Blood

Today I took blood, using the vacutainer system. I have taken blood before but today was the first time from a "real patient," as opposed to in the clinical skills centre practicing on someone with biggest veins around.

I was able to do it on two patients in the end (out of three - my colleague who is more sophisticated then the fuddled medic used a syringe in the end). I consider this to be a success.


The afternoon was spent watching an FY1 doing Intravenous cannulation on a patient, followed by them teaching us how to do it on each other (before this we had just practiced on a mannequin), with a bit of luck I was able to do this on my friend relatively easily - although tbh it was a bit of dumb luck that I was able to manage it.

In the meantime I have been set a challenge of finding out the scientific evidence for why doctors should wear there sleeves rolled up - to me it makes sense insticitively to wear short sleeve shirts, elbows and below exposed, but is there any evidence?

Where are you?

Earlier today I was procrastinating and I discovered that the manchester medics blog had disappeared. Where of where has he gone?

My week

I was tempted to do a day by day diary of my week, but eventually decided against it. Instead I'm going to summarise my week.

This Chart show the relative importance of three things in making a diagnosis. These are taking a history, examination and tests.
The original work can be found here. I have wanted to put this in for a while now but could not find a reason to. I have put it here because it is a reasonably indicator of what I've done this week.

Most of my time is spent chatting to patients on the wards and taking histories. If an F1/F2 is around and feeling nice they often get us to take a history and practice presenting to them. In clinics we often present to the consultant before he see's the patient. Most of the years above have told me that the main thing to get out of this attachment is to simply get good at taking histories and presenting back to people. After all this is the major thing in finding out whats wrong. Expensive tests usually confirm what we often know from the history.

A smaller amount of time is spent examining patients or looking/trying to interpret there test results.

Other time is spent in teaching, such as seminars and lectures. This week we have discussed colorectal cancer, practicing PRs, other sessions included going over the abdominal examination and discussing why we palpated for various bits and bobs.

This week was very similar to last week, thankfully it seemed a little easier and although I still feel completely out of my depth and very stupid I do sometimes get the feeling that a little bit more is slotting into place.

Weeked Homework- Pathology and Radiology teaching, immunology lecture to listen to, reivse anatomy of femoral/inguinal hernia's and make notes of cycstic fibrosis. Also to gut room and do some laundry

RCTs

The fuddled medic believes that if we should use evidence to support why we use something or believes something.

In poorly understood areas the best way to find out what works and what doesn't is to do a Randomised controlled study. It is thanks to RCTs that we know that women on HRT are at a higher risk of strokes, heart disease and breast cancers.

I have written the above because this made me laugh and i wanted to share it.

ABC

Our group have now met all three of the consultants who will be giving us teaching over the next six weeks, two are lovely - one is not.

Consultant A did some bedside teaching, this involved 7 of us crowding round a patient-the purpose was to go over assesing the ABCs(D and E) to. This consultant was very nice, telling us there was no such thing as a stupid question and smiling briefly whenever we said something stupid

Consultant B was the complete opposite, he told us the plan for the next two weeks and put the fear of God into us, warning that he would not be to kind if we did not know our anatomy. Our homework is to go away and learn the blood vessels of the body so we can draw them on the whiteboard

Consultant C was lovely, we met him on the ward but we quickly ended up in the Cafe having tea and biscuits. He asked us what we wanted to do (next week abdo examination, next week histoy taking and presenting) and then just talked a bit about his job, when he was a medical student etc

Medical students are often overwhelmed when they start being on wards full time, its kind of nice that most of the consultants seem to appreciate this.

Reassurance

Was at clinic today and whilst the consultant was having a cup of tea we all had a bit of a chat. He told he only expected one thing from medical students. This was just to turn up - thankfully even I can manage that!

Seven hours and fifty minutes

That is a rough indicator of how much sleep I need, if I fall asleep at around eleven I will wake up just before seven. And no I am not worried about loosing my marbles because I dont get exactly eight hours of sleep every night - you only need enough so that you feel refreshed when you wake up. There have been case reports of people who only needed to sleep for two hours a day - it was reported that they felt that most people wasted there lives in bed!

Where is this going? Is this going to be a biology related post? Have'nt done one of them for a while

Nope, this post is because of this.

Should a charity really have to do this? When I was younger my parents told me why sleep was important. Anyway should sleep and the reasons behind it be discussed in biology anyway?

I'm probably going to get shouted down for saying this but surely its down to the students themselves? During the school week if I noticed I was tired I would make sure I went to bed early, is to much to ask of people? You would not be happy if a lecturer or a teacher fell asleep during a lesson - they manage to stay awake

A new way of learning

The course I am is becoming more and more clinical (very rapidly in fact), so whereas learning before was just a case of learning lecture slides (give or take some extra reading) things have changed.

Now its more a case if you see a patient with a certain disease, you just go away and read about it in a book. Because of this I have obtained a copy of Kumar and Clarkes clinical medicine. It feels liberating to read a textbook aimed for clinical medicine as opposed to a book relating to physiology or pharmacology.

However the best book I have purchased in the Oxford Clinical Handbook of Medicine - perfect for taking a sneaky look as the consultant chooses who to pick on.

Autonomy

Had a lecture of pallitative care and euthanasia today, wasn't a lecture in the traditional sense - more a couple of videos to try and get us thinking about the issue.

With regards to voluntary euthanasia I am in favour. Everyone accepts that we have a right to life, therefore we all have a right to die when we choose to. One of the physicians duty is to take into account patients wishes and there right to decide on a particular treatment/course of action.

From this I think it is logical to accept voluntary euthanasia is fully justified and morally ok, unfortunately the law in this country seems to need to catch up with what is right.

Alice in Underland

Saw Tim Burtons Alice in Wonderland last night, a very silly, pointless film that did not pretend to be anything other then entertainment and a bit of fun. Despite thinking to myself this is terrible I could not help but enjoy it

Probably because I enjoy fantasy worlds, being able to escape somewhere new (even if its only for half an hour in doctor who) is good, particulary if your course places heavy demands on you.

Anyhow this brings me on to reading, I particularly enjoyed Harry Potter and also Artemis Fowl. At my Birmingham interview I was asked what book I had last ready and why. I answered truthfully and said Artmeis Fowl. This was followed by bemused/amused looks between the interviewers as I attempted to explain what the book was about!(Magic, Fairy creatures, an evil Pixie and a secret world underneath ours)

Back to the real world, the next hour is going to be a futile attempt trying to teach myself anatomy (again).

Reference Ranges

What is normal? What is healthy? When it comes to test results (such as electrolytes, glucose levels) normals means within a certain range. Normals is above the first 2.5% of the lower range and lower then the highest 2.5%. This means they include 95% of values from a healthy reference population.

Subsequently there is a chance that what could be normal for one person is marked up as abnormals - it is outside a certain range. And vice versa - what is abnormal for one person could be within the reference range

Which one should be worry about more? (based on these results, yes I know you would take a full history but its just to illustrate a point)

1) A fit guy in his early forties with a creatinine count of 135 in 200 and 132 in 2009
or
2) A little old lady with hypertension and diabetes whose cretinine levels was 68 in 2008 and 98 eighteen months later?
(normal range, 60-120 umol/L)

Mr Spock and Drug Reactions

Mr Spock had green blood, humans have a completely different physiology to Vulcans and normally have red blood. Unless we suffer a very rare adverse drug reaction when taking Sumatriptan.

This can cause sulfhemoglobinemia, which is when blood changes to green as a result of sulphur integrating itself within the haemoglobin molecule

Because this is a very rare condition I shall remember it.


But moving on, this blog is not here so that I can disover how my mind works.

When is 1500 deaths more important than 200o death? It is likely that these figures are wrong, but the point I want to make is that more people die from adverse drug reactions in the Uk then from MRSA. However because you can take pictures of doctors not washing there hands and it can give simpler headlines more resources are given to preventing MRSa then adverse drug reactions