I’m excited to start them J