Thursday, 24 February 2011

Life in clinic

Since last week I have been working in antenatal clinic. It's a completely different experience in so many ways to what I have already done. Every day there are clinics run by the consultants, who may or may not be in attendance. I am well aware that it doesn't sound right that someone can be booked for a consultants appointment and for the consultant to not actually be let me explain.

I had heard of the terms SHO, Registrar and Consultant but had absolutely no idea how it related to seniority....although I assumed that the Consultant was the most senior position. I assume that I am not the only person to have found it a little confusing as to who is who.

So an SHO is a Senior House Officer. This is a junior doctor who is undergoing training within a specialised area, supervised by the consultants and the registrars.

A Registrar is commonly called the Reg for short, and is a doctor who is undergoing advanced training in a specialised area in order to become a Consultant.

And finally the Consultant is the senior doctor who has completed all training in a specialist field and is deemed to be an expert in their area.

So if you are booked into the antenatal clinic for a Consultant appointment, it may very well be that it's not the consultant you will see. However rest assured, for if the SHO or Reg decide that the Consultant needs to be involved in any decision making, then they will not hesitate to bring him into the room.

So anyway being in clinic is very different from my community placement where we'd run clinics. The midwife there is autonomous and makes decisions regarding care herself, though of course, if she has any concerns, she would send the woman in to the hospital - whether it would be to see a consultant, or fetal assessment unit, or maternity assessment unit, or triage - it is the midwife that makes the decision. In antenatal clinic, it is very much the doctor that makes the decisions. Mostly I have been taking blood pressures and testing urine, and on some days I have also been palpating to check the position of the baby, and measuring the fundal height (the height of the uterus which gives an indication to the growth of the baby when compared with previous measurements) and listening in to the baby's heartbeat.  This has given me the opportunity to practise my basic skills and improve on them.

However I have also had the opportunity to listen and learn about care of more high risk women. The women coming into clinic are all coming for very different reasons - previous Caesarean Sections, bleeding in pregnancy, thyroid problems, sickle cell trait in the family, previous stillbirth, high blood pressure, recurrent urine infections and the list could go on and on. As you can imagine there are varying degrees of severity, which is why for some women, seeing the SHO is perfectly suitable and for others, seeing the Consultant is essential. It's not a case of special treatment, it's merely a case of medical requirement. You have to remember that in order to become a doctor, the SHO has already undertaken years of training. So if it turns out that when you thought you were seeing a Consultant, and you actually saw a Junior Doctor, it doesn't mean you are any less special, it just means that your care for the moment, is not as high risk as it may be for some others. And just to flip the coin, if you did see the Consultant, it may not be that you are extremely high risk, merely that he had already seen his highest risk patients and was now seeing anyone else waiting for their appointment. Confused? Yep I was too......after nearly two weeks there, I think I am just about getting to grips with it all.

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