Transition from university to hospital

Over the past few weeks, I've had to adjust to the hospital environment. Unlike at university where people can let their guard down at times, at public places in the hospital we must be prudent in our manner so that patients and doctors do not have a bad impression of us.

We are required to dress neatly, and at my clinical school, males are required to wear ties. They also like to send us txt messages to make announcements to us. So I guess they've kept up with the 21st century, unlike some primary and high schools. That reminds me of a UTAS professor who advocated for this kind of contact with high school students a few years ago. He said (paraphrased) "imagine the effect of a txt saying 'the principal wants to see you now'". Anyway, that's an aside.

Maybe our clinical school is old fashioned in some ways, but we are advised to refer to patients, other students and staff by their surname when on the wards, unless a patient told us they preferred their first name. That reminds me of a study showing that generally speaking, those who preferred to be referred to by surname rather than first name were older.

There is also the aspect of confidentiality. I am not someone who likes to talk about other people's secrets. However, for the purpose of improving our interview skills, I do have to debrief with my buddy and/or other people present at the time when I was doing the interview. During this time, we must make sure that others who were not present are not around. Another issue of confidentiality is that pulling the curtains around a bed when interviewing patients really doesn't prevent sound going through, but aside from bringing people into other rooms (which generally isn't done), we really don't do anything to stop others in the room hearing.

And finally, sometimes when I want to go from A to B quickly, I sometimes like to go down steps quickly and jump the last few steps before turning around to the next set of steps. Of course, it's not as extreme as sliding down the rails. But I was instinctively running and jumping down stairs a few days ago one or two times before realizing that maybe it wasn't such a good thing to do in a hospital as a medical student wearing a tie and having a hospital ID card.

[update] Grand Rounds

Today I sat in a Grand Round presentation for the first time. In the Grand Rounds, a few interesting cases are presented for doctors and medical students to listen about.

At my clinical school today, the topic was Paroxysmal Nocturnal Hemoglobulinuria; a rare disease. Cases were presented with a benefit with treatment of eculizumab, an inhibitor of C5; subsequent to which quality of life was improved and there was often no need for subsequent blood transfusions. Data from studies was also presented which showed a reduction in mortality with eculizumab treatment. However, the cost was not cheap; I think it was about $300000 per year for each patient. That raises a question about how much society is prepared to pay; there is a clear benefit to the patient, but money is limited.

The other thing I noticed at the Grand Round was all the pagers and mobile phones of doctors going off. Although I've been to the wards, I've only had two weeks at the clinical school so far so I haven't been attached to a team (that will come later). As such, although I've interviewed a few patients, I haven't really observed any consultants, HMOs or interns in action. All those pagers and mobile phones going off during the Grand Round just reinforces how busy they are!

[update] First clinical week completed.

Yesterday I finished my first week of clinical school. My clinical school decided to give us a relatively light first week. We only started at 8.30 on two days and only finished later than 3 pm once. We will definitely get longer hours in future weeks.

This week, our clinical groups were assigned to look at different parts of the hospital and report back. Our group looked at the kitchen. Our hospital is not small and also supplies food for other places, so the kitchen has an efficient production line process, where people at different parts of the process have different jobs; while still rotating the meals from day to day. Very impressive!

Another thing I have to do this year is get used to receiving online lectures, although the vast majority will still be in person; especially at the clinical school I go to. We didn't have any last year, and it took me a while to find them on the new IT system they have for medicine, but I've managed to find them now.