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My Geriatric Medicine Placement - Junior Doctor Vlog #02

2019-05-27 · Vlog or day in the life · Ali · recording, 28:30 · watch on YouTube

Topic: Medicine and his doctor years · mode: Explanation and tutorial · tags: Aimed at students

Looking back on his second F1 placement, on the geriatrics ward from December 2018 to March 2019, Ali explains what elderly medicine covers, walks through a standard day, and says it taught him the weight of discharge planning and social care, how bad dementia is, and to see the patient as a whole.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — A look back at his second junior-doctor placement, with a confidentiality disclaimer

  • ★★ Ali, a junior doctor in Cambridge, looks back on his second placement as a junior doctor, on the geriatrics ward. — 00:00:00 · Foundation Programme, Cambridge
  • ★ When Ali talks about patients in his junior-doctor videos, he uses fake names, genders and ages, and most are hypothetical patients amalgamated from many cases to keep confidentiality. — 00:00:48

00:01:18 — What geriatrics covers: over-75s with medical problems, dementia, care packages and discharge planning

  • ★★ In Ali's hospital the geriatrics team looks after patients mostly over 75 with medical problems; he thinks the average age on his ward was in the low to mid 80s. (hedged) — 00:01:18
  • ★★ Very elderly, frail patients are often not fit for surgery because its risks would outweigh the benefits, so geriatrics manages them conservatively, for example with painkillers and casts after a fall. — 00:01:58
  • ★★ Geriatrics covers almost any medical problem of an elderly person: an elderly woman with heart failure would come to the geriatrics ward, with cardiologists consulted when needed. — 00:02:41
  • ★★ Ali thinks over half of the patients on his geriatrics ward had some form of dementia, such as Alzheimer's disease or vascular dementia. (hedged) — 00:03:40
  • ★★ One lucid patient with dementia, who remembered her family and knew she was in hospital, was convinced the stuffed animals by her bed were real and called them her children. — 00:04:27
  • ★ Ali says that if he had to have dementia, he would want the kind that patient had, keeping people and places, since her belief brought her joy and harmed no one. — 00:04:55
  • ★★ Some patients with dementia, admitted for a simple chest infection, stayed on the ward for a long time because their families could not cope with them at home, so the team had to plan a safe discharge. — 00:04:55
  • ★★★ Ali says one of the really great things about the UK, unlike many other healthcare systems, is how much money and effort goes into social care, such as carers at home and meal delivery. — 00:06:18
  • ★★ The most home care the geriatrics team could arrange was carers coming in four times a day, and some patients had two carers four times a day. — 00:06:54
  • ★★ On geriatrics the doctors sorted out the medical side, while occupational therapists, physiotherapists and a discharge planning team assessed how safe patients were at home and arranged carers or care homes. — 00:08:02
  • ★★ Ali says discharge planning was something he learned little about at medical school and only came to appreciate as a doctor. — 00:08:40
  • ★★ With an ageing population and, many people say, funding cuts in the NHS, there were often not enough care home places, so some patients waited in hospital for one. — 00:09:43 · NHS

00:10:12 — A standard day: the morning meeting, the ward round, requesting scans, afternoon jobs and talking to families

  • ★★ Elderly patients who stay long in hospital are at risk of hospital-acquired pneumonia, and the longer people stay in hospital, the more likely they are to stay longer. — 00:10:12
  • ★★ Ali's standard day shift on geriatrics ran from 8:30 am to 6 pm with a half-hour to hour lunch; on call he stayed until 9 pm, covering all the geriatrics wards from 6 to 9 pm. — 00:10:41
  • ★★ At 9 am the whole ward team, from the junior doctor, registrar and consultant to therapists, discharge planning nurses and the ward clerk, met to go through every patient and set medically fit dates that cue discharge planning. — 00:11:11
  • ★★ Ali says the morning team meeting was a really good thing because everyone was on the same page about what to do for each patient. — 00:12:57
  • ★★ From 10 am to about 1 pm the doctors did the ward round, with the consultant on some days and the registrar on the others, checking notes, blood results and vital signs for each of the ward's 30 patients. — 00:12:57
  • ★★ On the ward round Ali kept a separate note on his iPad for each patient listing the jobs he had to do. — 00:14:13 · iPad
  • ★★ Being constipated for several days is bad for the body: blood tests can become abnormal, and it is a common cause of acute confusion. — 00:15:12
  • ★★ Ali says a junior doctor should request CT scans and X-rays early in the day, because scanners have queues and triage, and get MRI requests in early because there are only certain slots. — 00:15:41
  • ★★ It is recommended to have a diagnosis in mind when ordering a scan, so the scan confirms or rejects it; with abdominal CTs the reason is often that no cause is found, so the scan is negotiated with the radiologist. — 00:17:19
  • ★★ On his first placement, cardiology in August 2018, Ali found negotiating scans hard; with experience he pre-empts the radiologist's questions, for example knowing the patient's creatinine before calling about a contrast CT. — 00:17:48
  • ★★ In Ali's hospital all investigations and blood tests can be requested on the computer system, so after the ward round most jobs were done from the doctors' office and the afternoon was fairly relaxed. — 00:19:08
  • ★★ Later in the placement Ali brought a Bluetooth speaker into the doctors' office and played his Spotify study-with-me playlist of film and video game music to make the paperwork more pleasant. — 00:19:38 · Spotify
  • ★★★ Ali really enjoyed talking to patients' families on geriatrics, more than he expected, and is thankful for Cambridge's communication skills teaching, which prepared him for it and for breaking bad news. — 00:20:07 · University of Cambridge, Cambridge
  • ★★ Conversations telling families that nothing more could be done and the aim was comfort were difficult but very rewarding for Ali, who thought he did them quite well. — 00:20:39
  • ★★ On many days, with patients awaiting discharge planning and all jobs done, the last one to three hours of the geriatrics shift had nothing to do, so the doctors chatted and Ali got career and life advice from the registrars. — 00:21:09
  • ★ In quiet evenings on the ward Ali liked quizzing the registrars about their love lives and how they met their partners. — 00:21:55

00:22:17 — What he learned: social care and its cuts, how bad dementia is, seeing the patient as a whole

  • ★★★ Ali says one of the most important things geriatrics taught him was the role of discharge planning and social care in NHS healthcare, and how much money the UK health service spends on it. — 00:22:17 · NHS
  • ★★★ Geriatrics showed Ali what cuts to social care mean: it was no one's fault that patients waited on the ward for two weeks for a care home; the system was stretched. — 00:22:42
  • ★★★ On geriatrics Ali appreciated for the first time how bad dementia is; he really does not want to get it, and seeing it daily made him thankful for youth and cognitive power. — 00:23:24
  • ★★ Geriatrics patients are given cognitive tests such as the Montreal Cognitive Assessment, drawing a cube or a clock at ten past five, naming animals and remembering numbers, scored out of 30. — 00:24:30
  • ★★ Many patients without a dementia diagnosis had mild cognitive impairment: lucid in conversation but unable to do a maths problem; saddest were clearly educated people, now 85, frustrated they could not draw a cube. — 00:24:30
  • ★★★ After a consultant circulated a paper saying that appropriate vitamin levels protect against dementia, Ali started taking a vitamin supplement, wanting to do everything he can to avoid dementia. — 00:25:12
  • ★★★ Ali says geriatrics taught him more than any other placement the importance of seeing the patient as a whole, not single-mindedly treating their medical problems. — 00:25:51
  • ★★ When a very frail patient awaiting a care home had a blood finding that might mean leukaemia or lymphoma, the registrar and consultants asked Ali what invasive tests would achieve if she was too frail for chemotherapy. — 00:26:47
  • ★★★ Ali says doctors should not put patients through tests for their own curiosity: a test that will not help the patient is not needed unless the patient consents to it. — 00:26:47

00:27:17 — Placement dates, his surgical placement now, next year's rotations and sign-off

  • ★★★ Ali was on geriatrics from December 2018 to March 2019, the second placement of his first foundation year. — 00:27:17 · Foundation Programme
  • ★★ Ali is now on his surgical placement, the next of his first foundation year. — 00:27:17
  • ★★ Ali will make another video about his surgical placement towards the end of it. — 00:27:17
  • ★★ Next year (2020) Ali moves to a smaller hospital near Cambridge for four months each of psychiatry, obstetrics and gynaecology, and stroke medicine. — 00:27:46 · Obstetrics and gynaecology, Cambridge
  • ★★ After his foundation years Ali will no longer be tied to full-time employment and can choose what to apply for; for now he is thinking probably emergency medicine. (hedged) — 00:27:46

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Dementia · Discharge planning · Geriatric medicine · Social care

Also: Organizations: NHS · University of Cambridge

Concepts: Breaking bad news · Cardiology · Clinical communication skills · Emergency medicine · Foundation Programme · General surgery · Montreal Cognitive Assessment · Obstetrics and gynaecology · Psychiatry · Stroke medicine

Places: Cambridge

Products: iPad · Spotify

Also centred on Discharge planning: General Surgery - A Day in the Life - Junior Doctor Vlog

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