Paging Dr. James*....

(* names have been changed)

I had my first clinical communications observation at Princess Alexandria Hospital on Friday. Another person from my PBL group, Ryan, and I went down together as we were supposed to go in pairs. Our session was at 1pm and uni finished at 11:30 (the morning was quite the gong show with a clinical immunology lecture at the Education Centre at the Royal Brisbane Hospital and then we had 30 minutes to get back to UQ campus and have the next lecture - that might be a reasonable amount of you time you reckon...but it wasn't. If you were to take the bus it would take you 45 minutes (and that's matching up the connection times and everything). I was fortunate that I got a ride on the way back.

Ryan and I got to the hospital and finally found the doctor that we were going to be observing (not after having some issues with finding which outpatient centre we had to go to). He split us up - Ryan was shadowing a registrar (that's similar to a resident in the Canadian world of medicine). I was with Dr. James* (names have been changed). Now, Dr. James* was 40 minutes late. Apparently, he didn't start the day until 1:40pm. Does the medical school now about this? Why were we (the students) made aware of this. At times, it feels as if we (medical students) are the bottom of the totem pole for everything - and I mean everything. I do believe that in a hospital setting, patient care overrides everything else, including medical education. However, if a doctor is supposed to be somewhere (and Dr. Scott had approved of this observation well in advance) and has no other commitments, that scheduling time should be honoured. Regardless, he came late and started the show (of course without no apologies to Ryan or myself).

The very first patient of the afternoon was a 50+ year old woman, who seemed a bit mentally slow (almost as if she was a 7-year old in a older body - her mannerisms and the way she was speaking). She was experiencing bouts of spontaneous DVT (deep vein thrombosis...oh look at me, already using medical acronyms! Schmecktyo) and required a mammogram and pelvic ultrasound. The doctor turned on the xray light box and placed her mammogram on it. Even though I haven't done radiology/oncology yet, I knew what I was seeing - Mrs. Smith* had a tumour in her left breast. The doctor was quite somber and told her that this does not mean anything yet as a biopsy would be required to make any diagnoses. Mrs. Smith started to cry and I mean CRY. Dr. James* had no tissues for the patient (which is an absolute no-no, a physician should have those sort of things available for her/his patients). She was almost unconsolable - then again, I would be too if I just found out that there I have a tumour growing inside me. As for the reason why she was there (spontaneous DVT), the doctor ordered more tests. So, he gave her some forms that had to be taken to Pathology/Radiology/and Haematology. Now, as in any hospital getting to point A to point B is never as simple as anyone makes it to be. Dr. James* gave Mrs. Smith* verbal directions on how to get to Radiology from his outpatient clinic. She seemed really confused on how to get there and asked the doctor if he would draw her a map or at least write down the corridor names. He told her that that was not necessary and that finding it is an extremely easy task. My jaw almost dropped to the floor! I was thinking, "as her doctor, why not help her in such a simple task that puts her mind to ease. She just found out that she may have cancerous growth in her breast." Instead of placating her, he sends her off just having discovered something that may inevitably change her entire life.

All the rest of the patients that afternoon (the session lasted a little less than 2 hours) were 60+, except one man who was in his early 50s and had serious hepatic (liver) infections and jaundice. His reason - binge drinker for past 4 years. Mr. Scott* is now retired (not by choice) but when he was working, he would often set aside one day to drink. Yes, he would spend the entire day drinking. His exilir of choice was vodka. From his reports, Dr. James* told me that he would drink 2 - 3 bottles (and in one case 4) on the binge day. Good god. There were several public health issues that were raised - family history of alcoholism, depression, and the increasing hardships that people face today. Mr. Scott* had not consumed any alcohol since his last visit (which was October 2004) and this was verified by regular testing. However, Dr. James* questioned him as if he just had a drink last week. Mr. Scott* brought his younger brother along to verify the story that no alcohol had been consumed. Dr. James* sent Mr. Scott to blood services to have his blood check. During all of this, I realised that this isn't the type of doctor that I want to become - a doctor that has become disillusioned and jaded by their patients and the system that they work within. I know that I am a newly minted medical student but upholding the dignity and respect of your patients should be of paramount importance.

After finishing up the observations, I headed home and then went to a friend's place to meet up with some more friends (Kate, Maie, Phil, and Renee) to study. I have noticed that I quite like to sit down with a group of people (albeit a small group) and study (yet, there are the intermittent conversations but they become more and more related to the topic at hand as the session progresses - I like to call it "nerd talk"). I finished up the rest of immunology ending it with T-cell immunity and cell-mediated immune responses. The study session lasted for about 5 hours and then I headed off to the Regatta to meet up with Dave, Suzanne, Yvette, Dan, and a whole bunch of other people from class. I like being able to reward myself after a long day's worth of work. And at the moment, the best reward is being able to spend time with friends in an environment outside of medicine.