Friday, May 15, 2009

Starting E.D.

This week officially marks the end of my O&G term. I'm starting a 4 week rotation at Emergency Department which I am quite looking forward to as it should be more interesting plus the cases that I will be encountering are very relevant for my final examination. The management protocols for any patient that presents in an emergency situation is a DEFINITE MUST KNOW for the finals which includes the correct, appropiate steps of diagnosis, relevant investigations, immediate treatment and follow up management. We're supposed to split ourselves up into two groups and you are either allocated to the morning shift (8:00-1:00pm) or the afternoon/evening shift (1:00-6:00pm) which leaves ample room for studying in between. I'm hoping to gain more exposure in practicing my procedural skills which is something that I am facing difficulty in due to lack of experience and partly because I'm really scared that I might end up causing a haematoma when i insert a cannula in (which I have done before on one occasion), do the procedure incorrectly or cause pain to the patient. A lot of the registrars and consultants have told me to just 'Go on and just do it' as the more you hesitate, the more uncomfortable you become (not to mention your self-confidence further deterioates)and you put the patient at unease. How am I going to do these procedures at ease when i am a future doctor? I've just got to gather the courage and DO IT without thinking too much of the potential consequences. I know most of the time these stuff are done by the nurses and midwives but it just means that its an accquired skill a doctor should possess hence he/she need not waste time on it.

Anyway, I received some feedback from my supervisor. She told me that I need to work on my communication skills. By that she means I need to make an effort to build a good patient-doctor relationship and have a broader view of the social, occupational, cultural factors that may contribute to the problem. I mean it is neccessary to ask the questions relating to the physical health of the patient but you should ask the patient about his/her concerns, worries, understanding of the disease, social support as this can impact on treatment outcome. Eg: A patient may be suffering from menorrhagia (heavy menses) but has suddenly come to her GP after only a pariod of 2 years. As a doctor you have to find out what is the reason why she has come to address this problem today; could it be that it is affecting her marriage i.e. sex life or perhaps she is worried that she may be having cervical or endometrial cancer? Just like any clinical scenario, a doctor plays a 'detective' role; you are given the clues and have to work backwards in order to find the source of the problem. If you don't ask the right questions, you don't get the right answers. That's why my supervisor emphasised that its vital to build a good rapport with the patient. She says that its probably due to my 'timid and introverted' nature but I think its probably due to a lack of self confidence. I admit I'm not that much of an outspoken person so its something that I need to work on in the future. It will not only make my job as a doctor easier but you will get along better with the nurses and midwives which can make your life a living hell if they wanted to. Otherwise, she mentioned that my academic knowledge is adequate but 'knowledge is only a small part that makes a good doctor'. Her exact words were 'To be a good doctor, you need to possess knowledge, adopt a caring, responsible and reliable attitude i.e. chase results, follow up conscientiously on your patients'. That's why medicine is so demanding, you not only have to study/work extremely hard and possess some kind of intelligence but you need the right sort of character/personality to deal effectively with your patients and other colleagues. There are things that you can change but some things you're just born naturally with like a high IQ, an outgoing personality or leadership qualities which I apparently don't seem to have. That's why sometimes, I think that maybe I am not cut out to be a doctor; there's so many qualities that I clearly lack. But then I'm already almost at the finishing line of my course; I've just got to try and make use of whatever I have and pray that its sufficient to meet the demands and expectations of my exam and future career as a doctor.

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