Beautiful morning dew (taken in July 2010)

April 8, 2010

How to write a specialist referral letter, mock case conferences and everything in between

Wow, I feel utterly exhausted now. I think it's because of the heat. I've forgotten how hot it can get here in Townsville and the heat was sort of back today (hotter than what we've been experiencing anyways for the past 2 weeks). Anyways, today we had our ecology of health guided learning session and our human biology guided learning session. In our ecology of health guided learning session, we learned how to write up a drug prescription, a specialist referral letter and how to fill a diagnostic imaging referral form. The drug prescription was actually pretty cool because we discussed in class how if the patient did have hypertension for example and you told them that they are alright but that they would have to take a medication 3 times a day for the rest of their lives, they would basically be like wtf? I think it's easy to get carried away with the Science side of things and forget about how it feels to be a patient. So our lecturer (who is a general practitioner) told us that it would probably be better to give them another medication given 1 time a day for a longer period of time to not make them panic that something is very wrong. It's basically really important because these little things will make them trust you/ not trust your recommendations and thus affect their compliance. Also for the specialist referral letter, it's interesting that you write them an actual letter (I thought it was just like forwarding their medical chart of some sort) and you have to sort out which medical history of your patient is relevant to their specific condition you are referring them about.

We also did a mock case conference whereby students role-played different medical professionals (we had students pretending to be physiotherapists, dieticians, social workers, podiatrists, endocrinologists, general practitioner and a diabetes educator). Basically we were to pretend as if the general practitioner is holding a teleconference whereby he wishes to consult medical specialties from different fields of expertise to help his patient (who happens to be an obese woman with diabetes, hypertension and osteoarthritis in both knees who is feeling depressed about her condition and has a son who is also frustrated that the treatment offered by their general practitioner has not been working). It was really amazing to see the level of knowledge each medical expertise had and what they contributed to the treatment plan. For example,
- the podiatrist was concerned about the neuropathy that could result from the patients' diabetes and recommended her get massages from the physiotherapist, going in for checks of the rate of loss of sensation in her feet and also going in for checks of range of motion in her feet. Also, she was also recommended to get orthotics installed in her shoes to make her more mobile
- the dieticians told her that they would formulate an eating plan for her and make sure that it was gradual so it doesn't feel like its' impossible to stick to and recommended that the patient talk to her son about this
- the patient herself got to talk about how she is feeling and her reactions to the treatment plan recommended
- the social worker suggested that the patient could look into help groups near her home where she could get financial help with her situation, ask for support (nurse) that could perhaps take care of her while her son took a break from caring for her
- the endocrinologist suggested that the patient tell them what medications are working and what are not and recommended some medications for it - they worded it in a way that was asking her basically why she was not taking her medications regularly - "was it because you are scared that you don't understand how they work?", "how are they affecting you?"

so on an so forth. We actually ran the mock case conference realistically where students had to act as if they were specifically addressing the patient and their relatives on a treatment plan and word things correctly (don't offend them by saying directly that they are obese and need to lose weight but find a nicer way of putting things)It was just really really really cool to see how much teamwork in a healthcare setting really works. Our facilitator also mentioned though that sometimes we might run into problems in these conferences where some specialties overlap such as physiotherapists and occupational therapies whereby health professionals can often feel like "oh, there goes my idea because we are suggesting the same thing". However, it is important to keep in mind that the purpose of such case conferences is to treat the patient and that it should be patient focused.

In our human biology guided learning session, we talked about the social context of reproduction and how people's attitudes and society's attitudes towards menstruation has changed by looking at advertisements from the 1940s compared to that found in the 1980s. (We never got around to looking at ads found in the 2000s). And for that we watched light-hearted ads aimed at this topic and got a good laugh about it. Also, we talked about different reproductive technology- embryo freezing, artificial insemination, genetic screening of blastocysts and egg donation- and what their implications are to health professionals, friends + families, legal and political systems, economic system and society in general. We also talked about how infertility affects the female and her partner and others in terms of feelings of inadequacy, disappointment and also expectations from others to have children and also feeling like they're not fulfilling their role in society.

Although these sessions at first glance do seem pointless and common-sensical, it's these activities I think that really hammer it home and makes a difference as to how good of a doctor you can be not only by showing compassion, but also really trying to understand things from the patient's perspective. I'm really happy that we are learning these sorts of things :) Thanks James Cook.

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