Categories
Work Experience

GP Day Wednesday

I apologise in the delay for the last end of the week, here’s Wednesday in surgery.

Wednesday in surgery and it would be assumed that a morning shift for a GP and student would be relatively quiet considering I was only scheduled to be in for a few hours…

We saw a 5 year old boy with acute tonsillitis. His Mum told us how he had just got over his last case and was suddenly suffering again. A quick check over and all seemed fine in his observations, his chest was clear and he wasn’t struggling for breath. We took a throat swab just to confirm if the infection is bacterial. All, in all, it was apparent that this young boy had seen his fair share of GPs, even his throat swab didn’t phase him! He currently already had a referral back to ENT so we didn’t have to do any referrals this time, although it was discussed that the possibility of having his tonsils removed maybe the answer. He was prescribed with antibiotics as it was fairly certain this was an ongoing bacterial infection, despite the swab, and they were advised to come back if symptoms persisted, deteriorated and to call for his results.

An elderly gentleman attended surgery for a check up on a boil that was present near his stoma site. He had previously been in and started medication to help clear this up. The difference after his short course of medication had been noticed immediately and the boil looked very minimal, swelling and redness weren’t visible and it was healing nicely. He still had 4 days worth of his medication so was advised to continue and if he had any problems, he was to come back in, although we didn’t anticipate there would be any.

A middle-aged woman came in with persistent headaches, her temporal pulse was stronger on her right side, the side associated with her headaches. She said she suffered from similar symptoms expected from conjunctivitis – matted eyes in the mornings although, on seeking advice from an optician, her eyes were given the all clear. We performed a short eye exam and put dye into her eyes, examined them under UV which showed no fluorescence. We checked all her reflexes, BP and temperature. She was booked to get bloods taken as the Dr was concerned that the headaches could be something more serious e.g. query tumor on the blood vessel that supplies the brain and optics.

A male presented with a moles on his back that his wife had noticed some colour change. He had a history of BCC so they were of course being cautious. We examined the moles and all looked normal in appearance, were soft and squidgy to the touch. There were no signs of malignancy. After informing them that they were benign they were happily sent on their way but ensured that if they had any doubts, to return.

MDT Meeting:

Every week, the practice holds a Multi-Discipline Team Meeting. It gives the opportunity to discuss patients with District Nurses, OT, Physio, Safeguarding, Care and the Cumbria ICC (Integrated Care Communities). Patients are brought to attention and any concerns that are currently held for the patient raised. This can be as simple as discussing the fact that a patient has been admitted to hospital and is due discharge, the discussion of why they were admitted and what help; if any, that they require in place for discharge.

Patients raised today were:

  • A gentleman was discussed regarding his dementia and history of falls. He is often confused as to who visits him and when, does not know who his help is and there are cognitive concerns raised by his daughter. He has a history of strokes.
  • A breast cancer and Alzheimer’s patient who’s primary carer is her husband who is battling with bowel and ? bladder cancer. It is known that the wife is palliative. Concerns for her care as her husband is also in a position of needing support, himself.
  • A male who has been involved in adult social care, DN have noticed his right leg has been swollen, he is not eating or drinking and also appears to be wearing the same clothes he was wearing last week on their visit. He lives alone and is showing signs of self-neglect despite being supported by care 4 times a day. He is housebound and is very adamant that he does not require help and will decline it rather sternly when it is offered.
  • A patient being discharged from hospital imminently of spinal stenosis and is currently catheterised. She will be followed up but the discussion was surrounding her further care at home of which, she currently has a hospital bed at home and care being provided for her.

Home Visit:

Our home visit was to an elderly gentleman who’s son had requested the visit. We arrived and it was already apparent that this gentleman was struggling. He was extremely weak, pale pallor, visibly struggling for breath and breathing laboured. His oxygen saturation was low, his chest incredibly crackly and overall presentation poor. It was apparent that he would be an admission and due to his condition it was to be via ambulance. It was explained to his son that he should get things ready for an admission and that he was query chest infection that had progressed to pneumonia. Due to the lack of landline and being in an incredibly rural area, the call for an ambulance had to wait until we were able to get back to the surgery. Not ideal but overall the better option than hunting for somewhere with signal, risking it cutting out when the time taken to get to surgery would be quicker.

Overall:

For a short session, there was an awful lot covered. It was great to meet with the other healthcare and social care that work behind the scenes of patient care but are ever bit as important as any other.

What I learned:

  • It is important to build good relationships with other health/social care professionals – it gets jobs done quicker and is much more friendly.
  • Rural house visits are rural. Be prepared to travel.
  • You may also pass the ambulance that you’ve called for on your way home from the surgery.
  • When patients come back to see you again, it is not necessarily because you’re doing a bad job, it can also be to review how well treatment is going.
  • Your patient may be a young child but the majority of the time it may feel like their parents are the patient – they worry.
  • Patients do often take your advise and do visit when they are concerned about something as trivial-seeming as a mole – it can be really important that they do and you praise them for it.
  • Your instincts are not to be ignored in medicine.
Categories
Work Experience

GP Placement – Tuesday

Today we were at a different practice and completing minor surgical procedures. There was my Dr, myself and a qualified Nurse present for this.

We saw a total of 5 patients; 4 of which we completed procedures on.

Patient 1:

A male presents with a cyst on his back. Took him through and lying on the bed. The cyst was marked to show the margins and incision line (this was checked as the patient was standing – the cyst is pushed by two fingers either from the left and right or up and down to see which shows the most elasticity. The elasticity allows for suturing and minimises the risk of sutures bursting or the wound reopening and not healing.) Local anaesthetic was dawn and injected into the site, around the margins. The amount of anaesthetic used was as minimal as 0.5mls.

The site was checked to make sure there was no sensation and that the anaesthetic had kicked in. The initial incision was made with a round-bladed scalpel. This cyst was very superficial and could be seen very quickly from the first incision. With a bit of patience and retraction the skin was cleaned from the surface of the cyst. Forceps were used to help ensure the cyst was fully unattached before removal. This cyst was attached quite well and on removal, the base still remained attached. After a careful extraction of the base of the cyst, the sample was bottled and the would sutured with 4 sutures and dressed.

Patient 2:

Patient 2 was a male who had a mole on his back that he wanted removed. Again, it was inspected and found to be benign. We took him though and injected the local anaesthetic. Moles don’t need to be marked up as they have clear margins due to their colour and the procedure. Once anaesthetic has kicked in, the mole was literally scrapped away from the skin. Moles often will do this although it is not recommended that patients do this themselves! Once removed the sample is bottled and the wound is burned to prevent bleeding. (People mention the smell of burning skin and it doesn’t/ didn’t bother me but I can imagine some would be put off by this! It reminds me of when a big fly/ wasp gets zapped by the big killers!😂) The site was then dressed.

Patient 3:

Patient consulted for a mole. Mole was very ‘squidgy’, no colour changes or other features of malignancy. The patient was happy and so it was decided not to remove it.

Patient 4:

A lady came in with a skin tag on her neck. She was having problems with it getting caught on clothing or when she brushed her long hair. We agreed to remove it although had informed her that if she could manage with it, removal wasn’t necessary. Due to the location she was adamant that she would like to part with it.

We took her through and injected anaesthetic. The tag was removed using a flat ended scalpel, the area was then burned to prevent bleeding and dressed.

Patient 5:

This gentleman had been to have a cyst removed previously. Unfortunately, he hadn’t eaten breakfast, had been up all night with his young child and generally felt unwell. He told me how he had seen the instruments being prepped, eyed the scalpel and felt very unwell. He did the right thing and informed the GP and nurse who both discontinued the procedure. He assures us that he was well rested, had eaten and was feeling very well.

He was a very nervous patient and was oversharing and very chatty as a way of coping with his nerves. We took him through and marked out his cyst which was on his scalp. Again, injected local and once anaesthetised, the initial cut was made. This cyst had been present for a while and proved to be a bit trickier to separate from the superficial layer. It also presented as being deeper than the first. It took time and patience to get it to the position of removing it, although once there, it was removed easily and came out all intact.

With the position of the cyst being on his scalp, the sutures don’t follow the same rule as the previous and stitches were thrown from front to back of the scalp. My GP took the time to explain that throwing a vertical mattress stitch in the middle of the incision meant that the edges of the wound would close together, evenly. This would prevent the edges of the wound overlapping, healing unevenly and taking longer to heal. Two more stitches were thrown either side to close the incision nicely.

Afternoon:

We spent the afternoon in surgery, again, a variety of patients and ailments. We managed to see 7 patients in our short session.

First patient was a gentleman who had a ?UTI. He had booked the appointment however, had previously seen a nurse practitioner who had prescribed some medication and things seemed to have settled. He described himself as being well. He had brought a urine sample and it was dip tested. The strip lit up like a Christmas tree! He had proteins present, blood present, the whole works. Despite his reluctance due to feeling back to normal, he was strongly advised to finish his medication and to hand in another urine sample after the course of treatment to rule out any other possibility.

A women with knee pain and had a history of neoplasia. She was advised to have bloods taken as a precaution before further treatment/ investigation.

An 11 month old presenting with chronic pain up to 20 minutes after feeding, up to 3 times a day. The baby would go rigid and arch his back whilst screaming out in pain. Mum had brought baby in and seen a Dr who had prescribed lactulose for constipation and mum had not been convinced so requested a second opinion. Baby’s chest, ears and throat were examined. His temperature was within normal limits. He was examined, abdomen was soft and non-tender. He was stripped completely and check for any signs of construction or lack of circulation. He was extremely happy and smiley all the way through. No signs of any other cause of pain and it was explained that we weren’t siding with a colleagues opinion and that we would always welcome any patient or parent to do the same, however on this occasion we would recommend taking the lactulose, even splitting feeding up with cooled boiled water to help as breastfeeding. Any more problems and come back to the surgery.

A gentleman who’s forehead was quite scaly and red. He was given some moisturising cream and steroid cream to treat. He also had some moles he wanted checked. Happy to report all were benign and posed no problems so are happy to be left alone.

Another young child with a viral infection. Temp was high, breathing a little laboured, ears red. Prescribed a course of antibiotics and again, if not seeing improvements, to return to surgery.

A man had a cyst on his neck. He previously had one on his face, was booked to see Dermatology at the hospital however, before the appointment it resolved itself. We both inspected the cyst and were happy it was benign however, due to its location, it would be removed by Dermatology. Referral completed.

An interesting one! A gentleman came in after having a punch biopsy performed for malignancy. The area where the biopsy was completed wouldn’t heal. It was inspected and pathology results consulted. He was referred back to his hospital consultant. It appears that the clinic letter stated that the punch biopsy was completed and malignancy was removed successfully. However, the pathology results showed that there was only the punch biopsy completed. The malignancy was never removed, hence why the wound would not heal.

What I learned:

  • Always eat breakfast before minor surgery.
  • How to throw a vertical mattress suture.
  • That cysts can smell.. badly.
  • Patients won’t tell you when they’re nervous.
  • A qualified nurse isn’t always required in minor surgery but it’s really refreshing to have a fellow healthcare professional assisting.
  • Parents feel extremely guilty when they are ill and then their child becomes ill. It can be emotional.
  • Consultants and GP’s can often get things wrong/ make mistakes, we are human. It’s important to check your work (or that of your secretaries).
  • A second opinion is never a bad thing or a question of someone’s ability to diagnose.
  • The importance of taking a full dose of antibiotics/ medication. You may feel better or normal but infection can still remain.

Overall:

I thoroughly enjoyed the minor surgery experience. I’m not squeamish and it was great to see that a GP still has the opportunities to use some finesse and surgical skills should they want to. I enjoyed having the opportunity to talk with a qualified nurse. Claire was lovely! We discussed the importance of asthma checkups (she runs an afternoon asthma clinic) and how asthma isn’t always a 100% foolproof diagnosis. It’s all a learning curve.

Categories
Work Experience

First Day on GP Placement

FIRST GP DAY – Monday:

I started my GP placement yesterday at a rural, yet busy GP practice outside of Carlisle.

Who we saw:

We saw a total of 9 patients in surgery and 1 patient was a home visit. I’ll briefly describe each to get a feel of the variety of patients, their symptoms and our treatment steps.

Our first Gentleman presented with ear scarring that was originally a large bump/ wound. He was given cream and had no/ to little effect. Due to this, he was referred to Dermatology but not before he also volunteered for his flu jab!

Woman presented with shoulder pain, not a lot that could be done other than pain management and an x-ray being booked.

The next gentleman was well known to my Dr. He is currently under review as he has had malignancy within his lungs. Thrilled that his chest and lungs sound clear. Booked for further review.

We had my first child in. He was a 14 month old who had been ill for a week now and has had a constant high temperature. Not eating or drinking and passing no urine. Mum was extremely emotional so a precautionary admission to the paediatrics on-call at the hospital.

An interesting one. A lady came in following recent tests. Her HLA-B27 (human leukocyte antigen) gene test was POSITIVE. Whilst a positive HLA-B27 gene is not always a sign, she fit many of the criteria for ankylosing spondylitis and as such, had her first diagnosis. She was referred to Rheumatology.

A young lady had concerns for scar tissue on her nose from where a doctor abroad had taken away a query cyst. Scar tissue looked normal and didn’t show any indication of malignancy.

An other young mum brought in her baby boy. He had a wheeze however didn’t show signs of laboured breathing. His ears were red but his temperature wasn’t highly raised. He was prescribed a course of antibiotics and mum reassured.

We had another review patient who came in and we requested repeat bloods and cholesterol.

Part of a GP’s workload also includes home visits. I was fortunate enough to be invited along – an elderly, almost completely bed ridden lady who also suffers from Raynauld’s Disease. She presented with the feeling of stocking legs where she felt as if she was wearing compression stockings and had pain. Her pedal pulses were check and we weren’t concerned that she was presenting with possible DVT. District nurses were informed and would visit to ensure all is okay.

We also had a few phone calls to make – one to a patient to inform them that results had come in and were absolutely fine. They were an anxious patient so calling was a way of putting them at ease.

The second call was a bit different. It was a request from safeguarding for information regarding a mother, her unborn baby and the baby’s father. The father had been red flagged at appointments as being under the influence of drugs. They requested any information as to his substance abuse, mental health and admissions.

What I learnt:

  • I was given the opportunity to listen to a child’s laboured breath sounds.
  • I was able to look at a young child’s ears and see how red they are.
  • I was able to examine scar tissue closely and confirm no malignant markers.
  • I was shown how to refer and fill in referral forms to the hospital for various specialities.
  • I was shown how to approve medications for repeat prescriptions.
  • I was shown the admin sides of a GP’s role.
  • I was fortunate to experience the reception side of a practice too.

Overview:

A large variety of patients, all requiring different needs and clinical advice. A large learning curve but more hands on than I imagined. It’s set this week up to be really, really, exciting!

Categories
gamsat UCAT

Revision Sunday’s..

I was up early this morning and finished my first ever run through of Friends from start to finish. I’m both heartbroken and thrilled; heartbroken it ended and thrilled to watch it all again! 🙂

My housemate, Lauren finished her MSc a few months ago and gave me her flip chart paper for revision, which was really kind!

I’ve started using a random quote generator and began to ‘brainstorm’ my ideas around it. Pros and cons, what the quote means, what the quote is telling you, whether I agree or disagree.

Hoping to get into the habit of analysing quotes and it almost becoming second nature. I used to love English at school and did really well at GCSE. Throughout my degrees, essays have been a big part of my learning so I do feel quite confident with the structure and building of an essay.

I’m hoping to also crack on with some science revision too. I’m thinking Physics as I truly detested it at school so will definitely need to begin from scratch!

A positive day for revision! 🙂

Categories
The Application

The Journey Begins

I’m one of many UK Graduates who are looking high and aiming for Medicine.

I work full-time in the NHS, volunteer as a Community First Responder for the North West Ambulance Service and balance studying in between!

Currently, I’m focused on taking the GAMSAT and UKCAT in 2019 for September 2019 application to Med Schools.

My choices:
Nottingham
Swansea
Warwick
St George’s London

Trying to keep motivated with study and hoping blogging alongside will help!

Follow my updates on Instagram: @graduate_medic 🙂