Due to family financial pressures her studies and favoured ‘career and calling’ were about to be stopped in front of her very eyes. We are pleased to announce that we took up the request and funded her studies for the final 2 years of her medical degree at Aberdeen.
This enabled her to concentrate on her studies without any worries of putting further pressure on her family, affording the fees herself somehow or even borrowing at exorbitant rates to achieve her goal. All those avenues were closed, anyway. A brilliant student was about to have to change career, to what that would be we cannot contemplate.
The student has excelled herself academically with our grant, in our view, and we wish to share with you her written experience of a few days from her GP placement in North East Scotland. It details her ‘on the job’ training in the community supporting the medical profession with real life cases.
We are so proud to be allowing a young person to complete their studies, to put a new doctor on the ‘street’ and to ensure that in the future so many lives (thousands) will be affected by her future work.
This is a moving account and carries no names nor personal details.
Robert Frith FCA, Chairman, LRWMT
Notes from GP Placement, North-East Scotland
First official day entering the world of clinical placements, and what will be “normal life” starting the 1st August 2021 as an FY1. As an eager, but inexperienced 4th year student, my morning session shadowing Dr. F was hugely eye-opening. Apart from being cognitively stimulating, the sheer complexity and variety of “cases” appearing at the door was overwhelming (and slightly terrifying!) to say the least. Patients ranged from a young 10 years of age, to a grand 84, all of whom had to be welcomed in such a way as to build a rapport that would allow the more intimate of complaints and examinations to be explored and carried out without hesitation on both sides – a truly skilful art. Aside from the logistics of managing what are increasingly prevalent chronic, complex medical conditions and their associated polypharmacy in little under 10 minutes per patient, Dr. F also provided me with a greater insight into the current changes in primary care that are aimed at encouraging a more even delegation of the minor ailments presenting to practice. The rapid increase in the number of patients with comorbidities and long-term health conditions that require active monitoring and adjustment means that gone are the days where you would see your GP for that broken toe that won’t heal, or advice surrounding which contraceptive method to start. Such problems are now directed towards other skilled healthcare professionals within the practice, such as the Nurse Practitioners and, where available, specialist clinics run by nurses, physiotherapists, occupational therapists, etc. At this particular practice, a designated “unscheduled care” area was recently introduced to help manage the patients for whom A+E was deemed unsuitable (and quite honestly, a much longer wait!), but who still required urgent medical attention. Albeit a new addition to the practice, I couldn’t help but wonder, will the future of primary care survive such a bold amalgamation of healthcare services? Or will the backlog from our overrun and underpaid NHS hospitals consume the workload of physicians and healthcare workers trained to support the frontline, with the community fending for itself?
As is the case with learning new skills, I was pushed a little out of my comfort zone today and given several opportunities to make diagnoses based on presenting complaints and examination findings. Most of these diagnoses were made with the patient sitting in front of me with a look of slight terror and confusion, only for me to tentatively confirm that they did not have to worry about getting their affairs in order over a few seborrheic keratoses that have, presumably, occupied their lower back for several years already. There was one patient for whom I did not openly make the diagnosis with him present, but was rather asked my opinion prior to him entering and once he had left. Blood results had shown an isolated alkaline phosphatase (a liver and bone enzyme commonly elevated in biliary duct pathology such a gall stones), which had raised enough concern for the GP to arrange an urgent appointment. On entering, the 67 year old gentleman was already quite visibly concerned over the nature of the appointment, and sat down towards the far edge of his seat before rummaging in his jacket for a brown envelope. “Just wanted to show you this doctor, before you start” – somewhat throwing us off our initial plan to establish exactly which symptoms he had been experiencing, and what, if any, further investigations needed doing. The letter was from the National Bowel Screening programme, a scheme aimed at everyone from the age of 55, from which a stool sample is required every 2 years to test for faecal occult blood, a potential indicator of bowel cancer. His latest test had returned positive. Normally, as is the intention of screening programmes, a positive result may indicate the early stages of a pathology that can be identified and removed before ever causing the patient any symptoms. However, upon reading this letter, the hope that this may have been a spurious blood result, or a relatively benign condition such as gall stones flew out of the window. Combined with an isolated peak in alkaline phosphatase, the likely diagnosis was that this gentleman’s bowel cancer had already metastasised to his liver or his bone – a classic scenario given in medical school, but one that I had never thought I would see playing out in front of me so soon. After conducting a PR exam (which was negative), Dr. F had the job of explaining all of the possible outcomes of this consultation. Listening to him slowly and gently suggest that we need to consider the very worst of possibilities, the big “c word”, was emotionally draining to sit through. However, as one does as a medical student, I tried to focus on everything that made that conversation so great in terms of manner and sensitivity, and mentally noted down the importance of making 100% sure that the patient understands what you have conveyed to them, and that nothing was yet certain in this case. After the patient had left, I took a couple of minutes to distance myself from the situation, a natural (and essential) process that Dr. F engaged in after every one of his patients, and one that I will have to learn very quickly if I am to have a long and “happy” career. It crossed my mind several times today how privileged I am to be in the position I am, when people I have never met feel tha they can walk through the door and open up about their deepest and most personal worries and problems – how blessed am I to be on the other side, wanting to help.
Today I was placed in minor operations with a GP previously working as a consultant surgeon. As a mere 4th year, I was constantly in awe of the range of procedures that you are able to carry out within primary care, if this should suit your interests. Aside from the intricate stitching and contraindications to administering adrenaline before an incision, the take home message today was the importance of a good relationship between the doctors and nurses in the practice. Particularly when carrying out minor procedures, the rapport and synchronicity between these two individuals, and their combined influence on the patient’s experience and comfort really demonstrated to me the essence of what teamwork really embodies. Not focused on winning, or being the best at a task, but working together with the joint goal being the improved health and wellbeing of the patient. What I have observed and experienced today, and in other clinics, I hope to take forward with me in my future practice, as what lies at stake far outweighs the somewhat meaningless airs and graces of titles and ranking that often divides doctors from their fellow healthcare staff, be it intentional or not. As time moves on, and my exposure to the healthcare environment increases, I understand the importance of such thoughts and experiences in forging my path as a future physician, because whilst I am well acquainted with my personal characteristics and nuances, I am still early on in the process of learning what kind of doctor I will turn out to be.
First time taking bloods from a patient is a truly daunting experience when you’re used to the “dummy” arm provided in simulation wards. The perfect veins with previous puncture marks indicating where other students have found success are (unsurprisingly) not present in your average 80 year old. Assigned to the phlebotomy clinic for the day, I scanned my wardrobe for the darkest coloured clinical clothes I could find – naturally preparing for the worst. Luckily for me, I was in the presence of an expert, a nurse who I can only describe as my guardian angel, sent to guide me through the first ever “invasive” clinical procedure of my career. Aside from her enthusiasm to aid my education and share her top tips and tricks, I am perhaps most surprised by (and wholly grateful) for the wonderful patients who, knowing that this was entirely new to me, happily offered up their arms without even a second thought. It often crosses my mind, with examples such as this, how privileged I am to be in a position of such trust and responsibility. The kindness shown to me by the general public has really demonstrated that underneath it all, respect and compassion for others, no matter how different to ourselves, or seemingly removed in ideology or circumstance, is paramount not only for the daily running of our NHS, but for society as a whole. Whilst many nurses and doctors alike have joked about the best method of developing a “thick skin”, as I am sure I inevitably will, I am weary of losing touch with the real humanity of patient care that I have experienced so far.
Case study starting 24th June (first meeting)
Terminal illness is seen by some to be a justification for the outpouring of hate, insensitivity, and hostility towards the world and all it encompasses. By others, as was evidenced today, it is an opportunity to contribute, to reminisce, and to enjoy the people we hold closest to our hearts. Mr X was allocated to me as a case study for completion of an assessment held at the end of the GP block. What he turned out to be was a gentleman who will always have a special place in my memory for the impact that he has made, and the time that he took to sit with me in what are his final months of life. Diagnosed with small cell lung cancer in March of this year, Mr X, a 71 year old retired RAF chef was half asleep in his bed when I was first introduced to him by my GP tutor. His frail, thin body is what I would have expected of someone living through the hell that is metastatic lung cancer, but it was his smile, and his firm tap on the bed inviting me to sit down which really took me by surprise. Getting through the mandatory medical questions that I had lined up, I was eager to get to know more about the person behind the diagnosis, and he was simply thrilled to be having a conversation with someone who wasn’t asking about his pain and bowel habits every 5 minutes! I sat with him for 2 and a half hours on our first meeting, me on one side and his incredibly doting wife on the other. Although our assignment only required us to visit a patient once to gather information, I simply knew that I had to see him again.
On my second visit I met his brother, who had travelled up from the north of England to visit as he had not done so since the diagnosis was confirmed. I was thoroughly moved that Mr X had even remembered our appointment, let alone insist on keeping it despite knowing that he would be having much more important company! We chatted for hours, sitting with his family around us and talking about their life and experiences – I was simply overwhelmed by the love in that room to the point where I had to eventually excuse myself for fear of bursting into tears and ruining the atmosphere.
Our third and final meeting was in my last week of placement. Having asked special permission to say goodbye to Mr X and his wife, I made my way from the GP practice through a lovely green field to his house for the last time. On that short walk, I remember wondering if I would be anywhere near the patient, tolerant, loving person Mr X was knowing that I would have to endure an illness that had taken away all rays of hope that come with thinking of the future. To do this day, I am undecided. Sitting with our tea and shortbread biscuits, I cherished every story that he shared and piece of advice that he imparted. Not once had he complained “why me?”, or expressed any moment of anger or sadness. It was me who felt helpless, angry that such a wonderful person became victim to the wildfire that is cancer in today’s population. I knew that our final hug goodbye would be embedded in my memory for years to come, and I often think of him. Of my time spent in the community, my meetings with Mr X were certainly the most impactful and educational, albeit not in the traditional sense. Whilst I do realise that I have a bit of “toughening up” to do, this placement has shown me the importance of empathy and kindness, not only as a healthcare professional, but as a member of a much more intricate and complex network of individuals that make up our villages, our towns and our cities. I am thoroughly excited for what the next block brings!
The Lady Ryder of Warsaw Memorial Trust is a company limited by guarantee and is registered in England No.3935283 | Registered Charity No: 1082295