It’s that time of year again – There’s snow on the Ben (Wyvis), Halloween is a distant memory, and the John Lewis Christmas add has started showing on the tele…or in ‘GP-land’, coughs and colds are doing their rounds and the flu-jab programme is well under way.
Here in the Highlands, we begin the daily windscreen defrosting routine going into week 9 of 40 on the Dundee Longitudinal Integrated Clerkship.
…”General Practice, it’s not always that simple!”
Since the last update, I have had a vast array of opportunities both in General Practice and in Secondary Care. Currently, I spend 3 days per week in GP, undertaking parallel consultations – this is where I see the patient for 10-20 minutes on my own, before handing over the case to my tutor and having a three-way discussion about the history, examination findings, impression and management plan. This is an ideal system, that gives me confidence in dealing with a range of patient presentations – however, in General Practice, it’s not always that simple!
Some more complex cases can take up to an hour all in, and I often find myself finishing that day with a number of learning points to research in my own time, and more often than not – a patient experience to reflect upon. On an average day, I tend to see between 4-6 patients in this format including routine appointments and on-the-day emergency bookings. This format lets me assess and manage acute cases as well as seeing patients for follow-up, acting on blood results or adapting on-going management strategies for example.
Monday – AM Attachment with Midwifes, seeing my ‘Pregnant Patient’ follow-up; PM Parallel Consultations GP
Tuesday – AM Parallel Consultations GP; PM Self-Directed Learning
Wednesday – AM Parallel Consultations GP; PM Practice Led Training
Thursday – AM Outpatient Rheumatology Clinic; PM Radiology, Abdominal Ultrasounds and Echocardiograms
Friday – AM Medical/Surgical Admissions ward round; PM Outpatient Renal Clinic
“explore the dynamics of different teams and environments”…
8 weeks have passed since I started on the L.C – this is the equivalent to 2 blocks within the traditional Dundee 4th Year programme. Accordingly, I have had the chance to really integrate with the medical team here in NHS Highlands. From liaising with nurses and HCAs to arrange basic testing for patients within the practice, collaborating with the secretaries for making referrals to Secondary care, to experiencing the processes behind Ambulance control – the other side of the phone call when I book a patient transfer or indeed when a 999 call goes out.
On the other two days of my working week, I go searching for activities within Raigmore Hospital. Often this will involve attending Outpatient Clinics – advancing my knowledge in areas I feel particularly weak in or those which I may have a particular interest in. Turning up to regular surgical and medical admissions ward rounds allows me to see a range of presentations and explore the dynamics of different teams and environments. Spending time on the wards allows me to keep my practical skills up-to-date, an important part of medical practice and, indeed, my Preparation in Practice assessment. Through attending ward rounds, I have had the opportunity to assist in theatre, acting as cameraman for various laparoscopic (key-hole) procedures. Having the flexibility to choose where and when I spend my time in hospital is great, as I can tailor clinical experiences to my own learning needs and interests. I hope to make arrangements in the near future to spend short blocks of 2-3 days at a time in the one specialty, particularly in Acute Care/Anaesthesia, Psychiatry, Paediatrics & Obstetrics – departments which require a bit more continuity to gain valuable clinical experience.
In the next update…I will be discussing the various opportunities a rural longitudinal clerkship offers and the highlights of community integration.