New wards

The Thames from the Woolwich Ferry, May 2012

My (not so) new wards are busy busy busy. Or at least one of them is, referring patients left right and centre via telephone, or face to face when I wander too close. I'm just about keeping up at the moment, mainly because clinic this week was, in contrast to last week, slow. Only three patients showed up. But it was still difficult - they weren't easy to deal with. I don't think I told one patient anything she didn't already know and she is frankly sceptical that it will work, another patient I doubt will take my advice at all, and the third may or may not follow my advice but it probably won't make a lot of difference to the (hereditary) medical condition that she has. But I still enjoy the clinic far more than working on the wards.

Anyway, the (not so) new wards have urology, respiratory and rheumatology patients. There are a whole load more new abbreviations to learn, and new medical conditions to encounter, and I have discovered that a 'productive cough' is a really, really unpleasant thing when you are having a conversation with a patient. There are still quite a few patients needing tube feeding, and often for swallowing difficulties, but I haven't yet worked out how come they feature so heavily on urology or rheumatology wards. Respiratory makes sense: many of the patients have neurological conditions that affect both breathing and swallowing.

• Favourite abbreviations so far: 'TWOC' (Trial Without Catheter) and 'SOB' (Short of Breath). The latter is actually an abbreviation I've known for a long time and is still my all-time favourite. 
• Second and third favourite abbreviations of all time are OTT (On The Throne [toilet]) and TTO (To Take 'Ome [Out]) for medications and supplements that need to be sent home with the patient.
• Abbreviation that I've seen a number of times following CT scans of the head (I think) and still don't know what it stands for: 'SOL'
• Least favourite words that feature heavily in medical notes: 'sputum', and 'productive cough'.
• New word of the week: 'fasciculation', which is involuntary muscle twitching.
• Word that I am most proud of remembering since I first learned it: 'kyphosis', which is curvature of the spine into a hunchback shape.

I have also had a run-in this week with a doctor about providing a patient with information about a low potassium diet. In the end I had to call in a grown-up, in the shape of one of the specialist renal Dietitians, to back me up and write in the medical notes about exactly why it wasn't appropriate to provide this information to that particular patient. Now I need to embed this information so that I understand better all the reasons why blood potassium may be raised, and by which dietary and non-dietary factors.