The Muffled Screams of a Medical Student

PhysiologyRocks

I love medical school. I really do. I'm lucky to be able to study something so wonderful. I'm lucky to have met such great people there. I'm just lucky.

However, there are quite a few seemingly student-specific things that make me want to tear my hair out and throw a tantrum to rival some of the most difficult paediatric patients.

1. Futile history-taking. Great if it goes in the notes and gets presented to the consultant and actually contributes to patient care. Less so if I'm doing it just to have a history to present at a tutorial.
2. The consultants who expect us to disturb a sleeping patient to take a futile history.
3. The standing around with nothing to do. Yes, I am grateful for a break, but ward round followed by entertain yourself for 5 hours followed by tutorial is less than ideal.
4. The part in theatre when you have no role, nobody's teaching you and there are too many people around the patient for you to actually see anything. It's genuinely quite awkward. You want to look like you're interested, but you feel like a bit of an idiot. I say this as someone who loves surgery.
5. The whole apology for existing thing gets old. I really don't like the whole "would you mind talking to me..." thing. On a similar note, I also had one rotation where students saw many patients before the doctors did. Two of the doctors there used to sheepishly thank patients for "talking to the student" when they came in.
6. The way that many clinicians seem to have their own foibles when taking a history/examining/doing procedures that they consider to be "right" and considers your way to be wrong if it doesn't conform precisely.
7. The fact that very few doctors will tell you to go home, even if you had a 7.15 start and it's now 5.30 and there's nothing much happening at all.
8. The lecturers that refuse to teach the common stuff/basics and ramble on about complex areas of their own research that nobody really understands. Similarly, lecturers who answer yes/no questions with an essay can be somewhat frustrating.
9. As mentioned by someone in the "How is medical/other health science school going?" thread, the non-medical stuff is deeply frustrating at times.
10. I really don't like the way some doctors assume that because we're students our knowledge of biochemistry/molecular physiology can rival the fattest of textbooks.

That's what I have for now. All additions welcome! Thank you for listening.








And breathe!

A Neurotic

PhysiologyRocks wrote:

1. The standing around with nothing to do. Yes, I am grateful for a break, but ward round followed by entertain yourself for 5 hours followed by tutorial is less than ideal.
2. The part in theatre when you have no role, nobody's teaching you and there are too many people around the patient for you to actually see anything. It's genuinely quite awkward. You want to look like you're interested, but you feel like a bit of an idiot. I say this as someone who loves surgery.

A guy in my class dubbed this phenomenon "Med students: space-occupying lesions". Perfect.

Captain Albection

A Neurotic wrote: »

A guy in my class dubbed this phenomenon "Med students: space-occupying lesions". Perfect.

That's actually brilliant.

Dr Nic

I dont really get this apologies for existing, and waiting for consultants thing as med student.
Why not go do stuff? Cannulas bloods research. Make your future job easier by doing a little bit more now.

Guys in the class go on with caper and it sounds bad...
Sorry

ThatDrGuy

Have you tried not turning up ? It really makes very little difference to the final outcome. Everything gets learned in the final part
of the final year anyway. Your lives are going to rapidly turn to sh1t anyway once you qualify ( especially if your demented enough to
want to do surgery ) Live while you can.

PhysiologyRocks

Dr Nic wrote: »

I dont really get this apologies for existing, and waiting for consultants thing as med student.
Why not go do stuff? Cannulas bloods research. Make your future job easier by doing a little bit more now.

That's really not how a day in the hospital pans out for me. I attend ward rounds and all scheduled activities. If I'm scheduled to be in theatre (for example), it can be difficult to get out to do other stuff without looking like I'm skiving. This is particularly relevant if the operating consultant is evaluating me (which is of arguable importance, but I prefer to get the best grades I can).

If I need a "futile" history for a tutorial, I'll get one. I complete my assigned work.

Sometimes, the interns have no cannulas (or other similar activities) left to do and there genuinely is nothing to do for quite a while.

As regards "apology for existing," you do understand that I'm not literally apologising for existing. It's just a hospital subcultural thing. I thought it was well known?

Research isn't my favourite thing to do. I have undertaken some, however, and done reasonably well. Also, ethical approval issues make it difficult to say "I have nothing to do. I know - I'll pop off and research something!"

I'm reasonably proficient in cannulation and phlebotomy, can suture (including subcuticular sutures), will sit with a nervous or upset patient when necessary, have delivered babies and will sometimes come in on a Saturday night if it's likely to be beneficial. I'm not a slacker, and not a bookworm, but that doesn't necessarily make every day an action-packed adventure!





ThatDrGuy, it's just not really in my nature to skip stuff. I'll show up and try my very best to stay occupied. It just gets a little frustrating at times.

EugeneOnegin

While I agree with most of what you say, hospital placements are really what you make of them.There is always something to do (even in a provincial teeny weeny hospital) - you need to take ownership!

One history and exam per day at least, if you have time practice clerking/research the patient's condition/go bug SHOs and summarise histories to them etc etc etc.

Also, NEVER apologise for "being in the way", you are there to learn and should have full run of the place.
As for consultants, majority I've encountered are fine. Just play the game with the obstreperous ones.

Captain Albection

EugeneOnegin wrote: »

Also, NEVER apologise for "being in the way", you are there to learn and should have full run of the place.

I'd actually have to partially disagree with this.

Hospitals exist to treat sick people with a secondary aim of educating those who will one day take over the delivery of care.

Remember that we're the privileged ones to be allowed to learn this, not the other way around with the hospital being privileged to have us.

What we do is very important, but it's not terribly important just yet and any SHO etc. could actually do their job far easier if we weren't there so we are really in the way. But we need to be, there's no better way to do it, so it's ok.

I obviously accept that students can and do have very positive impacts on patient care, but we really get the majority of the benefit in most instances.

sillymoo

One of the med students in my team recently called himself "part of the med-student comet tail". I lol'ed

Stheno

As someone who will only ever be a patient, how do med students feel if patients refuse to allow med students observe/examine them?

Is it something that you see as a right or do you accept that some patients are not comfortable being observed by multiple people?

Captain Albection

Stheno wrote: »

As someone who will only ever be a patient, how do med students feel if patients refuse to allow med students observe/examine them?

Is it something that you see as a right or do you accept that some patients are not comfortable being observed by multiple people?

It's fine really. Happens a lot to us male students in Obstetrics and Gynaecology and it's just simply not an issue, we understand completely.

It's not something that we see as a right at all. We prefer it when we are allowed to be involved but we don't have notions of being allowed to do whatever we please and that it's a personal insult when someone declines.

Though obviously we do prefer it when people are polite about it, it's not nice to be treated as some sort of arrogant jerk with boundary issues for simply trying to learn how to help people. Thankfully, most people are actually decent when expressing that they'd rather we not be there.

sam34

EugeneOnegin wrote: »

Also, NEVER apologise for "being in the way", you are there to learn and should have full run of the place.

Ehh, no. The patients have every right to refuse to have medical students on the ward round, in clinic, in theatre etc.

Also, as a consultant I have sometimes asked the students to leave.... Eg if the patient is very paranoid or if I'm giving a diagnosis of schizophrenia to a devastated patient and family... They are not scenarios where it's appropriate to have a large group looking on.

EugeneOnegin

Yes, we are entirely privileged to have the opportunity to learn and to interact with patients (who are obviously priority)- I wouldn't ever suggest otherwise, and I wasn't referring to seeing patients.

I however do have an issue with some students acting like obsequious toads around consultants/NCHDs/nurses etc etc. There's always "sorry this", "sorry that". Being polite is one thing, but this is on a different level. It's unreasonable to apologise for existing.

mardybumbum

Stheno wrote: »

As someone who will only ever be a patient, how do med students feel if patients refuse to allow med students observe/examine them?

Is it something that you see as a right or do you accept that some patients are not comfortable being observed by multiple people?

I recently spent a few days in hospital after needing a bit of surgery. At an OPD appointment after my stay I walked into the examination room and was greeted by a happy smiley 3rd year medical student. My heart dropped.
I was tired, still upset about my injury, and really not in the mood to be examined by someone who didn't fully know what they were doing.
If I, as a medical student, were that upset by being examined by a fellow student then I can only guess how confusing/stressful it must be for a non-medic.
I felt terrible in the end for being so abrupt with her and let her take out my stitches.

I was only ever asked to leave by a patient once, before my stay in hospital, and I did take it personally tbh.
Now I can totally understand why a patient would not like to have a student in the room and I feel pretty privileged anytime a patient agrees to let us stay.
Moral of the story = how comfortable you feel is more important than what we can learn. Don't be afraid to ask a student to leave a room. They'll get over it.

trishasaffron

I spent 24 hours in an A&E last year. I was asked to give my history 15 times in that 24 hours - it was humiliating, frustrating and baffling. If my technology provider does that I ask how come they can't read what's written down already. But the general atmosphere of powerlessness and lack of dignity hospital engenders meant I didn't refuse.
But I cried inside.

chanste

Doctors and students went into medicine to help people (among other things) and this help is the priority. I think some people saying they won't see students because they have already explained their story 15 times or if they have just received bad news is absolutely fair enough, but at the same time, while it is not necessarily easy to say no to someone for fear of appearing horrible, you can and should do so if the whole thing is significantly upsetting you (I say significantly because honestly if its only bothering someone a little then I think they should suck it up - our training is important).

There is no better system for training and perhaps people are forgetting that as students we are only the intermediate benefactors... our future patients will be in the hands of better/more experienced doctors for the help our patients give us during our training. The people who are upset about their experience of hospital may well have been more upset if the doctor treating them never had these opportunities during their training.

As for people who simply don't allow us to take their history or examine them just because they are grumpy (and I've come across these too). or have a general disliking of medical students, well they are simply ignorant and may never realise how lucky they are that we were there.

echo beach

Many patients, especially public patients, don't have a real choice in being treated by students. Either they aren't asked or are asked in such a way that they feel powerless to refuse.
Everybody understands that students have to learn and most of the time it isn't a problem, and may even be a diversion, but when somebody is ill or tired they aren't always in the form for large groups or repeating the same thing over and over again.
If there was more then lip service to the idea of consent then both students and patients would benefit.

Joeyjoejoe83

Your missing the most annoying thing of all..."oh your doing medicine...what do you wanna specialise in?"

Why, WHY does everyone ask that?!?

Reality_Check1

Joeyjoejoe83 wrote: »

Your missing the most annoying thing of all..."oh your doing medicine...what do you wanna specialise in?"

Why, WHY does everyone ask that?!?

just follow up with the generic answer

"keeping options open wont out-rule anything etc etc"

Female GP placements tend to be the worst for getting asked to leave aka the "tears and smears" rotation

Dozen Wicked Words

The masses of Students on ward rounds remind me of a menacing gang, menacing in a similar vein to Anchorman. Students ASSEMBLE.

A Neurotic

dooferoaks wrote: »

The masses of Students on ward rounds remind me of a menacing gang, menacing in a similar vein to Anchorman. Students ASSEMBLE.

Some of my surgical rotations have had ridiculously crowded ward rounds. I've no doubt it intimidates patients into refraining from asking questions or raising concerns. I've heard of some people nervously dolling themselves up to try and look their best for the mass of doctors and students coming to gawk at them. It ain't right.

looksee

During one hospital stay when I was asked for my history multiple times, I finally realised what was going on, and felt rather embarrassed that I had been carefully answering all these questions about myself as though they were part of my treatment.

I'm not suggesting I would have answered inaccurately if I had known I was talking to a student doing an exercise, but it leaves you feeling a bit foolish. It also means that by the time someone comes round who genuinely wants to get information you have lost interest and might answer more casually.

A Neurotic

looksee wrote: »

During one hospital stay when I was asked for my history multiple times, I finally realised what was going on, and felt rather embarrassed that I had been carefully answering all these questions about myself as though they were part of my treatment.

I'm not suggesting I would have answered inaccurately if I had known I was talking to a student doing an exercise, but it leaves you feeling a bit foolish. It also means that by the time someone comes round who genuinely wants to get information you have lost interest and might answer more casually.

I remember someone in my class approaching a patient with something like "Are you Mr Smith? Do you mind if I ask you a few questions?"

No mention of the fact she was a student or that we were just practicing history taking. Unbelievable, and actually probably fairly common.

AndrewJD

A Neurotic wrote: »

I remember someone in my class approaching a patient with something like "Are you Mr Smith? Do you mind if I ask you a few questions?"

No mention of the fact she was a student or that we were just practicing history taking. Unbelievable, and actually probably fairly common.

On my last rotation towards the end of rounds in A&E my SHO would frequently say to the patient "my colleague here has to stay and ask you a few questions if you don't mind to get a better picture of your condition". When it came to presenting it I would be skipped through most of it to get to differentials etc, so there wasn't really any element of my contribution to the team. So I'm left in the awkward spot of patients thinking I'm helping them and the team when really I'm only helping myself, and there's not much I can say to avoid awkwardness.

That said I'd always ask again that it was OK to talk to them for a few minutes, but I felt bad anyway.

looksee

I have never had anyone say to me 'I am a student', on the odd occasion a consultant has said 'do you mind if the students stay while I talk to you?' but again certainly not every time.

One of my worst memories is of a long number of years ago now, in Crumlin childrens hospital. We were in a small room with our baby, we knew the baby was ill but no-one had told us what the illness was, and answers had been evasive. The consultant came in with a tribe of people, presumably students, briefly greeted us then turned to the milling throng who were surrounding the cot and said something to the effect that 'this baby is going to die' as bald as that. Then they all looked at me wordlessly when I burst into tears. Thank god things have moved on since then.

Going back to the original point, I would have no problem talking to a student, knowing they were a student, its a brief interlude of interest in an otherwise boring day, but I think they should explain what they are doing.

echo beach

looksee wrote: »

Going back to the original point, I would have no problem talking to a student, knowing they were a student, its a brief interlude of interest in an otherwise boring day, but I think they should explain what they are doing.

I have to agree. Be honest with patients and allow them to be honest with you. If it is a history taking exercise say so. At least then the patient knows what is going on and doesn't think they must have some incurable disease.
Most patients are happy to help, when they are in the form, but it shouldn't be an additional strain on them.

There is no need to feel guilty if what you are doing is for your benefit rather than the patients' benefit. The intention is that it will benefit somebody someday and that is reward enough for most patients, but it is never acceptable to mislead. It isn't acceptable for a consultant and it isn't acceptable for a medical student.

his_dudeness

1. Futile history-taking. Great if it goes in the notes and gets presented to the consultant and actually contributes to patient care. Less so if I'm doing it just to have a history to present at a tutorial.

I wanna jump back to the first point raised. From the medical side, there really is no "futile" history, unless the patient is a bad historian, and in fairness, its usually the case that the bad history is coming from the questions asked and not the patients lack of answers

Common complaints are about a lack of communication nowadays in hospitals, and communication is a two way street. It's not just about being able to tell a patient what's wrong. It's about spending the time with the patient to let them tell YOU whats wrong with them, and then as a doctor, you use the knowledge youve learned to treat them. And just because you see a consultant or Reg come in and take a very focused history doesn't mean that you shouldn't take the time to do a proper one, regardless of where the information ends up. The act of building a trust with a complete stranger to tell you something very private about themselves is not easy and takes a lot of practice. The amount of information you get can change depending on your body language, the questions used, the setting, loads! If you feel that you haven't learned anything from the history taking, even if about HOW you take your histories, then your probably not paying enough attention to the questions your asking or the responses that your getting. And fine, you may find it stupid and a waste of time delving into that strange reaction that the patients 2nd cousin might have had that time in hospital, but it could be a vital piece of information that could be pertinent to the case, that the admitting SHO doesn't have time to take because he's rushing through the history to get to see the other 10 patients already waiting for him! As a medical student you have the time to slow down and take the detailed histories and get the practice that you won't have when you start working.

For all the advances in technology and imaging and what not, every consultant I've ever dealt with, and most "good" registrars too, will tell you that the most important information that you'll get is in the history from the patient and to take a complete good history is a skill not to be sniffed at.

echo beach

his_dudeness wrote: »

For all the advances in technology and imaging and what not, every consultant I've ever dealt with, and most "good" registrars too, will tell you that the most important information that you'll get is in the history from the patient and to take a complete good history is a skill not to be sniffed at.

It is also important to remember that the technology is there is supplement the history taking and physical examination of patients, not to replace them. The scans etc give important extra information but without the proper history aren't much use on their own. It is easy to focus on the high tech stuff and forget the basics.
Having spent a lot a time in hospital with my parents over the years the most frustrating thing is that young, and not so young, doctors assume every old person is immobile and senile. No matter how many times you tell them that the person in the bed is very active and alert at home they are happy to accept that being disinterested in anything around them is 'normal'. One doctor asked my father how long he had been retired, except he wasn't. He still worked six days a week in his own business up to his death but nobody asked, they wrote 'retired' for his occupation and said that was 'standard practice' for anybody over 65. So much for factual history taking.

The best doctors are the best communicators, not those with the most clinical knowledge.

Captain Albection

Does anyone else think this thread is after getting very soapboxy and preachy?

EugeneOnegin

Captain Albection wrote: »

Does anyone else think this thread is after getting very soapboxy and preachy?

A lot of students have finished for Christmas…there is so little else to do other than create verbose replies.:eek:

looksee

Captain Albection wrote: »

Does anyone else think this thread is after getting very soapboxy and preachy?

Doctors and students went into medicine to help people (among other things) and this help is the priority. I think some people saying they won't see students because they have already explained their story 15 times or if they have just received bad news is absolutely fair enough, but at the same time, while it is not necessarily easy to say no to someone for fear of appearing horrible, you can and should do so if the whole thing is significantly upsetting you (I say significantly because honestly if its only bothering someone a little then I think they should suck it up - our training is importantB

There is no better system for training and perhaps people are forgetting that as students we are only the intermediate benefactors... our future patients will be in the hands of better/more experienced doctors for the help our patients give us during our training. The people who are upset about their experience of hospital may well have been more upset if the doctor treating them never had these opportunities during their training.

As for people who simply don't allow us to take their history or examine them just because they are grumpy (and I've come across these too). or have a general disliking of medical students, well they are simply ignorant and may never realise how lucky they are that we were there.

I don't know about preachy, but there are some disturbing egos around. Still I suppose Consultants have to start somewhere.