Burn, baby burn


My pre-OSCE hand wash

I get very nervous before exams, and I always have. I’ve been told it’s a normal response. Usually by the time the exam has started I’m alright, but the nerves before hand get very stressful. One thing that happens before OSCEs is my hands get really cold and clammy. Not only do I notice this, realise that it means I’m nervous, and get even more stressed out, but when I then go to shake a patient’s hand, it’s unpleasant for them and shows them that I’m nervous as well, and probably impacts on my global score. So I started a routine of finding a sink five or ten minutes beforehand and running my hands and wrists under the hottest water I can bear for about two minutes. It makes them go bright red, but forces them to vasodilate as well as warming them up directly. It might not make much of a difference come station #12, but it chills me out knowing my hands aren’t freezing cold.

 

Visualise success

 

There’s a big thing now about achieving success through visualisation. Sport, surgery, you name it, by visualising the task ahead, and thinking about how you might achieve it, react to obstacles and prepare in advance, you stand yourself in much better stead when the time comes. When reading through notes, picture yourself in a cubicle with a patient. What does the patient look like? What are they going to say/ask you? What are you going to do? How will you treat them? This way when the time comes, you’ll effectively have done it before, and will have a much more contextual understanding of the material, rather than abstract concepts on a sheet of paper.

 

Don’t study for exams…

This is my single favourite bit of advice I was every given:

“Don’t study for exams. Study for when you’re the only thing between the patient and the grave.”

There’s a real ethos at medical school of ‘what’s going to be on the exam?’ which is understandable since that’s how you’re assessed and allowed to progress through the career that you would like. However it’s easy to lose sight of why you started medicine in the first place – to help make people better (hopefully), and to learn as much as you can about the wonderful science of the human body and mind. The exams are designed to measure how good people are at being doctors, so logically if you work on being a good doctor, you’ll pass the exams. Sure, focus on the exams and honing technique in the months or weeks before the exam to get the best grade, but don’t let them dictate your education as a whole. Medicine should be an open-plan world of experiences, not a single-track obstacle course of exams. 

Think Grand theft auto, not flappy bird. Explore!

Just don’t go stealing cars and shooting people.

 

Fail, a lot

 

Failing sucks. Nobody likes getting it wrong, but it is an incredibly useful way to learn to get it right next time, because the emotional response to failure (especially in neurotic med students) really cements it in your memory. At medical school you have five (or six) years of opportunities to make mistakes, and hopefully learn from them, without having any genuine responsibility. This is invaluable and so take every opportunity to try things that you can. Obviously don’t try to fail, but don’t be put off by previous attempts or the fear of getting it wrong. The only way to be good at medicine is through repetition, and what better way to do so than when you’re not going to be blamed for getting it wrong?

See the post ‘It’s okay to fail’ for more indulgent tales


Dry your hands


Exam day. You’ve prepared. You’re ready-ish. You walk in to the cubicle ready to whip in a cannula or thread a catheter like a ninja, and wash your hands like the soap-wielding don that we all know you are.

You then spend the next 1 minute and 47 seconds attempting to balloon-animal your way into a pair of gloves that are just a tad too small for you. You panic. You sweat. The ballooning becomes more desperate.

Nightmare.


Spend a few seconds making sure your hands are super dry after washing them, and those gloves will slide right on.

 

Same principle applies to hand-gel – take a teeny tiny little squirt of gel, and your life will be so much easier!

 

Aspirate the needle


Whenever you put a needle in a patient, always aspirate first, before doing anything else.

Literally no bad things can happen if you aspirate a little through a needle. You might get some blood, pus or CSF, but as long as you don’t start draining them dry, it’s most likely that nothing will come of it.

Literally terrible things can happen if you start shoving fluids through a needle whose exact location you’re not quite sure about, especially when giving subcut local anaesthetic. Aspiration will tell you where the needle tip is, be that in a blood vessel, under the skin or the subarachnoid space. Make a habit of it, and you won’t see your patient falling apart when you accidentally fill their heart with lidocaine.

 

Lose control


More specifically, don’t try and control everything…

Having spoken to a number of my senior colleagues about how they ended up where they are, one thing became apparent: a lot of things are completely beyond your control, and this is not always a bad thing. One consultant described how he had applied for a job, and while awaiting a response had accepted another, as he was unsure whether the first would pull through. A few days later his original application was returned to his house by the postman as he hadn’t put enough stamps on the envelope. Opportunities may arise that you hadn’t anticipated, while other aims that you previously had may become unachievable for one reason or another. Whatever happens, as long as you keep in mind a vague idea of what you would like to achieve, and what makes you happy, you’ll always end up somewhere good.

 

Y’all got a video?


Nearly everyone has a camera on their phone nowadays, and nearly everyone uses it far too much. However it can come in incredibly helpful. Patients often facebook/instagram/snapchat their medical issue before calling for help, which – while incredibly unwise – does mean that most people, especially young people, have a picture or video of the events leading to the injury, or the rash from a few days ago.

You can use this to your advantage. A dated photo from when they first noticed a rash will tell you at least how long it has been there, while a video of a child’s seizure will help you work out what’s causing it. 

Just remember – don’t break confidentiality, and don’t do anything you wouldn’t want your Mum’s doctor to do.

 

My mum


“Would I want the doctor treating my mum to do/say what I just did?”

This is one of my favourites. Partly because it’s the only one I’ve come up with myself, although the principle is by no means new, and I’ve heard a similar grandmother one floating around…

It was borne from a number of occasions when medical students and even doctors have done or said something that stuck me as inappropriate, unprofessional or downright wrong. I try to make a point of thinking ‘would I be happy for the person treating my mum to do this?’ and if the answer is ‘yes’, you know it’s probably alright.

 

Learn to Reflect

An increasingly popular aspect of logbooks and e-portfolios, self-reflection is the bane of many students’ medical lives. It may seem pointless and frustrating at first, but just stopping for a second and thinking:


– ‘what did I do?’

– ‘did it go well?’

– ‘what would I do differently next time?’


has a number of benefits. It means you’ll spot your mistakes, and get better as a result. It also means that you’ll remember the encounter better, meaning your learning is more efficient and you won’t have to revise as much. Episodes that you have experienced are always remembered by your brain much more effectively than abstract concepts from a book, so taking that extra second to cement them into your memory is a valuable exercise to get good at.

 

Learn from the Nurses

He or she likely has years of experience on you as a junior doctor. Sure, you read the book and sat the exam, but they managed a real life patient with the condition before you’d so much as written a first draft personal statement. They know a huge amount, and they’re also some of the nicest, most compassionate people in the world. Learn the tricks and tips they’ve picked up over the years and you’ll become a much more effective clinician.

 

Document or die

WRITE EVERYTHING DOWN.

“Cannula sited in antecubital fossa, 1L normal saline given over 4hours”

“Patient swore at me and told me not to examine him”

“Patient seen in corridor”

Simple as that. It’s good practice, it makes it easier for those taking care of the patient later on, and it provides invaluable protection in any legal situations. It also shows you know what you’re doing and makes the hospital run more smoothly.