patient history

Mel Sarigul

/ Lauren Kennedy

First term complete, bags packed, presents wrapped and I am ready to return home after a busy semester.

I am now more comfortable with PBL. I still have the odd feelings of being left to drift alone in a vast, empty ocean worrying that I have missed something important but these pass fairly quickly. The learning objectives we come up with as a group on the whole match the intended learning objectives and the lectures continue to give us guidance on depth. Our group has really learnt how to work effectively together and we have a great dynamic. Aside from the educational perspective PBL has meant that students get to know each other and I have made great friends. I will be sorry to change my PBL group but also excited to work with a range of people.

I was quite late in ordering my stethoscope because I had to make the very important decision of what colour I wanted (turquoise or classic black? Smoke or brass tip?) and what to have engraved (should I include my full name or just my surname? Would ‘Life is short’ be inappropriate? Why isn’t ‘Laughter is the best medicine’ 24 characters long?!)  I was glad I waited though as often you are given a discount voucher at Fresher’s fair.  My stethoscope arrived as we were learning to do a cardiovascular examination and I got childish pleasure listening to a friend’s heartbeat. That’s one of the great things about Lancaster – medical students start their clinical training early on. Since you are practising on healthy individuals usually you can’t feel/hear much but the emphasis in first year is normality. The idea is that if you know what normal feels like you will immediately be able to identify when something is abnormal later on in your studies.

We have started Communication skills which teaches how to effectively take a history from a patient. It is nerve racking to have to get up and interview a stimulated patient with a camera and 5 sets of eyes focussed on you! Trying to uphold an image of calm and reassurance when in reality your mind is desperately searching for the next open ended question to ask all whilst nodding and maintaining eye contact. As embarrassing as it is to watch yourself back it gives you an opportunity to evaluate what you could improve on.

I feel that I am in a better position now than I was at the same time 4 years ago when I was doing my first degree. I have been practising clinical skills on anyone I could get my hands on, annoying friends with open ended questions and PBL means that I have made most of my notes already and remember the main concepts. Now comes the hard bit of learning the nitty gritty stuff in time for exams in January.

The beginning of third year…

/ Emily Hedley

As I write this I am coming to the end of week 6 of my first rotation of my third year at medical school. Year 3 is split into several rotations including; Managing Long Term Conditions (MLTC), Women & Children, Psychiatry, Neurology & Elderly, Sexual Health & Therapeutics and finally a third Special Study Module.

For the last 6 weeks I have been on the MLTC block. I have been on placement in General Practice 5 times and I have REALLY enjoyed it! As well as observing many consultations at the surgery, I’ve also accompanied the GP on home visits where I assisted taking patients’ histories and observations such as blood pressure and temperature.

Back at the surgery I had to also complete 8 ‘hot seat cases’. For these I sat on the GP’s chair and took the histories from the patient as though they had come to see me. I then had to examine the patient if necessary and suggest a management plan before getting feedback from the GP and discussing my ideas for the differential diagnosis. The first couple of these cases were really nerve racking and it felt a bit strange that real patients trusted me to listen to their story and examine them as though I was a real doctor. The GP was really helpful and so I become more confident so that by my 8th case I felt quite comfortable! In addition to my GP placement I’ve also been to some Ear, nose and throat clinics – I enjoyed this a lot more than I expected as they were really hands-on as the consultant had us practice using the equipment to examine the patients. Overall the MLTC rotation has enabled me to see such a variety of patients and conditions, which is why I think I have enjoyed it so much.

I am really looking forward to my next rotation – Women and Children, because it is something completely new to me as we did not go onto the maternity wards last year, nor did we spend much time in paediatrics. It’s also been months since I’ve been on the wards, with having GP placement first, so it will be good to go back!

Beth Stockton

/ Lauren Kennedy

First day on the ward

Our second week in hospital was the first time we were sent to the wards to speak to real patients. It was scary because there was nobody with us, and we had to approach nursing staff and the patients ourselves to ask to speak to them. You feel bad bothering them, but most patients are actually happy to have someone to speak to, and the nurses give advice on who might be better to speak to as well which was really helpful. It’s difficult to write notes the same way as we practiced in the OSCE because you can’t control what order patients tell you information. There tends to be a lot of stories that, even though they can be interesting, they aren’t what you need to write in your history. It can be hard to steer patients towards what you need to find out, but I’m hoping that will come with practice.