Wednesday, September 20, 2006

Holiday post with extra rant...

I love having a holiday. I’m at home and it is wonderful. Meals cooked, clothes washed, decisions made… I do kind of just switch off totally when I come home for the week. You know, hand over the reins to my parents and just sit quietly in the corner.

Or not so quietly, as I have a new guitar. A beauty too. My little brother chose it, as he is the fount of all (well, much) guitar knowledge. He would die without his. This is a replacement for a previous acoustic – a cheap starter instrument that died a slow death being abused by me and my bro. How sad. But me and the new one are fast making friends, and I promise not to drop it! I have been searching for simple tabs on the internet (did I tell you how much I love the internet?!) and found lots I like… The fingers of my left hand however do not. Anyone got a method for toughening the tips? Apart from practice, because I am already doing that, and it’s not the point of the question – I know practice will toughen them, but I want to cheat. I want it now. I am part of the instant gratification generation, you know, and we don’t know how to do hard work and patience.

Otherwise all is quiet on the Western front. Going t’pub with some old friends tomorrow – could be ok, could be bad. Unlikely to be good. Although the last few times I’ve seen them it hasn’t been as bad as expected. I’m seeing a very good and old friend on Friday – she’s at uni in Brum too, but at a different one to me (an ex-polytechnic, not a redbrick like mine teehee!) doing fine art. I may laugh at her, but a bit of me is jealous that she gets of paint and draw all day. But then I think about job security and satisfaction and doing some good in the world and I say to myself ‘But I want to be an artist!’.

We could get on to a whole thing here about doctors doing good in the world… butI haven’t the time, space or inclination to right now. Maybe one day…

Does anyone else have a little list of ‘Things I should blog about’? Mine are all deadly intelligent and would change the way you think about me. Honest to gods, they are all worthy, interesting and thought provoking topics. However, whenever I sit down to write, all this utter drivel comes out, and so the internet never gets to witness my genius.

Which may or may not be a good thing….

Talking of thought provoking, Med Neophyte’s latest post, on patient-student consent, was extremely so. Consenting patients for students to examine is always tough. I hate being introduced by a senior doctor as ‘training doctor’ or ‘young doctor’. Some of my peers also hate ‘student doctor’, but I think that is probably the most accurate way of explaining us to a lay person – ie a patient. I have been mistaken for a student nurse, pharmacist and physio when introduced that as a ‘medical student’.

But what can you do when a senior colleague – and its invariably the consultants who say it – introduces you to a patient as a young doctor? Technically it is lying, and lying to get consent makes a mockery of patient autonomy and any examination I do battery. I hate it – firstly, that I am made to feel like a liar by a doctor who is supposed to be supporting and encouraging my learning, and secondly that I do nothing about it. I stand by and let it happen. By my silence I comply, I say that it is ok to lie to patients.

But it is not ok. It is not ok to lie so that the patient is trickedinto thinking I am a qualified professional. I am so grateful to every patient who gives me the chance to speak to them, examine them and generally inconvenience them in the name of education. I should not undermine the trust they place in me. And I understand that patients may not wish to see a student, unlike some. Some of peers moan and complain when a patient refuses to see them or be examined by them. I respect that choice. If I was sick as a parrot (and patients in hospital are, as a rule, ill in some way…) I would not want to be prodded by a gang of teenagers, or tell my life story including the state of my bladder, bowels and sex life to a fair sized group of people. Lying to them to get consent is a gross misplacement of their considerable trust in us.

Medical students and doctors alike need to remember that being grateful goes both ways. Yes, patients should be (and most usually are, very) grateful that we are treating them, and remember that expertise needs to start somewhere, but we as doctors also need to remember that patients are people to, and be grateful to them for sharing their woes to further our education.

The best consent to see a student I know of is the form used by own GP practices. It states that we are students, and how many years we have been studying, plus (more importantly?) how many years to go until we qualify. It has separate sections for consent to take a history, and another to examine. It’s clear and concise and very difficult to administer in hospital.

And therein lies the problem. I don’t know how to make it better – for doctors, patients and students. For me. And so I will continue on, like many medical students, wincing every time a consultant calls them a ‘young doctor’, not knowing how to change the situation.

Goodness, rant over now. Phew. Congratulations if you managed to read this far!

<>(The post ended up so much bigger than I expected - I have been writing it on and off all afternoon. At least it wasn't all day, I guess...)

Currently listening to: The Amateur Transplants. Fan-bloody-tastic. Played some to my mum and she was in fits. Like me.


Marysienka said...

In the ER this summer, I was constantly presented as a "young doctor", which bugged me a lot at first. When I was seeing patients alone, I presented myself as a medical student and made sure to say the doctor would follow soon, and of course, I asked if it were ok for them. I have to say that since I was not in a teaching hospital, ppl were generally happily surprised to see a medstudent there, especially since I was from the town ("that's very good, I hope you want to come back here, we need doctors!").

However, I can tell you from my experience, how I hate teaching hospitals because there's an average of 5.6 people (residents, students, doctors. That's w/o the nurses and student nurses) coming to see you like everyday! I really hate it, and I know many people who do as well. But to be honest, in the heads of people, they are all the same, generally. As soon as you enter medschool, people think you know everything in the medical field. Remember your uncles and friends who kept asking you questions during Christmas of your first year? Imagine when you're in a hospital wearing a stethoscope...

I understand your point though. When I was presented as a young doctor, some people asked me what year I was in, how many I had left and such. They didn't make a big deal out of the terminology used by the "real" doctor, actually I think many of them didn't even notice it. By the end of the week, I wouldn't notice it myself how I was presented. I think you just have to be honest with the patient, if he asked a question I didn't know/wasn't allowed to answer, I'd just tell them I'm a medstudent and I'm not allowed/can't answer. It was always fine. We have a lot to worry about, and this I got over.

Marysienka said...

sorry, I wrote a novel ;)

med neophyte said...

Nice rant.

I agree that many people are happy to talk to medical students because they want more people to become doctors. I think, however, that it is easy to forget how opaque the whole medical system can be to someone who isn't in it. I don't know that I am clear yet on what all the different titles mean, better yet throwing in not-very-descriptive terms like 'young doctor' (especially since I am not very young, I might even be older than the preceptor I had today), 'new doctor' (what I was called today) or others.

On my part I am going to commit myself to being as open and transparent to the patients as possible, even if the training doctors aren't.