Monday, 27 September 2010

Another space filler

Urgh, I am having trouble finding the time for a proper post, but here's a little something for this evening: The Differential Diagnosis

There as many ways to do this as there diagnoses (PRO TIP: It's never Lupus, but it might be TB) but the one my PBL group has settled on for the next few weeks is the acronym, Investigations - a like so,

Idiopathic/ Iatrogenic
Neoplasm
Vascular
Endocrine
Structural/ Mechanical
Traumatic
Inflammatory
Genetic/ Congenital
Autoimmune
Toxic
Infective
Old age/ Degenerative
Nutritional
Spontaneous/ Social

And as for history taking, I'm yet to find a good one, so I just end up humming...

Sunday, 26 September 2010

Entertainment, journal style.

I have a proper post for this week, but I've just stumbled across A Good Poop and it reminded me that people write medical papers because sometimes life is just too bizarre.

It doesn't look like it's still being updated, but it does have a some intriguing papers and now I've got my BMA membership, I might well celebrate by hunting through the BMJ archives for more oddities...

Sunday, 19 September 2010

One thing I have in common with Don Draper

Last night was a night out at The Blues Kitchen in Camden which was pretty awesome. It's quite boutiquey and didn't get crazy busy which was nice. There was some great food, proper American Southern fare and some great drinks particularly the Old Fashioned that I spent most of the night drinking. And unsurprisingly the music was blues, which makes for good background noise when you're eating, drinking and chatting.

I'm quickly beginning to realise that this kind of thing will have to be a once in a blue moon event as I am now coming to the end of my last paycheque. From here on out it's student loans and whatever I can get from the occasional shift - although I'm still yet to actually get on the staff bank.

Saturday, 18 September 2010

The first of many

Another week down, first exam out of the way.

This week we covered a topic that I'm pretty familiar with, both from many years studying it and from having to care for patients who have had it. I hate being so cagey about the topic of the week, but our school teaches by PBL - problem-based learning and repeats the cases each year, so in the unlikely situation that someone from next year's group reads this they might get a feel for what cases they will see and I will get in trouble. Or something.

Gah.

Anyway, the PBL case was pretty cut and dried, compared to last week, so it was just a case of nose-to-book and sucking up as much information as possible. I think it's a little ironic that the course dresses up learning with so much back story, patient depth and the like, and it all just leads to going to the library and opening a book and IRL ctrl+c, crtrl+v. It's the self-directed aspect that I guess we do have the onus on us to work at learning, but still, I think my point stands.

Our exam this week was BSL (or CPR, depending on where you come from). It was a nice reminder for me that I still know it to a level considered competent. Inside a hospital CPR is a strange beast that doesn't involve "rescue breaths" and counting to 30 for the chest compressions, invariably because you're being led by an anaesthetist who is keeping track of everything for you. But for the sake of the exam I did my counting, I noted the lack of chest movement from Anatomical Annie and called for help in a suitably loud voice. I passed but was chastened for winking at the examiner on the way out. It wasn't a creepy finger-guns kind of wink, just a friendly gesture. The examiner didn't see it that way, but they didn't fail me either, so I'm not too bothered. Especially seeing as one of my course-mates failed AND got yellow-carded for swearing at the manikin.

And now the weekend, in which our intrepid hero tries to fix his bicycle so he can save a few pennies in train fare and lose a few pounds in excess body weight.

Sunday, 12 September 2010

That was the week that was

One week down, so very many more to go!

So it looks like my PBL case wasn't as straight-forward as it seemed - the presenting complaint didn't resolve into the most common differential diagnosis, but rather a <1% kind of thing. And at the end of the week we were treated to an expert forum with a specialist surgeon, to allow us to ask questions about aspects of the case we were not totally sorted with, only to have the surgeon say the diagnosis was "what you decided it was when you had ruled everything else out"!

To be honest, I'd suspected the straight-forward answer was unlikely to be it, if only because our learning around the topic is expanded 100% if we spend half the week chasing one diagnosis only to have it go lateral on us by thursday; leaving us to have to follow up on this new direction.

I've never worked this hard before, but it was fun and made the drink post-lectures on Friday night feel that bit more earned. However, on my walk home my iPhone made a brave leap for freedom and dashed itself on the pavement (this is my story and I'm sticking to it). This gave me ample opportunity to pick shards of glass out of my hand when I picked it up and admire the spiderweb pattern of cracks and fissures. Now the offending 'phone has an adhesive plastic cover on its back to cover the worst of the damage and a rubberised bumper around the edge; the net effect has converted a sleek piece of 21st century design into the cell phone Special Kid. It's not a great look, but it should avoid future damage.

I'm determined to keep as much of the weekend as I can for enjoying the company of my wife and my friends, a life away from medicine. Being suckers for a good film, we watched "The Crazies" last night and thoroughly enjoyed it - Timothy Olyphant does his best to survive escaping his midwest town after the populace go mental and start killing each other. Then this afternoon we went for dinner at Tortilla (easily the best Tex-Mex in London) and then went to see Inception at the BFI IMAX (allegedly the biggest screen in Britain, something I find easy to believe). Inception is a great, thoughtful, violent and engaging film that doesn't spoon feed you plot and expects you to keep up. The reward is another strong performance from Leonardo DiCaprio, incredible visuals (try and figure out what's CGI and what's just clever special effects) and a tight plot that keeps the pace up for the entirety of the film.

Oh, one last thing, a new resource I've just come across is http://www.keepingup.org/, a site dedicated to digesting the latest news in emergency medicine and putting out a weekly 25 minute podcast bringing you the more thought provoking stuff. This weeks was particularly relevant for me as they covered new research around the relative merits of chest compressions alone vs. standard CPR. It's free and a valuable learning resource, so it gets my vote.

Now a glass of whiskey, make my lunch for tomorrow and to bed.

Wednesday, 8 September 2010

Drinking from the fire hose of knowledge

So, Medical School.

It's been nearly two weeks since I got my ID card, locker and dissection room coat and I am so happy that I went down this particular trouser leg of time (sorry for borrowing your analogy, Mr Pratchett).

My course graduate-only and consequently it is a broad church; people from all walks of life (I'm not the only nurse!) and with lots of different reasons behind wanting to study medicine. I think for a lot of people it is a personal challenge, which is nice because I think it means they will be very engaged with the course.

The structure is very much oriented to Problem-Based Learning (PBL). We have a session for a few hours on a Monday morning where we are given our case, then we discuss the issues that arise from it and any learning objectives that we think are relevant to the case.

And then we turn on the fire hose.

I have never had such fun leafing through books in a library and learning. My knowledge-base from nursing has given me a bit of a leg up, I suspect, but this is just learning turned up to 11. I have spent every day this week buried in books and journal articles chasing learning objectives arising from the acute abdomen and I love it. And after the intro bumf of last week, it's nice to kick things into high gear and get learning.

Some of it however is covering old ground - a BLS session that I could have done with my eyes closed, even down to calling out "CAN I HAVE SOME HELP PLEASE?!" in a crowded room (something that always makes me feel stupid). But this is to be expected. One of the most exciting bits of the course for me is finding out where my knowledge ends and where the new material I am expected to learn begins.

The hospital my medical school is attached to has its own nursing bank so I have applied to work there, money being unsurprisingly tight and I want to keep my hand in, too. Nursing has given me a lot in terms of supporting knowledge for medical school and I hope it continues to do so for the next few years. As part of the application process I had to take an entrance exam - drug calculations and a scenario-based "answer of best fit" MCQ section. Happily I scored 100% on it, so I guess I've not got that rusty in the past couple of months I've been off work.

Perhaps the most surprising discovery for me is that I think I have found the soundtrack to my independent study - Trance. I am an indie kid at heart and wouldn't have listened to dance music if you paid me previous to this, but trance is the music I can study to surprisingly well. And it means if I get bored in the library I can, quite legitimately, start throwing shapes in the church of dance. Or something.