Sunday, 12 September 2010

B Placement - finished

At last it's over, 12 weeks completed and assessed and all boxes ticked. That's three months like no other I've ever experienced, in terms of the journey travelled and amount of learning acquired.

In my final week I was pretty much left to my own devices on the wards, reporting back daily and asking advice where necessary. I was looking after oncology patients, most of whom needed feeds and/or supplements. Nobody died, but nobody got better either. I saw one particular patient every day, until he went home the day before I finished. He seemed to appreciate my efforts.

In that last week I was also scheduled for an outpatient clinic. I read through the patient records in advance, and there was no way that I was prepared to see them on my own - most had complex dietary problems or mental health issues, and one had both. The only straightforward one came halfway through when I was completely overwhelmed with all the others, so the senior dietitian supervising me did that consultation as well.

One patient in particular provided much food for thought (no pun intended). She went to her GP with 'poor appetite' and her GP had given her some supplement drinks. When she came back for more he referred her to a dietitian before prescribing them, which was the correct course of action (although still a rare occurrence).

I was expecting the patient to be emaciated, or at least on the thin side. She actually appeared well-nourished, and I started the consultation by trying to find out what exactly the problem was. She had various issues, but in terms of quality and quantity of her diet, I thought there was nothing much to worry about.

At this point, I felt I didn't have the experience to draw conclusions and make any suggestions, so I handed over to my supervisor. She was confident and experienced enough to ask the patient a) whether she was concerned about the situation, and b) whether she actually wanted to change anything. If the patient had said no, then that would have been it, and we would have sent her on her way and wished her well. In fact she did want to make some changes, so a plan was agreed and a follow-up appointment made.

As I took her over to the receptionist to make the appointment, I noticed the patient was smiling, and I asked how she was feeling.

"When the GP referred me to the dietitian," she replied, "I thought I would just get what I wanted, rather than what I need." She almost sounded resentful.

"But you're smiling," I said.

"Yes," she said.

I'm still not sure if she was actually pleased with what happened, or if she was smiling because she had challenged us and 'lost' - she hadn't got the repeat prescription for supplements that she had wanted.

So the last week passed by for J and me, with our case study presentations, a trip to a local pub after work to celebrate, many patient consultations, and I spent an hour watching a nutrition nurse show a patient's wife how to look after a PEG feeding tube and administer a feed and flush the tube with water. On my last day I saw the senior dietitian for my final interview before heading off to the wards for what I thought would be a brief review of a few sets of notes, but turned into two new referrals. That was a more challenging final day than I was expecting.

I am glad that it's over, although I am still mulling over a few of the consultations in quiet moments. Lola II and Mr M have been here for the Leamington Food and Drink Festival this weekend, which has taken my mind off my hospital placement a little. I have commissioned them to blog about our weekend adventures. When they have gone and things are quiet again, I think I may think a bit more about what I did over the summer. I'm pretty sure we will discuss it as a group when I am back at uni for the final year.

While it was a valuable experience, there were a few things missing: most notably the department lacks a dietitian who specialises in weight management, so we didn't see any of that. There was also very little in the way of community experience, that is, dietetic work outside of the acute hospital ward. I have asked for this to be noted so that it can be addressed in my next placement, due to start in February after the next academic semester.

1 comment:

Anonymous said...

Well done Lola- glad to hear that you survived the placement. Back to school now?