Complimentary tropical lab medicine

Hi,

Having got though out miniOSCE tests, we're now well and truly stuck into the lab medicine course, although last week we had two slightly different days amongst the pathology. Wednesday was complimentary therapy day, where we had talks from various doctors on the usefulness of complimentary therapies. As well as it being important that we know what patients get up to when their out of our sight, with 10% of the UK population using complementary therapies, it is also necessary for us to know about them because, despite all the attached nonsense, a lot of them work. Generally, it makes sense that things like herbal medicines work, since most conventional drugs are derived from plants and combinations of active ingredients can have synergistic effects. And it also makes sense that learning to balance on one foot in Tai Chi lessons reduces the risk of falls in the elderly, irrespective of whether or not their "inner energy" starts bubbling around inside them. Even for the less well understood, but scientifically proven, effects of acupuncture, some reasonable explanations have been proposed. I'm still not convinced about the usefullness of pure water, beyond the placebo effect, though (sorry to any homeopathy fans).

One of the most thought-provoking lectures we had was about the use of complementary therapies in the developing world. Whilst they tend to conjure up the image of well-off people lying about looking at pink crystals here, the reintroduction of traditional medicine, alongside appropriate Western medicine, in less developed countries has been an effective way of reducing morbidity improving quality of life. Low-tech approaches, such as the use of honey and maggots to clean wounds, can be more successful than the introduciton of poorly-maintained high-tech equipment and poorly-regulated drug dispensing.

As well as the various talks, we had the opportunity to try out some complementary therapies. We had a Tai Chi lesson, involving a lot of arm waving and a bit of wobbling on one leg with out eyes closed, and then chose two more options to have a closer look at in the afternoon. I did acupressure massage, where we paired up to dig our elbows into each other backs (in a nice relaxing way, of course) and acupuncture, where we watched a Chinese lady flick needles into volunteers after hearing a lot about yin and yang. Conveniently, some of my housemates did Indian Head Massage, so we between us we now have the ability to poke the stress out of our heads and bodies.

Thursday was Tropical medicine day. This was slightly less practical (at no point were any infected mosquitoes released) but equally interesting. We had lectures on a variety of horrible diseases from experts in these areas and were shown photos of worms coming out of a variety of body parts. Parastitic diseases dominated the day, and there was a display of slides and petri dishes of parasites for us to have a look at in our lunch break, but we also heard about HIV and orthopaedic surgery in Africa. Both the complementary therapy and tropical medicine days were a nice change from the usual heart disease and pneumonia lectures. Having said that, the lab medicine course has been by no means boring. Seeing patients on out hospital attachments and GP placements has renewed our interest in common diseases and the lectures have been very focussed on exactly what we need to know to go back onto the wards having a better idea about the diseases we see and their treatment. In addition to lectures, we have small group teaching in groups of about 10, and histopathology, microbiology and immunology classes too. The teaching has been very useful, particularly since we won't get much time to revise before we're tested on the lab medicine course at the end of the term, so it's important to learn as we go rather than just accumulate lecture notes. On that note, I should probably do some work for my next class.
Bye.

GP attachment

Last week I was on my GP attachment, staying with a GP in a village near Maidenhead, and seeing what she and the other staff at the practice do. Each day I did soemthing different, sometimes sitting in on one of the GPs clinics or minor surgeries, or going on home visits with them, and sometimes following the practise nurse, district nurse or health visitor. After spending 5 weeks on the general medical ward, where very few patients are under 60, it was astonishing to see such a variety of patients. I was also impressed by the relationship the GPs had with their patients. In the hospital, bed and time shortages mean that the doctors are constantly trying to get people off their lists by discharging or transferring them, but in general practice they had an interest in addressing all of a patients worries during their consultation, as the patients would come back otherwise! However, the GPs also had the ability to review patients' problems over long time periods, giving them longer to work out the best solution. Another big difference to hospital medicine was the level of knowledge the doctors had about their patients' lives, especially in a practice where some patients had lived in area for their entire lives, with their families also visiting the same GP. Interstingly, two of the GPs at the practice had left hospital medicine to become GPs, so that they could settle down and start families more easily, so I was able to discuss the advantages and disadvantages of each with them.

One great opportunity I had during the week was researching a report on the impact of disease on a single patient, and the roles of healthcare professionals in her treatment and care. I was assigned a very chatty middle-aged woman with the debilitating condition diffuse cutaneous systemic sclerosis. She basically wrote my report for me, by telling me so much information without me having to ask many questions. I was also able to talk to her husband about the effect of his wife's disease on his life, and I am hoping to get in contact with the patient's consultant, a specialist in systemic sclerosis who works in London, for his views on her treatment and prognosis.

Now that we've had a good taster of hospital medicine and general practise, highlighting how much more we need to know about diseases and treatments, we're back to lectures in a pathology course until christmas to learn some of that information. Since we are split into two groups for the GP attachment, with the other half of the year doing it this week, we have teaching as just half a yeargroup at the moment, before we start on the pathology course next week. Yesterday we had lectures and tutorials on Evidence Based Medicine, where we built on our knowledge from last year about how to analyse research papers, with more emphasis on clinical rather than preclinical research. Today we each have to do a presentation on a paper, based on what we learned yesterday. I have chosen to look into the treatment of systemic sclerosis a bit more with this task, so that will help me to write up my GP report at the same time. We also have teaching this week on disability and lab medicine, and on Thursday we have a miniOSCE (little practical test) on clinical examinations.

Detective work and feedback

Hi again,

This is my fnal week with the firm I'm currently attached to. It's been a busy week for the house officer, since the consultant and registrar are away, and finding replacements for "consultant ward rounds" isn't easy. In some ways this has been an advantage, allowing us to be more useful on ward rounds, but it has also reduced the teaching time available for us. However, we did get a session with the senior house officer about some of the conditions we've seen, and we have also been set tasks of researching possible causes of some of the more mysterious complaints of our patients, such as the reason a non-diabetic woman is suffering from recurrent hypoglycaemic attacks. Another confusing patient has shortness of breath on exertion, despite no evidence of anything being wrong with her heart and lungs, so we have been able to watch and help with further investigations into the cause of her symptoms. This included a bubble test, where (despite repeated warnings that if we ever inject any air into a patient we will cause an embolus and kill them) several ml of air was injected into the patient's vein and then visualised on an ultrasound scan to show that there was no mixing if blood between the two sides of the heart.

On Friday I did a nursing shift on the Medical Assessment Unit, giving me the opportunity to experience the role of nurses and practise taking blood and cannulating. Unfortunately, MAU wasn't very busy because the hospital was on county divert (where no new patients are admitted from GP referrals due to a lack of beds on the medical wards), limiting the amout I could do. However, I did get to watch a rectal examination, do an ECG, take a patient for an endoscopy, and watch a blood transfusion, as well as helping with toileting and moving patients.

Today I'm going in a bit early to complete a task set in a communication skills session last week. We have to clerk a patient (take a history and examine them) whilst being watched by another student and then practise giving each other feedback on our clerking skills. It is a useful activity but I couldn't help thinking that the communication skills tutors had gone a bit far when not only did we have to fill in a feedback form about the teaching session on feedback, but we were also given a feedback form to fill in about the task of giving each other feedback.

It's not all been hard work and feedback this week though. We've also had our graduate freshers' dinner in college, where we had the chance to talk to our new college tutors as well as getting to know some of the other graduates in college. Since I'm living out in a house, I haven't been into college much at all so far this term. I might be making a few more trips back now though because the undergraduates have now also returned, ready to start their term next week, so more of my friends are around.