I’ve only recently finished my 1st year exams(!) and, before we get our results, our medical school organised a year 2 introduction week. This consisted of two key parts, a First Response Course and a short hospital visit to shadow a doctor. The First Response Course was quite insightful, and was given by an A&E nurse who explored the basics of dealing with medical emergencies – i.e. cardiac arrests or an unconscious patient.
As for my hospital visit, I was allowed to shadow an FY1 doctor working in Gastro/Hepatology at the Royal Free Hospital in London. FY1 stands for Foundation Year 1, and is one of two compulsory years of training after graduating with a medicine degree. The shadowing only lasted for 3 hours but I did learn a lot in that time…
The day begun as I entered the hepatology ward (concerning the liver) on the 9th floor at Royal Free. After greeting the doctor, I followed her around as she prepared for her next task: to take a blood sample from a patient. This sounds like a routine task, especially in a hepatology ward, but this particular patient proved tricky even for the phlebotomists (people highly trained in taking blood). In this case, she decided to do an arterial blood gas. This is taking blood directly from the arteries rather than the veins, which is the usual source. It is a more reliable source, but also more painful as the arteries lie deeper within the wrist. The procedure went smoothly and she took two samples, for determining the Full Blood Count (FBC) and other biochemicals in the blood. The preservatives used are different in each case, hence the different bottles. They were then placed in a hard plastic cannister, to be sent off to the lab conveniently through a suction tunnel system (which is pretty cool).
Discharge letters & patients:
Aside from this, the only other task I really saw the doctor do was write discharge letters. Unfortunately, junior doctors in the early years of their training spend a lot of their time doing administrative work such as this. For each letter (sent to their GP), the doctor needs to update their records with all the medication they are taking. This includes existing ones and new ones given during their stay. The time spent on this is an issue, but more so the errors that can be made during it. As an example, the infamous ‘doctor’s handwriting’ nearly led the doctor to mistake ramipril for ranitidine (imagine how bad it must’ve been). Thankfully, hospital pharmacists are tasked with the responsibility of checking doses so that these are not fatal errors.
With the advent of technology, I hope that this would cease to be the case, but this is a discussion for another post. However, this meant I got to look at a few medical cases and the types of patients to expect in such a ward.
For example, a patient had presented with a 2-week history of pain in the epigastric region (stomach), which he rated a 9/10 in terms of severity. He also had cardiac problems, but this pain wasn’t indicative of a heart problem. Those pains would normally radiate into the shoulders and upper arm, with palpitations and possibly vomitting. He noticed that the pains started a couple hours after eating, so doctors localised the possible cause to the gastro-intestinal tract. An ultrasound was done to look for gall stones, but they returned negative. An endoscopy was ordered for later during the day, and the patient would be discharged temporarily from the ward (assuming the endoscopy found the cause and this could be treated). If the endoscopy does not show anything, a state-of-the-art video endoscopy capsule can be used. This shows the gastro-intestinal tract in much better detail and there is a higher chance of spotting hte possible bleeding.
I thought I’d include this section to write about the smaller things about a doctor’s job on the ward that give a deeper insight. For example, something I hadn’t noticed before was how doctors keep track of their jobs for the day, and the patients to be seen. This is done on a piece of paper, printed each day and updated for the next day as they work. The table features, in columns: patient details, bed number, presentation (what they came in for), patient history (in brief), investigations, procedures and plan. I found this astonishingly archaic, as technology has existed for years that could make this much more efficient. From what I’ve seen, a big barrier stopping the adoption of this is essentially that staff are too used to it.
However, the doctor did routinely make use of apps tailored to working in a hospital. There is a phone app which lists the Bleep Numbers of every doctor in the hospital, which is very convenient. A bleep number is used to call the telephone of a specific ward, and specify the doctor you want to speak to (it’s still painfully inefficient, as the doctor is not near this the majority of the time and needs to call the person back). Another app used is called Doctor’s Toolbox. It’s a great tool which has guides to each specialty for doctors to refer to, including doses and hospital-specific protocols.
The doctor also spent a bit of time going through blood tests, which are especially important on a gastro ward. They are ordered routinely for every patient to monitor key variables such as haemoglobin and markers of infection. It’s important to order the bare minimum number of blood tests, however, as there is a cost associated with each marker looked at. These costs pile up and hurt the already struggling NHS.
As a doctor, you will always have to deal with ethical dilemmas and working in the gastro ward is no exception. For example, many people are given liver transplants but then do not take the immunosuppressants needed to stop rejection. This means that emergency measures need to be taken, including a second transplant. This brings to attention the cause of liver damage: was it caused by excessive alcohol intake or was it an autoimmune issue that is encoded within their genes? We as doctors will be taught that transplants are given first to those with highest medical need, and there is a transplant MDT (multi-disciplinary team) that is given the decision in tricky situations.
That is all. I hope you have learnt a bit more about life as a doctor in this article. Stay tuned for more posts in the new journal category.