East Lancashire Hospitals Trust Work Placement – Day 3
Orthopaedics (Fracture Clinic)
In this placement I was given the opportunity to sit in during some patient-doctor consultations. The first patient I saw had fractured his arm after smashing it through some glass. The doctor told me that this is quite a common case which is often seen on the Orthopaedic ward, especially amongst young men. The x-ray results showed a shadow which suggested that there was a piece of glass which was still stuck in his arm, but the doctor decided it would be better if he sent him for another x-ray to rule out any possible inaccuracies which could have occurred. The second x-ray confirmed this suspicion so the patient was able to be discharged from this department and sent to the Occupational Therapy department instead. This highlighted the importance of doctors working to their competency and I learnt that it’s important to know when to refer a patient as they may benefit better from somebody else’s specialities.
The second patient was a child. I noticed the different approach taken by the doctor when speaking to this young boy as opposed to the adult he spoke to previously. He spoke using more basic language and attempted to lighten up the atmosphere by cracking jokes which made the patient feel more at ease. He explained the fracture to the parent, whilst making sure that the child still felt involved. He said that the location of the fracture has disrupted the growth plate in the arm so could potentially prevent his arm from growing anymore. I thought this was rather interesting as I had never considered that a broken bone could have such a great impact on somebody. However, the doctor reassured the patient by telling him not to worry as this was not likely to affect him as he was only young and therefore has a higher chance of fully healing. This taught me the importance of integrity and being honest as a doctor so the patients are able to trust you as well doing this without worrying them.
I also learnt something through the consultation of a young girl who was suffering pain in her hand after a fall despite the x-rays not showing any fractures or breaks. I learnt about the scaphoid bone and thought it was quite interesting. The doctor applied pressure to different parts of her hand and tried to notice any swelling or bruising, but there were no physical symptoms present. He concluded that this may be due to a crack in the scaphoid bone as this cannot be picked up on an x-ray until two weeks after the injury. I recognised the way this was clearly explained to the patient and she was also given a thumb spiker in order to help keep her comfortable in the meantime until the second referral appointment.
One of the most remarkable things that I saw was a young lady walking for the first time after she had her cast taken off after 6 months. The doctor assessed whether she was fully healed and ready to walk on her leg independently. She was given a pair of crutches to take home for support. I spoke to the healthcare assistant who told me that they provide most of their patients with crutches even after the have had their cast takes off as more of an emotional reason. She said that the patients tend to psychologically feel that they can’t cope so being given the crutches makes them feel more confident and comfortable.
As well as gaining an insight in to the role of the doctor I was also given the opportunity to see the plaster room and the various equipment that was available there. There was a selection of different braces for the ankle, elbow and knee joints. I was mesmerised by the functional braces which could be adjusted in order to allow limited movement. I learnt that this would be really useful for a patient who had undergone surgery as it would protect their limbs and also keep the joints moving to prevent the bones from becoming stiff. The time I spent there also taught me more about the role that the plaster technicians play in order to allow the patient to recover. I was shown how the plaster machine works and noted the use of a synthetic layer of plastic to set the cast into a hard shell. I also learnt about the relevance of asking a patient about how they received their injury as it may bring to light other hidden injuries which have not yet been diagnosed.
One of the things which really amazed me was being able to recognise the importance of every member of the healthcare team fulfilling and completing their duty properly. For example, in the plaster room, wool must be placed on the base to prevent the cast from irritating the skin, which could cause it to break and result in an infection. It’s also important that this job is done carefully to ensure that there aren’t any wrinkles in the cast for the same reason. I was quite surprised at the speed which all the professions were working at due to having a huge number of patients. I did not expect there to be such a large number of bone injuries and so many people to be requiring the fracture clinic. I also picked up two terms which were quite frequently used in this department: a proximal joint is one that’s closer to the trunk of the body; and a distal joint is one that is further away from the trunk of the body.
Year 5 Surgery Lecture
This was a revision session for fifth year Medical students regarding examining the abdomen so it was quite difficult for me to understand. However, it was still very useful in allowing me to be able to make a comparison between the PBL sessions and lecture based learning. Despite being unable to fully understand everything, I thought the context of it would definitely appeal to me and I picked up the importance of the shape of the abdomen and whether it is scaphoid, distended or flat during examination. Something that I found really interesting was the idea that doctors should take notice of the manner in which a patient enters the room as it may give an idea of what type of issue they have with their abdomen. For example, if they have Pancreatitis they will be bending over to release the pressure. I was also fascinated by the detail and logic of many of the information which taught. For example, the students were taught that they should start palpitations from where the pain is the least and gradually move to the area where the pain is more intense, in order to make sure that they don’t unintentionally hurt the patient by pressing on a painful area.
At the end of the day I also gave a presentation to a senior gastrologist, a group of fifth year medical students and some other students who were also doing the placement regarding everything I learnt on my placement. I felt this was a very useful exercise as it helped me reflect on my experiences and put me in the position of being a medical student. I really enjoyed this opportunity and I know it was a really great experience as medical students and doctors are expected to deliver presentations in front of their peers or colleagues quite often.