Promoting the Physician Assistant profession in the UK since 2005

Experiences in Elective Rotations

Tales of elective placements both in the UK and across the pond.

Overseas…

by Pete Gorman

On work days I rose at 5 a.m. in order to commute to Camden, New Jersey and undertake the four ten hour shifts that I worked every week. As part of my hour and a half commute I would pass over the vast River Delaware by train via the impressive engineering feat of the Benjamin Franklin Bridge. The river which is just shy of two miles in width at this point is stunning at this hour, glistening in the light of the new day. What was notable to this viewer was the relative affluence of Philadelphia with its striking architecture and private yachts, in stark contrast to the degradation and relative poverty in Camden, and all this separated only by a river crossing. Notable landmarks in Camden include the Campbell’s Soup factory (the area’s main source of employment) and the imposing figure of The Madonna, the monument at the top of Our Lady of Lourdes Hospital, my new place of work.

On my first day of work I was picked up from the station by my preceptor as I was advised that I should not make the five minute walk to the hospital as this was a “bad neighbourhood.” On subsequent days I caught the complimentary hospital shuttle bus for this final part of the journey. It was a striking yellow school bus of the type I had only seen in American films. As I passed through the security doors to the busy Emergency Department I was greeted by several large security guards who would check my identification.

The first patient in whose care I was involved had been in an altercation in which he was struck several times on the forehead with the butt of a gun. Gun crime is not infrequent in the Camden area. The gentleman, who was physically imposing and towered over myself even as a male of over six feet, was angry and animated. He had two gaping lacerations to his forehead and wanted to get “sewn up quickly to leave the hospital and settle the score”. I helped to calm the gentleman so that my colleague could begin suturing him. To my surprise he was amenable to my British (Midlands) accent and consented to me finishing the suturing of his forehead, even agreeing to delay his plans for retribution and stick around for a CT scan. It was during this memorable first day that I realised that work at Lourdes Hospital might be a frightening but necessary ‘baptism of fire’ to the world of Emergency Medicine.

A significant proportion of patients presenting for treatment at Lourdes were Spanish speaking and as my Spanish is limited to asking if they have dolor (pain), which when spoken with a Midlands accent is not particularly effective, I often had to gain assistance from my colleagues in order to take an effective history. Fortunately several of the Emergency Department staff were fluent in Spanish and happy to help.

By the third day of my placement I was carrying out history taking and examination of patients by myself and feeding back their cases to ‘the attending’ (the senior doctor in charge of the Emergency Room for that shift). I was jokingly told as I fed back my first case to the attending that, “if I did not speed up in examination and in conveying the findings, he would throw me of his Emergency Room.” He seemed impressed at my commitment to carrying out full neurological assessments but stated that the patient in question was “going to get a CT scan and this was a busy Emergency Department!” This particular doctor was very inspiring as he was sharp, rarely seemed to miss a trick, and had a no nonsense attitude. It was interesting to watch him interview patients as his opening line was, “so, what’s up?” This was in stark contrast to the more formal approach I had seen in the UK but both seem to achieve answers. It was feeding back to this doctor that made me begin to refine and prioritise patient examination and précis my findings, a skill that I continue to work on.

Initially many of the patients that I chose to see presented with minor orthopaedic trauma such as: fractured hands, lacerations, and inversion ankle injuries, but as the weeks progressed I began to see patients with more complex medical needs while having a low threshold to obtain senior support. A memorable example of this occurred after I took a history from a patient presenting with atrial fibrillation. The patient was well known to the attending and he allowed me to carry out cardio-version under his supervision.

At the beginning of this document I may have painted a bleak picture of the Camden area, however this was probably more as a consequence of my impression of the environment, rather than the people themselves. My actual experience of the residents was one of gratitude for treatment and courteousness. It is of particular note that at no point did I receive any verbal abuse from the patients or their families though they were amused by my accent and seemed surprised at my lack of inside information about the forthcoming royal wedding.

And Closer to Home…

by Teresa Dowsing

I spend my four week elective placement at a GP practice in a village called Measham about an hour’s drive away from my home. I was really lucky to get the placement – helped by my University Facilitator who was a local GP in the area and knew the practice well. You never know who might be able to help you find a placement so ask everyone!!

I arranged to go and meet the team a few months before starting my elective there to try and help keep the first day nerves to a minimum and so I might have a chance of getting there without getting lost or being late… I think my record is 2 hours late trying to get to Rowley Regis!

On my first day I was handed a timetable with all sorts of exciting things on it including a morning spent on the minibus which is used to bring patients in from the neighbouring villages for their appointments. Apparently no one else in the Practice had been offered a chance to do that and they were all really jealous! I also had visits with district nurses, baby clinics (including the jabbing with needles one which I didn’t like, and the babies didn’t either!), home visits, travel clinics, COPD clinics, meetings with patient groups, a morning with the phlebotomist taking bloods and my own open surgeries both at Measham and at the Appleby Surgery. The Appleby Surgery was great. It was really tiny with only enough room for the GP, the patient and me, just about!

The Practice Team is huge with 13 GPs, 2 Nurse Practitioners, 3 Practice nurses, 4 healthcare assistants and an array of office and reception staff. Running it must be like a military operation!

They let me settle in for the first week and then the hard work began! I had an open surgery each day with about 6 patients to see and would help out in clinics or shadow home visits in the afternoon. The thing I love about working in General Practice is that you really never know what going to walk in the door. My patients ranged from little girls with veruccas, babies with viral rashes, workmen with grit in their eyes, schoolchildren with funny eating habits, coughs, colds and headaches. I gave advice, reassurance, sometimes prescriptions and often just a friendly ear for someone to talk to. There were difficult situations to deal as well and on my last day I was with the duty doctor and it was about 6pm and we had a home visit to do to a drug user who had a DVT and was refusing to go into hospital despite the fact he couldn’t walk and was in so much agony.

During my time at Measham we had the huge snow storms to deal with and the doctors would regale the staff with the stories of bumping car into lampposts and getting stuck uphills over cups of tea and cake in the staff room. I don’t know how they did it but everyone managed to have a morning tea break and afternoon break together and still keep the practice open and get the work done. It was the friendly place I think I’ve ever worked in; it really was like one big happy family.

As I drove home I thought about how quickly the four weeks had gone and that I was now a qualified PA with no more work to submit or exams to take, but at the same time it felt like it was just the beginning of a very long journey…

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