Clinical School

Those of us still in Cambridge have just finished our second week of clinical school (I was going to update at the end of the first week, but then the weekend was as hectic as the week, so go figure). Distressingly, after three whole years of introducing ourselves with a variation upon "Hi, I'm Felicity, I'm a medic", the gap between us (bottom of the food chain) and the all-knowing consultants and GPs we see seems just as huge as ever. More distressingly still, the gap between us now and the FY1s, who are brand new doctors fresh out of clinical school, seems almost equally gigantic: they know things, like how to diagnose and what drugs to give people and what they're listening for when they play with their stethoscopes and so on; and yet even they are often seen as ignorant little pawns in the grand scheme of the NHS.

The thing is, despite three years of what was ostensibly 'medicine' at the best university in the world, I am still pretty sure that I could not diagnose anything from a list of symptoms above 0·1% of the time. That tiny percentage where I might hit upon a diagnosis is when the symptoms happen to match something that I, a close friend, or a family member has had. None of it is the result of any of the knowledge I've clung to from my actual degree. I'm terrified by the sheer volume of knowledge I'm apparently expected to just pick up over the course of three years in an institution which we are constantly reminded is 'chaotic' and does not have our education as its main purpose (obviously - there are patients to care for, primarily).

So, at the end of our second week, what have we learnt? We have been taught how to introduce ourselves to a patient. We have been given a framework for collecting information about what is wrong with a patient - both 'biomedically' (i.e. in terms of symptoms and diseases) and 'from the patient's perspective' (which reduces down to 'how are these symptoms affecting the patient's life, in their own opinion'). We have been taught to stick needles into people (so far only each other) in a safe, hygienic, aseptic way, and hopefully achieve a bottle of blood at the end of it. In the last three days, we have been taught how to examine a patient's cardiovascular (heart and junk) and respiratory (lungs) systems, and their abdomen.

Unfortunately, we can't actually do much with most of this. I can get a full history of what is wrong with a patient, including what they think about it (if the patient is nice and co-operative); I can possibly work out which bit of them is going wrong and check for other symptoms that might be associated with what they've already told me. If they have something wrong with one of three bits of them, I can examine them to find out other stuff. I've been told that I am so far incapable of presenting any of this information to anyone more senior than my friends, so I can't pass it on. I don't know any diseases, so I can't decide what is actually wrong myself, and even if I could, I can't decide what to do about it. Worst of all, if I examine a patient, I'm so busy trying to remember what comes next and not miss anything out that I more than likely have forgotten what I worked out by the time I'm finished.

Finally, a secret: I suspect stethoscopes are mostly a fashion accessory. So far, I have yet to hear anything other than a vague rushing noise through the earpieces of that symbolic bit of kit - even when assured that the patient has the most obvious *insert medical term here* that whoever's watching me has ever heard. I'm pretty sure it's all made up.