The MDT Meeting

In my time at the Marsden I sat in three MDT meetings, and they were referred to at least four or five times a day aside from this. From this you can see how integral these meetings are to the daily workings of the hospital.

The "MDT" stands for "Multi-Disciplinary Team" meeting, and essentially it is where everyone that is associated with a patient's care comes together to discuss treatment, review objectives and eat a few biscuits.

Each patient under a consultant is talked about in depth, their latest blood count, their CT (computed tomography - learn more here) scans, their progress through treatment and their general well being is covered.  It was here that I really got a feel for how integral teamwork is to successful patient care. The amalgamation of professor, nurses, registrars, research nurses and other key team members was impressive to say the least, because for each patient a different opinion is heard, and in this way all the information is present at the same time, leading to a streamlined system of care.

However, later in the week one of the registrars and I were seeing a patient (I say seeing, what I mean is that the registrar was seeing the patient, I was mostly nodding and accidentally getting under people's feet). This out patient, I'm calling her Mrs Williams*,  had been discussed in that morning's meeting; she had pancreatic cancer, and had just finished her third cycle. In the MDT meeting it was concluded that she was responding so well, from a medical point of view, that her treatment would be extended for another one and a bit cycles. This all sounded very promising, but later that day I was there when we saw Mrs Williams in clinic (learn more here), and she told us about the side effects she was experiencing. Which I learned vary between chemo treatments, as each plan is tailored for the patient, sometimes different drugs are used, or some are left out all together - hence the diverse side effects. Mrs Williams was alarmed by the size that her ankles had swelled to as a result of the chemo, and she was in pain. The registrar, too, was concerned that there may be clotting in the left leg that was much bigger than the right, but both looked painfully enlarged (similar to in this photo), with the skin stretched uncomfortably. Furthermore, she was suffering from constipation, excess urine and nausea, all very uncomfortable conditions. An ultrasound was proposed by the registrar to make sure there were no clots in the left leg which could lead to more problems. This lady and her husband were frightened of the seemingly alarming side effects, to the point where it was only reluctantly that they agreed to carry on with more cycles of the chemo. The registrar prescribed a cocktail of drugs to deal with the side effects; which for Mrs Williams means another set of pills to take every morning.

Afterwards, the registrar was telling me that there is a major flaw in the MDT meeting set up, because discussing something in a meeting in a boardroom with colleagues and biscuits is very different to seeing the patient right in front of you with hugely swollen ankles who can barely walk. There isn't much that can be done about the problem, but it's there.

Thank you for reading, I wish the brave Mrs Williams a comfortable and speedy recovery.


*All names in my blog have been changed to respect patient confidentiality.

A Med Student's View

...Of the Royal Marsden, Oncology and Medicine

Before the first day of my work experience at the Marsden I found myself in the queue for the staff bus that goes directly to the Sutton site. Now, I'm not certain that I was allowed to use this bus, but in the queue I made friends with two doctors that kindly said they would vouch for me if the suitability of my taking the bus was questioned. This was very generous of them, because I'm not fond of red buses and even if I were, I didn't have the faintest idea of where to find one.

Safe in my seat, I began talking with a third year junior doctor, on his elective (learn more here) from Germany. We talked about oncology, and his experience so far of medicine. He had been at the Marsden for eight weeks, and I asked him what he thought of the Hospital. Like so many of the people I would talk to that week, he told me how friendly it was, how all the staff were happy to be there and how generous everyone had been with their time when showing him the ropes of a modern cancer hospital.

He mentioned also that he had worked in an A&E (Accident and Emergency Department - learn more here) in Germany, when he saw the book I was reading (In Stitches by Dr Nick Edwards, a cracking read, but more on that later). A&E is, he told me, very intense, but in his opinion it simply does not compare to Oncology. Where A&E gives you the thrill of emergency, often instantly life-saving medicine, oncology provides a deeper, more real experience about what it means to care for and treat a patient, as you stick with them, build up a repertoire, and see their story right until the end, in most cases. Granted, he said, it is draining and not a job for everyone, but on an emotional level it is an incredibly gratifying job, and he would not trade it for the "drama" that you experience in the A&E department. I wonder if many other medical students rotating between areas of medicine would agree.

It was very interesting to hear his views, as he has had a far more extensive taste of what different areas of medicine are really like, and I was glad that I had taken the staff bus, even if it did get me a few odd looks.

Thanks for reading!

Taking Patient Histories

We were shown how the registrars (who are they? learn more here), the Prof and other doctors deal with patients that have just been admitted to the hospital, usually by their GP. Most of the people we saw had at this point been already diagnosed with cancer. Although this is a sombre setting, for the oncologists it is part of their daily routine, and meeting patients for the first time in clinic is often refreshing, because every person, and unfortunately every cancer, is unique.
Seeing the registrar collect a patient history was mesmerizing to listen to. Though I'm sure it requires great practice, she made it look as effortless and breezy as a coffee morning chat. As we said our goodbyes to the patient, the doctor showed me her notes: they were detailed, clear and concise, yet she never even broke eye contact with the patient for more than a few seconds! Witchcraft!
I've noticed that communication is vital skill in Medicine, and although this would seem obvious I never really understood it until shadowing the four different doctors that I did today. Each had a different approach to understanding their patients' concerns, but all of them were reassuring, clear and genial in their address of the patient. Of course, the patients deserve nothing less, but I can more clearly understand why medical interviews for universities place so much emphasis on interview. It's a people person job, and listening is key.


Thanks for reading!
 

Work Experience First Impressions

Today I undertook my first day of work experience shadowing and observing registrars, nurses and consultants at the Royal Marsden (Sutton) and I was scribbling down notes all day, twenty pages worth in fact! I planned to do a blog post about all my experiences that I've had today, but rather than write what would be a rather mammoth post, I've instead decided to break it down into digestible, hopefully even interesting, accounts of my glimpse into the fascinating and varied world of modern medicine.

For now though, just three of my first impressions of one of the most state of the art, welcoming and genuinely friendly hospital environments that I've ever found myself in: there is a tangibly strong sense of community at the Marsden, the staff are exceptionally talented and hardworking at what they do, and the patients definitely appreciate the excellent care that the hospital provides.

More to come, thank you for reading!

Can a Daily Dose of Aspirin Reduce Cancer Risk?

Skeletal Structure of Aspirin, featuring skeletal representations of the benzene ring, double bonds and OH group.

Today the front page of the BBC News' Health section proclaimed that "Daily dose of aspirin can prevent or even treat cancer". Along with many others I'm sure, I excitedly began reading the article, as surely anything even suggesting a "cure" for cancer is very engrossing news indeed, even in early research stages. I recommend reading the article in full, and if you're interested take a look over the three new research papers published by the medical journal The Lancet. Aspirin (acetylsalicylic acid) has been used for many years as a painkiller. It can be antipyretic (reduces fever), anti-inflammatory (reduces inflammation) and analgesic (relieves pain). However leading the headline of the BBC article is, it does not hide the harmful side effects (which you can see in full here) of taking aspirin on a regular basis, which include internal bleeding.

It seems that the crucial advice one can take from this news is that whoever is thinking of taking a daily aspirin should talk it over with their GP due to the risk of the side effects. Likewise, critics of the study have pointed out that some of the doses given in the study were much higher than the 75mg dose typically given in the UK. Also, some very large US studies looking at aspirin use were not included in the analysis. The researchers acknowledge both of these points in their published papers.

While I too am excited by the prospect of the new evidence and more studies to follow, I hope that the article on the front page of the BBC News Health section does not prompt anyone to rush out to buy and self-administer daily aspirin without first consulting their GP and talking it over with the health professional who knows them best.

Thank you for reading!

Do not resus?

My view on an article published in the Student BMJ

"Making Decisions about your Death"

Should a doctor presented with a 22 year old unconscious woman with a tattoo that reads 'Do not resuscitate' heed the order that has been inked onto her skin?
On some level, I believe they should not help the patient, it says clearly on her body that she had made this decision about the way she wanted to die, and cared so much that it be followed she had it tattooed onto her skin in case this circumstance arose.
However, a much stronger part of me argues that as a physician one simply cannot take the risk of letting a patient die if that is not exactly what they wanted in such a life-threatening situation. What they may have wanted when planning a tattoo may not cohere with their wishes in the emergency room.
Would the situation be different if the woman was 92 rather than 22? Maybe. From a legal perspective, the three letter phrase is not binding, as the article points out. Considering the situation rationally, in my opinion there is only one course of action that can be taken: to give the patient the best chance at life that a doctor could provide, and the strongest incentive for this argument is beyond the legal and social expectations, it is simply that the risk of letting a patient die who had wanted to live is far too grave a risk.

If you're interested you can read the full article in the Student British Medical Journal
2012;20;e658 Or read it here.

Thank you for reading.

Talking About Cancer

Today at school our year group listened to a talk on cancer, given by a representative from Macmillan Cancer Support, which is a UK-based charity that strives to improve the lives of people living with cancer (link to their website is below). It was an informative and hard-hitting talk that elaborated upon what knowledge we already had of cancer and the symptoms associated with it. Primarily the talk focused upon emphasizing the need for people to know their bodies well and "know what's normal" biologically. This included demonstrations of checking for lumps in breasts and testicles, where an uncannily lifelike collection props was used by the speaker.

The most valuable piece of information that I took from the talk was that cancer affects everyone, whether they are diagnosed with cancer or they know a loved one who has been. I undertook some personal research and found that in 2008, it was estimated that there are just over two million people living with or beyond cancer in the UK who had previously been diagnosed, and this is predicted to rise by more than 3% a year. These figures were taken from Cancer Research UK, (link also below).
I was heartened to learn about the groundbreaking work that Macmillan does, and other charities like them, and I was touched by the sincerity and bravery of all the survivors of cancer that the charity represents. I recommend taking a look at their page, supporting their cause and getting more people talking about cancer.




http://www.macmillan.org.uk/Home.aspx
http://info.cancerresearchuk.org/cancerstats/incidence/

Dear Reader

Very happy to be starting this little blog, and hope to keep readers updated with my progress as a potential Medical applicant. I will be writing opinion pieces, referencing medical journals, recounting my experiences and posting items of general interest, and I promise I'll try my best to keep my posts succinct, regular and maybe even interesting! If you have any questions about anything I write, just comment and I'll get back to you as fast as possible!

Thank you so much for stopping by, 

Best wishes, Annabel B.