Monday, 6 February 2012

Monkey See, Monkey Do.

People think medicine is difficult to learn. You blag your way through anatomy for the first few years, learning just enough to scrape through exams- safe in the knowledge that you will never use most of it again.
Once you hit clinical placements it comes down to the age old teaching of; monkey see, monkey do.  Monkey sees it enough times, and monkey remembers it.  Simple.

A few weeks ago, 3 weeks into my 6 week neurology placement I was in a TIA (mini stroke) clinic. It was with a particularly boring doctor, who didn’t feel much like teaching. Giving monkey plenty of time to observe.  

An ambulance patient was bought to the clinic, before we went to see the patient we checked the bloods which had been taken on the ward earlier. The patients troponin was raised (indicating they’d had a heart attack).

After taking a brief history it was time to examine the patients  cranial nerves (the nerves to the face and neck). Part of this is examining the patients eye movements.
“Mrs X, look at my finger”, the patient doesn’t look, “I said LOOK AT MY FINGER”.
“Doctor, I’m registered blind”.
“Well can you see light?” huffs the doctor.
“No, I can’t see a thing”.
“Great, well I’m going to shine this pen torch into your eye and I want you to follow the light”.
“I can’t see it, I’m blind!”.

The doctor looks frustrated and gives up on the examination. He decides to move onto her arms instead.
“Mrs X, can you put your arms like this”, says the doctor as he strikes a chicken like pose.
“No, I can’t see what you’re doing- I’m registered blind”.
Finally the doctor has heard that she’s blind enough times to give up on examination all together, rather than adapt it- like he probably should have done.

Suddenly the patient started experiencing chest pains, “they’re like the ones the other day” (i.e. the heart attack). The doctor looks flustered, grabs his notes and leaves. He asks the nurse to fetch some GTN spray to ease the pain, on his way out. Instead of going to the cardiology clinic (which is next door) where every man and his dog will own some…. They spend 10 minutes looking through their drug cupboards.

During this time me and one other medical student were left alone in the room with a blind woman having a heart attack. I shout the nurse as she is about to be sick, it’s a little blood stained so I go to find the doctor.  I peer round his office door to see him finishing off the dictation of his notes. He THEN (20 minutes later) picks up the phone to call the A &E chest pain clinic. Then he calls a porter, which takes a further 10 minutes to arrive- so all in al,l it is 30 minutes after the patients symptoms began.  Is this professional behavior? Is this in the patient’s best interest?

Monkey has seen, monkey has learnt what not to do.

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