Clinical Elective at RMH (Day 1-3)

Day 1
Met the elective coordinator, Debra, a nice and friendly person she is. She brought me around the hospital and introduced me the place where I can find good food to eat. Ha! After that, she helped me to settle with the ID Badge and there, off she went. And it was time for me to head to respiratory department to meet with Savi and my supervisor, Professor Lou Irving. I was quite confused on what I should do on the first day. I was then being introduced to the registrar, Dr. Mary and interns at the respiratory ward at Level 5. And here I started to join their ward round. It was great to be warmly welcomed by them and greeted by one of the respiratory physician, Dr. David Smallwood. From the ward round, I could observe how the physician approached the patients in a good way. He was able to build up good rapport with them. He set a good example for me. Not only him, but all the staffs! They were really good examples for me. And what was different from what I had observed in Malaysian hospitals was that the team will review on the patients’ condition, their clinical investigation results, x-rays, CT scans etc in front of the nursing counter first before they went to the patients’ beds. And everything was computerized. Staffs could obtain patients’ profile, clinical results and other investigations with just a few clicks. It is really convenient.

After the ward round, I followed 2 medical students (Laura and Ian) to interview a patient who presented with cough, high fever and shortness of breath. Those students had good interviewing skills. They made good use of open-ended questions and they tried to figure out the possible differential diagnosis by asking relevant questions to the patient. Again, they built a good rapport with the patient. The patient was a kind man and very cooperative. Another thing which I had learnt from the students was that having discussions with the colleagues is one of the best ways for learning. We share, we discuss and we learn together. That was pretty awesome.

Finally, I followed the intern, Dr. Eugene to a meeting. Interns were presenting the case summary of each patient and their progression to the physicians and there the discussions took place. I could see the spirit of team work in solving the problems and deciding a better management for each case.

Day 2
Another story began. First we started at the Respiratory care unit, a place where patients were being observed closely (It is some sort of ICU but it is in a respiratory ward). After the registrar reviewed on the patients there, we went to a radiology meeting. Before the meeting started, there were students who were presenting their research progressions to the physicians. Their topics were really deep and heavy! During the radiology meeting, CT scans and Chest X rays of the patients were being shown on the screen.

About an hour later, I went to the respiratory clinic. Medical students distributed themselves into different rooms. I was lucky to join Dr. Rubinfield’s clinic as she was friendly and was willing to teach. We had four patients that day. The first patient came for follow-up and complained of chronic dry cough, usually worsened at night and exercise. According to the Dr., it could probably be asthma. However, her lung function test was normal and there was no abnormal finding on auscultation. In order to confirm the diagnosis of asthma, Dr. suggested to have a bronchial provocation test (with methacholine) done. This would help in deciding a proper management for the patient.

Another patient had a past history of hospital admission with SOB, hemoptysis and epistaxis (septal perforation was the cause of epistaxis). She also experienced loss of weight and loss of appetite. Radiology findings showed ground glass opacity in her left lung (which according to Dr. the ground glass opacity could be infection). When I was being asked on the relevant examination I should do on that patient, respiratory examination was what I could think of. In fact, I should have looked at the hands for sign of clubbing, examine the abdomen as well for any lumps (as the patient presented with LOW and LOA, we should look for sign of malignancy on other systems as well). Gosh! I shouldn’t have deemed that as trivial complain!

Here came another asthmatic patient with sleep apnoea. During the examination, I could hear wheezing after she took her steps to the bed. She seemed to gasp for air while she was sitting on the bed. Obvious rhonchi could be heard bilaterally on auscultation.

Lastly, a middle-aged gentleman stepped in, bringing his son who was a four-year-old cute little sweetie. I was being told that the gentleman had hereditary hemorrhagic telangiectasia. It is a condition with small vascular malformations which can occur in the skin and mucosal linings of the nose and gastrointestinal tract. He suffered from frequent nosebleed and he had rhinitis. There were obvious sign of telangiectasis on his skin, lips and mucosa of the tongue. Interesting case!

Again, there were good communication skills and good patient-doctor-relationship. She spent around 15-30 minutes on one patient. And I really felt grateful as all patients smiled and wished me have a good stay in Melbourne. The last patient even wished me to be a good doc when i go back to Malaysia. They were wonderful persons! Teehee !

Day 3
As usual, we started with ward round. And then we went to the emergency department to see a patient with clots in her lungs. This was followed by another clerking with Morgan, a medical student. Oh! By the way, the medical course here is only a 4-year-course and they all will start their clinical years at year 2. Wow!

We clerked a patient who presented with decreased effort tolerance (20ft to 5ft), SOB, extreme exhaustion for 6 weeks and the symptoms worsened. She had medical illnesses of hypertension, diabetes mellitus, atrial fibrillation, and liver cirrhosis. She suffered from heart failure which contributed to her current symptoms caused by fluid overload and pleural effusion. She was a cheerful and cooperative patient. Got to know she had a good hobby of reading especially bible.  She also did missionary work. May God bless her so that she will get well soon.