Train your trainees

I’ve been spending a lot of time in labour ward anaesthesia this past month. It’s great, because I get all the gratification of the caesarian sections (I remember it well from internship), without having to wade through blood and amniotic fluid and human excreta myself.

This tweet in part inspired this post.

Another thing I remember well, is the tension in theatre when the intern is cutting. I had such difficulty getting my ten caesarian sections for our logbook signed off, because so few seniors were willing to let an intern cut. It’s not only the obstetrician – often, it’s the theatre nursing staff. To be fair, nobody likes to be scrubbed in for a routine caesarean that lasts ninety minutes. Other times, it’s the anaesthetists. Because nobody likes to worry that their spinal anaesthetic might wear off before the surgery is over.

I have had a taste of the same with my new position, too. Not having done anaesthesia in four years, there is a lot I have had to relearn. My “teachers” have been great, and I seem finally to be finding my feet, but there have often been grumblings from surgical teams when I was slow. As an intern, I might have minimised myself and declined to perform the procedure. But now, I need to learn, and quickly. So I have been pushing back harder (when not to the patient’s detriment) – and to my new colleagues’ credit, they have supported me.

Check the replies on this tweet – they made me feel so much better.

Having experienced this, I will always be the annoying medical officer who encourages the intern/student/newbie to perform procedures. Not because I think I’m so wonderful, but because I want trainees to feel as nurtured as I have felt these past few months, and not as burdensome as I sometimes did as a student and an intern.

Sometimes, I think clinicians forget that they were inexperienced and under-qualified juniors once, too. There is nothing admirable about learning to place an intercostal drain on YouTube, without senior supervision, as many of us like to brag. That is a sign of a failing system. We should be taught and guided by others with experience. We deserve that. Our patients deserve that.

I also know that it is a system that fails not only interns. I know that demoralised doctors have little interest in training juniors. (But that is a discussion for another day.)

Interns who are not competent become dangerous medical officers, wherever they may go for ComServe. They have both the right and the responsibility to be trained. We have the responsibility to ensure that they attain their very best, even if they are afraid while doing so. We do it to pay forward the teaching we have received. Or if we were not so fortunate, we do it to improve where others failed us.

Train your trainees. It kind of goes without saying.

Finally had my “magical paeds moment”

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Not the same child, photo with permission.

The little girl had come in hurt and bleeding. No too bad, a small gash that was easily approximated and taped (gosh, I love steri strips).

Next: the Tet tox.

She doesn’t know about it yet. For a moment I consider not telling her at all, but she is old enough to feel betrayed. So she sits on her dad’s lap, and we tell her about the special injection that will prevent her from getting sick. We may have used some imagination and invoked superheroes, too.

I braced myself for the struggle the moment the needle pierced her skin.

Nothing. Nada. She sat chewing her candy while I taped the injection site.

You know all those cute videos of doctors giving kids their shots without them noticing? I finally got mine, and that felt kind of special. Sometimes, you need just one small success to give you a bounce in your step.

The Best GP Advice I’ve Received: Part 1

 

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(c) Simon Prades

The night before my first shift in general practice, I frantically messaged one of my doctor-heroes on Twitter (@sindivanzyl). I think I was hoping for a cheat sheet, something about hypertension and diabetes, but the one thing she emphasised was, “Please, please, always examine your patients.”

For medical students that would probably sound absurd. Duh, how can one not examine the patient? 

But I learned quickly that, in an environment where there are always more patients to see, it is sometimes easier to make a quick observation from across the desk than to do as we have been taught. Continue reading “The Best GP Advice I’ve Received: Part 1”

Sometimes I Don’t Want To Know

a4c50964f550a70443d53e51fe887a82I didn’t want to know that the man with the compound skull fracture had fallen into a sewer drain while being chased by the police because he was the man that had been scamming poor people out of their grant money for months.

I didn’t want to know that the man with the gangrenous arm had been bitten two weeks ago, by a girl he was trying to rape.

I understand the importance of a good clinical history. But right now, while I’m saving their lives, can I not simply¬†know that he fell in a ditch? Or that he suffered a human bite?

I don’t want to know WHY these things happened to them. Not right now in any case. Tell me later, when they have pulled through the worst. Tell me then, if you must.

Is this wrong? Continue reading “Sometimes I Don’t Want To Know”

How To Run A Clinic Without A Voice

When I was asked by Figure 1 which one piece of medical equipment I valued above all others, I said “my hearing”. We were taught from the very beginning that a good history was our first step to an accurate diagnosis, and I have always valued a physician who LISTENS: to their patients, their students, their allies, and their contemporaries.

Remember the game we always played? –¬†“If you had to lose one sense, which would it be?”

I thought¬†of my dad, who is blind: when he applied to do an honours degree in Psychology, his application was denied¬†based on the fact that he would not be able to see his client’s faces (ridiculous, really. That was nearly 30 years ago). It had me thinking: what about a blind physician? We have many blind physiotherapists, but surely doctors must SEE… a quick Google search proved me wrong.

Blind doctor Albert A. Nast holding his ear to the back of a 3 month old instead of using a stethoscope.
Blind doctor Albert A. Nast holding his ear to the back of a 3 month old instead of using a stethoscope. Image: Time Life. Click for link.

Continue reading “How To Run A Clinic Without A Voice”

Patience with Patients

There have been a few times in the last year that I was ashamed of myself.

In this particular case, I was on Vascular Surgery Week. It is one of our toughest weeks of Student Internship. We started the day at 07:00 and never left earlier than 21:00 that whole week. The days were incredibly busy and filled with terrible rotting appendages. In addition, the doctors we worked with were just awful and never really taught us anything. Such hours seem harder when you are a student. So… I was in a pretty bad mood.

A young hand touches and holds an old wrinkled hand Continue reading “Patience with Patients”

Four Years Later: A Metamorphosis

Today¬†this blog turns four years old. Technically a few minutes to midnight yesterday, but it’s much of a muchness really. Four years ago I wrote about practising speculum exams on sim-dolls in the skills lab. I was so embarrassed to do a bimanual examination on a doll in front of my male classmates. Everything was new and scary and who would have guessed that four years later we would be effortlessly sliding speculae and doing Pap smears and getting ready for the big wide world.

I don’t even know. But it’s funny right.

Continue reading “Four Years Later: A Metamorphosis”

A Simple Gesture To Make Gynae Exams Less Awkward

I’ve been on OBGYN for three weeks now. I had four weeks of OB in third year and four weeks of GYN in fifth year, and through it all the speculum examination has always been a bit of a nightmare for me. Visualising the cervix with as little as possible pain to your patient takes practice, like any other skill, but it is also very uncomfortable for most women I’ve seen. Lithotomy is possibly the least dignified position we have ever come up with. Not to mention that an uncomfortable woman in lithotomy will inadvertently tighten her perineal muscles.

gyno tips Continue reading “A Simple Gesture To Make Gynae Exams Less Awkward”

IV Lines: You’re Doin’ It Wrong

A quick contribution to this month’s Medical Monday. I am in the last week of Family Medicine and trying to finish of the mass of projects we have to present this week. Additionally I have just realised that my first set of exams (the B.Ch-part, a.k.a. Surgery) is in two months. I am not feeling prepared for that and will definitely need to focus more intently on studying.

Anyway, here is an incident that made me laugh. The rural hospital where I am working is relatively small and sometimes, patients sleep over at Outpatients’ Department while awaiting a bed. We start their treatment in the meanwhile, run tests and set up IV-infusions. The next morning, OPD essentially as its own “ward round”.

We were scratching our heads as to why a certain patient had not received her treatment overnight. Then we saw her IV line.

IVmess

(As you can see, that IV isn’t going anywhere but down the drain.) As we are fairly certain that no nurse or doctor would have done this, the only conclusion we could reach was that the IV came out and the patient or a relative tried to “put it back.”

Regardless, we had a good laugh. This has got to be even funnier than when this happened.