Sunday, March 18, 2007
1 word to describe today's exam? Butchered.
My OSCE stations (not really in order):
1)
Counselling.Young patient with BMI of 26, he wants me to prescribe weight loss pills. Advice him.
Did ok for this one, forgot all about asking him to have family/social support, peer support groups etc. 2)
Angry patient, father had a total knee replacement which resulted in tonnes of complications. Main issues for anger were father's disabilities, complications, costs, anxious that after downgrading to B2 ward he will have less care.
Pretty good, examiner was expressively pleased. *Thanks, YX!!!*3)
Consent for procedures. Patient (who was the examiner) had a pneumothorax, I need to put in a chest tube. Get consent.
So-so, and the nice examiner helped me out a lot! =) Was so engrossed in telling him what will be done that I almost forgot to go through the form. Killer question for this station: "When will you remove the tube for me?" And I wasn't really able to suggest alternatives ... 4)
Breaking bad news. Patient came in with miscarriage, break the news to her, and tell her she needs an evacuation of the uterus.
So-so also. Was able to calm her down, and I forgot to offer her tissues (had plenty in pocket, fack!!). She came up with a sob story of how her husband wasn't around, I told her that her doctors and nurses will always be around for her - forgot to offer to call him for her. ARGHHH. The fascilitators were extremely surprised that I came out in like 5 minutes, shit. But the patient didn't have anything else for me what!! 5)
Prescription-writing. 7-month-old boy with urinary tract infection, tell mommy that I need to give antibiotics. Then need to write in IMR the prescriptions for ampicillin and gentamycin, and maintenance IV fluid regime.
Not too good. Fack - forgot to educate her on the signs and symptoms of UTI and when to seek help. Reassured her that it's ok though. ALAS. ALAS ALAS ALAS!! I forgot to oralise the gentamycin!! But I guess I kinda salvaged that a little - after all, I *did* say that it's empirical, that the antibiotics may have to be changed after cultures come back. Mommy's question: "Can he just have antibiotics to eat?". Crap. Forgot to tell her that it's hard for 7-month-old to swallow tablets. When you have only 8 minutes to do a billion tasks, common sense evades you apparently. 6)
Blue letter. Patient has biliary atresia, post-Kasai. Write to dental surgeon (OMG) regarding dental clearance for liver transplant.
So-so. But erm ... HELLO. I don't even know why the dental surgeon needs to see him! And didn't have enough time to write down all the investigations, and that HORRID piece of blue letter paper was so puny. 7)
Emergency call. Pregnant patient with SLE comes in at night with breathlessness and haemodynamic instability. Call the registrar at 3am to come to hospital and see this patient.
So-so, examiner (who was on the phone) was very, very nice. Guided me through the entire thing, cos I had NO IDEA what was happening. SERIOUSLY, DO YOU EXPECT A MEDICAL STUDENT TO BE ABLE TO DEAL WITH DISSEMINATED INTRAVASCULAR COAGULATION AND PULMONARY EMBOLISM?? For us, SLE = renal complications. Was shocked, because I've always been taught that SLE gets better during pregnancy - not that we get much teaching on SLE anyway! 8)
Anxious patient's daughter. Patient had chest infection causing frequent falls, and on warfarin for atrial fibrillation and coronary heart disease. Daughter demanded to know WHY he is still on warfarin, and is the warfarin too much, and rehabilitation.
Not good. Aspirin evaded my head until the very, very last moment. The very last. Well at least I touched on it. And the actress was mean!!! I mentioned AMK hospital for rehab, she insists she lives in Tampines and wants to know rehab places near there. Good thing is, examiner was my tutor last time and I think I made a sparkling impression on him while under his tutelage. Hope he'll be nice about the marks. =\9)
Procedures and prescription. Subcutaneous insulin injection, show how to do it, and fill in IMR for it.
F*CKED UP. BAD BAD BAD! I KNOW I failed this one, unless examiner is very very very nice (he is very nice, but whether v.v.v. nice .... ??) - I could have killed my patient, but remedied it in the last minute. I mis-read the instructions, and thought it was a subcutaneous insulin INFUSION. OMG. After I injected the insulin (wrongly), I forgot to cross out the prescription on the IMR. In my state of shock and hurry my mind registered a complete blank to stupid questions like "where will you inject it?" and "how often do you monitor my glucose?" Sad case of exam nerves getting the better of me. One point though, the nurse in the room was EXCELLENT. She was a complete dear, and I MUST remember to thank her personally one day. 10)
Another prescription - fill in IMR for something, can't remember.
So-so, not too good. CRIPES. MUST buck up for the rest of the exams, I am definitely not happy at all with what's been happening so far.
Wenky
4:00 PM
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