Week two

'My' office

The first day of my second week saw me thrown in well and truly at the deep end. I arrived bright and early, hoping to find time at last to get the room sorted, discover the contents of the filing cabinet, and look for all the official diet sheets or patient information or whatever I could find. Instead, I found a) a note from the main DSN saying she forgot to mention she and the other principal DSN wouldn't be around until lunchtime, b) a list of 23 patients who were due to be seen by the doctor that morning, of whom I could see as many or as few as I chose. I also found a small table had appeared in 'my' room, which was absolutely ideal for sitting with patients.

That was a difficult morning, because I didn't understand what was going on or what was expected of me. I tried to get an explanation from the Support Worker and the DSN working in the clinic, and they did tell me how the doctor worked and what all their roles were, but despite repeatedly asking for suggestions, I didn't get much help with what I was supposed to do. I did the best I could, and at the end I discussed how I'd found it a bit hard going, at which point the DSN said "Well, Dietitian X [one of my colleagues who comes over to participate in a joint renal and diabetes clinic] does it like [this], and it seems to work very well." That's what I wanted to know at the start of the day; I don't know why she didn't tell me then. It's all a very big learning curve.

Then on Wednesday I went to the meeting with four other Dietitians, three working in Diabetes in the big hospital and the community, and one working with obese patients. There are distinct differences in the services offered by this team compared with my previous team - for example, I used to offer support for a Very Low Calorie Diet (using meal replacements like SlimFast) to enable weight loss; this team advocates carbohydrate reduction and has two different programs to support this approach. My carbohydrate reference tables went down very well, but my hypo treatment illustrations provoked some discussion about whether the appropriate treatment should be 10g or 15g fast-acting carbohydrate followed by 15g or 20g slower acting carbohydrate.

The main problem through the meeting was that I had to interrupt them repeatedly to get them to explain all sorts of jargon and references to people, events, places, teams, programs and treatments that I wasn't familiar with. I didn't manage to get the full overview of the service that I was hoping for, but I can easily get back in touch to clarify and get more information at a later date.

I still haven't had time in 'my' office to get the hang of what goes on. I was looking forward to time on Thursday, when it didn't seem that there was anything scheduled. At the end of Wednesday, however, the DSNs mentioned that they wouldn't be around on Thursday because they were attending a study day on Type 2 Diabetes, so of course I asked if it would be suitable for me to attend, which it was. So that was where I went on Thursday.

It was a full day of talks from various doctors, nurses and researcher, but Ben Goldacre's views were thoroughly borne out when it became clear that the sponsor's products were featured heavily. It was useful to me anyway, because my knowledge of Type 2 and its features and treatments is a bit flaky. One of the strongest non-pharmaceutical messages that was delivered was that if you are diagnosed with diabetes and continue to smoke, then your risk of death is so enormously raised that if you understood the probabilities you would be thoroughly shocked. Maybe even shocked enough to stop smoking. I don't remember the numbers, but maybe I'll look them up when I get a spare minute. I have no idea when I will ever get a spare minute again.

I saw patients on Friday, which is my 'short' day, so I was home early. I had foolishly suggested to Mr A that we might go out on Friday night to a gig in which a friend was playing, and he was quite keen. I, however, had come to regret the suggestion and would have paid a considerable sum including body parts to be allowed to stay at home on the sofa. We went out, it was good, we came home very late indeed, and I slowly recovered over the course of the weekend. Then the working week started again...