The four weeks of my rotation at the Bicol Medical Center has come to an end. Looking back, I think the objectives that I have set were more or less achieved. I was able to be exposed to the hospital, to some of its staff, and even to some of its policies, concerns, controversies, and plans for improvement. I was able to take history of some patients using the Bicol language (and even the Rinconada vernacular) though sometimes I just speak in Filipino/Tagalog for better communication with the patients and because either the patient or I end up incomprehensible. I was able to see certain cases of cardiology, pulmonology, gastroenterology and endocrinology, some of which are very common in Bicol. Through this rotation, I was able to attend general assemblies, service censuses, conferences and lectures; and see how doctors do some procedures, have their endorsements, make rounds or admit patients at the ER. I was also able to chat with some of them regarding their medical student days and some toxic issues of being a doctor at BMC.
Unfortunately, I cannot deny the fact that I had a lot of tedious situations for the past month. My learning depends mostly on me, on what I ask, or on what I ask the doctor to teach me. My schedule was very fluid and dependent on the doctor rotating on the subspecialty that I am also rotating in. Most of the time, I feel awkward tailing the doctor wherever he/she goes and wait for him/her until he/she finishes writing on the charts. I can see that doctors at the institution are not used to teaching or having medical student/clerk in their midst. Or maybe, it is just the busy work and the number of patients that flood their rounds or referrals. Or maybe it is the mere fact that somebody is behind them waiting to be taught. Sometimes, I already think that the doctor I am following is already uncomfortable of me. I also feel awkward of my purpose in the hospital because I see each individual busy doing his/her tasks yet I am practically doing nothing.
If I may, for the improvement of future elective clerkships at BMC, I would recommend to the institution to provide a more structured schedule and a set of specific tasks for the rotating clerks. The clerks may also be given patients in order to participate in the diagnosis and management with the guidance of a consultant.
Nevertheless, I am thankful to the residents, nurses and consultants of BMC especially those who extended their patients for my learning. Going with the doctors’ rounds, especially with some consultants, became a personalized review of what I have learned (or forgotten) from previous years. Reading Harrison’s becomes interesting when signs and symptoms are encountered for real.
Awkward [BMC Clerkship]
1) Nakabuntot lang ako sa resident na rotator on the field that I am also rotating in. Rounds or referral, kasama niya ko, either nagtuturo siya or ako nagtatanong. Kapag nagsulat na siya sa mga charts, yun na yung oras na maghihintay na lang ako na matapos siya. Awkward maghintay lalo na at walang kausap, pakiramdam ko tuloy, med rep na rin ako na nag-aabang ng duktor. Yung ibang consultants, they know how to impart their wisdom.
2) Hindi aware ang BMC patients sa clerks/med students. Hindi ini-explain ng mga doctors na may clerk silang kasama, mahirap din i-explain sa pasyente kung ano ang clerk since ang concern lang naman sa bawat rounds ay yung nararamdaman nila. Kaya naman, awkward mag-auscultate after the resident has just auscultated the patient, unless sabihin niya na “pakinggan mo, may murmur siya.” Pag pinakilala ako ng resident as “doctor,” less chance na maisip ng pasyente na for learning lang yung pag-auscultate ko sa kanya.
3) 8AM to 5PM ang daily duty ko, pero pag tapos na ang rounds o clinic or pag walang conferences, naghihintay na lang ako. Awkward kung saan ako tatambay at maghihintay habang ang lahat ay busy doing their tasks. Minsan, tumatakas na ako pauwi.
4) Nagtataka ang mga nurses kung sino ang nakabuntot sa duktor every rounds. Minsan pinapakilala ako ng resident/consultant, kadalasan hindi. Kapansin-pansin ang mata ng nurses squinting just to see what is written on my nameplate. Ipakilala o hindi, awkward pa rin kasi naghihintay lang ako sa duktor na kasama ko. Some of the nurses knows what clerks are, some don’t.
5) May night duty ako sa ER para mag-observe. Nasa akin na kung magpapaturo ako sa nurses sa mga procedures. Awkward kasi nurses are systematically doing their jobs, tapos ako nakikigulo minsan para magpaturo ng procedure i.e. IV lining. Some nurses would also wonder bakit ako nagpapaturo ng ganun e hindi naman yun gawain ng duktor. The residents said they will teach me how to intubate, pero bihira mangyari yun.
6) Stethoscope = Responsibility. Once na duty ako sa ER at umalis yung resident, ako ang naiwan with the nurses. One nurse asked me what the GCS of the patient was and whether intubation should already be done. Anong alam ko sa GCS haha, inaral ko yun pero natataranta pa ko i-apply yun. Ayoko din nagsusuot ng steth on my neck, delikadong matanong ng mga pasyente/bantay sa hallway.