General medicine – part two
Part two of the post on general medicine was going to be on all the things I disliked about the rotation, but it was too uninspiring to sit down and write about properly. It was the poor rostering of half days being scheduled on the team’s busiest post-take days, the almost daily overtime that the hospital refused to pay, the unrewarding nature of the work where the more patients you sorted out and discharged the more new patients you were distributed, the inefficiency of rounding – by yourself, then with the registrar, then with the consultant, all on the same morning… and more that I may have conveniently forgotten now with the passage of time.
Not as many emergencies as you might imagine
Emergency was better, without any of the above. It is stressful, yet not for the reasons seen on TV, where excitement is constant and crashing patients is the norm. These are a series of patients over one night. Looking back, I find some of this amusing now.
1. A middle-aged lady with some description in the triage notes about vague dizziness, weakness all over, anxiety, headache and pains here and there. Had extensive scans with her local doctor, which were normal, and it was unclear why she came in at midnight to emergency. It was very difficult to ask questions because whatever symptom you mentioned, she would say yes, I have that. Her friend who was with her, obviously concerned, chipped in constantly with additional symptoms. I guess if you don’t know what’s going on, even minor things can seem quite worrying. At least in the end she agreed that perhaps there was a psychosomatic component and maybe some things are managed rather than cured. It hurts my head thinking about that consult. I realised that no one likes presenting histories or making referrals with cases like this, because it always makes you sound unfocused, compared to more well defined things such as a fracture, or chest infection.
2. A nice chap with an infected finger. Had it drained but lots of pus had re-accumulated. I drained it again, and he went to short stay for the evening. Nothing much to say here.
3. A man who came in with feet swelling as the triage complaint. He looked like a homeless man you would pass by on the streets, and said himself that his memory was impaired due to excess alcohol. His feet swelling ended up not being swelling at all, but redness and skin slough in parts of his toes where his shoes had been too tight. He bought these shoes at the market several weeks ago and had been wearing heavy socks in summer. The toenails were yellow and overgrown, the feet were drenched in sweat and the smell permeated the poorly ventilated room. He said over the holiday season his podiatrist was away, and also he couldn’t change his footwear because there was no money to buy shoes when a proportion of the allowance goes to pay for supported accommodation and you need to afford things like, smokes. We made an agreement before he left, and he said his father is not alive now but had taught him to always keep his promises.
4. A young lady who usually gets gastritis and vomiting after taking particular types of pain medications, came in with those symptoms after taking the same medications she knew she couldn’t tolerate. She sighed, and whinged, and carried on, whilst giving her story and whilst I examined her. Unless there is a specific reason not to have them around, I don’t normally ask accompanying friends or family to leave. But during this consult, I wish I did, because the boyfriend would say every few minutes, “oh baby, are you okay?” and she would sigh louder and complain even more about the pain. Then the boyfriend turned to me and explained that they were in their first year together, and was in that honeymoon period where they were so in love that they didn’t mind catching each other’s diseases, and they had gotten colds and things more frequently lately because of that; but maybe after a year or two they would ask each other to keep away when they were sick. Oh well, at least he had good insight.
5. A man with multiple abdominal surgeries, the most recent one being done for a complication of a previous surgery. He came in with pain and abdominal distention, after reaccumulation of a collection that had been drained. He had come in some days prior to when I saw him, and the family was angry that “nothing” had been done. They were angry that the drain tubes had been taken out several weeks post-operatively. They wanted nothing more to do with their private surgeon and told me to make sure that they didn’t have to see him in his rooms again (huh? from what I understand they chose their own private surgeon and have no obligations to keep seeing him). There were three daughters, who were caring towards their father, but whom I found confronting and unpleasant. Though I do find it easier to not be affected now that I see people are frustrated not so much with me, but their situations, or the health system, or about having health problems at all.
6. An elderly man who came in with recurrent chest infections. His wife was fixated on the idea that this was because of a surgical procedure two years ago, in which his pacemaker insertion had to be revised. She was angry at the hospital, demanded to see the surgical team that had performed the procedure “today, now!”, and wanted to sue the hospital. When the registrar came in to speak to her, she raised her voice and became even more angry. I wanted to tune out, and maybe I did. She was angry that being a waiting room patient, her husband could not sleep on the consult room bed but had to wait in the waiting room for results.
There is such a sense of entitlement (even after explaining how the public health system works) of why should I not have my MRI now, why am I seeing you instead of the consultant on the inpatient specialty team now, why am I being seen in outpatients clinic instead of having my problem sorted now. Aside from patients there is also the conflicts with other staff. The unpleasantness of registrars who hate you for giving them referrals and hence, more work. The teams who instead of taking a few steps across the room to speak to each other, argues by passing messages through you. The nursing staff who patient after patient take only say, the pulse and saturation, instead of doing the full obs. Or those who are annoyed at you for asking them to give medications, when it’s not actually possible for you to just administer it yourself. I think delegating is important, because there are people employed to do certain tasks and they should do them; but often the sarcasm received and the delay in getting things done, was not worth the effort. Interacting with people is exhausting.