Oh, the Irony

When I first started working as a doctor in January of this year, I prepared myself mentally, emotionally and physically to be yelled at, and berated by my senior colleagues.

Haha, I know, that sounds horrible! Of course, I didn’t expect it to happen all the time, but after hearing some nasty horror stories, I would rather anticipate it than be taken by surprise. With that being said, I’m happy to say I’m approaching the end of my 8th month of employment and that still has not happened.

However, I have been yelled at. It was loud, terrifying, awkward, and made me feel like I had done something terribly wrong.

It happened during my first weekend shift at the beginning of the year. I was on Medicine, working ward call. I had just finished ward rounds with the consultant and met up with my colleague to see what other jobs needed to be completed. She asked if I could check in on a patient that she was just notified had gone into complete heart block. A precarious situation, I immediately went to see the patient. On the way, I was stopped by the nurse and given his latest ECG – he was back in 2nd degree heart block, no longer complete heart block.

The curtains around the patient’s bed were drawn and there were visitors behind the curtain. I could hear talking but could not make out what was being said. The health of the patient above all else, I excused myself and entered behind the curtain. I said hello, introduced myself to the patient and his 3 visitors, including his wife. I explained we had received a call from cardiology that his heart had gone into an abnormal rhythm and wanted to make sure that he wasn’t experiencing any symptoms of shortness of breath or chest pain. After a brief talk and examination, I was happy that the patient was clinically stable and apologised for the interruption. I told the patient that I would now go familiarise myself with his chart and have a chat with the senior and let him know if there was anything else that needed to be done. The patient and his wife said thank you and I excused myself.

As I reached the hallway, I heard a very angry, “Excuse me!” I turned around to have one of the patient’s visitors towering over me, 15cm from my face, who proceeded to yell at me at the top of his lungs, “Do you know how rude it is to interrupt a minister in the middle of praying?! How dare you! You should be ashamed of yourself!” Before I could apologise (again) for interrupting and explain that it was necessary for the safety of the patient, he stalked off.

I was shaking. Not because I was hurt, but because I was furious. How is it possible that an adult cannot treat another adult with respect and communicate more calmly?

Being yelled at, for the first time in my (short) career, by a Christian minister – OH THE IRONY. He who should practice what he preaches.

A few minutes later, I returned to see the patient, his family, and more importantly, the minister. Despite the fact that I stood by my actions, I wanted to apologise again if they felt I was rude. The minister was not there and the patient and his wife looked mortified. Both she and her husband apologised profusely for the minister’s behaviour. They said it was appalling and that they were so embarrassed. They agreed with my actions and thanked me for putting the patient first. I thanked them for their understanding.

And that, is the story of my first experience being yelled at as a doctor.

Intern year so far

Intern year has really been incredible so far.

Unfortunately, where writing and blogging used to come so easily to me, I now find it immensely difficult to sit down and make time for it, particularly on my days off! As a result, I have not been able to keep the promise to myself to blog regularly but I hope to share more of my work experience today 🙂

It seems like ages ago, but when Michael and I came back from our 5 week holiday in Canada (March 27), we completed our next 10 week rotation – Michael on Surgery and I on Medicine. In hindsight, second rotation passed by in a blink of an eye. I have always, and continue to absolutely love general medicine. The complexities of patient presentations, the intricacies of patient care, and the teamwork required with Allied Health to ensure patients are at their optimal level of function before going home. A great experience with wonderful teaching and support from all seniors.

Then, both Michael and I moved on to spend 10 weeks in Gladstone, 1hr20min away by car from Rockhampton, where Michael completed his rotation in Medicine and I in Emergency Medicine.

Now that, was an experience. Unfortunately, the ED was constantly understaffed with numerous new faces that came and went as locums. However, as a result, I gained a lot of independence and experience. It took a few days, but I got into my own groove and for once, felt comfortable handling anything thrown my way.

Here are some points I took away after 10 weeks of Emergency Medicine:

  • Recognizing a sick patient is sometimes difficult, but shouldn’t be. If the little details don’t fit a proper bigger picture, something is wrong. Trust your intuition. Never hesitate to present your concerns and get a second opinion, you will be surprised how often you are right.
  • I can totally handle paediatric patients – they are so much more trusting of you than I used to believe. You can easily win them over and make them feel at ease, even in hospital. That stethoscope they don’t want you touching them with? Let them listen to their own heart and suddenly the room is full of giggles. And always have a lower threshold for concern when dealing with paediatric patients.
  • Lots of patients will come in for abdominal and/or chest pains. And sometimes, you just don’t find a cause for their symptoms and have to send them away. I’ve been pleasantly surprised to learn that patients will rarely be upset if you cannot give them the answers they’re seeking. The key is attentiveness and good communication. Listen to their concerns, investigate appropriately, rule out the dangerous causes, good pain relief, follow up plan, and safety netting are key elements.
  • Finally got some proper suturing experience! Thank you patients who don’t shy away from letting a junior doctor stick them with needles.
  • Presenting patients and making referrals used to take a lot more time and thought. Now it is almost second nature as I was constantly seeing and presenting patients to seniors in ED.
  • People break a lot of bones. Some people are huge wimps when it comes to pain, others are so stoic you may not even think they had a fracture. Kids are almost always excited to have broken a bone because it means they can get a cast!
  • So many young men come into ED post electric shocks at work.
  • If a patient who rarely comes in hospital presents to Emergency 4 times in the last month, and each time sent back home, something is not right. Be their advocate. Whether it’s a medical condition that needs more investigations or a home situation that needs more support – something needs to change or they will continue coming into hospital.
  • Keep a log of patients you see! Record procedures you’ve done, interesting patients you’ve treated, those you want to follow up. Future case presentations, continuity of care, and personal interest are only some reasons to keep a good record!
  • Working at a small, understaffed hospital unfortunately has its disadvantages: No formal teaching and less opportunity to participate in “real emergency medicine.” I did not get the opportunity to participate in proper resus or trauma situations. As a result, I’m sure I will be terrified and at a disadvantage when the situation arises in the future.
  • Never be scared to say “I don’t know” and never shy away from asking questions. That is how you learn! Seniors would rather hear you don’t know and teach you, rather than hearing your pathetic attempt at pretending you know more than you actually do.
  • I don’t see myself doing Emergency Medicine as a career, but it is certainly an experience every doctor should have in their arsenal to be a better physician. As someone who wants to do GP, there was one observation I made: some of the terrible referrals from GPs in the community. Note to self: Keep that in mind on “How not to refer!”

And this past week? We started our 4th rotation, back in Rockhampton, yay! I have moved on to General Surgery (less enthusiastic “yay”) and Michael is in ED.

So far, I’ve survived! I’m back to feeling like a pen with legs, but I think the work load will pick up soon. Luckily, all the seniors have been more than pleasant and I haven’t been yelled at – always a bonus 😉 I have no inclinations of being a surgeon, however, as a GP, it would be good to have surgical skills for minor procedures under my belt. I have made that known to the surgical team and they are keeping me in mind, which I really appreciate! Day 2 and I was called down to clinic just to do a punch biopsy because of my interest in GP. I’m looking forward to the next 2 months on surgery, will keep you updated!