Why I Don’t Like Letting Strangers Know That I’m a Doctor

When it comes to people knowing my occupation, it’s something I’m not comfortable about. It’s not that I’m ashamed of my job or anything, it’s more that I fear the reactions I get, and feeling like I’m put on the spot. I don’t like it when I’m put on the spot.

Upon others knowing I’m a doctor, the reaction received is a kind of awe I get from others. It’s happened when I’ve been introduced by friends to others with “he’s a doctor by the way” or when others ask me what I do for a living. Either way, the reaction is immediate, and I can feel that feeling of respect placed upon me for what I do as a job.  The reactions are a palpable expression, where the other person has a micro pause, and then they are genuinely interested in what I do, asking what field of medicine I’m in, and whether it was hard work etc. This was the same when telling others I was a medical student. Compare this to when I was a Bachelor of Science student, and the reactions were nowhere near as palpable and obvious. In those days, I’d just get a quick acknowledgement, and then on to another topic. None of the questions about what area in science I was studying, or whether it was hard work etc. It made the feeling that being a doctor was special.

Mind you however, I don’t feel that special in what I do. And I’m not trying to sound elitist in what I say, because I genuinely do feel that I’m just doing any other job; a job I was trained to do through education, and on the job learning. In other words, a job essentially anyone can be trained to do if they have put in the time and effort. It just happens that the job I’m trained to do, is to help people, no different from any other job like a policeman, a bank teller, an IT technician, or a hair dresser. They all help people. But it’s likely that the doctor is held in a more esteemed position, due to the way people are helped – by treating serious illnesses, relieving suffering, and from having a lot of in depth medical knowledge; we’re seen as people who are doing something noble and honourable by treating ailments, diseases, and suffering.

The contrast in reactions I received were really something that was initially very surprising, but now has now made me somewhat apprehensive. I feel that many times, I’m being put on a pedestal, and I really don’t like being placed on a pedestal, because I’m sure I’ll probably fall off. I want to be seen as an equal with others, and not be placed on a higher social ranking or anything just based on my job.

When it comes to these kind of interactions, I try and divert the attention away from myself as quickly as possible, asking the other person what they do, and then exploring their job with questions and curiosity at hand. I feel it helps to take a lot of the attention away when I do this, but I admit, it could come across as a bit peculiar.

Have you been in a similar situation with such responses? How do you deal with them?

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Getting A Second Opinion

In medicine, the same illness may present in different ways and with different severity. And that is one of the challenges of medicine – the same illness may not present the same way in different patients.

Therein however, allows the doctor to put their art into practice – they need to be able to grasp the vital and crucial aspects from taking a history, from performing an examination, and ordering appropriate investigations. The doctor needs to be able to see what is relevant, what are red herrings, and in their mind, piece together all the evidence to support a diagnosis that they make.

Making the correct diagnosis however, is only half the work done. Next, the doctor must give the appropriate treatment.

And that presents another new challenge, because clinical judgement needs to be made on the appropriate extent of treatment. There are guidelines, but one must remember, they are just that; guidelines.

As an inexperienced junior doctor, I have had trouble deciding appropriate management plans for the patient. One patient I had had an elevated potassium level which I thought was fairly high (6.2 mmol/L). She had chronic kidney failure. At such a level, I would have thought that treatment would be instituted, and some textbooks encouraged treatment at this level.

On asking one of the senior doctors, they didn’t think treatment was needed, but suggested just 1L of IV fluids. Being concerned and conflicted over this conflicting management compared to textbooks, I was confused and tried to get a second, then a 3rd senior opinion – in summary, it’s a bad idea. One other said to treat, and the third said not to treat.

In the end, I decided to listen to the first opinion and not treat, but to give some fluids, and added on for a repeat blood test the next day.

On checking the blood the next day, the potassium level dropped to 5.6 mmol/L, and the patient was instructed by the handover doctor to represent in 2 days time for monitoring of K+ (the repeat potassium was 6.9mmol/L – I don’t know what treatment she got).

Moral of the story: stick to the first advice from the first doctor most familiar to the patient. If there is something you find concerning about their advice, use graded assertiveness; ask them why are we doing this, and should any other treatment options be done.

Having a Good Laugh Over Faecal Matter

I never realized how little I laughed with the patients in my job until just a few days ago. In our job, we’re always usually seeing a patient that is quite sick, and laughing at times just seems a little inappropriate. Also, depending on some patients, it can be hard to build up enough rapport to crack some jokes with them after just a couple of minutes (in ED, we’d probably only spend 10-15 minutes on history).

One of the patients I was seeing came in with chest pain, and was quite hard of hearing. So I ended up almost shouting my questions. In coming to systems review, I was just asking about bowel motions and urinary symptoms. Here’s how my conversation ended up:

 

“So how have your bowel motions been lately?”

Patient looks at me with puzzled expression

“Are you having any problems going to the toilet to pass stools?”

Still has puzzled expression on face.

“Ok, are you having any problems doing poos in the toilet?”

Patient thinks a bit, and then looks at me with understanding

“You mean how is my shit?”

 

I had a really good laugh after the patient said “shit”. Considering the patient was hard of hearing, and I was shouting my questions at him, I wonder what the patients in the next cubicles would have been thinking, and how disgusted they would be that I was so curious about how my patient’s “shit” was like.

But the man reminded me, that even though in medicine, you face a lot of serious disease, and people who are unwell, it’s certainly nice to have a laugh about things. My patient certainly made the day that much more enjoyable after such a laugh.

 

Medical Lexicons Thrown Around In Hospital

In medicine, there are essentially new words and terms to learn. It’s like a whole new language you have to learn.

Below are some of the more interesting terms and abbreviations we doctors throw around verbally and write in medical notes all the time:

 

BIBA – Brought In by Ambulance

I have just seen a 90 year old male BIBA, who came off his Harley Davidson doing 160km/h on the highway

DDx – Short for Differential Diagnosis

Med Student 1: Um, the medical notes have a heading DDx, and then just a list of medical conditions. What does DDx stand for?

Med Student 2: That stands for differential diagnosis – it’s essentially a list of the most likely medical diagnoses based on the history taken.

DRE Short for digital rectal examination (same as PR)

ED Consultant: The patient in bed 3 hasn’t passed bowel motions in over 10 days. Let’s get one of our interns to perform the DRE on that patient *high fives the other ED senior doctors*

Drip – Cannula (a piece of plastic tubing inserted into the veins to allow blood access for administration of medications)

Intern (speaking to patient): Ok sir, I’m going to need to give you a stab to put this drip in

Patient: You’re going to stab me? That sounds really painful!

Intern: Oh, terribly sorry if I scared you. I meant I’m going to insert this needle into your vein, and leave behind a plastic tubing so that we can give you fluids.

Perf – Short for perforation

On review of the patient’s X-ray, free gas was seen under the diaphragm. The patient has probably got a perf, probably from his peptic ulcer.

PMHx – Short for Past Medical History

Med Student 1: I don’t get it. The notes have PMHx and just the patient’s current illnesses. What does it stand for man?

Med Student 2: Past Medical History. It’s just a list of the patient’s current illnesses.

PR – Short for per rectal (a rectal examination)

Intern (to another intern): Ugh, just had to do a PR on a patient who hasn’t defecated in 10 days after being co-erced by the consultant.

SOB – Shortness of breath

I saw a 55 year old gentleman that presents with acute onset SOB on a background of a 40 pack year smoking history…

Stat – Instantly

That 55 year old gentleman is severely dehydrated from diarrhoea! Give him a fluid order, STAT!

 

I Have to Put My Finger Where?

In medicine, everything’s about the clinical skills. Taking a history, explaining results, performing an abdominal exam, performing a rectal exam, auscultating the heart…

HOLD ON

Performing a rectal exam??!!!!

The “Rectal” Finger

Yeap, that’s part of the clinical skills of medicine too. For any normal person, the idea of putting your index finger up someone’s anus is not a very pleasant idea. It’s something that no one likes to do, but it’s something that must be done. The doctor doesn’t like doing it, and the patient doesn’t like someone’s finger up their back passage either.

For me, the very first one I did was in a coaching tutorial. There were actors who got paid to have medical students perform rectal exams on them. I applaud those actors for being “live” practice models. Medical students really don’t know what they’re doing, and I’d certainly give those actors a bravery award.

Anyway, I remember the sheer awkwardness in having the actor tell me where to put my hands, and how far and how deep to go in. After placing my finger as deep in as it could go, I was instructed to do a 360 degree swivel of my wrist, feeling the prostate with my index finger. Knees bending, and body swiveling too, I somehow managed a 360 degree turn, and shortly after withdrew my finger with great relief.

Fast forward to this year, and I had to face doing a rectal examination on a patient. In the time from my first rectal on an actor to a real patient, about 2 years had elapsed. I’ve seen other doctors do it, and I felt sorry for them doing it. But now I had to do it. So, I asked one of the other doctors if they could supervise me doing it. The doctor looked at me weirdly and laughed it off “I never got any supervision when I did my first one”.

Yikes! So, next best thing was to ask a nurse to “assist” me. She helped to get the patient ready and in position. All I had to do, was put on some gloves, some lube, and put on a brave front as I anticipated my finger will be in someone shortly. Suffice to say, the procedure went smoothly, and I couldn’t feel any abnormalities of the prostate.

At least now that I’ve done it, I can perform many more with more confidence ><