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!

What’s it like being a doctor?

How’s your job? Do you like it? Are the hours crazy? Are the nurses nice? Are the surgeons mean?

Just some of the repeated questions I’ve received from family and friends since starting work as a medical intern. 😉

I was on the General Medicine ward for my first 5 weeks. Then we went on our annual 5 week holiday (which I’ll definitely tell you more about later) and now I’m currently week 8/10 of another Gen Med rotation. Where has the time gone?!

First day on the job… I knew absolutely nothing and no one, it was fantastic. (Not). I spent every day imitating a sponge as best as I could. Trying really hard not to look too much like a fool while absorbing everything I was seeing around me. Trying to remember patients and their issues, staff members’ names and their roles, which forms to fill and how, where to find equipment and leave specimens, etc.

It was exhausting. For the entirety of my first week, I got home, ate dinner and immediately fell asleep.

However, like many other tasks in life, I gained familiarity and through that, confidence. With time and experience, I’ve even built some competence! 😉 These days, not only do I leave work on time, I also don’t take work home with me AND I can stay up for hours after having dinner!

Some of you may have heard the saying, “Interns are just pens with legs.” The reality is, there is some truth in most medical stereotypes. I mean, we do have to…

  • Make sure the patient list is up to date
  • Write the chart notes during ward rounds and patient reviews
  • Fill out request forms, such as pathology, imaging, referrals, etc
  • Complete the discharge summaries

So yes, a lot of writing is involved. But can you imagine if this pen ran out of ink?

Who would keep people up to date with patient notes? How would patients get their required tests? How would GPs and other doctors know what happened to their patient and what follow up was required?

As the ones who spend the most time on the ward, and through the above roles, we often end up spending a lot of time with patients and their families. We are the first point of contact for nursing staff in caring for patients. We help to clarify questions and provide more information. We listen to and acknowledge concerns, even if only to provide a joke and share a smile. Not to say the senior doctors don’t do all the above and more, it’s still a rewarding experience for us junior doctors.

So yes, we are at the bottom of the totem pole. Some days you feel it, but most days you’re definitely an essential part of the team.

Orientation Week

January 12-16, 2015

Looking back, our one week orientation in preparation for our new job as medical interns went by in a blur. Was it useful? I sure thought so at the time. But when you have so much information being thrown at you with the expectation that you will remember everything – sometimes it feels like pouring water over a duck’s head… nothing sticks.

Important aspects I remember:

  • A chance to meet our colleagues, the other new interns – at social events as well as part of orientation. It’s nice to start a new job as (at least) acquaintances rather than strangers. Also a good idea to socialise when you’ve just relocated to a new city 😉
  • Meeting the staff of the Medical Education Unit (MEU) – they look after us and make sure we are alive and well… and still do!
  • Cultural Practice Program – an introduction to the culture and practices of those who identify as Aboriginal or Torres Straight Islander. Amazingly, I have never received such a talk through out medical school. Even simple knowledge like how their family hierarchy works can make a difference in the care of those patients.
  • Listening to a panel of 2014 interns sharing their tips – interesting at the time… but honestly can’t remember everything everyone said.
  • Skills rotation – refreshing our suturing, cannulation skills, etc.
  • Spending time with the previous interns on the ward we are rostered to. Good to get handover and tips. Would’ve been even better to spend more time with them getting hands on experience prior to starting our first shift.

Everything else… can’t say I remember much of it now. Not to say I didn’t find it useful at the time, but we really had to learn most aspects of our jobs on the go. Listening about how to do paperwork or order tests is never the same as going through the process of doing it yourself.

Then it was pretty much ‘hit the ground running’ on our first shift. Exhausting because you are so unfamiliar with everyone and everything. But by the end of first week, everyone gets the hang of things.

Do we become smarter? Knowledge-wise? …Maybe. Administratively? Most definitely!

People joke that medical interns are ‘pens with legs’ … sometimes, I don’t disagree! 😛

Joking aside, my first few months working as a doctor has been great. Impossible to sum it up in a single blog post but I hope to share stories in the future!

MBBS Graduation – we’re doctors!

December 20, 2014

After a long journey, MIchael and I officially became doctors – yay!

Our graduation ceremony took place at the University of Queensland campus and attended by Michael’s parents, my mom, Ong Ba Ba, and Di Loan.

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Micheal receiving his “diploma” and being congratulated by the Chancellor. You actually receive an empty cylinder on stage and receive a packet of documents, including your diploma/testamur once you leave stage 🙂

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My turn 🙂 I didn’t faceplant on stage, success!

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As with every university graduation ceremony I’ve attended, the graduates are asked to turn around, face the audience, and give our family and friends a standing ovation. To thank them for their never ending love and support, for helping us achieve our dreams, and celebrating with us. This is a moment of happiness for many students, but a bittersweet moment for me. Happy to have succeeded but with tears stinging my eyes, remembering my father who’s no longer on this earth to see his daughter graduate. I know he would’ve been extremely happy and proud 🙂

My Ong Ba was quite exhausted after the long ceremony

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With a class of over 400 people, you can imagine how crowded the campus was!

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Family photo!

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My biggest support

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My other half, my meant to be!

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We decided not to hang around for long as it was quite crowded and hot, plus everyone was tired, but we were able to grab a few photos with our friends on the way out!

With the lovely Sarah 🙂

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Josiah and his family are amazing people – so warm and gracious – will never forget their hospitality!

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Will be working with Chuan in Rockhampton in 2015! Woo hoo for getting jobs!

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Can’t forget these 2, Fiona & Smiley, PBL 25 represent from Day 1. Missing Christine (elsewhere), James (on his honeymoon) and Kristen (with her baby girl)!

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And of course, Tom!

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While getting our diplomas framed, we ran into Lauren!

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Woo, we did it!

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Part of the reason why we were eager to leave was because we had already made plans. My Ong Ba Ut couldn’t attend our graduation (not enough tickets) so we had decided to come back the following day (Sunday) to take some family photos together. We would dress up again and come back to campus to take photos at our own leisure. It would work out perfectly because our graduation was the last ceremony of the year so campus would be completely empty.

So with that plan in mind, we went back to my family’s apartment to celebrate!

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Lots of toasts!

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Lots of “1-2-3-Voooooo!” (1-2-3 cheers!)

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Michael and I had wanted to take our families out to dinner to thank them. But everyone was tired and we decided to get McDonald’s takeaway instead. With wine. Ended the day super classy!

Thank you again to all my family and friends for your love and support! Couldn’t have made it to today without all of you!

Mental Health: The End!

Yesterday marked the end of our fourth rotation, Mental Health – yay!

The past 8 weeks seemed to have gone by in the blink of an eye. We saw patients when they were admitted, learned their stories, followed their progress and said good bye when they left… a humbling and worthwhile learning opportunity.

Despite being laughed at by our registrar many times at our pathetic initial attempts of presenting a Mental Status Examination and formulation… in the end he said we did well and our evaluation backed that up.

Many thanks to our Registrar and the Consultants who took us under their wing and taught us throughout this past rotation. They are so knowledgeable and have so much experience to impart, couldn’t have done as well as we did without their guidance! And of course, to the wonderful staff at our hospital 🙂

On Thursday, we had our clinical exam where we were provided a vignette (clinical situation on paper) and 20 minutes perusal time. Then we had 20 minutes to present a summary, formulation, differential diagnoses and rationale, additional information needed and management plan to 2 consultants/examiners. I was SO nervous. But as soon as I sat down and started reading, I immediately calmed down – a case of an elderly patient in the hospital who developed delirium. Something I was familiar with and had prepared for, yes! I think that exam went well, but only time will tell what my 2 examiners thought!

Then we had our written exam yesterday, 50 multiple choice questions. As always, there were a handful of questions that left us thinking, “What was… what?” But in general, we left with a sense of security rather than panicked with the thought of, “Oh my god, I might’ve failed that,” racing through our minds.

So now, one week vacation!

Haven’t done anything… yet 😉 Hopefully it will be relaxing and full of nature! We have some plans but I’ll update as it happens!

My Ways of Being a Better Medical Student

I believe trying to observe the following makes me a better student doctor.

Here are My Ways of Being a Better Medical Student:

(Didn’t realize this post would be so long, so I added some pictures from the internet. Photos are linked to their sources!)

Always introduce yourself – to patients and to other staff members. You’ll be meeting people all the time, under a variety of circumstances, at all times of the day. It is only polite and respectful to let everyone know who you are – even just in case you’re not even wanted! It has happened to me a number of times, sometimes patients just want medical students to sit out from consults. It can definitely be awkward, even scary, to find the opportunity to introduce yourself but you just have to man up, find an opening, and do it! Trust me, I know first hand how awkward it feels, especially when it’s one of your registrars or consultants you’re finally seeing for the first time (maybe during rounds) but completely ignoring you. But, more often than not after introducing myself, people will treat me differently – I’m no longer invisible and even addressed by name, who would’ve thought! 😉

Say hello when passing others, and smile. It takes no effort from you and can brighten someone’s day. Win win.

Don’t gossip. And if you must, do it outside the professional environment and out of earshot from everyone else. It makes you look unprofessional and you never know who might be listening. The medical world is small and word can travel fast – don’t sink yourself! You never know who you will cross paths with again and that one person you bad-mouthed could end up being your preceptor, your examiner, etc. If there’s someone I particularly don’t like, I always try to find someone else more constructive to my learning and morale and spend my time with them instead.

Never be afraid to ask questions. It shows you are listening, processing information and are willing to learn. Some people are great teachers and love the opportunity to share their knowledge – they’re just waiting for you to take initiative. Of course, with that being said, there’s always a proper time and place for questions. If someone is having a heart attack, no one wants to hear, “Could you show me how to read the ECG?” And you should really have enough common sense not to ask “stupid” questions that will only make you look bad. If you’re a 3rd year medical student asking, “What’s aortic stenosis again?” you are going to be in big trouble and look ridiculous!

Never be afraid to say “I don’t know.” I have no problems saying, “I’m sorry I don’t know, could you show/tell me?” when I really don’t have a clue how to answer a question I’ve been asked. If I can give an educated guess, I do, but otherwise, there is also nothing wrong with, “I’m sorry, I’ve forgotten, could you remind me?” Sure it’s embarrassing for you, but you will learn on the spot and/or never forget that information again. I’ve lost count how many times I’ve heard, “That’s okay, this way you learn and won’t forget again!” For example, the other week, my surg team was commenting on the long half life of the drug Rutiximab (21 days). The registrar then says, “At least it’s not as bad as Amiodorone! Sandra, what’s the half life of Amiodorone?” I laughed (as if I would know this) and replied, “I know it’s more than 21 days!” Now I will never forget Amiodorone has an extremely long and varied half life of 25-100 days. However, not knowing the answer should happen much less than 50% of the time you are asked questions, otherwise, you don’t know enough and you should go study!

Learn as much as you can on the spot. At this point in our lives, we’re not going to have our hands held and be told what to study. Pay attention on the wards and learn as much as you can – that’s often the useful stuff that you can’t learn as easily from textbooks. Bring paper or a notebook and jot down all the things you learn throughout the day. Write down topics that come up which you need to go home and read up about – follow through with it. Interns are a wealth of knowledge, it wasn’t too long ago they were in the same position as you, ask them questions and listen to their suggestions.

Be keen and willing to learn. Someone who shows they want to learn will be taught more and given more responsibilities. Put in the time and effort you think is necessary for you to reach your learning goals. Ask to participate and ask for opportunities to practice your clinical skills or to broaden your knowledge. Try not to decline a learning opportunity that comes up.

Be that medical student you would want to be partnered with. It’s great when you’re paired with another student who’s friendly, encouraging and easy to get along with, who’s knowledgeable but not cocky, who helps you learn without stealing your thunder, who can shine without throwing you under the bus, who’s not the super keener but not a lazy bum, who’s respectful of patients and confidentiality, etc. But it’s even more important to try and be that person for others. You surround yourself with the people you deserve, so be deserving! 🙂

Bake. Everybody loves home baked goods. If you can bake, you should share that deliciousness. No one will fault you, people will love you.

Keep up with your studying. Cramming doesn’t work anymore. Unfortunately, you have to remember everything you learn and build upon it. It’s hard, I know, I’m continuously working on this point.

Eating is important. But don’t just eat, eat healthy – your body will thank you. Also keep snacks on you – granola bars, nuts, chocolate, etc. They will save your life when you are too busy to take a break.

Get enough sleep. If you function well with 5 hours of sleep, that’s great. If you need 7 hours – make sure you get it. That also means you need to time manage well. Don’t sacrifice your studying or your eating time to make more room for sleep. You really need a balance.

Do things that make you happy. Keep up with your hobbies, take up new ones, see your friends, have quality time with your partner, take time for yourself to rest and relax. Otherwise, you will be lonely, stressed, and crazy.

I’m sure there are lots more that I can’t think of at the moment! 🙂

What about you? Do you have any tips?