Getting Compliments

So I just finished 3 weeks of my immunology rotation. I knew zero information about immunology before starting this rotation and now I know a little bit more than that.

Anyway! I had a consultant on this rotation who I had briefly during my general medicine rotation. He’s also an immunologist. Who knew!

He is without a doubt, the nicest, most down to earth consultant I had ever seen in any specialty. He’s always ready to help literally anyone with any issue, regardless of their position in the hierarchy.

He is extremely respected as a consultant by his department. He’s just generally nice and funny and smart.

I have massive respect for him too. Not only does he teach and answer my questions clearly and lets me see patients in his clinic, but he also acknowledges my presence wherever and whenever he sees me. Even when I am on a ward round with a different team. If he walks past, he waves and smiles sincerely. 

Which, I can say from 6 years of experience, is a Huge deal. 

Anyway the point of this topic is that for some reason, he seems to think I’m great. 

Now. I’ve mentioned before that I’m awful at receiving compliments and basically not good at being given any attention at all. Dr. AJ (This consultant), told me I’m really good and it’s been a pleasure working with me in both general medicine and immunology.

Err as great as it was to hear that, it immediately made me 10 times as nervous around him. 

Okay I don’t know what it is, but if someone likes me and gives me compliments like that, I feel like they have these expectations of me that I’ve got to live up to. 

Which makes me super nervous because I have no idea what I’ve done to have these expectations of me.

I still think I’m pretty average. 

Yes I realise this is probably a self-esteem issue but whenever I realise that someone seems to think I’m good at something, (specifically something I don’t believe I’m necessarily great at), I start freaking out a little bit.

Which is the last thing I should do because it’ll make me overthink everything and make mistakes. And it also seems to manifest as this weird giggly version of me. It’s very bizarre when I get compliments I get uncomfortable to the point where I think the best thing to do is laugh it off. 

It’s really not the best thing.

Giggling like a 5 year old is hardly what you want from someone you just told was extremely professional or intelligent or whatever. 

Oh God is this one of things I have to hope will go away with time? 

I seem to have a long list of those particular traits. I’m starting to worry they won’t just go away with time. Blechh. 

Anyway that’s my self reflection.

Point is though I’m super grateful to have met Dr. AJ and so grateful I was able to impress him, even though I’m not too sure what I did. 

I Am Not A Fish

4 weeks into this gastroenterology rotation, I’ve found that it’s quite specialised again.

I’ve found this on many rotations before and I’ve mentioned it on here. I don’t know what it is about being in a particular department that suddenly means you are wearing horse blinders and can only focus on one part of the body.

As in, you are admitted under gastro so therefore for the time that you are here, you are nothing except your liver and bowels.

One of the other med students and I admitted a patient together. As part of admission we completed the standard history and examination. This patient was being admitted for bowel preparation before a routine colonoscopy. While examining him, I found that his pulse was abnormal. The other med student confirmed this and we were concerned that he may have an arrhythmia. When we reported this back to our intern as part of the admission notes and said that we would like to request an ECG, she gave us a very pained look.

“…Really?” She said. “I mean. He’s just here for a colonoscopy. His pulse doesn’t really matter.. You can request an ECG if you want, but it’s just an extra thing to do…”

We were both a bit disappointed by this. Yes it probably isn’t relevant for a colonoscopy. But if it’s a heart rhythm that could descend into VF at any time during the anaesthetic administration for the colonoscopy, I would imagine the anaesthetist would question why the patient made it this far without anybody picking up his irregular heart beat. The chances of this happening are very low of  course as we did request the ECG and he had a benign RBBB. But the chance exists and I would hate to be the one to fall in that percentage. I wondered why my intern didn’t feel the same way.

Then today, a patient who had an endoscopy for a bleeding ulcer was found by the gastroenterologist to have something pressing on her stomach externally. He had ordered a CT scan to find out what this was. My gastro team received the result and it appeared that the patient had multiple large cysts in her abdomen. There were multiple cysts in her liver, and some pressing on her stomach. My registrar was satisfied with this finding and was glad that we found what was pressing on her stomach. I asked him what would have caused the cysts. He told me he had “no idea”. “Some people just have cysts. We just don’t touch them. We just need to know what was pressing on the stomach”.

I just…. Eugh.

What if those cysts were hydatid? Caused by parasites? What if they become infected? Again, super low chance of this happening. And I appreciate that. But no referral, no plan to monitor further, nothing really.

Ie. Let’s just wait ’till it becomes a gastro problem that needs fixing.

What is this mentality? I’m seeing this in all parts of medical practice that I have experienced. And it really bothers me. I appreciate that once you’ve confined yourself to a specialty, your priorities are the problems that come to that specialty. But surely that doesn’t mean you have to intentionally ignore the patient’s other problems? They bang on and on about ‘holistic’ patient care in med school. I wonder how people interpret this. I am still a student so obviously I’m trained to think about every possible issue a patient presents with. But I’d like to believe I’m not just trained that way for the heck of it.

For me, if you’re the sort of doctor that says “they’re only here for a colonoscopy, don’t worry about their heart”, you’re just not providing good enough care for the patient. Like it’s just not multi-dimensional.

Okay I understand that people are busy. I understand that you cannot possibly be expected to fix every problem someone comes in with. It would be super stressful and will probably shift focus from the problem you’re supposed to fix, but it’s just the attitude. It’s just the way you’re doing your job. Why would you tell the medical students to be just as uncaring about these things?

It’s broken as Seth Godin would say. This sort of thing would come under the “I am not a fish category” Whereby the person who designed the water exit for a fish placed it one foot above the water level. The fish can’t even get up there. Why did they guy design it that way? Because he’s not a fish. He just did what his job description said: To build an exit.

Really interesting talk if you’re interested:

 

Anyway. Point of this is. I want to know which field of medicine I need to be in for doctors to not shrug off certain problems just because it’s not part of the body that they are assigned to. I wonder if there even is such a field.

Maybe I just have to try to maintain my student training mentality.

I don’t know.