Two Days with the Phlebotomist

I spent Thursday and Friday of this week doing something a bit different form observing Dr B and spent 2 days with with phlebotomist (she was so lovely!).
Basically she runs the clinic and people just come in for bloods all day long! Before I started I had the opinion, "oh I can only watch blood being taken so many times!", I was wroong and I learnt some handy tips about taking blood!

A phlebotomist is a support worker or healthcare assistant (HCA) who collect blood from patients for examination in the lab. 

Things and Tips

• It is surprising how many patients come in with a huge phobia of needles and having blood taken. The blood taking process lasts no longer than 30-60 seconds, depending on how much you need to collect. Patients always say they have had a bad previous experience with having blood taken, and have had nurses that have been rough, left bruises and left them with a really negative experience. A lot of patients also don't like the "idea" of a piece of metal being inserted into their body. But Hannah (the nurse) pointed out that you need to focus the patient on the positives of the blood taking process, such as after it's finished and your chatting away and it wasn't really that bad etc. Otherwise they will just carry on being petrified of needles!
• As a doctor you don't receive a great deal of training in terms of taking blood, so be proactive and take some time to shadow a phlebotomist for the day and improve your blood taking skills.
• Feel for the veins, don't just go for the ones that you can see. Hannah said practice feeling and bouncing and rocking the veins for some fat juicy ones. 
• Problems you face taking blood: the elderly, who's veins have lost their elasticity, they have fragile, weak veins, arthritis may mean they cannot fully extend their arm for locating available veins. 
• Practice makes perfect! 

Now I'm at home practicing feeling my mums veins! 

GAMSAT Example Questions

Sorry about the lack of posts over the past few days, I've been a busy bee! Anyways, I managed to get my hands on some sneaky GAMSAT mock papers and I thought I'd show you what kind of questions you will encounter in the exam. 

 In case you cant read the text:
Newspaper reads: Labour to end something for nothing culture
Caption reads: Don't panic man, they're talking about the unemployed.

Q- The illustration above suggests which of the following?
A-In the midst of movement and chaos, keep the stillness within you.
B- Workers are often paid peanuts.
C- There are people who get paid for doing almost nothing
D- Unemployment gives rise to labour movements.

The speech in the picture reads: " Screaming Eyeball was a good movie but Bludgeon of Death was a great movie".

Q- The joke in this cartoon arises from the speaker
A- comparing good and great films
B- attempting to compare such different films
C- not seeing a greater difference between the films
D- expressing admiration for such bloodthirsty films

I'll post the answers if you somebody leaves a comment asking for them! :) 

Question to My GP - Why Did You Want To Be a Doctor?

It's a biggun - this question will be in your medical school interview, and people will ask you all the time!

WHY DO/DID YOU WANT TO BECOME A DOCTOR? WHY NOT ANY OTHER HEALTHCARE PROFESSION? 

Everyone will have their own reasons of course but I asked this question to the GP I am shadowing and these are the points he came up with:

• He wanted the responsibility for the patients health and the long term relationships that you can build with patients. 
• He was more interested in the diagnostic side of medicine, using your brain to solve a case, rather than doing something like radiography where you are performing a task. He didn't want a task based job, he wanted one where he could use his brain more.  
• Medicine is a constant learning curve, you never ever stop learning new things.
• Not that being a doctor is a superior job compared to roles like a health care assistant, but things like taking bloods, etc just wasn't for him, he wanted a big more.
• As a doctor you receive the clinical training that nurses and other roles don't. 
• He also wanted to get involved in the teaching side of medicine

Another question you might be asked in your interview is "Why not being a nurse?"

DO NOT SAY NEGATIVE THINGS ABOUT NURSES

It takes people with different levels of responsibility to work together to create effective teamwork in order to treat a patient. Also success and ambition mean different things to different people. Somebody might be more than happy taking bloods all day, or undertaking x-rays all day and thats fine! But you might want more, and thats fine as well, you should respect that fact everyones idea of success, job satisfaction etc are different. 

Some Interesting Cases in the Surgery!

Another day of GP shadowing today and I saw some pretty interesting things!


1- Potential Bladder Cancer Case  80 year old male presented with blood in urine, although there was no more visible blood in the urine today, a dip stick test showed that the urine sample was full of microscopic blood drops.
Diagnosis depends on the patients age sometimes:
Somebody of my age (20's) = they would want to exclude infection first
Somebody 50-60+ = You would want to rule out any chance of bladder cancer as it is easily treatable when caught early. The patient presented with 2 kidney stones but they were non obstructive, so the patient was referred for a cystoscopy, which involves passing a flexible camera down the end of the penis to view the bladder and see if there are any polyps on the bladder wall (done using local anaesthetic of course)
If anybody presented with blood in the urine, the first steps are to perform a blood test and an ultrasound of the bladder.

2-Lady With CRAZY High Blood Pressure  47 year old female had been taking blood pressure readings at home for years and failed to bring to the attention of her GP that her blood pressure was dangerously high.
We're talking 200/122! 
She is being seen weekly until her BP in under control.

3-Super Cool Fracture  Male patient came in today about his problems with fully emptying his bladder and problems with the flow of his urine, BUT the interesting things about this patient was that he has a permanently fractured odontoid peg that doctors discovered after he electrocuted himself on his boat a few years ago, and have said it is too risky to operate on.
You can see in the photo an x-ray of a patient with their mouth open and you can see the odontoid process quite clearly. The process is a projection of the axis and allows us to rotate our head.

4-Necrotic Toes 
80 year old female came in a few weeks ago after stubbing her toe, and the nurses thought it was a haematoma, so dressed her and sent her on her way. 2 weeks later the patient was back complaining that her toe wasn't healing, and on removal of the bandages it was very clear that the injured toe as well as the adjacent toe was necrotic. 
The nurses took her blood glucose just as an off chance and it came back as 22.4!! The lady confessed she hadn't been to the doctors in 13 years and that she had a terrible diet of chocolate and sweets, obviously she has developed type 2 diabetes but not presented with any usual symptoms and so went however many years with uncontrolled diabetes! The wound she sustained from stubbing her toe then obviously did not heal properly due to the decreased blood flow to the feet from the diabetes. The lady had both the toes amputated at the local hospital later that day. One of the major complications of diabetes is the development of PAD - peripheral artery disease, which is the blockage or narrowing of arteries, in particular the ones in the legs.
I wont upload a photo of necrosis, it aint pleasant!

Got Me Some Books!

While I was on Amazon ordering my UKCAT books I decided to order a few more books to help with med school bits and bobs:



Medical School Interviews - http://www.amazon.co.uk/Interviews-Questions-Analysed-Includes-Multiple-Mini-Interviews/dp/1905812051/ref=sr_1_2?ie=UTF8&qid=1372946398&sr=8-2&keywords=medical+school






Get Into Med School, Write the Perfect Personal Statement - http://www.amazon.co.uk/Get-into-Medical-School-statement/dp/1905812108/ref=sr_1_2?s=books&ie=UTF8&qid=1372946468&sr=1-2&keywords=get+into+medical+school




I shall you know if they are any good after I've had a read!

Work Experience Day 5 - Whats It Like Being a GP?

GP shadowing is going really well, with a huge variety of patients coming in everyday, but I'm just struggling with the 6am wake ups! I've been going to bed at 10pm (which is super early for me), and then when I get home at the end of the day I need an hour nap!

I also had a good chat with Dr B (Dr I'm shadowing), about the hardest parts about being a GP.

1-Patients expect you to know a lot about everything, compared to a specialist who only has to know a lot about their area.

2-The volume of work to do everyday, the lack of time, and the demands on you from nurses,social services and the hospital, if a patient is discharged from hospital because staff don't know whats wrong with them, they will go straight back to the GP, and a good proportion of people who come in with an appointment don't necessarily need one for medical reasons, they just want reassurance. Which is where the "social worker side of the job" comes in. 

3- The stresses on the GP's to take back working 24 hour shifts. Working 24 hour shifts were originally taken away from GP's, and in the Cornwall area given to a private group named SERCO, and now it turns out they are pretty poor and and government want to give the 24 hour shift back to GP's. Dr B said working from the early morning doing appointments, then doing visits and the huge amount of paperwork, then to go onto working nights you become exhausted and its not possible to work both days and nights. 

4-The demands from patients wanting resources. As a GP you cannot investigate everything because you cant afford to do so. You can't go ordering head scans and every test under the sun willy nilly, and GP's are also under pressure to save money (the NHS has to save £20billion this year).

 For example a 80 year old woman had been on long term drugs as a preventative measure against osteoporosis. The recommended duration of treatment is 5 years, but she has been on these drugs for 10 years and was wondering why she had suddenly been taken off them. Dr B explained the recommended duration but she wanted to go back on them, but she cant, not without good reason. She had already been on them for double the recommended duration, but we simply couldnt given them to her without good reason, and outside of the guidelines,  because it is expensive! Imagine if we put every post menopausal woman on preventative treatment for osteoporosis and to prevent fractures, that would cost thousands of pounds for every fracture you would save. 

Home Visits

Today was quite a sad day for home visits. We went to visit and elderly lady with schitzophrenia and end stage cancer of the gullet, she was not aware of her cancer diagnosis. Upon arrival she was all alone in the house, bed bound and extremely weak and pale. She said she has nurses come in 4 times a day to get her up and feed her, but apart from that she is basically laying bed bound in a dark room waiting to die. The reason for the visit was because her carer said she had fallen and hurt herself. But the patient had no recollection of the fall and was adamant that she didnt need anything else and was fine. (apart from being so weak she was able to move). And so myself and Dr B (after checking her over) had to leave because there was literally nothing we could do. There seemed to be no plan for her care, having her go into a nursing home would be so much better for her because at least she would get the company and the interaction with staff etc. But she literally spends all day laying in a dark room! :( Very upsetting today! 

GP Surgery Day 2 - An Elderly Population

Today I traveled down to one of the surgery's partner clinics in a tiny little village about 10 miles toward to coast in a very wealthy but to a part of Cornwall with a HUGE elderly population.
I sat in on consultations for most of the day as well as doing home visits to patients who were not able to make it to the surgery.

The surgery was tiiiiiny! It consisted of one consultation room, a tiny waiting room and a little dispensary as the town did not have one! (cute)

Few facts about today:

Average age = 72
Most Common Reason for Appointment = Arthritis, chest infection, heart issues and sore knees!
Procedure I Saw Most of Today = Cortisone steroid injections in the knee.
Most Prescribed Drug Today = Amoxicillin + Flucloxacillin
Youngest Patient = 62 female with sore knees after having both half knees replaced.
Oldest Patient = 98 year old man with a chest infection
Most Interesting Case = 77 year old male with an atrial flutter, which can been identified by a "saw tooth" looking pattern in an ECG trace

Example of a "saw tooth" pattern in ECG

The doctor supervising me mentioned that he hardly "cures" anything anymore, it is more managing the wear and tear seen in the elderly that come into the surgery, trying to manage their symptoms and pain.

Aaaaaannd on a negative note, I've managed NO revision today, been busy napping this evening.