Things that upset the Fuddled Medic

Am usually able to control my emotions, was unable to do so in these situations
1. Seeing a severely ill person whose partner had been raped four days earlier, who was unable to go home and see them
2. Seeing a sixty something chap who had suffered a suspected stroke – had to wear incontinence pads
3. Talking to an eighty years old woman whose only daughter had died of breast cancer, with liver metastasis six days earlier

Very Sad

Teaching and Politics

Teaching session involved the FM presenting a patient she had clerked to a consultant. It was a relatively simple case. As a result people got easily sidetracked and the meeting descending in a spirited debate about the role of the private sector in the NHS. The consultant looked bemused and when someone apologised for the fact that our firm were now engaged in a passionate discussion he replied that it was good we were doing this. In his view medical students did not get enough time or encouragement to discuss how they wanted healthcare to be provided. Should it be the case that a few seminars/tutorials be held so that we can discuss all of this? As he said we’re the ones who are going to have to work in whatever system for the next forty odd years

Dr McCoy, Mental and Looking Back

My favourite star Trek film is “The Voyage Home,” which you may or may not know is the one where they go back in time to find some whales.





Some very good scenes involved Dr McCoy being absolutely disgusted at today’s medical practices – my favourite being the good doctor giving an old woman who was awaiting a kidney transplant a tablet so her kidney grew back. Miraculous.


I remembered this film last night when watch “Mental-A History of the Madhouse.” Back then they used to give Insulin Shock Therapy to patients. It was thought that giving people suffering a Schizophrenic Coma an insulin induced coma on a regular basis was a good idea. Absolutely horrible, but back then they thought it was revolutionary.

But when we look back in sixty years time, what do we think will be considered barbaric about today’s health treatment?

Pathology and Stereotypes

“So we’re going to take the object with the biggest negative entropy in the entire universe and cut it into bits.” These were the words of one pathologist as he started to cut up the brain whilst doing a PM. If you really want to study the brain of someone who has died the best thing to do is to stick it in formaldehyde for a while, but this isn’t usually practically or necessary. This means the pathologist usually cuts it up into slices and quickly looks for any major abnormalities.

“Are there many female pathologists?” More than you would expect, said our chap - apparently it has relatively friendly hours. This appeal’s to the FM, who loves dealing with patients but dreads the idea of spending the best years of life stuck doing continuous night shifts, working days where you start at four in the morning and then finish at six/severn/eight/nine at night.
However pathologists, according to one respiratory consultant have the highest rates of suicide within the medical profession.

The FM does not know if this is true- the reasoning behind this consultants statement is that pathologist spend a lot of time isolated in basement offices, surrounded by bits of bodies. Maybe this is an unfair stereotype. One pathologist sarcastically said that people impression of them is “that of a guy with a beard who sits staring at stuff under a microscope all day, with a rotting heart and lung sitting next to them, who perhaps gets up to have shave after three weeks.”

Anyway the other reason supposedly is that they get very worked up when they can’t decide what’s going on when they see a slide under a microscope. Is it really dysplastic tissue that is being seen? Or perhaps it’s just inflammation making them look dysplastic?

Most medical students and doctors think the FM is mad when she says she is interested in pathology, why is this the case? Have the stereotypes presented above gone too far? Is it ok to pick on pathologists? Are they really “proper” doctors is a common question. Is it acceptable for medical students to say there interested in it and are considering it as a career?

Shall I become a GP?

The GP who I am attached to is absolutely lovely; sometimes he will pop out to the local shop to get some biscuits and chocolates for the secretaries. Occasionally whilst we’re walking back we will see the next patient on the list across the road.

It’s a nice feeling giving patients a wave and smile in the morning.
I don’t think that I’m likely to become a GP (but time will tell), but I can understand the appeal. Sitting in on a GP surgery is more interesting than seeing 15 cases of ulcerative colitis or crohn’s disease at a hospital clinic.

Consultant Syndrome

The FM did not come up with the term, but she shall tentatively offer a definition.It is the “Inability of a medical student to say anything rational or sensible when questioned by a consultant.” This is something that the FM suffers from.

This happened last week to the FM when she was asked about Meckel’s Diverticulum. This was something that had been read about in Kumar and Clark, so with confidence she shouted out “Rules of two!” Unfortunately consultant syndrome kicked in and this is the only thing to have left the FMs mouth.

So revisions for the weekend, finding out what these rules of two are, they include
1)2incheslong 2)2 feet from the ileocecal valve 3)2% of the population have it 2)Males are twice as likely to get it.

Unfortunately now this knowledge has been learnt (again) it is unlikely that the FM will be questioned about it in the future, thus will not be able to show off.

This condition particularly affects the FM when examining patients in front of six other students and a consultant/registrar. She is quite confident doing the basic examinations on her own (or even when being assessed-the FM passed comfortably when being watched by one examiner last week). The FM is able to progress from one stage to another, looking for any pathology. But when asked to do in front of other people she falls apart, always wondering whats she's going to miss out next (liver flap, chest expansion etc)

Any wacky cures out there?

Hangovers

Drinking has a much bigger effect on me than it used to, definitely cant drink as much as I could two years ago. Any rationale behind this, I am only twenty two years old. What has happened to me?
Any RCTs out there giving an indicator as to the best hangover cure?

Voted

Probably posted it to late, but earlier today I posted my vote.

Sigh

FM attempts to take a Past Medical History, she thinks she gets everything. Looks in the notes and sees that patient has had four heart attacks.
On someone else FM sees that a patient has a lanz incision or other surgical scar, asks if patient has had any operations. "No" is the answer. Later on examination FM politely asks what those scars are from, "Well from my operations of course!"
FM feels stupid, especially when presenting back to the FY1 who informs her that said patient is epileptic, despite FM asking on SE if they had had any fits or seizures.
All good fun!