Surgery... loving it!

I am having a fantastic time in Surgery. As expected I enjoy it more in General surgery than Orthopaedic surg. I enjoy the diagnostic challenge, the ability to take a problem and deal with it. I like that learning anatomy, while hard, provides almost instant gratification when you know where something is in theatre. I like that just when you think you know the anatomy, a patient will have some rare varience or anomally that keeps you on your toes. I like the high pressure environment but still the degree of mastery required. I am loving it !!

Ortho...a great experience!

Well, I must say that my last two weeks in orthopaedics have been great. I saw many very common problems, a few not so common, I got to scrub in and assist numerous times. This leaves me a little confused, as out of all the specialties to do, I thought ortho would be my least favourite - I am not very sporty, never really had much sympathy for guys (or girls) who do stupid things and end up with impressive, yet completely preventable injuries.

Then again. I saw many average people just like me who really were in the wrong place at the wrong time. I saw how debilitating a musculoskeletal problem can be, how it is mostly amenable to surgery (the skeleton is remarkably resilient and partially self repairs) and how greatful (mostly) patients are when you intervene. I realised, it was no worse than the guy that keeps puting drugs in his veins, smoke on his lungs or alcohol in his liver - patients often have hang ups. What makes sports worse? If anything it is a negative outcome from a potentially less harmful activity. [I am still yet to find strong evidence that exercise is good for you (apart from a gentle stroll etc) - anything more intense often ends in fractures, arthritis, torn ligaments and so on...]

What I did learn is once you learn the anatomy (which is a LOT of work) surgery is fun, you get to fix problems with almost instant gratification and orthopods aren't all knuckle draggers as often portrayed. All in all a great experience!!

Surgery... an early start!

Since the blogs for my last two rotations have been few and far between, I thought I would get a head start for this one. I start 8 (supposedly grueling) weeks in surgery tomorrow. The first two weeks are in orthopaedics (Assessment = 1) consultant mark, 2) clinical case - complete following pre, peri and post op 3) random joint examinations and 4) a take home (for 24hrs) exam later in the term). I am doing my ortho with other students at a main tertiary hospital in the city.

The next 6 weeks are at a smaller hospital in general surgery where assessment = 1) 3 clinical cases (as in ortho), 2) consultant mark 3) surgical images paper 4) final paper. I am one of only a few students so hopefully I will get a bit of hands on experience.

At this stage, even though anaesthetics is on the top of my list, I haven't completely written off surgery as a choice. My background is physiology; it is where I feel comfortable whereas my anatomy knowledge is somewhat more rudimentary. But there is something about surgery which excites me. Surgery is sometimes seductive as a path and most books about the journey of becoming a doctor tend to be written by surgeons (probably says more about the personality types) and I can't help but wonder if anaesthetics was "sold" more actively would it be more or less popular?

In my elective rotation I saw both and I must say I was much more fascinated by anaesthetics. I like the idea of taking a problem and fixing it though...

At this stage I want to spend my elective in fourth year split (4 weeks each) between general surgery - hopefully trauma, and anaesthetics - again hopefully some trauma as well. I wonder if that will change after my surgery rotation??

Rural Med - that's a wrap

Well I have finished my rural med rotation already. Things generally went as predicted. It had many great moments; it was sometimes lonely, sometimes boring, but mostly relaxing (The lack of traffic, the country air, the generally slower pace of life was fantastic – to live I am not sure, but as a break from tertiary hospital life – awesome!) Unfortunately internet access was very difficult to get (except to quickly check an email or download a paper and was definitely not conducive towards blogging) and therefore my rotation passed by very quickly with no updates here.

Orientation week was busy, lectures and intro to rural medicine. Generally this week was helpful, but it did seem a bit dragged out. It also provided an opportunity to hang out with fellow students also on that rotation (about 40ish) which was great.

I spent weeks 2-7 at a small rural centre. I was welcomed and put to work straight away (Got there Sunday afternoon, called in to the hospital Sunday afternoon to assess patients about 1-2hrs later!) Sometimes, particularly after big sporting events (which saw people coming in from outside regions), the trauma workload was intense. We didn't have access to CT, an operating theatre or any obstetric services and any bloods needed to be flown a few hours away to a regional centre, taking >>6hrs for any results and so anything major involved stabilisation, finger crossing and flying out (Helicopter or small fixed wing plane with the RFDS) if the patient survived. This made you think about how essential advanced imaging/testing really is. Clinical judgment is more important than ever, and I think it help to really develop your clinical skills!

The hospital (About 10 beds) was staffed by Nurses and the town GPs (there were 2 doctors not 1 as previously thought) would take turns to cover the calls from the hospital. I was usually 1st call, I assessed the patient(s) and called the doctor on duty for advice/to attend. Sometimes I was scared, but a few slow breaths, a quick read of the therapeutic guidelines (similar to the BNF in the UK I think) or UptoDate and remembering to return to basics - Good history, comprehensive (but case specific) assessment - and things usually went pretty well.

A few of the things I learnt were...

• Common things present commonly! OMG how many people with a slight cough or obvious URTI did I see. Patients/Mothers who had made up their minds before attending that they required antibiotics.
• How to examine a eye and remove foreign bodies
• Venipuncture – lots of practice
• Stabilisation of trauma patients (particularly suspected neck trauma)
• Assessment and management of general orthopaedic trauma – rolled ankles, fractures, dislocations

Running in the back ground of all this was a rural health project where we had to design and carry out some sort of project that benefited the community medically, justifying in terms of current literature. This had to be written up by end of week 8.

The final week (week 8) consisted of exam revision, last minute lectures and study. The exam was only short (1hr) and was quite predictable (stabilisation of trauma, bush bugs e.g. Q fever and Brucellosis, aboriginal health, skin cancer, management of medical problems in a rural environment requiring transfer, referral etc) – the least stressed exam I think I have ever had. I'm really looking to the week off to catch up with my friends and family, do non-medical things (except maybe a little anatomy study for surgery rotation ;) )

Rural - an introduction

As I am in my "week off" I have been mentally preparing for my upcoming rural rotation. In case I forgot to mention previously, all my clinical rotations are 8 weeks long. The first week involves staying in a rural centre (in my case 8+ hrs drive away) and consists of an intensive orientation with lectures and procedural skills.

Weeks 2-7 are at another location (small rural town) where I stay at the local hospital and learn about rural med. From what I can tell will be a cross between general med and general practice without the luxuries of CT, Operating theatres etc. In Week 8 I go back to where I was for the first week and attend more lectures. The exam is on the Friday of week 8.

I am really looking forward to the rotation actually. The doctor (one doctor in this town) has to rely on his clinical acumen a lot (lack of access to many tests/pathology services). Of course anything major will be transported to a larger more metropolitan location or even back to a tertiary hospital, but we (him and I) will be there at the start. And while I appreciate that I still have a LOT to learn, I am not too nervous. I am, however, very glad that I have already done General Practice and have just gone through General Med. As I will be away from home and very homesick, I am sure I will update you much more frequently for this experience then I have previously (that is, if I can access the internet!!)

General Med - A wrap up (part 2)

On a More reflective note...

The rotation as a whole was draining, but fantastic. One of the key things it did was cement my clinical skills, which I must admit were lacking a bit having started this year with Psychiatry - where you DO NOT touch - and General practice - in which examination is very problem based and often sub-standard [done through shirts (limited exposure) and poor positioning for the sake of convenience and time].

There were days when I was totally enthused, and days when I felt exhausted and completely discouraged. But coming out at the end of it, I feel much more confident and I feel I'm clinically more efficient (and unfortunately perhaps a little more impatient with verbose patients).

In summary, I feel in this rotation I learned the most, but it took the most out of me...

General Med - A wrap up (part 1)

Well I apologize that I haven't written more for this general med term. I meant to. The term was very hectic and when I finally got a moment to think, I just didn't want to write.

The tone of the rotation dramatically changed toward the end. It went from being part of the med team, being part of rounds (generally experiencing life as a junior doc on general med) to one of, looking for long and short cases, trying to fit in study where you could around all the scheduled tutes and generally in exam prep mode. It was a necessary shift in focus (if we would hope to pass the exams) but after that the registrars/consultants seemed less inclined to involve you in the care of the patients.

The assessment (like all so far this year) consisted of 4 parts worth 25% of which one part was the consultant's mark. On this rotation the other 75% was from 2 short cases and 1 long case done on the last day.

The Long case was a patient on the ward. You were told the patient name/bed number and went straight to that patient. You had an hour alone with the patient (mostly uninterrupted, there is always morning or afternoon tea or the tv hirer or some physio/nurse interrupting which you have to quickly deal with) to take a detailed history, work out active problems (noting inactive ones) and taking a detailed social history intergrating all with a physical exam. You then have ten minutes to organise your thoughts then you have to formally present the problem to 2 examiners (one being the specialist looking after that patients presenting/main issue). You are then asked to list problems, investigations, and might have to interpret an ECG, blood gas analysis or chest xray. You are pimped for about 10mins by the two examiners. An example might be... Mr S is a 60 yr old man who presented with increasing SOB and productive cough of two weeks duration. This is on a backgroud of Chronic airway disease, Ischaemic Heart disease, Hypercholesterolaemia, Hypertention and poorly controlled Diabetes Mellitus. He has a cumulated 90 pack year smoking history, still smokes and has been on oral prednisolone (30mg) for 9 months now for frequent exacerbations of his COPD".
The problem list might constist of

1. Diagnostic and Management problem of Increasing SOB (DDX: Exacerbation of COPD or pneumonia, Lung cancer, Heart failure etc) - Including tapering steroids if possible (risk of osteoporosis, high glucose levels)
   
2. Management of his IHD (Incl. Cholesterol, HTN etc)
3. Management of His Diabetes Mellitus
4. Assist lifestyle modification (Stress reduction, wt loss, quiting smoking)
5. Assist with rehab to work or short-term financial aid (welfare etc)

The two short cases immediately follow where the examiners then take you to patients (often brought in especially for the exam) with nonurgent, but often interesting pathology. You have 10mins per patient to examine ("Mr x presents with increasing shortness of breath on exertion, please examine his cardiovascular system") Short cases took 10 minutes. Obviously, not all cases are cardiorespiratory in nature, they are very common however and these were the first I thought of as typical examples.

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!!!

GP --> Done

Results are out...I passed the G.P rotation yay!!!

'Real' Medicine

I am one week into my first 'real' medicine rotation (I use this expression with tongue in cheek, because the undifferentiated patient and all their issues and concerns encountered in general practice is in many ways truly patient focused medicine). It is great though. It is interesting to see really sick patients and the accompanying end of life issues and to see someone improve or get worse so quickly. Pathology and treatments are discussed in much more depth, and because everyone is teaching and learning education is a high priority.

General impression of how things run...

Team work is the rule, however it is far from a democracy. For those who don't know the (medical) hospital hierarchy is as such:

• Specialist/Consultant
• Fellow - extra post fellowship training (1-2 yrs) Optional
• Registrar (training to specialize) OR Principle House Officer (not in training spot)
• Resident - Senior House Officer (PGY2+) then Junior House Officer (PGY2)
• Intern (PGY1)
• Med student

A consultant has the final say, directs treatment and has ultimate responsibility. He (or she) is in the position most of us aspire to eventually be in. A registrar (equivalent to a senior resident in the US) is the consultant's right hand man and as they have chosen that specialty (in this case General Medicine) they stay for longer periods and know the service well and function with a reasonable degree of autonomy depending on seniority.

Next is the Resident. He is either a Junior House Officer (JHO), who is 1st year after an intern, or Senior House Officer (SHO), second and subsequent years. They are still trying to get clinical experience, pass exams and get into a training position. They rotate every 10-12 weeks and the standards vary greatly depending on their experience and amount of learning they have done (some are real slackers) and so their responsibility is varied and they tend to do the after hours cover, relieving rosters etc. The intern (if present) also rotates about every 10 weeks and as they need to impress to get signed off and get a good recommendation for a JHO job, do the scut work (otherwise the RMO has to do it).

Then finally comes the medical students. There are often too many of us per team (2 in mine) and we walk around and generally get under peoples feet. Sometimes it seems we are treated better than the interns, about on par with the RMOs. Perhaps because we are outsiders/visitors and the consultants want to give a good impression/sell their discipline to encourage the best applicants try for their team. But it is pretty clear that we are outsiders, have no responsibility and so low in the pecking order we are not really in it. Allied health plays an important role and without speech therapists, occupational therapists and physios a service wouldn't run smoothly at all. The nurses are very important. They interact with the patient and do a lot of the dirty work.

Now this is just an observation...please don't lynch me!!
Often there seems to be an unsaid power struggle between Allied Health and middle level doctors. It is subtle and usually not a problem in well run units, but seems quite real, just under the surface. As the nursing staff and allied health staff are assigned to the ward and often don't change for a long time they are often trying to assert themselves against the more frequently changing doctors. The consultants have absolute say, they are rarely challenged. The registrars although newer to the service often have a great deal of training and knowledge and mostly come out on top. The resident though are usually not game to argue with Allied health or nurses outright and smart Interns usually don't even put up a fight, knowing that they have to get things done for the consultant and if the other staff don't want to play nice, it will be very hard for them.

Maybe it is all in my head...not sure though

A note of thanks to readers...

Hi All

I have noticed that the readership has increased a fair bit recently and some have even been making comments and giving encouragement. Thank you! It is great to know that others find the journey through my final years of medical school (and hopefully Junior training years) to be interesting enough to return.

Also, although this is in many ways a one way blog, I do welcome any constructive criticism or feedback or even the sharing of similar experiences. At this stage, I will keep the comments moderated to prevent unsolicited or offensive posts (not that I anticipate many), but that may change in the future.

Anyway, to summarize. Enjoy, feel free to say hi and Thanks for reading!

GP - a conclusion

Well I am finally all done. I sat the theory exam this morning. I was actually pleasantly surprised considering how random the exam was rumoured to be. I really ran out of time at the end though and I am (in the back of my mind) a bit stressed that when I very hastily transcribed my answers onto the electronic marking sheet (this exam comprised of MCQ) I may have made some errors. I hope they are not all out by one! If so, I will be in a world of hurt.

For the clinical exam I was not so lucky. Two cases: one diagnostic, the other management. The management one was a little different than what was expected, but I think I did OK (I definately left out a few things though), but I froze in the diagnostic. I forgot to be systematic and missed the diagnosis completely. In hindsight, It was staring me in the face! I hope the management case will pull me through - or I will have to do a resit. Now I have a pounder of a headache...and I am off to get my Age of Empires on.

Finishing up my general practice rotation

My last clinical session for the GP rotation was Friday. I think it all went pretty well. By the end, I was interviewing and examining patients and prescribing treatments (with Dr M's close supervision and signature on the scripts etc). I would like to think I did some good. Dr M slightly (in some cases) altered his choice of Antibiotics more in line with the current therapeutic guidelines (where there was any major difference) and some new protocols were established due to patient experiences while I was there.

The "First" major excision I did, turned out to be an SCC...I now find myself questioning...did I allow a 4mm margin? I think maybe a little less. The current recommendations require a 4 mm (SCC) and 3mm (BCC) clinical margin and at least 1mm microscopic margin. The pathology report indicates, I got it all. I guess I will always have times when I think back and wonder if I should have made a different decision. oh well. Dr F is very diligent, I am sure she will keep an eye out with him. No infection or ischaemia with the wound, just a nice fine scar without bunching or hatch marks, very impressive if I do say so ;) The excision from Dr F was benign, but at least it won't cause her concern anymore. Sometimes it is not worth the "wait and see" approach, esp when therapy is so simple and the consequences of delay are so disastrous.

Now, time to study. Less then 47hrs to my clinical exam. 71 hrs to my written (not that I am counting!)

Operation on Dr F

Wow three blogs in less than a week! I don't think that is sustainable (I will try to increase frequency though). Just a quick update on the removal of the skin lesion.

Dr F came straight in, I anaesthetised the area for excision. I "played" with the skin and told her my margins (no marker this time) she agreed and went to see another patient while I scrubbed up and prepared. She came in and sat on the bed, wrist on a pillow and I went ahead. Her skin was a lot thicker than the leg skin on the older gentleman from yesterday. I cut too softly, I was scared of hurting her. EVENTUALLY I got through and stitched it up , very carefully! Quite neat in the end, I was proud. I will find out for sure in about 10 days.

After my first 'real' patient for a skin excision...

Today was great as expected. I got to draw up and give a couple more injections, I am getting better at recognizing different sounds in the chest and I did my first 'real' excision.

I am much more confident with anaesthetising with local anaesthetics. Dr F showed me a few cool tricks and helped me redraw the margins for excision (you need to feel the skin - to determine the tension and therefore might avoid making the ellipse so big!). I cut the skin and as I peeled the skin back, dissected the skin from the underlying tissue. As I used 2% xylocaine with 1:80000 adrenaline, there wasn't too much bleeding, but still a fair bit...being quick helps! Using 3/0 monofilament non-absorbable sutures I set to work. I used a vertical mattress suture in the centre to pull the wound together (most of the way), then using the rule of halves, placed the rest of the sutures (simple, interrupted). I must say that human skin is much more resiliant than you would initally think, but much easier to handle than the pork trotters and bellies I have practiced on. Happy I was doing well, Dr F left me to finish up while she saw some patients. I tried my best to place even sutures tension wise (I put a few more in the middle as there was a bit more tension on the skin there). I removed that original holding suture and replaced it with a simple suture, tidied the ends and cleaned the wound site. I placed a few steri strips for extra hold (it was on the proximal anteriolater aspect of the leg) after I swabbed the site with betadine. I am paranoid about wound dehisence or infection, so after I was sure Dr F was satisfied, it was dressed and a water proof covering was added and the patient was instructed to leave them covered for at least two days and that they will need to be removed in two weeks. When tying I used 5 throws (2+1+1+1). I think they normally don't do the last, but as I said, I didn't want dehiscence. My only regret is that I think I may have actually tightened the sutures too much (too much tension) and considering, they will be left in for 2 weeks. I am hoping the tissue doesn't become necrotic, but I am expecting cross-hatch scarring. I hope not, but it probably will happen. I hope I am there in 2 weeks when he comes for the removal of stiches...I will give the verdict then.

Dr F asked me this afternoon if I could remove a small, but troubling lesion on her wrist for her tomorrow. She must have some confidence in me!

A great "hands on" experience

Yesterday I had another full day with the GP I have been with for the last week (my supervising GP is on two weeks holiday). She is fantastic, unlike my official doctor Dr M (M for male, F for female) who has been a GP for 20 or so years, Doctor F is a relatively recent graduate (FRACP for about 5-6yrs). She is very knowledgeable and is very good at mental health, antenatal care and technical procedures, though if doesn't know the answer to a question she looks it up straight away. I really appreciate how she involves me in the consult and asks my opinion. Rather than me just being a spectator, then asked a difficult question in front of the patient to make me look stupid (pimped to boost the doctors ego)

Anyway, yesterday I was giving a bunch of different injections in adults and kids. Apart from putting about half a varicella vaccine intradermally (forming a bleb under the skin) because an untrusting mother (who's baby cries at the doctor just listening to his chest or touching his ears), let her little boy squirm and the sub cut injection almost came out - needle stick city for sure - I did OK. And bless the elderly gent with numerous skin lesion (and multiple past excisions) who offered for me to cut out a rather large SCC from his right leg. He is booked in for Thursday when Dr F can supervise and guide me... awesome! He also had a benign, but large and irritating skin tag on his back which was causing him grief. Dr F explained it was harmless but it could be removed, but unfortunately she was too busy today. She did however say that if he was happy with it, I (Kaydon) could remove it now. He said it would do HIM a favour! So while Dr F was seeing patients, with the assistance of the practice nurse (I suppose it will pass, but at the moment I feel guilty with someone running around and setting things up for me and fetching things when I need them), I anaesthetised the skin and then cut of the tag. The wound was very shallow, so didn't need to suture it and the nurse put a dressing on it. I will review it on Thursday when I take out his SCC.

Afterward as I was about to leave, I popped in to talk to the nurse in the treatment room and there was a patient who had been waiting for a fluvax for 30mins but his doctor still hadn't checked it, so Dr F came and checked it and I quickly gave it to him (as the nurse was busy cleaning). I told him about potential side effect (local and systemic reactions) and he was very grateful that I could help him as he was in a hurry to get home. Wow I was actually useful! What a fantastic day.

My General Practice experiences

This post is actually a completely rewritten post that started along the lines of "So I am now two weeks into my GP rotation..." Well now I am about to start my fifth, I WILL actually complete it.

I have had highs and low with this rotation but overall I have enjoyed it. My psych rotation has come in handy like expected (I am not nearly as anxious about the concept of anxious/depressed patients or the schizophrenics and borderlines which tend to be more prevalent in the community than I once realized) but I sooo glad to be actually physically examining patients again.

So what have I been doing? Off the top of my head

• I have been giving injections - I have immunized a bunch of kids and a few adults,
• Syringed out a few ears and done basic physical exams.
• Frozen a few skin lesions (cryotherapy)
• Examined a few babies (youngest 15 days old) for hip problems etc - narrowly missed being peed on.
• I have observed a few excisions, and I have practiced excising and suturing on a pork belly and hopefully I will get to do one on a real patient soon.
• Learnt about how that sometime treatment require perseverance and ultimately good luck

I enjoy the fact that almost anything can come through the door. It keeps you on your toes. I really like the mix of counselling, reassurance, education, procedures encompassing follow-up, preventative medicine and immediate management.

Psych - A conclusion

I have finished my psychiatry rotation. I received excellent consultant and patient interview marks - though I am unsure about how I fared in the viva or the final exam. All in all it was a fantastic experience and I thought it was well run and gave me a pretty good peak into the world of mental illness. I enjoyed the luxury of being able to hypothesize/formulate how a person got to where they were in life. As I have eluded to previously, I definitely see how the skills I have learned will help me with patients from any background. I would like to do a psych term as a registrar in the future, but I doubt I will have the time...ohh well. Onward with my general Practice rotation..where I actually get to touch patients!

Work update

A bit of an update with work

I have, like most do, taken the "new job" in my stride and I quite enjoy it. I couldn't do it for a living but as a weekend reprieve, it is great. I am getting a lot of exposure to radiology (not literally!) which I otherwise wouldn't get. One of my favourite parts of the shift is when I take a patient to get a CT or radiograph, I get to not only see the indications for the scan and later follow up in how they were treated (at least in emergency) I actually get to see the imaging and pathology real-time.

A bit of a scandle a while back (if you are one to assume). A gent was brought in by his wife with a broken penis (that's right, penis) but he had been home 'alone' (wife was out somewhere when it happened) though he happened to be on viagra at the time. Coincidentally, his neighbour (who is about the same age), was also home alone...

Exam stress!

Just a quick note to say that I am really starting to feel the stress of exams now. Just a bit less than one week to go then I am expected to be at intern level in my psych formulation/diagnosis and management...no pressure!!

Clinical rotations are coming to a close tomorrow and I am partially scared, but also very glad. I feel that I have seen quite a variety of patients and as much as I hate to say it, I just need to polish up my book knowledge, seeing more of the same patients won't help me much.

I am Looking forward to the GP rotation coming up soon!