Role-playing

Had an interesting experience role-playing the GP today. Each Monday, we've (the med students) have taken it in turns role-playing the GP whilst an actor comes in and pretends to have a condition commonly seen. The idea is that we get experience in consulting and managing common problems in General Practice.

So I did mine today, and my patient was terrible. Stupid bloody somatisation woman and she never listened to a word I said. It's pretty annoying when you explain to someone that there is no possible way that stomach and leg pain are related, yet they keep insisting its true. And nothing can convince them otherwise.

It was a total nightmare!

Anyway, I need to get back to the books. I have no idea about how to treat someone with Meniere's disease. Also need to get good at taking a thorough history again, after losing all my skills in the GP surgery. Have to learn the dosing instructions for Stematil too.

Study and blog at the same time

Zyban (buproprion)

Unknown mode of action. Presumably neurochemical.

Used in nicotine withdrawal in assoc w counselling

Contraindications
allergic
seizures
MAOI use (has a slight antidepressant property)

Adverse effects
insomnia, nightmares, dizziness, agitation, anxiety, fever, rash, itch, nausea, constipation etc
palpitations
can predispose to seizures

Come back if: you develop a rash, lips swelling, breathing probs
Don't drink alcohol much (seizures)
Can cause drowsiness (machinery/driving)

Dosage
Start at least 7 days before smoking cessation
150mg mane initially for 3 days, then 150 mg bd for 7-9 weeks
(Take in morning to avoid sleep disturbances)
Assess in 7 weeks. Discontinue if marked reduction in smoking has not been achieved.

Bored, amotivated

You'd hardly think that the exam is on Thursday, for the amount of effort I seem to be putting in. I don't really know how much they expect us to cover. They reckon it could be anything we've seen in GP - but for me that isn't a great amount.

They won't have skin lesions. I know that, because they expect us to diagnose the problem mostly from history. And they won't have a common cold because that's too damn easy. I expect it would most likely be something like asthma, back pain, depression, STD... Not sure what else. And I still don't know whether I know enough. And I can't be bothered studying.

Gosh I sound like a whinger.

Tomorrow I have to hand in the long case and the portfolio. My preceptor must like me or something because he gave me a pretty good mark.

The long case is full of shit.

The most important lesson I have gained from this case is the patient-centred approach to management. Visiting the patient in their own home and asking them to explain what their understanding of the disease has given me a much better realisation of the weight a doctor’s words carry. As such, it is very important to remember that it is the patient (and not the disease they have!) that needs to be treated and kept at the forefront of our thoughts.

Haha!

Arsenal - what more would you expect?

Longmire does Romance Novels

How funny is this?

Results of boredom

You are 'Latin'. Even among obsolete skills, the
tongue of the ancient Romans is a real
anachronism. With its profusion of different
cases and conjugations, Latin is more than a
language; it is a whole different way of
thinking about things.

You are very classy, meaning that you value the
classics. You value old things, good things
which have stood the test of time. You value
things which have been proven worthy and
valuable, even if no one else these days sees
them that way. Your life is touched by a
certain 'pietas', or piety; perhaps you are
even a Stoic. Nonetheless, you have a certain
fascination with the grotesque and the profane.
Also, the modern world rejects you like a bad
transplant. Your problem is that Latin has
been obsolete for a long time.


What obsolete skill are you?
brought to you by Quizilla

Nothing much today

Just trying to do some study for the exam on Thursday, voted in the election and surviving on junk food.

Junk food and study don't really go together for me. I think study is losing.

General Practice

So its been about a month since I last posted here. And what can I say about what's been happening?

Well, I've seen some stuff, chatted to some patients, and now I'm stressing about the exam next Thursday. Watching skin lesions being cut out of people is cool, and then suturing them up again is even cooler. Last week, I saw a guy with a basal cell carcinoma (bcc) on his nose, and one of the GPs had to cut it out. That was interesting - the way the cut was made (along the lines of Langer) meant that his nose had to be pulled up. Like Nicole Kidman, as the doc said.

But all in all, GP has been pretty boring.

I've been sitting there on my ass in the corner of the surgery and watched my dude consult, write out prescriptions, teach me the bloody wrong thing (MR is a pansystolic murmur, not a diastolic one, you dolt!) and then nick off at 3pm. 3pm. Yeah that's a good thing, finishing early means I can go home earlier - but for some reason when I get home, I am so exhausted. Even surg term last year wasn't that tiring - or maaybe it was but I wasn't so bored!!

Other things I've seen? A girl with Charcot Marie Tooth disease, coming in for assessment of her ability to work (which the GP couldn't do as he hadn't seen her before), plenty of UTIs, someone with chronic bronchitis, sinusitis, otitis media, 2 pap smears, depression, anxiety, viral URTIs.

Gotten some nice drug company lunches and morning teas, and went on a nursing home visit with my dude after one of his patients had a stroke. Turned out it was most likely a TIA as she was back to her usual (albeit not so good) self.

Then we have sessions at the Dept of Gp in Claremont. Each Monday and Thursday we meet there to discuss cases we need to learn, and different approaches to patient management. They suck too.

But what sucks the most is the exam next Thursday. 15 minute consult. Talk to the patient. Diagnose. Manage. Arrange follow-up.

It's a little daunting.

Let's see how we go.

Bloody tiring

Who would have thought sitting in a GP's surgery would be so tiring. Saw a ganglion cyst and a kangaroo tick.

But when this happens, nothing really matters does it?

Fark.

GP is good

General practice is pretty good. The people are generally quite friendly and I'm getting pretty good teaching with my doctor. He's been working at the same place for 22 years and is very good at what he does.

Interesting things I've done? Sutured a wound. Removed sutures. Urinalysis. Seen someone with Dupuytren's contracture. Looked into some ears. Seen a dodgy guy want some viagra.

There's a lot I need to learn and I hope I have enough time to learn it all thoroughly. It will be a very valuable term if I can manage to get everything that I'm supposed to into my head.

What else? Played tennis today. I can serve now. Hewitt lost the tennis to Safin. Iraq is having their elections. Kim Beazley is the new opposition leader. Arsenal take on Man Utd next. Chelsea have made a rocrd 88 million pound loss.