Insights and Tips for Medical Students Starting their Clinical Rotations (1)
This is a summary of my insights and what I have learned (and what I am continuing to learn) from my experiences having just started out attending clinical rotations at 3 main hospitals in Thessaloniki, Greece.
Disclaimer: I am not experienced enough to give FULL in-depth advice to anyone. I am just giving an overview of my experiences so far and what I believe to be crucial for me and anyone else looking to improve their skills of becoming accustomed to clinical rounds and being present within the environment of clinics in general. Also, since I am attending Greek hospitals, it goes without saying that the things I am talking about go hand in hand with being experienced in the Greek language.
Initial impressions and my "oh shit.." moment:
As I had no real prior experience working in clinics or attending clinical rotations apart from occasionally watching surgeries in a select few hospitals in Cyprus, I honestly had no real concrete idea of what I should've expected. I knew that the issue regarding my proficiency in Greek was going to be a problem. I am quite proficient in understanding and listening but IMMEDIATELY become intimidated when it comes to speaking (this is just something dumb I keep overthinking but it will eventually go away). What hit me and made me think "Oh shit.." was the amount of stuff I realized that I didn't know anything about. I mean yeah, no one expects 3rd-year medical students to know exactly what drugs should be given and in what quantities to specific patients or what the pain could be caused by or what condition it could result in later, but realizing that I will have to eventually know a substantial amount of this is what gave me an overwhelming sense of dread and made me think to myself "should I even be in medicine?".
What's even funnier is that I knew that I would eventually come to this point where I would feel that there is SO MUCH to take care of. "How will I be able to take a concrete history of the patient without screwing something up?", "How can I do all of that in Greek and not forget a word and then look like a complete twat in front of the patient?", "How am I able to improve my clinical skills while balancing my lecture material?". These questions probably only make up 2% of the number of total questions I was contemplating. While I knew that I would EVENTUALLY be able to come to a point where I could balance half of that load, it still cast a blanket of pure blackness over my self-confidence. I could not stop doubting myself over everything regarding my knowledge and capability to learn enough for the sake of my future patients. I guarantee that while you are reading this, you too reader, have felt some of what I am feeling. If you are even remotely passionate about pursuing a career in Medicine, it comes without a doubt that you have felt varying degrees and mixes of these emotions.
1st week:
General interactions with patients were mostly the norm for the first week. We didn't do any checkups or take the history of the patient. Instead, the Doctor would introduce us to cases and perform the actual process of "History taking" for us while going over (in detail) why he would be asking such questions. There were also many cases in the following weeks where all we did was go over 1 case such as being introduced to a patient, the doctor taking the history, discussing possible diagnoses between us, and then going for coffee (which in all honesty was most of the cases but I can't complain since this is only the first month). But then there would be days when we were suddenly thrust into trying to take full clinical histories of the patients, both physical and written. These were the days when you were forced out of your comfort zone. This is where your experience as a real doctor is shaped. Where your mindset and level of tolerance start to take form and you start to see what it means to be a doctor. Now, of course, you don't have nearly enough knowledge to even compare yourself with a knowledgeable doctor and neither are you going to perform an emergency tracheostomy anytime soon (like you see so often in medical dramas), but, at least some light will be shone across a portion of the path that lies ahead of you.
There was one patient that week who made me feel a sense of urgency, not for myself, but for her. And what was worse for me was that I felt that I didn't know enough to be able to help her. It was a woman in her late 20s who had a complication regarding a perforated esophagus. She lay there on the bed with chest tubes directly feeding her a vile mix of "nutrients" (as she was not able to swallow food) while also pleading to be let up to walk around a bit. This was my first encounter with a patient that made me realize just what it meant to be working (or becoming familiar) with this field of study.
2nd week:
The second week was a lot more hands-on. We were thrown into a situation where we were told to examine the patient's physical capabilities while also taking a detailed history of their condition. The first time never really goes as planned. My mind kept blanking when I was asking my assigned patient questions regarding his condition, why he was admitted to the ICU, and how it could relate to any familial conditions (if there were any present). I also had to perform a BP measurement but funnily enough, I had completely forgotten how to do it without a machine. I also forgot where I was supposed to auscultate the patient and what exactly I was supposed to be aware of when percussing him. So, in total, it was a complete disaster. I also didn't even measure his HR correctly and when I told the doctor my "estimate" he ran to go check the patient's HR again because my "measurement" was below baseline...So yeah. Note to self: Don't "estimate" things when it comes to taking VITAL signs. Learn how to do it correctly and DO NOT make the same mistake again.
We were also introduced to a patient with an extreme case of jaundice whose skin had become completely yellow. From his forehead to his legs, every part of him was a different color. He was covered by a blanket to not show off his condition. The man also could not speak properly (I don't remember or know why) but I gathered by the look on his face that he wanted to keep the blanket on him at all times. This was also reinforced by the fact that when the doctor pulled off the blanket for us to see his condition, his face became exacerbated. Like a plea that could never be answered.
3rd week:
This was a pretty good week. On one particular day, we were tasked with performing respiratory examinations on multiple patients. This was also the first time I had heard multiple respiratory conditions through my stethoscope. Our first patient that day was an older man in what I believe was his late 50s. He had a condition with his left lung which caused his expiration to have a crackling sound. This could have been assumed to be present within both lungs since the crackling could be heard without the aid of a stethoscope. But, that is why it is so crucial to perform a thorough respiratory examination because only then did we deduce that the condition was present only in the left lung. Again, I forgot to introduce myself to the patient but thankfully I remembered with the following patients.
My most memorable encounter with a patient that week was with a patient who was in a complete vegetative state. He was unconscious and also had dementia. He could not stand up or walk around. He basically couldn't do anything. We were permitted by the doctor to listen to his breathing with a stethoscope but one thing that stuck with me was what the doctor had told us. "Even if your patient is unconscious, still you must introduce yourself". I didn't need to ask why, I knew what he meant. So, that is what I did, and even though I didn't get a reply, at least there was that element of humanity still present. I was not dealing with something. I was dealing with someone.
4th week:
This week we were only able to attend the hospitals once but that once was still enough for me. I got to take the history of a patient for the first time in a 1 on 1 scenario, This was a HUGE deal for me because I was so incredibly afraid of speaking Greek in front of others and in front of the patient. Not only that, I was scared that I either would not ask the correct stuff or would miss key questions that would help me gather the information I needed. Yes, I did mess up. A lot. But that was the goal. To find the gaps in my understanding and current knowledge and fill them in. For example, I forgot to elaborate on the pain that the patient was feeling. Instead of asking if she had any episodes of vomiting or diarrhea, I jumped straight to asking "So do you smoke?". But. I can PROUDLY say that I did introduce myself this time. Mad flex :D
Thankfully I had the doctor by my side guiding me and helping me understand what was going on. Many words in Greek that I did not understand and thus I will have to learn over time.
Useful tips and some general advice:
Make sure to ALWAYS introduce yourself to the patient. This is something I KEEP FORGETTING and to be honest I have no idea why. This even goes for patients who are unconscious such as the patient I talked about above who was in a complete vegetative state with dementia. You want to create a feeling of trust between you and the patient. Yes, introduce yourself to patients who are not even able to hear or understand you. I don't care if this sounds stupid to some but I emphasize that it simply IS NOT. Perhaps the patient will get the "feel" that you are indeed there to help them. Even if they don't understand I believe it is common courtesy to show that you are treating them as a human, not a "special case".
There is always more to every case. When taking a history of the patient always be mindful of information that either slipped their minds or was deliberately withheld from you. As I explained above the doctor was completely done with taking the patient's history only for her to burst out and tell us "Oh yeah my uncle and sisters also have x,y,z".
If you make a mistake or understand that there is something you don't know then try to correct it ASAP! What I mean is that if there is a mistake you made and realize you made it, make an effort to not make the same mistake next time. I did that when it came to not introducing myself. I forgot to do it with multiple patients until a friend of mine told me right after I made the mistake again "Introduce yourself with the next one, ok?".
Conclusion:
If I am to conclude with something it is this. Make sure to be present in the moment. Do not shy away from making mistakes AS LONG AS THEY DO NOT HARM YOUR PATIENT. Find the gaps in your knowledge and fill them in ASAP.
That is all for now. Hope you enjoyed it and I hope you were able to learn something from all of this!
