Today I had my first day of volunteering in the Urgent Care Centre. It was quite different and definitely more fast paced than my volunteering at the hospice. My role was to offer drinks to patients being treated by the doctors as well as asking them to fill in some feedback forms. The department sister told me that the feedback they receive is very useful for them in order to allow continual improvement. I did manage to get a few feedback forms completed during today’s volunteering shift, however, it was difficult for two reasons: it wasn’t always appropriate to ask a distressed patient to fill in a form and I had to take into consideration the condition they were in before approaching them; and the healthcare staff were quite busy and had to quickly go through all the patients waiting, a feedback form being filled in was a rather significant delay for them. One of the key things that I feel I have already learnt from this placement is the ability to be able to judge a situation and decide on whether I should do something or whether I shouldn’t. Offering drinks and asking for feedback is a really basic example of this, but the principle of it is still the same as doctors have to do this on a daily basis whilst consulting a patient: they have to decide on the treatment, whether it’d be appropriate to ask certain questions, whether it’s appropriate to carry out certain procedures etc.
I also learnt about how the system in the UCC works: when a patient comes in they report to the reception desk where an overview of their problems are logged. This is placed on the system which can be accessed by the triage team, they are responsible for prioritising certain patients and managing those who are going to be treated. Once the patients have been prioritised, the doctors are expected to work down the list in order. As a patient is called in, it is logged in the system; if they are referred to another department or another hospital, it is also logged. I thought this was a rather efficient and helpful system in ensuring the patients are all seen and treated properly. This also ensured that all the doctors were kept updated on each patient’s progress without having to keep asking each other.
During my shift, I was also given the opportunity to observe a consultation. I noticed that the approach taken when communicating with the patient was quite similar to the one used by doctors in the wards, however, it was also quite different as the doctors asked more direct questions in order to identify the problem straight away. The first consultation I saw was of a ten year old boy who had cut his knee. He had come with his grandmother, who said that his school has told him to come to the UCC. This was clearly not a major accident, so the doctor didn’t spend too much time on him as they were still other patients waiting. She provided him with a sterlie plaster and discharged him. I’m able to reflect that effective communication ensured that this patient could be sent home really quickly and the doctor could then treat other patients.
The next patient I saw was a man from Lithuania who had been involved in a car accident approximately 6 months ago which resulted in some minor injuries. He had been previously provided with a sling to help his arm to heal. Following that, he had 3 x-ray scans and an MRI scan due to complaints of pain in his collar bone and difficultly breathing. He was convinced that his collar bone was broken and was obstructing his breathing passage. The doctor double checked the previous notes, scans and carried out a physical examination before assuring him that his bone was in a completely healthy state. However, the man did not take this prognosis very well and he began raising his voice, demanding for some form of treatment and to see his x-rays. I noticed the way the doctor dealt with the situation by getting a second opinion before returning to the patient. This time, upon entering the room I noticed that the doctor stood near the door and later she told me that this was because she was cautious as some patients can become violent. She showed me a button at the back of her ID badge which could press if a patient did become violent as this would call security. I was rather intrigued to learn this as I wasn’t aware that measures like this had been put in place. This particular consulatation ended with thr patient barging out of the room saying that he didn’t “have time for this.” This experience allowed me to be able to directly see the struggles of being a doctor and enabled me to understand that you have to be able to effectively deal with dfficult situations like this. I also learnt some of the emotions of dissatisfaction you may experience of not being able to fully provide what a patient wants, but you must remain assertive as this is part of a career in Medicine.
The final patient that I saw was a 6-day old baby who had been brought in by her mother due to a number of concerns including: being sick, a rash and occasional irregular breathing. This was the mother’s first child so her concerns were understandable. I’m able to reflect on the way the doctor reassured the mother that these symptoms were nothing to worry about by explaining each one. She told her that the rash was perfectly normal for newborn babies and explained to her what a worrying rash would look like. She also said that the breathing pattern mentioned was normal in newborn children. Regarding the sickness, the doctor suggested the child was being over fed after asking a few questions to establish an understanding of the child’s feeding habits. The patient appeared to be satisfied with these explanations, but I noticed the way the doctor continued to ease the mother by providing her with suggestions on how to reduce these symptoms. I am able to reflect on the effectiveness of this as the mother was able to leave the hospital feeling fully content. Another part of the conversation which I felt was really significant was when the doctor told the mother that she had still done the right thing by bringing the baby in. I thought this was important as I learnt from my 3 day work placement at the Royal Blackburn Hospital that many patients feel that they did the wrong thing coming in to get checked if they don’t result in needing treatment. If they are additionally made to feel like that by their doctor, this will make them feel reluctant to to come with any other problems they have, and any of them could actually turn out to be serious conditions.