This week I feel like I have suffered a lot with my current exam week. Monday I had a 3-hour written paper; Wednesday I had an OSCE (Objective Structured Clinical Examination - assessing practical skills); Thursday another OSCE; and today a final OSCE, this time over an hour of rigorous one-to-one assessment. I always struggle with exams. Not only in revision, when I find it difficult to concentrate on books for very long, but also pre-exam nerves where my body gets flooded with Adrenaline.Once I'm in there, I'm fine. In fact, today I really enjoyed my OSCE. It consisted of six 12-minute stations, two of which involved conducting a consultation with an actor playing a patient, and being examined for communication skills. It is all very frantic and stressful. Perhaps that is the idea: Doctors have to be able to cope with stress, especially in emergency situations.
By mid-week I was thoroughly exhausted. I was feeling withdrawn, unable to revise, and quite despairing (especially after I prescribed Viagra for a patient's hospital stay. Why??)
But I'd like to focus on today's exam. It was testing skills in General Practice, mostly consisting of an examiner asking us questions about hypothetical scenarios. Even so, it is easy for morally objectionable subjects to crop up. I felt like my answer to these were quite good considering the added stress and pressure!
Luckily I had recently read an excellent chapter in a book sent to me by Dr. Charlie O'Donnell (one of the authors) which I'd heartily recommend to any medical student or doctor concerned about complicity with the moral problems of medicine:
Chapter 8 is brilliant, especially for a career in General Practice. Mike Delany gives some excellent advice on how to handle a patient requesting abortion, which enabled me to find this particular station entirely unproblematic. My first step was to explain to the examiner the criteria of the 1967 abortion act, and that if taken legitimately it is much harder to justify 'abortion on demand' which is clearly a violation and abuse of the law. The examiner agreed. Next I was able to mention the moral objection clause, which protects doctors from doing anything they feel uncomfortable with. But ultimately I was able to score my points with him by giving the requirements which the other doctors would need to meet if the patient sought a second opinion (which I would be required to freely enable). It is certainly easy for me to say this, but how to practice this well, as a good Christian, is better left to the expert! I quote Mike Delany in abbreviation:
This may be so, and I was grateful at the time for this advice, which I found incapable of obtaining elsewhere. But like I have said, the approach outlined by Mike Delany in this book seems more in keeping with a compassionate Christian approach, where the temporal concerns of the patient (and not just the eternal welfare, which may require a judgemental approach) are taken into account and treated sensitively. That is what we are trained as doctors to do, in all situations, and there is no reason why we cannot apply it to the case of abortion. It is very rare that a patient's demands must be bowed to without considering all the implications. However, as I said in a previous post, there is a tendency for an 'autonomy' obsessed healthcare system to become consumerist, which we have to be careful about. I also need to take the following duty of a doctor into account, which is no longer from the Hippocratic oath, but rather part of the GMC recommendations for tomorrow's doctors:
But I'd like to focus on today's exam. It was testing skills in General Practice, mostly consisting of an examiner asking us questions about hypothetical scenarios. Even so, it is easy for morally objectionable subjects to crop up. I felt like my answer to these were quite good considering the added stress and pressure!
Luckily I had recently read an excellent chapter in a book sent to me by Dr. Charlie O'Donnell (one of the authors) which I'd heartily recommend to any medical student or doctor concerned about complicity with the moral problems of medicine:
Cooperation, Complicity & Conscience: Problems in healthcare, science, law and public policy. Ed Helen Watt. Linacre Centre: London, 2005
Chapter 8 is brilliant, especially for a career in General Practice. Mike Delany gives some excellent advice on how to handle a patient requesting abortion, which enabled me to find this particular station entirely unproblematic. My first step was to explain to the examiner the criteria of the 1967 abortion act, and that if taken legitimately it is much harder to justify 'abortion on demand' which is clearly a violation and abuse of the law. The examiner agreed. Next I was able to mention the moral objection clause, which protects doctors from doing anything they feel uncomfortable with. But ultimately I was able to score my points with him by giving the requirements which the other doctors would need to meet if the patient sought a second opinion (which I would be required to freely enable). It is certainly easy for me to say this, but how to practice this well, as a good Christian, is better left to the expert! I quote Mike Delany in abbreviation:My approach... is to view the situation as I would any other medical consultation: I have training in medicine alone and can only offer a medical opinion... So, I begin by taking a history and performing whatever examination or further investigation is appropriate; I am then in a position to discuss my findings... I will do all I can to provide support through this pregnancy and facilitate connection with other services available... If she persists along the lines of seeking an abortion, I share my experience of treating the aftermath of this procedure... deleterious psychological sequelae... the nature of the procedure and the risks entailed... Sadly few are swayed... The first precept of doing no harm [non-maleficence] has been honoured; the rather thornier issue of respecting autonomy follows.So it is then appropriate merely to remind the patient of their right to a second opinion from another doctor of their choosing. The most important aspect about this approach is the compassionate way we feel bound to approach a mother contemplating a difficult unsupported future, for example, and not merely to send them out the door without any guidance merely to keep one's hands clean of the situation. Incidentally, it was a Muslim doctor who advised me to do the latter, since most patients have no interest in religious motivations.
This may be so, and I was grateful at the time for this advice, which I found incapable of obtaining elsewhere. But like I have said, the approach outlined by Mike Delany in this book seems more in keeping with a compassionate Christian approach, where the temporal concerns of the patient (and not just the eternal welfare, which may require a judgemental approach) are taken into account and treated sensitively. That is what we are trained as doctors to do, in all situations, and there is no reason why we cannot apply it to the case of abortion. It is very rare that a patient's demands must be bowed to without considering all the implications. However, as I said in a previous post, there is a tendency for an 'autonomy' obsessed healthcare system to become consumerist, which we have to be careful about. I also need to take the following duty of a doctor into account, which is no longer from the Hippocratic oath, but rather part of the GMC recommendations for tomorrow's doctors:
...make sure that your personal beliefs do not prejudice your patients' care... avoid abusing your position as doctor... [and] in all matters you must never discriminate unfairly against your patients or colleaguesI am happy to abide by these principles as long as they do not infringe upon my own spiritual life. This is perfectly reasonable, and there is no reason to think that being a doctor is not compatible with being a saint.
Bah!
ReplyDeleteYou look exhausted there. Rest well. Sleep enough. Eat well, and drink plenty fluids!