I begin my reflective placement diary with a week of GP, and this week’s theme is examinations.
I didn’t expect to do so many, given the pandemic, but ask any GP and they will agree: sometimes you hear something over the phone that makes you think this person needs to be seen, just in case.
I wasn’t nervous, but my heart was still pounding.
It was more… excitement? This was an unfamiliar feeling. For so long, placements had felt like a significant challenge and another platform for me to disappoint myself and my mentors. This time felt different. I met my student colleagues (who are both lovely) and had the induction, safety talk and general chats.
A couple of hours later, I was palpating an epididymal cyst.
Things tend to move quickly in medicine so I was definitely expecting to be hands-on (sorry, that pun was too easy), but not quite this quickly! However, unlike before my year out, I was able to focus on the examination findings and clear my head. It’s important to remember there is a vulnerable person who needs your reassurance and attention.
A few phone consultations later (a huge variety of issues: dementia, MRSA, tummy pain) and then I had another testicular examination to do. This was a classic varicocele, where the veins above the testicle become engorged, classically feeling like a “bag of worms”.
Reflection: previously, I would focus too much on whether I was appearing to do the examination correctly. I need to show I’m looking at the patient, I need to maintain rapport, I need to look and then palpate. This inevitably meant I wasn’t focusing on the actual findings.
By clearing my head and going in with a set plan, I was able to focus on the findings and simultaneously reassure the patient.
During this week, I did another testicular examination (this time epidydimo-orchitis, aka inflammation of the testicle and the epididymis). I also did a smattering of quick heart and lung examinations (including a rip-roaring aortic stenosis murmur) and a full knee exam.
I also got my first experience of remote consultations. Digital health is an interest of mine and I do think that telemedicine will feature more heavily in future healthcare. I certainly saw the benefits; patients were able to be seen without travelling and could solve quick problems (such as medication reviews) but also have the safety net of coming in if need be.
I also got to see the magic of AccuRx, which is the remote consultation platform that enables GPs to see images, send text reminders and directly link NHS information pages to the patient. I think this is a fantastic service and I was able to diagnose a BCC (basal cell carcinoma) from one of the images.
What went well:
1. I performed a full knee examination with a correct diagnosis (ACL tear)
2. I investigated a head lump and the surrounding lymph nodes and found a sneaky one behind the ear, which led to a (correct) skin infection diagnosis!
3. I re-discovered my intrigue and interest in medicine
4. I met some wonderful colleagues and patients and have solid action points to develop next week!
Making the most of clinical opportunities necessitates a healthy mindset. You can’t be overthinking, you can’t worry and anxiety will cloud your judgement. I’d love to speak to you about how I overcame this- just drop me a line!
Hardeep Lotay 