My Medicine term... half-time commentary

Wow time flies! I am half way through my medicine term already and I have written very little. The pace is much faster and I have been busy.

A typical day:
Get to the hospital a bit before 8am, print the lists for the day, this can be quite daunting post take (the day after the consultant for our team was on call) check outstanding bloods/radiographs (x rays) and see how patients are going (on paper). By 8am the rest of the team has arrived, and doing similar things (except for the consultant who just turns up). We go see the critical/less stable and the new patients first.

The consultant walks in to the patients room first, followed closely by the registrar and resident (who is holding the chart) with the med student/s following in the rear usually holding charts for the few patients either before or after this one and they draw the curtains closed. The consultant is usually all smiles "Hi Mrs... how are we today?" while the patient is tell their story, the Reg is telling the key changes over the last 24hrs (the resident was the one who actually arranged the tests and chased up the results). The consultant seamlessly gets to the guts of the problem in less than 30 seconds and if there is an interesting sign, gets the students to elicit the sign. (if the student fails, he is shown and the patient is in awe of the consultant...he is the guru.. If the student finds it, the student is excited but it is assumed that anyone could elicit the sign, the patient is in awe of the consultant..he has taught them well...either way the consultant is revered). The consultant pimps the students for a differential diagnosis or the pathology of disease x (the med student now has homework...he had better know the next time this comes up!) and then asks the registrar for a management plan. Generally, the registrar nails it, but inevitably he forgot a key aspect, the consultant corrects him and the registrar or resident writes the plan up. The resident adds the tasks e.g. order a gastro consult, get psych referral or do an ABG to his ever going scut list. The team moves on.

By lunch time the Consultant is usually gone. The rounds are mostly done (anyone left is usually not urgent and the registrar and resident see them without the consultant). The consultant is off either doing paper work, attending a meeting or teaching the registrar and the resident is madly running around trying to get things done on his scut list plus writing up medication orders and fluid orders. The registrar is called if any curly questions need to be answered. The med students go to tutorials (often happen to coincide with a free lunch) and then go and see people on other wards who have interesting signs and practice exams.


Generally, I am loving this rotation. I enjoy the acuity of it (well at least compared to GP) and the time to think (compared to a 15 minute consultation in GP land) - You have time to look something up if you don't know (you are expected to know to a higher level than in GP and even though there are consults available form other services, they are your patients and you do most of the work). I love the team work - nurses, pharmacists and allied health (physios, speech pathologists, psychologists etc). I think I am very well suited to the hospital environment. However I like the Monday-Friday 8am to 5pm (with occasionally weekend shift) though. Naturally, I am an evening person but my current schedule dictates I function well in the early AM. I am a very sensitive sleeper (can't sleep in cars, public transport, with light, without ambient noise etc) and if I sleep in, even once, on the weekend, or do an evening shift at work (which often has me all wound up with the cool stuff I saw), it takes me most of the week to get settled back into the early morning routine. I am wondering how a career in anaesthetics will be possible? will I learn to be less fussy about my sleep? I hope so!!!