help-im-a-medstudent

[help-im-a-medstudent]

8pm, the end of a long day, we're at a periarrest GI bleed major haemorrhage in resus

F2 to consultant: do you want an ABG?

Consultant: *stares at her* what?

F2: *shows him a gas syringe*

Consultant: ohhhhh that makes more sense. i thought you said do you want the little baby jesus

[help-im-a-medstudent]

Doctors on TV shows: beautiful well fitting scrubs, glamorous, always completely put together

Me: gets a huge sweat patch during intubating and bronching a patient and have to change my scrub top less than 2 hours into my shift

[help-im-a-medstudent]

This this this

If you dont know where to start thinking about this or talking about it with your family can I recommend reading Being Mortal by Atul Gawande. It's got a slight American slant when talking about the healthcare system but has a lot of relevance to how anyone thinks about aging and dying. Obviously disability and terminal illness can happen to people at any age but if thinking about aging is what starts the conversation then start there

Just to say, I don't care how young you are - please think about things like your will, DNRs - and DNRs in specific circumstances! - and organ donation. Please encourage your family to think about them too.

I don't believe in euthanasia being legalised, because frankly, even if I have met SEVERAL people in end-of-life care who are suffering immensely in a way that cannot be alleviated, who genuinely want to die but cannot take action themselves - people who deserve dignity and as much comfort as can be granted to them... I have also seen far too many situations where a law such as this could be abused, either by relatives of vulnerable disabled people, or by the health system/capitalism itself.

But if you do have agency over your medical decisions, USE IT. Think seriously about what you want. Make those decisions early and have that conversation with your loved ones, before you find yourself in a situation where either you cannot make those decisions yourself, or you are having to make that decision for the people you care about.

Discuss this shit as early as possible, and keep discussing it throughout your lives. Demystify death. Research end-of-life care, legal ramifications, and understand your choices. Grab every ounce of agency you have over your health and cling onto it, please.

IT SHOULD BE YOUR CHOICE. Don't let anyone take it from you.

[help-im-a-medstudent]

I have come to realise, infuriatingly, that I BOTH crave novelty and dislike change.

Why.

[help-im-a-medstudent]

Me: I should revise

Also me: ooh look the X files theme for piano let's play that, it's good to take a break from the revision (that i haven't actually done)

[help-im-a-medstudent]

Giving myself a gold star for being very brave and putting an NG tube in an awake patient

Ask me to do chest drains, LPs, central lines, intubate? Absolutely no issue but I cannot stand doing NGs, especially not when the patient is awake

[help-im-a-medstudent]

in recognition of World Down Syndrome Day on March 21

[help-im-a-medstudent]

my most toxic trait is i fucking love work gossip. i play neutral not to be the bigger person or take the high road but to hear slander and hearsay from every side. two coworkers complained about each other to me in the same afternoon and i nearly blacked out from the rush

[help-im-a-medstudent]

"these researchers published a paper on something that literally any of us could have told you 🙄" ok well my supervisors wont let me write something in my thesis unless I can back it up with a citation so maybe it's a good thing that they're amplifying your voice to the scientific community in a way that prevents people from writing off your experiences as annecdotal evidence

[help-im-a-medstudent]

When a nurse says they think a patient is seeing multiple people, it's important to clarify if they mean hallucinations, or romantically

[help-im-a-medstudent]

kill the imposter syndrome in your head because not only is there someone out there doing it worse than you, they’re also using chat gpt to do it

[help-im-a-medstudent]

@importantanimalmemes

[help-im-a-medstudent]

Sorting my portfolio out for ARCP has to be one of the most soul destroying parts of my job

I was not made to do admin and stress about whether I've got the right type of form there for people to decide I'm good enough to continue

Please just let me give fentanyl and ketamine and put lines and tubes in people

[help-im-a-medstudent]

Things to not say to infertile folks:

A lot of people don't really know what to say when discussing infertility, and a lot of people who are struggling with it complain that people say hurtful or triggering things to them - often unintentionally.

So I thought I'd write a guide about what not to say, taken , unfortunatelyfrom hearing or seeing people express these opinions:

You just need to relax/get drunk/go on holiday/not stress so much/not want it so much.

Telling someone to be more relaxed or less stressed doesn't work - kind of like telling someone to calm them down doesn't, in fact, calm them down. It also minimises the fact that a lot of people with fertility problems have actual medical problems causing the situation, which may require treatment or might even be untreatable.

It also comes with the (likely unintentional) implication that it's your fault for not conceiving because unlike everyone else, you're just not relaxing enough. You fail at relaxing. You're doing trying wrong.

So you can't have kids? Like, at all?

Putting aside that it is a little insensitive to say this, technically infertility means that a couple tried to have kids for a year or more but were unsuccessful. Infertility is reduced fertility, and sometimes the term subfertity is seen as more accurate.

People can be told that they have a condition that affects fertility like fibroids, PCOS or endometriosis, but they may still conceive if having unprotected PIV sex and should still use contraception if they do not wish to get pregnant.

This is also why folks on T and folks on oestrogen/progesterone HRT should talk to their team about contraception, whether they are cis or trans. Whilst taking HRT can sometimes reduce fertility it does NOT render you sterile and people often need to use an additional contraceptive.

Sterility means being completely unable to have kids - for example, if you have had both gonads removed.

Infertile couples can sometimes eventually have children unassisted, and most infertile couples manage to conceive with fertility treatment.

Have you tried having sex/tracking ovulation/insert absolutely beginner knowledge here)?

Oh crap, we've been mistakenly putting it up the ass this entire time! Silly me!

Unless you're the couple's doctor and your job is to walk them through every possible issue and make sure nothing is missed, please assume that they have done their research and have the basic stuff down.  Treat people as if they are sensible and competent. Believe people when they say there is a problem. Leave the diagnosing to their fertility team.

Because when you think about it, if a couple have been trying for like 3 years and you ask them if they've tried LH strips, it's kind of patronising.

You didn't become an expert just because you accidentally got pregnant 5 years ago or conceived first try with your second. People who have been struggling with a health problem for years have usually done a ton of reading, speaking to healthcare professionals and lots of tests - they almost certainly know a lot more than you about it.

Oh yeah, I know how you feel! I've been trying for 2 months / hope to have kids and I'm terrified of being infertile, I couldn't stand that. It would ruin my life!

There's a place for sharing your concerns, but please don't expect people suffering a condition to have to console you about how bad it would be for you to live their life. Infertile people don't want to hear that their life is your worst nightmare, it's just a rude thing to tell someone.

Don't tell people with coeliac you'd die if you couldn't eat pasta, don't tell people who are blind that you'd end yourself if you couldn't paint or watch TV. Just ... have some tact.

Ha, being a parent is hard, are you sure you want that? Would you take one of mine?

No, Debra.

Please stop making light of someone's personal grief or disability. This is like making boomer "I hate my wife" jokes to someone who just lost their spouse.

But what do I say, then? I don't know what to say!

I've legitimately seen people say the most insensitive thinfs and then turn around to say this.

But...

You don't have to say anything- believe it or not you don't have to offer an opinion or advice on sonething you know nothing about. They aren't waiting on YOU to fix their problem or give them advice on something a team of specialists hasn't been able to fix.

If someone tells you that they are having fertility issues, just tell them you're sorry to hear that and that you hope it works for them soon. Or ask them if they want to talk about it and let them know you are there to listen.

More things not to say after the cut...

My friend's aunt's cousin was about to have infertility treatment, then they just had twins! I'm sure that will happen for you, when you stop trying!

Everyone tells us their one in a million "miracle stories"... but they just aren't fun to hear, for many people with infertility. They may give some people hope, but they can make people feel even more isolated and unlucky because we KNOW how unlikely it is that we'll have that same luck.

Also for most of us, stopping trying would make actually conceiving and carrying to term extremely unlikely. Please don't discourage people from seeking medical help when they need it.

Well I don't think IVF/using a donor/single parent families/lgbtq families is right/natural.

It's great that you don't need it and don't have to have it, then! But your opinion is kind of irrelevant to everyone else.

Lots of modern medicine isn't natural - and as a doctor, I REALLY don't think "naturalness" or your personal comfort level with a treatment you are completely ignorant about is a relevant metric for how beneficial a medical treatment is to the people who need it. 

We've spent all of human civilisation working to give us more tools (and better ones) to help people. IVF is a tool. It's an accommodation for a disability or inability due to circumstances that lets some people overcome their medical conditions or circumstances.

Are you saying that to cancer patients? To people wearing a cast for their broken arm? To people wearing a prosthesis for their amputated leg? I absolutely hope not. Please do not do that.

Other people's medical treatments are between them and their clinicians. If you don't like it? You're free to not have said treatment. If you don't want kids, you are free to not have any. I'm a passionate advocate for access to reproductive care, contraception and abortion.

But if you're pro abortion, you cannot meaningfully be anti-fertility treatment. Because you either believe in bodily autonomy or you don't. You can't pick and choose only when it benefits you.

I just think that if you can't have kids naturally, then your body/nother nature/God is telling you something and you should just stop trying. Maybe your genes are just bad and shouldn't be spread. Maybe you just wouldn't make a great parent.

Look, nature is stupid. It gives kids type 1 diabetes and genetic conditions that kill them in infancy and gives your loved ones cancer. Do you go around telling everyone that they should just due or accept being permanently seriously ill or disabled because nature gave them an illness? Do you refuse all modern medicine because you should be listening to nature's plan for your body? I bloody well hope not, because that's dumb when modern medicine exists.

There are all sorts of dumb reasons why people are infertile - why would having a tube blocked by endometriosis or slow sperm make someone a bad parent? Why are you literally telling someone to their face, whose meducal problems you dont even understand, that you think they are just too defective to make a family?

Let's stay away from the eugenics, shall we? We could have a nuanced conversation about how genetic testing of embryos can potentially reduce or eliminate rare fatal diseases which kill children and have no hope of a life without significant suffering. And how most couples who have IVF successfully go on to have healthy chikdren who live normal lives. But no, Steve, stopping your mate with a mild varicocele from having children is not going to revolutionise the human race or fulfil some alternate divine fate.

Well, fertility is a first world problem, some people have real problems, we should be focusing on that instead.

Actually, it's a problem for millions of peole, around the world. The IVF industry is huge in certain parts of the Global south, for example India.

People think it's a white rich people problem because most of the people who can  afford to undergo fertility treatment privately or adopt...are the wealthy. But it's always been a problem - that affects people across cultures, socioeconomic groups and sexualities. And infertility has often been accompanied with shame and ostracisation. Stigmatising fertility care hurts everyone. Especially the poor.

Many LGBTQ couples need fertility care - whether because their gender affirming surgery or HRT or health complicates things, or they and their partner's combination of gametes makes things tricky. Making fertility care less taboo and more accessible helps them too. The conversation very often side tracks and ignores them but their struggle is valid too.

You people only want kids because they are brainwashed by the patriarchy. Infertility wouldn't be an issue if women were emancipated and not brainwashed by the patriarchy.

Look, I've been feminist in online spaces since before some of you were born. I'm not unaware of the patriarchy and how it colours our choices.

But we have to stop infantilising women abd removing their agency. I know single women and lesbians who have spent decades working through their issues with the patriarchy...who still want kids and are dealing with fertility treatment. Sure, we will never be entirely free from the many ways society affects us. But that doesn't mean we're all blindly falling into motherhood.

You don't want kids, that's great. But it doesn't mean that every single woman choosing to have them is brainwashed and unable to understand what she is getting into - and it's pretty misogynistic to frame it that way.

Nobody should be having kids because the economy/environment/etc

OK there's a conversation to be had about cutting our carbon footprint and being aware of how our choices affect others and the planet. We should all be trying to live more sustainably - I say as I wear thrifted clothes whilst typing this on the train.

But... are you saying that to able bodied people having kids? Are you sacrificing everything that you want for the cause? Or is the easiest thing to give up the thing that someone else wants? I'm all for encouraging everyone to be mindful of the planet but we shouldn't be restricting the rights of people with a disability to make that happen.

We make choices for ourselves, not for other people.

Why not adopt or foster? Adopt don't shop!

Well this is a whole post in itself...but basically, please assume that anyone who is trying for kids for a while... has at least considered adoption. Please tryst people to choose the right option for them and their family.

Children are not puppies, and the massive adoption industry isn't always ethical or safe, can be hugely expensive (often moreso than IVF in some places!), and also doesn't actually guarantee that they get to have a child at the end of it.

There can be a lot of trauma and complicated feelings for the adopted child and their birth family and many kids need very specialised support that not every potential adoptive parent can provide.

There are also far more infertile couples than kids who need adoption - so not every individualor couple could adopt. Many kids just need temporary fostering with the aim of placing them back with their family, which is important but very different.

I intend to flesh out this argument more in a separate post but IMO adoption should ideally be rare - because birth parents should have free access to contraception, abortion and be empowered and supported to look after and raise their kids within their communities if they want them. Adoption should serve the needs of the child, not the potential parents. And certainly not the agencies.

If you truly believe there are millions of kids out there needing a home, why aren't you adopting? Why aren't you clamouring for every fertile couples to adopt? Because on some level society still that's these kids as a consolation prize. And because many of the people judging infertile couples for having IVF over adoption aren't all that invested in actially learning about these kids or helping them.

Infertile people aren't solely responsible for solving complex societal problems on their own. This is something that we as a whole society need to address.

[help-im-a-medstudent]

Hi! I was wondering if I could ask you for advice about OSCE prep? I'm a final year medical student and one area I've noticed I've struggled with is time management during OSCE stations? Eg, I find that I take a history and by the time I have to do a management plan, the OSCE station time has finished. One area I also struggle with is how to structure a management plan of the level of a first day FY1. I'd be extremely grateful is you could give advice? Thank you in advance!

Hi anon! apologies I didn't see this in my inbox, I hope I'm not too late with this reply

My final year exams were MOSLERs so we had a little more time and they were split so we had a specific amount of time for the discussion afterwards and were told to move on, but we did have to manage a history and examination in the time so I hope these help

If your medical school publish the generic mark schemes for OSCEs look at them and look at what you have to cover and how many marks each part is. For example, there may be only one point to ask about medication and allergies, but more for digging into the history of presenting complaint, but it's important not to forget those small things as they can be easy marks to pick up with just one question.

Practice getting a balance of open and closed questions - if you're asking lots of closed questions you're taking lots of time up asking them, whereas something broader to cover more things lets you get more information with only one question. "Are you having any other symptoms" is better than "do you get x, y, z"

Practice with a timer, over and over. There's resources out there with cases so you don't get bored of the same things, but practice with someone, and only do the history part and try and get it down to less than the osce station time. Then you'll get a better sense of how long you're taking on the day and be able to move on through the questions.

In terms of a management plan I would think of it as bedside investigations, bloods, imaging and treatment and this will help you structure it - bedside are tests like urinalysis, peak flow, ECG - bloods - think about why you want them rather than just reeling off all you can think of - will the one you're asking for help with the treatment or diagnosis - imaging - again why are you getting it, justify why are you getting a chest XR for cardiac sounding chest pain? etc - treatment - this depends on what the case is, if it's an emergency case then using the ABCDE structure and treating what's wrong in each part is usually the best way to go, if it's more of a chronic disease then it's going to be disease specific, but don't forget more holistic things such as giving an asthma plan, or referring to a specialist nurse/physiotherapist

I don't think we had to describe management plan of a first day F1 in our exams, but if you want my advice generally for starting out as an F1 and how to make a management plan my advice would be:

If you're on a ward round the question you need to think is how does this person get home? It might not be that day, but what are we aiming for? they need to be off IV treatments onto oral, they need to be at a mobility and independence level that they can get home, and they need to have follow up organised if it is needed. So think: is this patient ready to step down to oral antibiotics? Do they need physio/occupational therapy?

Or alternatively - is the current treatment working? are their bloods getting better, do they feel better? if not, how can we change the management or do they need more investigations?

I know this all sounds really overwhelming and you won't be doing it on your own, and you won't cover everything when you first start but that's ok! You're there to learn and I would encourage you to make suggestions. It feels horrible if the consultant disagrees and even now 5 years in I don't like writing my management plan before the consultant has seen the patient because 'what if it's wrong' but often it's not 'wrong' just not quite what that particular consultant would do, and another consultant might do things completely differently (it's very frustrating)

Hope that's helpful with my hazy memory of exams at med school haha. If anyone else has advice then feel free to add! and good luck anon :)

[help-im-a-medstudent]

Hack for doctors - haven't had a break or sat down all night? Get a needlestick so you can have a little sit down in a&e to wait for them to take your blood