First day on the wards

June 18, 2012

I found the whole experience of being a healthcare professional very humbling. I did a traditional course where you have two years pre-clinical just having lectures, tutorials, doing experiments and anatomical dissection. But not seeing patients. All theoretical. Then the final three years are on the wards (apart from the pathology rotations where you attend post mortems and look down microscopes). Those first days on the wards were scary. We were put in to ‘firms’ – a group of about eight students who would be together for the next three years, going from unit to unit, specialty to specialty together. We were given brand new starched white coats, had our Littman stethoscopes, a green rubber tourniquet, a pen torch, an ophthalmascope, an auroscope, a tendon hammer, a copy of the British National Formulary (a drug index), a pen, a notepad and I had Lecture Notes in Clinical Medicine which fitted in the capacious pockets. Other people had different texts. I chose the Noddy’s guide type of book.

As an introduction to the clinical side of medicine we were given a few sessions on how to take a history and do an examination. There is a standardised way of taking a history that we were taught; what we had to ask and in what order, what we had to write down, what we had to try to find out. There were new symbols to write, new acronyms to learn. There seemd to be shedloads of critical information one had to elucidate from the patient. How would I remember what I needed to do? How would I know what to ask? It all seemed rather daunting.

The first time I was assigned a patient to take their history from I couldn’t belive I could ask them these very personal questions and they would tell me. Me. Just 20 years old and knowing nothing. Asking adults with a lifetime of experience about their bowel movements. Or whatever. What I didn’t realise is that most people are happy to talk – hospital is very boring if you are conscious – and most people like to help the trainee doctors learn. People feel they are being useful. And they are. It took me probably about an hour or so to get the history from a patient the first couple of times. Waaaay too long for real life medical practice. But practice is the operative word and I got better and speedier as I learnt the template and learnt which follow up questions I needed to ask and which I could leave out.

Even more staggering for me was that patients allowed me to examine them. It took me three days to pluck up the courage to ask someone to let me examine their chest as I felt I had no right. It was an invasion of their privacy. Until I realised there was no other way for me to learn.

We would also be taken to see specific patients to practice various techniques of history taking and examining on them. Training to be a doctor then was a process of public humiliation by the tutor. It was mortifying at times. But that’s the way it was. We would stand around the bed and the Consultant or registrar would fire questions at us. The patient often unacknowledged in all this, simply the object being used to terrorise us with our lack of knowledge and technique. I would stand praying that I wouldn’t be asked a question.

One time is etched in my memory. We were taken to a side room to see a young woman. Probably the same age as me. She was sitting up in bed putting her eyeliner on. The consultant asked me to listen to the back of her chest. When one was asked to listen, one had to go through the entire process of examination and auscultation, not simply use the stethoscope. So I started with palpation – where one feels the chest to see if there is any tender areas, then tried to assess the expansion of the chest – seeing whether there is any restriction of movement. Then I moved to percussion – that’s the finger tapping when you are listening for the different sounds made depending whether it is going through air or not. There are three sounds – normal, dull (when there is fluid) or hyper-resonant (when there’s virtually no tissue, just air). So I fumbled through those. Then at last I was ready to listen. The end of the stethoscope (the bit you place on the patient) usually has the option of listening through a diaphragm (the flat one) or a bell ( the cupped one) depending which frequency of sounds one is listening for. I checked mine was turned to diaphragm. It was. Nervously I placed the stethoscope on her back and asked her to breathe in and out through her mouth. I went from side to side up and down the chest. To be honest, I couldn’t really hear anything at all.

I was about to start asking her to “Say 99” and continue to listen in an effort to hear increased vocal fremitus or whispering pectoriloquy (great terms and in those days useful signs – now probably superceded by routine scans and the like), when the consultant stopped me. “Well Miss Morgan, what did you hear?” “I didn’t hear any abnormal breath sounds.” I mumbled “No,” said the Consultant “I don’t expect you did.”

She was looking pretty pissed off. ” It would help if you put your stethoscope in your ears .” She wasn’t smiling. She didn’t find it funny. Not even remotely. I was beetroot with embarrassment. Sure enough, my stethoscope was simply dangling from my neck. It hadn’t been anywhere near my ears as I had painstakingly examined the patient.

The other students on my firm were relieved that they had not been the first ones to have been so completely and utterly humiliated. They were looking superior as if they would never do something as basically stupid as that. And they were finding it hard not to smirk.

But I was able to look back and realise that wasn’t the worst mistake to have made.

After all, during a cardiac arrest it wasn’t me that put the defibrillator paddles so low down on the patient that they didn’t shock the heart, they shocked the full bladder instead. And it dutifully contracted and emptied its entire contents over the Consultant who had been recalled from a posh function and had just appeared through the bedside curtain in his dinner suit.

Defibrillator paddles roughly where they should be. “Clear!”


2 Responses to “First day on the wards”

  1. kate Says:

    oh so funny this one! Apart from this, I like that you explain to us what terms are – but I don’t know what auscultation means, and asheamed if its not a mediacl term! but there we go.x

    • I did wonder whether I put too much jargon in, but glad you liked it. perhaps this one is more educational than entertaining! If you haven’t already googled auscultation it just means to listen. Perhaps I should edit in……

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