Navigating the Transition of Responsibility from Medical Student to Doctor – Shower Thoughts 🚿 ep. 18

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Show Notes

We talk about the shift in responsibility Dan has experienced as he’s started his final year GP rotation. How confident are you ‘allowed’ to be in your clinical impression and formulation of a patient as a student?

In Shower Thoughts we overthink those random questions and life-changing thoughts we frequently have in the shower and maybe come to a conclusion, all in a casual conversation.


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What is Getting It?: In a Nutshell
A conversation where we explore topics both familiar and unfamiliar to us to find out what makes them interesting, so that we can expand our horizons and further our understanding of the world and people around us.
From science to lifestyle design, languages to religion, plus everything in between – anything can be interesting if exposed to you through the right lens. We hope to spark your curiosity through open-minded and thoughtful discussion, as well as a healthy dose of overthinking.


About us
Subaan is a 4th year medical student, motion designer, and an avid rabbit hole explorer. He has keen interests in lifestyle design, technology, investing, and metabolic health. Follow him on Instagram and Twitter.

Dan is a 5th year medical student, pianist, and random fact connoisseur. He spends most of his time learning about languages, playing sports, music, and geopolitics. Follow him on Instagram and Twitter.


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Transcript

Note: This transcript was generated using AI. Therefore, the transcript will not be 100% accurate in some parts.

00:00:04:14 – 00:00:05:05
Dan
Good evening, Subaan.

00:00:05:25 – 00:00:06:18
Subaan
Good evening, Dan.

00:00:06:27 – 00:00:13:16
Dan
So this is the third day in a row that we’ve recorded this madness. This is this is how it should be. Yeah.

00:00:13:22 – 00:00:22:29
Dan
Is so much easier just being here because like today, for example, I just message, do like, I’ll finish it. five half five. I’ll just come round after so easy.

00:00:23:07 – 00:00:34:03
Subaan
Yeah. The only problem is if we talk about any time related matters, it just seems really out of context for when this is going to be. Because this is this episode is going to be uploaded in three weeks from the time of recording.

00:00:34:09 – 00:00:34:28
Dan
three weeks.

00:00:35:09 – 00:00:53:12
Subaan
Or two weeks. Yeah, yeah, yeah. two weeks. But see if we record again tomorrow, we’ll record another episode today right now. They’ll be three weeks. So it’ll be interesting if we do talk about any time related topics. I mean, yesterday we spoke about the whole Tesla madness that was happening, but that’s going to be uploaded well one

00:00:53:12 – 00:01:11:14
Subaan
week from when we recorded it. So bye bye then. Who knows where the price could be, so they will know why they’re getting the prises 600 what they mean, like 1000. So be. Yeah, it’s interesting. Or we just absolute idiots because we just won’t have like new information.

00:01:11:14 – 00:01:22:04
Subaan
So we will be talking without half the information about a particular time related matter, whereas everyone’s like all of this has been solved, like, why are you trying to discuss this is over?

00:01:22:09 – 00:01:34:06
Dan
So like because I wanted to make a couple more observations on Tesla, but now it’s just far too late. So we like we just, yeah, we just can’t. It’s too far away. I was thinking what to talk about today?

00:01:34:14 – 00:01:39:03
Dan
If you don’t mind, I would like to reflect on GPU placement so far that I’ve had. If that’s cool with you.

00:01:39:18 – 00:01:41:03
Subaan
Sounds good. I mean, I’m comfortable.

00:01:41:23 – 00:01:53:09
Dan
So, yeah, it’s something that I started yesterday and it’s my first experience in GPU since second year. And then secondly, I didn’t really know what was going on too much. It was more just to get used to the environment.

00:01:53:25 – 00:02:13:05
Dan
It was more just to get used to the environment. Now there’s much more of a responsibility on me as a final year student. So like, for example, today I was doing my own consultations and afterwards would speak about it with the doctor to make sure that I didn’t make any mistakes and also, for example, doing vaccines for

00:02:13:05 – 00:02:26:21
Dan
adults and children without supervision. It’s just a different vibe, and I’m something I’m still acclimatising, too. So, yeah, I’ve just got a couple of thoughts from it. I’d like to share and then see what you think about as well.

00:02:27:23 – 00:02:43:29
Dan
So the first thing is I realise now that the way I make decisions has to change because when I’m speaking with a patient, OK, I need to be careful how I say this because I don’t want it to come across like I’m lax or like, I’m careless.

00:02:44:06 – 00:02:59:17
Dan
Hmm. I’m very careful. But you can never be 100% with patients. So, for example, a lot of the consultations I’m doing over the phone, I can’t see what they’re describing sometimes, you know, so for example, one lady today, she had chest pain.

00:03:00:08 – 00:03:14:22
Dan
She phoned because she had chest pain since early in the morning. I spoke to her. I was very confident that it wasn’t something cardiac related. It was an inspiration. It was on the right hand side. It like it just didn’t sound like something content related to me.

00:03:15:00 – 00:03:18:05
Subaan
I mean, just seeing those signs, someone’s probably going to like, write a.

00:03:18:05 – 00:03:20:08
Subaan
Review like one star called the differential.

00:03:20:09 – 00:03:21:17
Subaan
Or cardiac.

00:03:21:17 – 00:03:21:29
Dan
Reality.

00:03:22:11 – 00:03:25:15
Subaan
And then the this like, yeah.

00:03:26:23 – 00:03:43:05
Dan
No. I mean, for sure like this. I spoke to her for like a good ten minutes, and it definitely didn’t sound like something cardiac related, especially because she’d had it for a few days. It wasn’t related to exercise or anything, so it sounded more like a musculoskeletal pain, which is obviously very common as well.

00:03:43:06 – 00:03:59:14
Dan
Yeah. Anyway, I was very even despite being very confident, it wasn’t cardiac related. I didn’t want to just leave it and say there’s probably nothing. And safety net, which is where you tell the patient what to do if they get worse and make sure that you know they know what to do.

00:04:00:00 – 00:04:13:22
Dan
Yeah, I don’t know. The situation changes. So when I spoke to the doctor about it after, I was quite like dubious of my decision and I was not very confident. The doctor was like, Oh yeah, it’s definitely MSC.

00:04:13:23 – 00:04:29:04
Dan
Like, Don’t worry, I was like, Oh my goodness, this doctor hasn’t seen the patient, though, but they’re already very confident because for them, they’ve seen thousands of cases, you know, and they can recognise immediately the patterns. And I realise you cannot be 100% sure in his mind as long as of safety netted.

00:04:29:21 – 00:04:47:01
Dan
The patient knows where to go. If she gets worse and she knows who to contact, is she? She will almost certainly be OK. And you can’t, you know, you can’t assume the worst differential diagnosis for every patient. Otherwise, the system is going to get overloaded by 95% of them being nothing.

00:04:47:11 – 00:05:01:13
Dan
But I still wasn’t completely confident. I didn’t trust myself enough. So what I did is I’ve. I asked him if I could ask her to come in. So she came in and I saw her for like five minutes, like a cardiac exam and just like.

00:05:02:04 – 00:05:14:05
Dan
I didn’t I wasn’t able to do an EKG on her, but yeah, what I realised after it was almost certainly musculoskeletal pain. By that point, I was very confident and I realised I didn’t need to do these, this five or ten minutes.

00:05:14:05 – 00:05:29:04
Dan
And probably when I’m working as a GP, I’m not going to want to do that every morning, you know, take an extra patients unnecessarily. Just for my peace of mind. More than anything is not right. So by the afternoon, I was more used to making a decision and sort of committing to it again.

00:05:29:05 – 00:05:46:26
Dan
As long as I’m being safe and the patient knows what to do if they get worse, then like I have to get used to that feeling and it’s something that I haven’t really had before. You know, I guess as students and as junior doctors, we don’t we’re not in the final line of responsibility, but it’s a different

00:05:46:26 – 00:06:02:18
Dan
feeling already having that sort of, yeah, I don’t know. And for example, with the way I’m treated by people, I notice there’s a difference now. Like, for example, when I went to the hotel today, Ashley, do you have any thoughts following on from what I just said?

00:06:02:18 – 00:06:03:14
Dan
I don’t. I keep talking.

00:06:04:01 – 00:06:06:29
Subaan
Just just just carry on with your current train of thought and OK.

00:06:07:21 – 00:06:18:06
Dan
Basically, the only other thing I was going to say is I noticed that the way people treat me is a bit different now as well. And like in this GP surgery and for example, today we went to a hotel to do some vaccines.

00:06:18:17 – 00:06:25:16
Dan
The way that I was being treated was different. People like I can see what people mean by respect like that you get.

00:06:25:23 – 00:06:27:00
Subaan
From the medical profession.

00:06:27:00 – 00:06:44:05
Dan
Yeah, people are not used to it really like people who are really being respectful towards me and usually become a young person. And I don’t know like I don’t deserve. I don’t want automatic respect from people, necessarily. It was just something quite like it took me back a little bit because, yeah, it was really quite nice.

00:06:44:16 – 00:06:51:05
Dan
So, yeah, that’s another thing I have to get used to. It’s just an observation I made, but I suppose it’s just a nice thing. I guess a nice observation, but.

00:06:51:06 – 00:06:57:04
Subaan
Could it not have just been the manners of the people at that hotel? And so was the like the staff or whatever? Or was it.

00:06:57:10 – 00:07:10:20
Dan
Could well have been, but it was more that one of them, I think, is because they they’re waiting for us to do the vaccines and they’re happy that we were there for. But it’s I’m still very confident, like, for example, with the patients when I speak to them.

00:07:11:09 – 00:07:23:27
Dan
A great example. When I speak on the phone with them, they explain that I’m a medical student, but I think some patients don’t really make the distinction between doctor and medical student. Yeah, I think they just hear the medick and we’re talking about.

00:07:24:08 – 00:07:44:07
Subaan
They make the what’s it called the distinction to great. Whether all medical is in no way. No, no, no. But if you’re, it depends on certain hospitals, especially in London, where there are different ethnic groups. You know, concentrations, especially like the Indo-Pak Lake region, all ethnicities, saline Ealing Hospital or something.

00:07:44:24 – 00:08:00:12
Subaan
The doctors would never say medical students. They would say, Student doctor. I don’t know if you’ve had this discussion before where it’s like twofold. one student doctor is just automatically it just sounds nicer than a medical student. You just sound like a weird uni student.

00:08:00:20 – 00:08:16:02
Subaan
So think like my brother was saying, is I? Oh, you go to uni? Not university kind of thing. A medical student. And then the other thing was student doctor is that you’re saying doctor lost. So then that’s the thing that gets stuck into their head and they kind of exclude the student pungency doctor.

00:08:16:03 – 00:08:21:00
Subaan
Oh, yeah, basically, doctor. Whereas when you say medical student again, student is lost, then a student? No.

00:08:21:10 – 00:08:24:24
Dan
That’s there’s something I haven’t done. Like, I introduce myself as a medical student.

00:08:24:24 – 00:08:36:17
Subaan
I would always introduce myself as a medical student, but it’s just it’s interesting to analyse the change in response that you get when the doctor introduces you as a medical student or a student doctor.

00:08:36:27 – 00:08:45:01
Dan
That is interesting. I remember at Dartford when I was on placement, one of the doctors would introduce me as a senior medical student and a senior student doctor who was like.

00:08:45:10 – 00:08:45:12
Subaan
The.

00:08:46:16 – 00:09:10:27
Dan
Doctors and I was a senior student doctor in the senior student doctors, a doctor. But anyway, so yeah, the other thing I noticed is going on from the respect thing. Patients, when the patients who I can tell haven’t really made the distinction between medication and doctor, they will feel almost ashamed when they admit something bad that

00:09:10:27 – 00:09:28:12
Dan
they’ve done or like. I asked, for example, do you smoke multiple people? A very sheepish about it and they say, yes, it might be because it’s in the community. I don’t know, but they’re like, ashamed to admit it, whereas in hospital, I’m not really noticed that so much people will just say, like, Yeah, I smoke.

00:09:28:18 – 00:09:32:10
Dan
Yeah, I know there’s a small sample size, but I thought it was quite interesting.

00:09:32:17 – 00:09:47:06
Subaan
Yeah, I think the admitting drugs, it depends massively on the part of society they’re from and their cultures and stuff, and whether it’s looked down upon. Because, yeah, I’ve had some people when they like that, they’d like hesitate or almost choke and be like.

00:09:48:00 – 00:10:02:14
Subaan
Uh, no. Or and then you do like, oh, they have to. Have you ever smoked an ambulance? Yeah. You know, when I was really young and then realise it was a 20 to 20 pack year smoke in history, even though they started like 20 years just because they’re elderly and stuff.

00:10:02:14 – 00:10:15:00
Subaan
So it’s sometimes really hard to get out of certain people because they are ashamed, and I suppose it’s just all the cultural stuff being imposed upon them. Some people are like, you know, smoking or, you know, maybe they’re not smoking.

00:10:15:05 – 00:10:29:23
Subaan
Have you taken any recreational drugs or do you ever take any? They’re like, Oh yeah, I take Premiere by that. Oh yeah, I take, you know, cocaine. They’re just happy to tell you that almost like boasting. So, yeah, it’s interesting the different kind of types you get.

00:10:29:24 – 00:10:33:25
Subaan
So I think that might be, you know, probably very society related. But.

00:10:34:00 – 00:10:41:09
Dan
And another thing is the way that our present and management plan hasn’t really been questioned yet. And I’m thinking like, I’m surprised, well.

00:10:41:09 – 00:10:41:29
Subaan
Like to the doctor.

00:10:42:12 – 00:10:48:11
Dan
To the patient. So if I talk often to the patient about the management plan, yeah, sometimes they’re like quiet.

00:10:49:26 – 00:10:51:08
Subaan
Can you give an example of.

00:10:51:24 – 00:11:09:26
Dan
Yeah, okay. So me one moment I’ll think, Okay, a couple of examples. one guy, a woman wasn’t a woman wasn’t feeling well this morning. She had a problem with. I think she had what we thought was just a foot infection, so prescribe some antibiotics, called her back.

00:11:09:27 – 00:11:21:13
Dan
It was like we prescribe this amount of our text will be at the pharmacy. Later, she was like, OK, she’s not my. No, she didn’t. Because I feel like as a patient, I would be curious, you know, like, oh, like, you know, why?

00:11:21:14 – 00:11:35:12
Dan
Why do you think it’s that? Because I didn’t see it in person. I just spoke. I just took the history, presented it to the doctor. We both agree that sounded like an infection. She’d sent a photo of it and then the antibiotics were prescribed.

00:11:36:05 – 00:11:49:17
Dan
But yeah, like I guess, is the way that it’s just accepted or, for example, someone else found and they’d been feeling anxious. And um, we I phoned her back and told her that maybe she should take two weeks off of work.

00:11:50:12 – 00:11:53:00
Dan
And she just said, Yeah, OK, like she was like, OK.

00:11:53:13 – 00:11:54:18
Subaan
But because a lot of people aren’t going to quit?

00:11:54:27 – 00:11:56:02
Dan
Yeah, yeah, of course.

00:11:56:02 – 00:11:57:25
Subaan
two weeks of work, there’s no progression.

00:11:57:26 – 00:12:06:22
Dan
Yeah, of course. But it’s just I could just feel like what I said was really listened to, and I’m not used to that so much and was.

00:12:06:22 – 00:12:07:09
Subaan
Or wasn’t.

00:12:07:09 – 00:12:22:20
Dan
Is listened to like at the moment when I speak to a patient. Yeah, I feel like they really take on board what I say, and it’s just something I haven’t really experienced before in the hospital setting where I guess we’re not expected to really give our opinions of the patients too much.

00:12:22:20 – 00:12:34:14
Dan
The best thing when we’re in hospital we can really do is take a history, present it to the doctors on the ward, look for signs. And yeah, we don’t really get too involved in that. We don’t really get too involved in the active management.

00:12:34:19 – 00:12:37:23
Dan
So, yeah, I don’t know. It’s just a different feeling, essentially.

00:12:38:17 – 00:12:40:15
Subaan
So responsibility, I suppose.

00:12:40:15 – 00:12:41:27
Dan
At the GP or in the hospital.

00:12:42:03 – 00:12:42:25
Subaan
At the GP.

00:12:43:04 – 00:12:47:00
Dan
Is more responsibility. And that’s why I’ve been thinking about decision making. And I suppose.

00:12:47:00 – 00:12:49:04
Subaan
It’s the nature of just being in sick there as well. So.

00:12:49:19 – 00:12:52:19
Dan
Um yeah, I guess so. It’s something that I don’t feel ready for yet.

00:12:53:03 – 00:12:56:20
Subaan
It was a very different in like the hospital in sick there as well.

00:12:57:10 – 00:13:09:11
Dan
I know in the hospital it felt like I was in third or fourth year and they all feel the same is more in GP that I’m starting to notice that it was really different. Like sometimes this like again, I don’t want this to sound bad.

00:13:09:11 – 00:13:18:15
Dan
Ultimately, I’m a student and I’m there to learn. Sometimes I don’t really know what I’m doing when I’m like taking the history, you know, so I’m just figuring it out as I go along. And that’s that’s the point of it.

00:13:18:15 – 00:13:29:06
Dan
You know, you’re put in at the deep end and they want to challenge you. And there’s always the supervisor there making sure that you’re, you know, you’re not doing anything bad. And I know how to make sure the patient is safe and everything.

00:13:29:06 – 00:13:37:02
Dan
But yeah, sometimes like, for example, with hand examinations, I don’t really know what I’m doing. I’m just sort of figuring it out as I go along.

00:13:37:10 – 00:13:39:12
Subaan
And examinations, you get on that.

00:13:40:08 – 00:13:51:21
Dan
There’ve been a few hand examinations like joint like, yeah, pain in certain joint of the hand, which I know nothing about. And I don’t know. I’m there just to ask questions, try and get the information out and then give that accurately to the doctor.

00:13:52:03 – 00:14:05:12
Dan
But yeah, what I’m saying is I I’m sitting there with the patient asking these questions, but I don’t actually clearly know what’s going on, but you don’t want to show that so much. So it’s a bit of a slight like you have to show deceptive.

00:14:06:00 – 00:14:16:05
Subaan
You know, you’re not deceiving, but I suppose it wouldn’t be particularly reassuring if you could turn on the doctor say they have like they have no idea what they’re doing.

00:14:16:05 – 00:14:25:14
Dan
Basically, yeah, it’s a fine balance because you don’t want to exaggerate. So I wouldn’t say like, Oh, I don’t know, I wouldn’t do something silly, like, Oh, I know what this is or, you know, obviously you shouldn’t do that anyway.

00:14:25:14 – 00:14:36:24
Dan
But if I really don’t know what something is, I won’t say, Oh, I have absolutely no clue what was going on. I would rather say, Okay, like, hold on. Let me just speak about this with my senior and we’ll come back.

00:14:37:05 – 00:14:46:05
Subaan
Whereas you are typically the type of person to straightaway admit, like in a general kind of somebody be like, Oh yeah, I no idea. Oh, no, an expert, blah blah blah. Yeah, my my opinion basically means nothing.

00:14:46:05 – 00:14:55:24
Dan
100%. That’s what I. Generally, so that’s why I’m that’s why I’m saying it’s been a bit of a shift for me because I usually very like happily will say, I don’t know anything about this because I don’t know.

00:14:56:01 – 00:15:07:24
Dan
It also takes away the pressure. But in this, you shouldn’t really be relieving yourself of the pressure because the patient is coming to you wanting an answer or wanting help. You know, the last thing they want is the person who they’ve come to for help to just say, I don’t know what’s going on.

00:15:08:06 – 00:15:10:14
Dan
That’s not very reassuring. So, yeah.

00:15:10:17 – 00:15:23:09
Subaan
So there are two points I have of this. I suppose one thing is that just because of the nature of medicine, a lot is just unknown. So it’s not supposed so saying, I don’t know. So say the patient, ask you a question, right?

00:15:23:23 – 00:15:35:14
Subaan
And it’s not actually established in the literature or within the science as to what the mechanism will cause or you know, why something has happened, saying, I don’t know, like, you’re putting that upon yourself, then saying, I don’t know.

00:15:35:17 – 00:15:50:28
Subaan
Or is it to say that, you know, we haven’t looked like a scientist, we haven’t figured it out kind of thing, because then that takes it off you. So then. But if you would say, Oh, I don’t know, then the patient would probably feel like the answer is there, but you personally don’t know.

00:15:51:24 – 00:16:15:00
Subaan
So I think that’s an important clarification to always make. And yeah, that would still maintain confidence in you as a doctor from the patient, whilst also admitting to the fact that medicine isn’t just so clear. Like a lot of people like to assume or, you know, maybe just don’t have the insight into it, knowing that a lot

00:16:15:00 – 00:16:36:07
Subaan
of it is always a bit wishy washy, kind of like trial and error may give an antibiotic around them. Let’s try another one and another one. Okay, fine. So, yeah, that was point one. And the other point is I sometimes use the medical student thing as an escape route out of any kind of responsibility.

00:16:36:07 – 00:16:48:24
Subaan
And I suppose that’s what it is, right? So you can’t be really held liable as a student because you know you are a student, so you technically have no responsibility is upon the supervising doctors or teachers or whatever.

00:16:49:18 – 00:17:05:05
Subaan
But sometimes a patient asked me a question like, just say I was. I was on psych over the past couple of weeks and I was just in the, you know, psych ward bit. And, you know, because the patient was walking around, just came up to me, started talking and asked me a couple of questions and stuff.

00:17:05:05 – 00:17:12:21
Subaan
And then she asked for, like my opinion, if I don’t know what I’m meant to do, then do I give my opinion as to.

00:17:13:12 – 00:17:16:04
Dan
Oh yeah, that’s why I would give.

00:17:16:04 – 00:17:32:03
Subaan
A very vague answer that’s non-controversial. But then I’m just like, like, you know, I’m just, I do. I would start off with, I’m just a medical student, so I’m not really allowed to, you know? Give like might like it, or it’s the doctor’s job to give his opinion and figure out what the treatment plan is or, you

00:17:32:03 – 00:17:53:02
Subaan
know, whether you’re allowed to go out on leave or something, which is a big issue in Psych or I can’t remember. There was another situation where a patient asked me like, Oh, what causes this? Or, Okay, you know, the situation was the patient was asking me about mind control because so she was she she had had an

00:17:53:02 – 00:18:07:00
Subaan
acute episode of psychosis and, you know, the delusions that come from it in terms of delusions of like, you know, thought possession, thought insurgent. Yeah, that was it thought in sergeant withdrawal and, you know, thought blocking that kind of stuff.

00:18:07:08 – 00:18:19:02
Subaan
And then her, although she she had really good insight and she’d recovered well and stuff, and she was a really high functioning individual at the end, she she wanted to obviously know, you know, why it happened, what causes it and stuff.

00:18:19:13 – 00:18:30:29
Subaan
And you know, it’s obviously multifactorial. But then she was she had an overvalued idea on the aspect. So not a delusion, but an overvalued idea on the aspect of mind control and, you know, hypnosis, that kind of stuff.

00:18:31:07 – 00:18:48:03
Subaan
She was really digging into me, so I asked if she had any questions and she’d mentioned it before. But you’ve really started digging about as to whether I think mind control is possible because she thought that was there was another person that, you know, was part of the history that, you know, she thought was like causing the

00:18:48:15 – 00:19:04:08
Subaan
hallucinations. And so she was having. And so she really like drilled me about mind control, and I was like, How much do I say? Do I just say outright? Like, No, like Collins medical science? No. Or do I try and give a more softer answer?

00:19:04:08 – 00:19:19:12
Subaan
And or obviously, I’m not going to agree with her because she’s posing. I don’t think it’s going to literature as well as in terms of causing street delusions and thought with withdrawal and stuff like that. You know, I’m not really aware of anything, I mean, or anything like that either.

00:19:19:20 – 00:19:32:26
Subaan
So yeah, how much? How much would I say? How much would I say is not or is backed by certain literature? Or how much do I say is my opinion? Well, let’s just give another example of like an infection or an autoimmune condition, right?

00:19:32:26 – 00:19:54:00
Subaan
Something that’s probably easier to tackle. You know what causes it or what do I think causes it? And when it comes to certain diseases, especially ones like autoimmune conditions or diabetes, really anything that’s metabolic related or even immune related, I generally have, you know, a different subset of opinions compared to, say, what is like the Orthodox Medical

00:19:54:00 – 00:20:09:04
Subaan
School teaching. So if if I did just agree with, you know, what medical school said in certain ideologies or what the best management is for a certain condition, then I wouldn’t have any really concern of just saying, you know, this is what they say is probably what’s best.

00:20:09:11 – 00:20:17:03
Subaan
But because I don’t, then what do I say is like, you know, what’s my opinion was backed by science? What’s the like I this way? Do you have you have?

00:20:17:03 – 00:20:30:24
Dan
That definitely is again, in the last couple of days, like a patient one lady, the lady with chest pain, she was saying to me, Do you think like she was worried about having breast cancer?

00:20:30:25 – 00:20:31:10
Subaan
Interesting.

00:20:31:18 – 00:20:41:14
Dan
And she said, like, could I? This could an acute like breast cancer have come on this morning? Could that be a cause of the pain? Mm hmm.

00:20:41:23 – 00:20:43:16
Subaan
And this is why you got ice patients.

00:20:44:05 – 00:20:55:09
Dan
Yeah, this is where I got to check their ideas, concerns and expectations. But like, I didn’t want to just say, Oh no, it’s definitely not breast cancer because, you know, you wouldn’t have symptoms. Come on that quickly, because I don’t know.

00:20:55:10 – 00:20:57:10
Subaan
They can always be that weird edge case.

00:20:57:11 – 00:21:06:14
Dan
Yeah, exactly. So but then if you also you don’t want to encourage someone to think that that’s a possibility when it’s extremely unlikely.

00:21:06:14 – 00:21:12:08
Subaan
You know, because I feel like a senior consultant in that kind of something beyond, you know, not possible, like it’s incredibly easy.

00:21:12:15 – 00:21:12:17
Dan
Can.

00:21:12:24 – 00:21:13:29
Subaan
Say with certainty.

00:21:14:03 – 00:21:20:07
Dan
The like when he you speak to a patient, he would just be like, No, it’s like, it’s not that.

00:21:20:17 – 00:21:28:26
Subaan
You know? But the thing is, is that sometimes I have the confidence and saying like, you know, yeah, it’s not that or is this, but am I allowed to be that confident if I make sense?

00:21:28:29 – 00:21:39:15
Dan
Because again, it’s like, OK, I translate this decision making process into driving. When you’re driving, you are taking a series of risks as well. Would you say that’s fair?

00:21:39:26 – 00:21:41:00
Subaan
Yeah, it’s very risky.

00:21:41:06 – 00:21:57:21
Dan
Technically, but you’re just committing like everything you do, I suppose, is a series of risks. You’re just constantly taking risks if you’re going outside. The risks are absolutely minuscule, but it’s the same in medicine as well because you can just miss something you know, like that’s very plausible.

00:21:58:00 – 00:22:13:09
Dan
You obviously have to do all you can or you can to make sure that risk is 0.0 or, you know, those injuries one as small as possible. But you can never know if you’re discharging a patient. You can never know for sure that they’re going to be 100% OK and that you haven’t missed something, but it’s just

00:22:13:09 – 00:22:27:19
Dan
getting used to that idea. And also safety netting. That’s in my head. The biggest takeaway from it, or the biggest way to quell that concern is think OK, right? Like. With this lady, I think it’s so unlikely that she has breast cancer.

00:22:27:20 – 00:22:50:02
Dan
I think it’s unlikely that she’s having a heart attack. I think it’s very confident that it’s a musculoskeletal pain. But I then explained to her like how it feels to have a heart attack. And I explained to her the importance of checking your breasts for lumps and like how you can do that and then her leaving.

00:22:50:15 – 00:23:00:01
Dan
I realised, Oh, OK, I feel a lot better now because I have made that clear to her that sort of now she has a part in this in terms of responsibility to make sure that she’s OK as well.

00:23:00:12 – 00:23:18:19
Dan
I think educating patients is incredibly important as well, and I know I don’t want to sit here and I’m like, I know how to like, manage patients because I’m actually a complete baby. But in terms of like my medical career, I’m still, you know, I haven’t even graduated, but I can already see the importance of sitting down

00:23:18:19 – 00:23:27:04
Dan
with the patient and just for two or three minutes. She was so worried she was having a heart attack this morning, but she didn’t. She thought the heart is in the right hand side of the chest.

00:23:27:12 – 00:23:28:22
Subaan
That’s fair enough.

00:23:28:23 – 00:23:31:27
Dan
You know, like which is like, you know, I guess if you.

00:23:32:07 – 00:23:34:00
Subaan
Have studied any of the.

00:23:34:01 – 00:23:34:29
Dan
How are you going to know.

00:23:34:29 – 00:23:35:17
Subaan
Exactly?

00:23:35:19 – 00:23:47:20
Dan
So she she thought it was on that side of the chest and even explaining that to her made her feel so much calmer, thinking like, Oh, you know, we’ll be in the middle of your chest on the left hand side of your chest because that’s where the heart is.

00:23:48:10 – 00:23:50:03
Dan
Unless, you know she has that.

00:23:50:18 – 00:23:50:28
Subaan
Yeah.

00:23:51:14 – 00:23:57:15
Dan
Unless she does that, unless unless you has to do to make sure you actually know.

00:23:57:16 – 00:23:59:03
Subaan
Yes, that’s her cardio.

00:23:59:05 – 00:24:11:25
Dan
But I did a cardiac exam, so now I’m just walking through it in my own head. So I think you can end up spiralling in this sort of job as well, like you can because of this, like never being 100% certain, you can just second guess yourself all the time.

00:24:12:01 – 00:24:12:17
Subaan
Yeah.

00:24:12:17 – 00:24:26:04
Dan
Oh, suddenly you have to like control, I guess, in yourself and your internal dialogue. I know. Yeah, that’s what I had to say really on this is just sort of thinking about how to make decisions, accepting that everything I do is technically a small risk, every decision you make.

00:24:26:14 – 00:24:42:08
Dan
I don’t know if you can ever be 100% sure on something, but then thinking, OK, what can I do to make this as safe as possible, basically and minimise that risk? And yeah, I think the answer to that, in part, is education of the patient and openness to let them know what you’re thinking and like how to

00:24:42:08 – 00:24:46:24
Dan
look for signs of like if you’re wrong, how they could possibly tell.

00:24:47:01 – 00:24:50:23
Subaan
Do you think this is going to change how you make decisions in other aspects of life?

00:24:51:02 – 00:24:52:08
Dan
Yes, I think it is.

00:24:53:03 – 00:25:01:09
Subaan
Is more risky or less risky. Like, are you going to be more open to taking more riskier decisions or going off less information or something?

00:25:01:24 – 00:25:13:27
Dan
I think I think it’s oh, it’s a difficult question to answer because I think it depends on the context, you know, true. The only thing I’ve noticed so far is when I’m driving, where like I’ll commit to a decision more.

00:25:14:02 – 00:25:20:17
Dan
And also, I realise, like if you commit to decisions drivers around, you will more likely understand what it is.

00:25:21:00 – 00:25:35:00
Subaan
You know, you see commitment is like just committing and just taking the stick for it. Almost that, if you are wrong is I think that’s appreciated more in his own. Maybe not in society. Or maybe it’s kind of frowned upon in society being just like stone like, yeah, no.

00:25:35:00 – 00:25:45:11
Subaan
This is what I’m going with is what I think is right kind of thing. But in general, like on an individual level, everyone appreciates when someone can just make the decision and just like, confirm it and go forward kind of thing.

00:25:47:06 – 00:25:51:20
Subaan
Just your face. You look really confused or like disgusted.

00:25:52:12 – 00:26:11:14
Subaan
Anyway, when I was on radiology for a bit, the radiologist was saying that if you are to become a radiologist, you have to get good at just making decisions and just calling the shots. Because a lot of the time the medical team are waiting upon your or busy expecting a shot call from you as to what to

00:26:11:14 – 00:26:26:18
Subaan
do next, or, you know, I think this is X-Y-Z. You should seek, you know, surgical referral, blah blah blah neurosurgical. I would do this or do that or, you know, investigate x y z. They want that for or to just give the diagnosis, blah blah blah do this next kind of thing.

00:26:27:03 – 00:26:40:10
Subaan
That’s what they want from a radiologist. Pretty much every time, if you’re just then and you’re just kind of a bit wishy washy, you’re not committing to what you’re saying. They just they don’t like because you haven’t given them any information.

00:26:40:10 – 00:26:53:05
Subaan
It was like, what’s the point of doing the radiology referral if you aren’t actually going to tell them what to do at that point, because you’re essentially at the loss straw buy. Okay, radiology referral. We need to know what this is or what to do next and blah blah blah, you know, can I drain this abscess or

00:26:53:05 – 00:27:06:23
Subaan
something? If you’re like, uh, could be, you could drain. It might be like, you know, I don’t know what the different, you know, contraindications are, but yeah, they’re just going to be like, Okay, so what should we do?

00:27:07:02 – 00:27:21:22
Subaan
Because you’re the one with the best knowledge to tell us what to do. Is it possible? Is it not possible? So he said they’d rather you just get to the shot and the preferred that respect you if you’re wrong because you just call the shots, you know you did what you thought was best in your clinical judgement

00:27:22:10 – 00:27:34:06
Subaan
. So I think. Like all walks of life, people actually respect you a lot if you just call the shot you. And you just kind of take it on the chin if you are wrong, but you were confident and you reasoned with yourself as to why you thought that was the correct.

00:27:34:15 – 00:27:35:22
Subaan
Obviously, within reason.

00:27:35:27 – 00:27:42:02
Dan
That’s why I like prefacing because I can say, like, this is my opinion. I might be wrong, but I guess that, yeah, but.

00:27:42:04 – 00:27:46:20
Subaan
You can’t do that like a radiology. You know, I’d say, do this by just my opinion kind of thing.

00:27:46:20 – 00:27:49:00
Dan
I guess you just mentioned, is this my impression is.

00:27:49:00 – 00:27:51:26
Subaan
That that is the phrase they use, you know? Yeah.

00:27:52:01 – 00:28:04:17
Dan
Anyway, OK. So today, the reason why I have to go is because half seven I’ve got a football match at 7:00 now. It’s about a 1015 minute drive as opposed to just, you know, head off in the moment.

00:28:04:22 – 00:28:06:26
Dan
Yeah, but another fruitful episode.

00:28:07:06 – 00:28:09:04
Subaan
It wasn’t. Well, I don’t know if it was fruitful.

00:28:09:19 – 00:28:11:07
Subaan
And maybe we’ll listen back and look at how.

00:28:11:11 – 00:28:12:24
Dan
We can be certain that this isn’t.

00:28:13:02 – 00:28:13:13
Subaan
Yeah.

00:28:14:10 – 00:28:16:23
Dan
So, yeah, but any any final thoughts?

00:28:16:26 – 00:28:17:06
Subaan
No.

00:28:17:19 – 00:28:18:15
Dan
It’s back yourself in.

00:28:19:09 – 00:28:21:01
Subaan
Yeah, I stand by what I said.

00:28:22:02 – 00:28:23:29
Dan
OK. Not until the next one.

00:28:24:05 – 00:28:28:12
Subaan
Peace. Peace. Thank you for listening to this episode of Getting It.