Hello everyone! Sorry for the delay between posts. I am not really used to writing in a blog and was never much of a journal person, so it takes me time to type my thoughts.
And I have so much to learn here that I spend most of my afternoons reading up on what I saw. It's so nice to have time to read, which I found difficult to have in the US because I was always exhausted or had a bazillion other errands to run when not working.
After an initial few awkward days on the ward, I think I am starting to find my place, kind of. Some of the interns and registrars have started to understand my qualifications and will ask me questions if they are uncertain, which is really nice because then I feel useful. Otherwise, I often don't feel too useful as I don't speak the language and sometimes I feel that I am just getting in the way. It's especially hard when patients come up to me talking in Sinhalese and I cannot answer their questions. Some of the patients who speak English or have been there for a few days understand my limitations but still let me examine their children. That has been the best thing: the respect the patients have for doctors and their willingness to permit me to see their children even if I don't offer anything back.
Now that I understand the system better and am starting to get a sense of the epidemiology of diseases here, I give my input in management decisions. There is one particular case I am becoming very invested in: a 4 month old child with large left sided neck mass. They think it is a cystic hygroma that maybe super infected though the child has no fevers. Oddly though they picked amp and gent to treat, which has poor staph coverage and no anaerobe coverage, but they wanted to continue the same even after 4 days of no change in mass size. And now day 6 the mass is growing and so they sent the child for repeat ultrasound. I suggested CT but they said no, haha. I understand due to child's age and risk of CT but an ultrasound only tells you so much.
But interestingly here, even if the Consultant (our equivalent of Attending) wanted a CT the radiologist may refuse to do it if they don't think it is needed. Also, the registrars here cannot make the decision to do an LP, change antibiotics, or send patient for imaging or special blood studies without the consultant's permission. I understand that this helps to preserve resources and save costs but it also really delays treatment and tailoring management. It frustrates me because thanks to my training, I do feel comfortable making plans and executing them but am bound by the limits of the system.
I think the registrars lack of autonomy as well as the concern for poor patient follow-up is at least partially why antibiotics are used so freely. But I also learned this antibiotic use is attending dependent (as always!) and some are really better about it. The other problem is many patient's come in on antibiotics so you are stuck treating.
Things are so different here and yet also the same. It's challenging (in a good way!) adopting my knowledge to this system. Also, AAP guidelines are sometimes different from WHO guidelines, and I don't know the latter too well. But now I get to learn! Very exciting.
I must add that I have been impressed by the variety of pathology (ex-31 weekers, CDH, congenital uretral obstruction, myelomeningoceles, neonatal hepatitis, and so much more!) I see here and that despite the apparently cumbersome system care is delivered in a timely manner when really needed.
Anywho, that was a lot of medical talk. Sorry to bore everyone, but I wanted to get some of my thoughts out before I forgot them. No fun pictures today but the weekend is coming up so I am sure that I will have more soon!!
And I have so much to learn here that I spend most of my afternoons reading up on what I saw. It's so nice to have time to read, which I found difficult to have in the US because I was always exhausted or had a bazillion other errands to run when not working.
After an initial few awkward days on the ward, I think I am starting to find my place, kind of. Some of the interns and registrars have started to understand my qualifications and will ask me questions if they are uncertain, which is really nice because then I feel useful. Otherwise, I often don't feel too useful as I don't speak the language and sometimes I feel that I am just getting in the way. It's especially hard when patients come up to me talking in Sinhalese and I cannot answer their questions. Some of the patients who speak English or have been there for a few days understand my limitations but still let me examine their children. That has been the best thing: the respect the patients have for doctors and their willingness to permit me to see their children even if I don't offer anything back.
Now that I understand the system better and am starting to get a sense of the epidemiology of diseases here, I give my input in management decisions. There is one particular case I am becoming very invested in: a 4 month old child with large left sided neck mass. They think it is a cystic hygroma that maybe super infected though the child has no fevers. Oddly though they picked amp and gent to treat, which has poor staph coverage and no anaerobe coverage, but they wanted to continue the same even after 4 days of no change in mass size. And now day 6 the mass is growing and so they sent the child for repeat ultrasound. I suggested CT but they said no, haha. I understand due to child's age and risk of CT but an ultrasound only tells you so much.
But interestingly here, even if the Consultant (our equivalent of Attending) wanted a CT the radiologist may refuse to do it if they don't think it is needed. Also, the registrars here cannot make the decision to do an LP, change antibiotics, or send patient for imaging or special blood studies without the consultant's permission. I understand that this helps to preserve resources and save costs but it also really delays treatment and tailoring management. It frustrates me because thanks to my training, I do feel comfortable making plans and executing them but am bound by the limits of the system.
I think the registrars lack of autonomy as well as the concern for poor patient follow-up is at least partially why antibiotics are used so freely. But I also learned this antibiotic use is attending dependent (as always!) and some are really better about it. The other problem is many patient's come in on antibiotics so you are stuck treating.
Things are so different here and yet also the same. It's challenging (in a good way!) adopting my knowledge to this system. Also, AAP guidelines are sometimes different from WHO guidelines, and I don't know the latter too well. But now I get to learn! Very exciting.
I must add that I have been impressed by the variety of pathology (ex-31 weekers, CDH, congenital uretral obstruction, myelomeningoceles, neonatal hepatitis, and so much more!) I see here and that despite the apparently cumbersome system care is delivered in a timely manner when really needed.
Anywho, that was a lot of medical talk. Sorry to bore everyone, but I wanted to get some of my thoughts out before I forgot them. No fun pictures today but the weekend is coming up so I am sure that I will have more soon!!
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