RESPIRATORY CLINIC & WARDS 🌬🚬

East Lancashire Hospitals Trust Work Placement – Day 2     

Year 1 Early Clinical Experience

In this session I was able to experience a clinical exposure session with first year medical students. It was a really incredible experience as I was able to recognise the differences between them and the fifth years whom I had sessions with on the first day. I was very intrigued by the way that the students are trained to act and sound just like doctors throughout the five years. The first activity was a video of a clinical scenario which intended to teach us all that we must be more focussed on our environment, as doctors have to be very alert and observant. I then learnt about the acronym ALL EARS to use when consulting a patient:

• Acknowledge – we have to have the ability to be able to reflect back on a patient’s words and use non-verbal communication to show them that they’re being received well.
• Legitimate – to be accept that their concerns are legitimate and reassure them that they have made the right decision by coming in.
• Listen – allow them to expand their concerns with the appropriate use of silence.
• Empathise – to demonstrate that you can see the situation from the patient’s perspective.
• Appropriate Reassurance – avoid giving too much information and making the patient feel overwhelmed and report any concerns.
• Summary – providing one demonstrates to the patient that you have been listening.

I think this model is very useful as it lays out the basis of communication between a doctor and their patient and has taught me the extent of the value of effective communication in this relationship.

After discussing the best approach when speaking to patients and the importance of introducing yourself, I went with two medical students in order to speak to some patients in the Respiratory wards. The first patient we spoke to was a gentleman who was suffering from Asthma. He was very willing to speak to us and he described the frustration and toll his condition has had on his life. He provided us with details on how he first realised he had developed Asthma and changes he had to make to his previously very active life, involving sports such as rock climbing to accommodate his new illness. Something I found quite interesting was his mention of the fact that he could tell what the weather was like as he’s waking up in the morning, simply because his Asthma is very much affected by the weather. I noticed the way the medical students applied the structure above and the way in which they just nodded and smiled, not speaking in order to allow the patient to release his emotions and I thought it was really effective.

The second patient we visited was an elderly lady who had been staying in hospital for the past week and was preparing to leave today. She was suffering from COPD and was finding it difficult to communicate, but she was very grateful for the company. She spoke about her mother whom she was worrying about and felt she had to go and look after. She said that quite finds there’s an immense amount of pressure on her and that she feels she is burdened with this responsibility. She also spoke to us about the mental breakdown she had when she first entered the hospital and told us about some of the thoughts she was having at that time. I found it rather remarkable in the way that patients were prepared to divulge a lot information about themselves to us. I also learnt about the importance of speaking clearly to patient as this particular lady also had hearing problems. Her situation taught me that a doctor’s role isn’t solely about the patient’s illness, but also about other social aspects of their lives which may affect their wellbeing.

Due to confidentiality purposes, we had to be very careful about discussing any of the patients we spoke to when walking in the hospital corridors. Once we returned to the learning centre we shared experiences and challenges. One of the examples which really affected me was of a lady who broke down in tears in front of the students upon remembering the time when the doctors suspected she had COPD. This made me really appreciate the difficult situations which doctors are expected to handle and made me realise that it’s a career which requires a lot of emotional strength and strong reassurance skills.

During our time on the ward, we also asked the patients of their opinions on the type of doctor they would like to be treated by and I think it’s really important to reflect on their responses. The patients said:

• They would like to have a doctor who speaks to them on the same level and not down to them. He felt that many doctors speak to patients with the idea that they are in a superior position. I can understand how this would make a patient feel uncomfortable and feel like they cannot relate to their doctor on a personal level.
• Someone who demonstrates compassion and takes the time to actually listen to the patient.
• They should demonstrate effort by showing they cate for their patients on a personal level and not just rushing through them like they’re ‘ just another patient’. She gave an example of a doctor she once had who followed her up after she stopped being his patient, and how touched she felt by this gesture.
• They wanted someone to provide them with information and explain what’s actually happening to them. I can imagine how confused and uninvolved a patient would feel if the doctors were not prepared to clarify and justify their actions. In this particular situation, the patient was worried that they were having daily blood tests without any known purpose to them.

Respiratory Clinic

During my time in the Respiratory Clinic I shadowed the ward sister to see how the nurses approached patients and the effect they had on the patient’s overall experience. I was given the opportunity to carry out the final checks by asking a series of questions, under the guidance of the nurse, to a patient who was about to be discharged. It was an amazing opportunity and I was able to practise the skills I noticed the Year1 students demonstrated. This particular patient was suffering from COPD due to her smoking. The nurse later asked her whether she would be happy being referred to a counsellor to help her to give up smoking, but she declined. I was very shocked by this, as despite the nurse describing the symptoms, she still wasn’t prepared to withdraw herself from smoking. I thought people would be very willing to try to stop their smoking habits. The nurse also asked the patient to demonstrate her technique of using an inhaler and it was clear that she wasn’t using it correctly as the gas was escaping from her mouth. After this problem being identified, a spacer was found for her and she was taught how to use it. I thought it was a great insight to be able to see how problems were detected and dealt with, because otherwise the patient would have been deprived of her medication.

One of the other patients the sister needed to ask a few questions to and clarify certain problems with was a lady suffering from dementia. I was able to recognise the issues which may arise when having to speak to patients with health conditions like this. The nurse was unable to obtain any accurate answers from her and told me that she would have to discuss these questions with her caregiver instead. This was an eye-opener for me as I was able to truly understand the limitations patients with neurodegenerative diseases may have to live with.

During this particular placement I learnt about COPD (Chronic Obstructive Pulmonary Disease) which I wasn’t aware of before. I was able to understand that COPD is a gradually worsening condition which causes the narrowing of the airways, unlike Asthma which varies greatly depending on many different factors. I also learnt that on this particular ward doctors were responsible for taking the medical history, pharmacists the drug history and nurses the social history. I thought it was quite remarkable to see exactly how they all work together in a team caring for the patients.

One of the patients that I saw that had a great impact on me was a lady who had recently started receiving palliative care after reaching a case of very severe COPD. The lady said that she’s “so scared that (she’s) going to die, that (she) can’t sleep.” This made me realise that a doctor’s job isn’t just about treating people and sending them home happy, but also having to deal with sad situations like this. I reflected on the importance of the qualities of empathy and compassion in a doctor as you will have to experience extremely vulnerable and unwell patients and also witness many deaths. Resilience is key in a career like Medicine. I learnt the importance of possessing skills which allow you to remain emotionally strong as well as provide reassurance and ease to the patient. I noticed that when speaking to her, the nurse clarified her identity and condition before asking her about how she feels she’s progressing with her disease. I recognised that she was using the ICE model and understood its relevance in practice as it allowed the patient to voice her feelings and concerns.

This experience made me realise the differences in the role of a doctor and a nurse and how they cooperate when dealing with a patient. The doctors must make the decisions and referrals and the nurse has a sole caring duty as well as filling in paperwork to keep the doctors updated. Doctors must also demonstrate a caring nature, but nurses are more so responsible for the patient’s social wellbeing. This affirmed my choice of wanting to be a doctor as I want to particularly be able to diagnose and choose the right course of action for a patient.

I also learnt more about Asthma during my time on this ward and the fact that it is an inflammatory disease. One of the really interesting things that the nurse told when I was talking to her about Asthma was the mention of an injection which is used to lower the inflammation. She said that it is extremely expensive and there are very strict guidelines in place on who can be prescribed it. An application has to be sent through NICE in order for a patient to be given it. I feel as though if the NHS had money to spare, this injection would be a very beneficial investment, as particularly in England the cases of Asthma are quite severe due to the weather conditions.