Monday 17 September 2007


I recently was talking to junior doctors about career options. They've been sharply curtailed and the freedom to explore specialities as active doctors in one speciality (rather than as a more passive student) has largely been lost. Speaking with one doctor it dawned on me how much even early clinical contact can have formative influences that resonate with how I work now.

My first clinical attachment as a 2nd year medical student was General Surgery. I loved being on the wards and seeing patients and finally getting "stuck in" to proper medicine.

The quirks (having to illicit Boas sign on a ward round), the theatre of it all (ward rounds with an entourage whirling around the deific Consultant at the epicentre), the needles (learning to take take blood and cannulating) . . .

. . . the patients were the thing, though. Finally doing history taking and examining folk, being proper medics, then clever folk sussing out what was going on, it was being a part of magic!

For me, over time I loved the patient work up on the wards, the sleuthing out why a patient had jaundice, then what could be done to sort it.

Sadly, the "sorting it" didn't interest me. Surgery as a speciality was great, 'cept I didn't enjoy the cutting which kind of wrote it off for me :-)

Still, that attachment was fantastic both for teaching a wealth of skills and for learning from surgical folk who were interested in their patients. At variance with the sterotype back then, good modern surgeons would delight that even way back then there were surgical teams that valued undergraduate medical education and were essentially patient centred (but never would have called it that). The patient focus stayed with me, drawing me to train as a GP before back to hospital medicine and mental health.

What was my conclusion with my trainee? It was that the sum of my training and experiences means that for me the heart of good medicine and the quiddity* of psychiatry is a genuine interest in the patient narrative.

* A great word I really must try and use more :-)

Edit : Milk & Two Sugars just blogged about surgical training this morning, too. Snap! Her more lucid medical student perspective is here.


Milk and Two Sugars said...

Hi Shrink! I feel it incumbent upon me to make the post available to anyone, not just those few with blog access. Here, therefore, it is:

Dr Andrew Brown said...

I think you meant a "nice" word, n'est-ce pas? :-)

Calavera said...

I love this entry, it totally strikes a chord with me.

You're right, it's very easy to be influenced as an open-minded medical student going from speciality to speciality.

I did my first rotation in colorectal surgery - by the end of it I was convinced that I wanted to be performing laporoscopic cholecystectomies and panproctocolectomies my entire life.

Then we rotated to Elderly Medicine, and suddenly there was no doubt in my brain that this was I had been waiting for all my life - I would be a Care of the Elderly physician.

Then we rotated to a whole batch of surgical specialities, which convinced me once again that I wanted to do colorectal surgery, I didn't want to do breast surgery, I most definitely wanted to be a head and neck surgeon, I really didn't want to go into urology, I really didn't mind thyroid surgery in small doses... ad infinitum.

It's a pity that having a crap rotation can really put you off a speciality. My breast surgery rotation was a totally crap rotation, and somehow in my brain I've automatically closed off breast surgery, which isn't really fair on the speciality.

I hope I manage to reopen some of the doors that I've no doubt unjustly closed in my head.

Calavera said...

I've just checked out the link that you gave me on Kurt Vonnegut - I've never read any of his stuff!

I've placed an order at the local library for Cat's Cradle (just cos it sounds cool) - though are there any particulars that you would recommend?

Also, I got a comment from you some time ago about comments and delete buttons.

Yes, comment disabling is intentional - I'm still looking for an option that allows me to disable blogger comments by default on entries cos I always forget to do it myself, and then I get a whole load of comments through which I didn't want.

Oh and the delete button. Hmm.

I can't really say much (here!)

The Shrink said...

M&2S, changed link to that, thanks :-)

Dr Brown, my feelings about nice aren't.

Cal, don't you dare, missy :-)

Dr Andrew Brown said...

I'm sure there was a very good reason why I became a GP. But I've forgotten it.

My "local" attachment in the 4th year was with a warm charismatic woman, and it may have been her influence. (She was the partner of the Regional Adviser who was extremely rude and unhelpful.) My "residential" attachment was with a male cold fish who failed to provide adequate nutrition, so I had to resort to smuggling in chocolate biscuits. I think I sort of enjoyed the attachment despite him.

Bookish Bipolar said...


Slaughterhouse Five and Player Piano are good too. Also, you might like E L Doctorow, especially The Book of Daniel and World's Fair.

Shrink - I like your blog and agree with you about the horrible term "Service User". I'm a PATIENT because I've got an ILLNESS (albeit in remission). I also happen to be too bloody minded to accept any term imposed on me by others, especially by normies.