On Being Genuine

The other day, my consultant saw me as we were about to do ward rounds and said “Hey doctor, how would you like to do a mental state exam on our next patient while we give you feedback later on?”

That was not a question at all I must say, in firstly, saying something like “no thanks!” would reflect badly on me. So I ended up saying “yea sure!”, and then felt the fear build up inside of me.

So in to the interview room we went, where there were two consultants, my colleague, one medical student, one nurse, one student nurse, and finally the patient himself. The patient himself was a man I had done the admission work for, so I knew his history.He is a man in his 50’s, who was brought in by police from his flatmate in regards to suicidal intent, and alcohol intoxication.

What happened next, was that I proceeded to establish rapport with him, asking basic things like “how have you been feeling lately?”, through a nervous bodily sensation. As I asked a few more questions, I felt more comfortable, and followed up on important cues such as his recent nightmares.

On closing, the consultant told me I did pretty well. He followed up with a few questions, such as “what specifically in hospital has contributed to your mood improvement?”. I wish I had asked that.

What surprised me next, was the consultant’s feedback that I was genuine in my interview with the patient. My interview persona was a reflection of how I interacted with others normally, and in a way, I brought my personality with me as the doctor, to how I am as a colleague.

In a way, it’s something I never really considered, but it’s something I feel is actually quite important. Being genuine with patients is a way of building rapport, and of being sincere to the patient. It helps to establish trust, in that in a way, it lets the patient know a little about the doctor’s true self. And I guess that being doctors, we don’t share our personal life stories, so the patient has very little knowledge about us as a person, other than their first impressions and the personality/persona we display to them. In that sense, to put forth a fake persona to patients, is really in a way distancing ourselves from the patient, in that a mask is worn so that patient’s don’t get to know the person behind the mask.

In a way, I guess my consultant has seen the fair share of other doctors who wear a mask, and adopt a different persona to patients compared to how they are normally. In my view, it isn’t authentic, and it would be difficult to maintain. Perhaps some feel the need to hide their true character between a persona to patients because of the fear of revealing too much? Maybe some try and adopt a more confident persona, or try and tailor themselves as a person similar to the patient to try and build rapport?

Now that I’ve come to it, I think I’d prefer a doctor who showed their personality through in a consult over someone who tried to be someone they are not. Eventually, it’ll show through that they are trying to be someone else.

But it’s definitely something I didn’t consider until now. From now on, I’m going to continue being genuine in my patient interactions.

Things I Learned in My Surgical Term

I have avoided writing about my surgical term until now (re: I have been too lazy lately to post much to my blog). It was a time of stress, a time of dread just thinking about work, and a whole lot of hard work with very little appreciation of the efforts put in at work.

Here are 5 of the things I learned about surgery during my rotation:

1. The consultant will blame you for things not going smoothly (read: the consultants are control freaks)

One particular patient seen during the ward round, was only being kept in because of his rising LFTs following a cholecystectomy. If his LFTs were fine, he could go home. The consultant decided to blast me vigorously about my lack of proactiveness in not asking the 6am phlebotomy blood rounds to have taken bloods from this patient so that we could discharge them during the ward round. The only problem: there are no 6 am phlebotomy ward rounds, only the 8 am rounds, and by the time they get to the surgical ward, it’s not till at least 9 am. Conclusion: my consultant is a control freak, and terribly clueless about the hospital schedules.

2. Hard work goes largely unappreciated. It’s all about results at the end of the day.

Despite us interns constantly working 2 hours overtime each day, some of us were told that we treated our jobs like a “9-4” job. We were also slagged for how little discharge summaries we were doing (since we were way too busy with lion’s share of ward work), yet the registrars got more discharge summaries done (the overnight registrar usually has a bunch of time to do them).

3. A met call on surgery doesn’t get you any senior staff – you’re pretty much on your own

My first met call ever was in surgery, after a patient’s legs gave way. Only 3 nurses and another intern attended the met call. Registrars and consultants were no where in sight. Fortunately the incident was fairly minor with only some torn skin (ouch).

4. The sickest patients should be looked after by the least experienced (interns)

Surgical patients are some of the sickest patients in the hospital. Most are elderly, with several comorbidities, and who have gone through some extreme surgery starting with “radical” and ending with -ectomy (ie a major major operation). Subsequently, nurses would constantly be asking interns to review patient A or patient B because of fevers, reduced urine output, high blood pressure etc. Being interns of course, we had hardly any experience with these patients, yet were expected to deal with them. Registrars were no where in sight again (see 3).

5. It’s teach yourself surgery.

Not once did any registrar sit down to properly explain about why we are managing patient A with such a management plan. We had to figure everything out ourselves by reading, and by experience. Asking questions were met with raised eyebrows and judgemental questioning of  “shouldn’t you have learned that in medical school already?”. The worse thing: registrars claiming how much you learnt at the end of the rotation due to their excellent teaching.

So there you go. A list of 5 things that surgery taught me. May I never have to repeat that again.

How Can Anyone Survive In Surgery?

As a medical student, I had a terrifying surgical experience. The general surgery consultant grilled me and a bunch of other medical students rigorously, and expected us to know answers to some pretty tough questions. He was a terrifying man, who only slept for 4 hours every day (according to himself), and who backhandedly disguised a praise to his registrar with a nasty comment (“great presentation Dr X, this is the first time you sound like you know what you’re talking about”).

Perhaps another thing that terrified me, was going to theatre. The scrub nurse would tell me off for not scrubbing up properly, because I wasn’t sterile enough (any more sterile and I’d have been castrated ha!). It was my first time, and the nurse didn’t have to be so mean about it! Perhaps the most terrifying scrub experience, was at a rural location where I was needed to assist in a c-section, but was delayed for a very long time because of the scrub nurse needing me to get the scrub perfectly. The consultant was yelling off “come on, I need you here right now!”. I almost gave up under the pressure, but in the end, I scrubbed up, amidst a ton of pressure.

Fast forward to now, and I still feel terrified of surgery. The consultant gives the impression of friendliness, but I feel as if she’s just as deadly, and I feel she will explode some point in the future with rage, rage at us residents for not doing an extremely brilliant job. She has high expectations I feel, and her offhanded remarks at us at times reflect this. We are all doing our very best, and we can’t help it if everything is so disorganized and chaotic!

There are days where panic just sweeps over me because of the tasks I have to balance simultaneously. Consent, x-ray forms, sorting out a man who has passed about 20 mL in the past 2 hours, patient about to be discharged soon etc. It’s just the constant stream of tasks that we have to balance that is freaking me out now. I am afraid that I’m going to make a mistake because I cannot multitask. Afraid that my memory won’t serve me correctly, because it isn’t photographic in nature, and afraid that I will forget some urgent task to be done, because I would have had 2 or 3 of those I am trying to balance at the same time. And I am afraid that I will get a stomach perforation, because I am constantly having lunch or dinner 2 or 3 hours too late. Perhaps they’ll put me through an x-ray and find free gas under my diaphragm?

So, I am still getting my head around surgery. But I am freaking out here because of the consultant, and the tasks I have to balance. The registrars are too busy to help us residents, so we are left to deal with things ourselves, learning from trial and error. What a horrible way to learn from making mistakes. But what doesn’t kill you makes you stronger right?