Housemanship: Week 34–36

And just like that, it’s a wrap for internal medicine.

9 Months down, 3 more to go.

The past few weeks were really dramatic for me and I want to write down major lessons that I learned and that I believe every house officer (Medical intern) should learn too.

3 lessons in 3 weeks

1. Always Document Properly

This is very important. For medico-legal purposes majorly and also to save your own skin.

For every procedure you do (wether you site lines or collect samples) make sure you document that you did your work and put the time you did it.

I’ve had a fair share of patients denying that I had collected samples to be analysed at the labs. Sometimes they loose the samples (I have no idea how) or they just leave it and don’t take it to be analyzed at the labs because of financial constraints. Make sure you do your job properly, document that you’ve done your job and if possible inform the nurses so that they can be witnesses as well.

It would shock you very much how patients or their relatives suddenly develop amnesia.

If you want to do something for a patient, for example to site a line, and the patient declines, document. Say exactly what the patient says.

‘Doctor please come back later and site this line, I want to eat’

‘Doctor come in the morning, I’m not ready for you to site the line yet’

‘Doctor, I would be discharged soon, there’s no need for this line’

Whatever they say, document.

If you’ve prescribed medications or you’re asked to inform the patient about a procedure that should occur, for example the patient is advised to go for dialysis or is to have blood transfusion and the patient or the patients relative refuses, document.

‘Doctor in my village we don’t collect blood o’

‘Doctor my aunty did this surgery last year and she died, so I don’t want to do it’

‘I don’t need to take drugs, my mother-in-law suggested some herbal medications for me’

Don’t stress yourself dear house officer, just document it.

After documenting, also inform your senior colleagues about what happened and if possible inform the nurses as well, so they would be witnesses.

Don’t let patients or their relatives put you in trouble.

It might seem a bit cumbersome and tiring to document every single thing that happens but it’s worth it in the end. Trust me.

2. Always communicate effectively with your patients

Counseling is one of the skills that we were required to learn in Medical school. One method we were taught is the GATHER technique

If there’s one thing I’ve learned, it’s that patients tend to be more compliant with treatment when they understand fully well what is happening. They need to understand their condition, you as a doctor should debunk any myths about the condition. Counsel them on prevention and the treatments available for their condition.

If they have any questions, answer them in a respectful manner. Be patient, avoid medical jargon, use words that are easy to understand.

If there are lifestyle modifications to be made, let them know.

Not everyone would listen really, but let it be that you did the best you knew how to do.

If you can, also inform the relatives about the patients condition (with the patients permission of course)

And also dear house officer when you’re done counseling, please document that you did. 😂

3. Pay attention to little details

As a house officer, as the one at the bottom of the food chain, you are very likely to be in contact with patients first and you’d be with them more often than the other senior colleagues.

You’re the one who is likely to notice any nitty gritty about the patient.

For example, drugs have been prescribed, but has the patient actually been getting them? Is the patient having financial constraints?

Has the patient developed a new symptom? A new rash? Bed sores? Have you noticed any new swellings?

Did the investigation results show anything new? Are the investigation results out yet? Why aren’t they out? We’re they paid for?

Be very observant.

And with whatever new thing you observe be sure to inform your senior colleagues. Unless instructed or permitted to, don’t take matters into your hands. Your license is temporary, try as much as possible to be very careful.

Anywho, I’m moving to the 4th and final Posting

Obstetrics and gynaecology AKA Women, pregnant women and their wahala.

I’m not excited about it at all. Not only is it the most stressful posting (Literally in almost every single hospital), it’s quite delicate. I mean we all know how women can be. 😒

It’s never been my favorite unit, even when I was in medical school.

I can only hope for the best.

All the postings I’ve been in, I’ve had different experiences than people who went through it, so I’m hopeful that my O and G experience would be different. Hopefully it would be better and I’d end up enjoying it.

WE MOVE!