Friday, 30 March 2012

An average week of a fourth year medical student: Friday

An average week of a fourth year medical student: Friday

Firstly I finally just got down and did a reasonable amount of essay, woo! Secondly yes this does mean I am in at home on a Friday night doing essay rather than out :/ still on the plus side at least I don't have finals in a few weeks like my fifth year friends!
I'm so sorry...I just couldn't resist!

So its friday today, which means it is GP day, I don't have GP visits every Friday, just 8 in the year but today does happen to be one of those 8.
Here is my rough day:

8.15 Leave for GP surgery
8.50 Get stuck in a horrible traffic jam and only move 1mile in 30 mins. Perfect.
9.30 Arrive at GP surgery 30 mins late, and very stressed and panicked.  GP is ok about this though and very understanding - phew!
9.40-11.00 See patients at the GP surgery, a good mix of cases but mostly older patients due to the demographic of the town this GP surgery is in.  Quite a few "heart sink" patients though like an elderly lady who has recently gone blind, has epilepsy as well and now is also very depressed.  She is a "heart sink" patient because its quite difficult for the GP to treat her depression through medication at any rate as anti depressants can increase the amount of seizures in those with epilepsy and also certain antidepressants may interact with epilepsy drugs so this makes it harder for the doctor to choose a treatment for her which will not complicate  things further.
11.00-12.00 The GP goes on house calls at this point.  This GP surgery seems to do a lot more house calls than other surgeries I have been attached to although maybe this is partially because of the older population here.

The house calls bring a whole new level to the heart sink factor as the five the GP I am shadowing takes are all at a care home for people with very advanced dementia.  It does really shock me how absent some of the residents in this care home are, some are able to answer the GPs equations about their symptoms but others are simply staring vacantly at the walls/ ceiling.  Now when I say phrases like "vacant" I don't mean any disrespect to the patients or their families, that's just simply how it is, some of these patients had such advanced dementia that they had absolutely no idea what was going on around them and didn't ever realise the doctor was there.  These cases are heart breaking as there is so little that can be done for the patient (beyond treating whatever acute bout of illness has caused the doctor to be summoned).  I think in many ways its probably harder for the relatives than the patients once an individual reaches this degree of illness because beyond the occasional lucid moment that they may have, for the most part the patient will not be aware that things had been different / that they are ill.

Afternoon:  I picked up those desk chairs I bought off ebay, definitely a bargain at £5.98! And fortunately it turns out you can fit 4 desk chairs in a ford ka, if you try really really hard! Anyway means I can now sit at my desk and write my essay on a comfy seat rather than a wooden fold out seat stolen from elsewhere in my house!

Met up with my research supervisor and get some of the stuff I need though not all of it, he is a very nice guy and we randomly talk about other career progression things for most of the meeting.  He always enthuses me research wise when I meet up with him, its just when I'm not meeting up with him it can be quite tricky to hear back from him and get help with the bits I need help with :/.

In the evening, I cook/eat dinner, do a decent amount of essay, write this and now its bedtime and the weekend!

My weekend will not be exciting so here is its summary: Tomorrow I will be working till 5.30 at WHSmiths earning money for food and other such luxuries (or for another four desk chairs, who knows!), Sunday I am determined to virtually finish that essay.

So there you go, the average (rather than exciting stories) week of a fourth year medical student :)

Halfadoc x

Thursday, 29 March 2012

An average week of a fourth year medical student: Thursday

An average week of a fourth year medical student: Thursday

Bit of an annoying day today, just kind of one of those days where nothing goes quite right/ as you planned it.

So to start with today is my designated research day, now my research hasn't been going very well this year at all through no fault of my own (but probably one of those things thats better not to moan too much about on this blog in case my identity is not as anonymous as I would like to think it is).  Well for the unmentioned-moan-reasons a lot of my Thursdays have effectively just been days off this year as I haven't been able to do anything with them, but today I hoped I was actually going to be able to get some of the data I need to get.  I spoke to my supervisor on Friday in person and it looked like I was going to be able to come in today and get some of my data but he needed to talk to some of his colleagues and check this and then let me know what time.  He ask me to email him and remind him, so I did this first thing on Monday....

.....Wednesday morning: Still no reply... *Emailed him again with a polite nagging email*....
.....Wednesday Evening pre sleep: Still no reply :/ great, set my alarm for 9am so I can see if he replies first thing

9am: No reply... Reset alarm for 10am....
10am: No reply, decide he clearly can't do today and turn alarm off going for a lie in.
10.30: He replies saying to come in for 12.30 (yep thats 2 hours notice when the drive to get there is around an hour...) I'm asleep now so don't see this!
11.30: I wake up, see email. Too late! By the time I'm changed and ready thats just toooooo late.

Quite frustrating tbh!

I realise he is a busy clinician and probably get tons of emails, still it is frustrating because he gets funding from the medical school for each student he supervises and if he doesn't have time to offer each of us the help we need (which really isn't that much) then he probably shouldn't take on as many students :/

So the first part of my day (admittedly not morning due to the excessive lie in...) was spent trying to rearrange this, it is now hopefully happening tomorrow.

So then I decide to make today a day of serious essay work, I set up my desk just so, (with a very geeky dualscreen system set up so that I can read journals and have my essay up at the same time, very geeky but also very useful) and start essay.

My nice tidy desk and organised dualscreen system! (and yes that is a coffee cup on the desk...standard)

Do about an hour of good work when I get a text from the president of a committee I'm on asking me to meet someone this afternoon about a talk we are doing later this year.  Well I could hardly say I was busy when I was just sat at home but it was unfortunate timing when I was actually genuinely being productive for once.  The meeting ends up taking two and half hours which with time for getting there and getting ready (out of my essay writing very non professional slob clothes of trackies and a hoody and bedlook hair) was really 3 and a half hours gone from my day.  Not to mention that my concentration was completely shot after the meeting (it was a necessary and productive meeting, just bad timing for me productivity wise!) and I certainly wasn't feeling as productive.

Still finally 6pm: Start doing some work for about another hour, but then I have to go on a pre decided supermarket shop and cook dinner... and before you know its late and I haven't done anywhere near as much essay as I planned :( Fail of a day really, and very boring too, no interesting clinical stuff for you the reader to hear about today I'm afraid! Maybe tomorrow :) (and maybe I will do a decent amount of essay tomorrow too!)


Wednesday, 28 March 2012

The average week of a fourth year medical student: Wednesday

The average week of a fourth year medical student: Wednesday

7.30- 8.25: The usual excessive pressing of snooze!
8.30-8.45: The equally usual rush to get ready and quickly downed coffee
8.50: *Once again running late!!*

^ I really do wish these things had never been invented!

9.05-12.30:  A morning in the eye hospitals A+E department
Eye hospital A+E is in someways much like a regular A+E in that patients can just self refer and turn up on the day with eye problems and wait to be seen, equally GP's (and because its the eyes: opticians) can suggest to patients that they attend the A+E and refer them.

In some other ways though its very different to a normal A+E, for starters I saw a number of patients today (and during subsquent mornings I have sat in on this department) who had appointments booked for them for a weeksa time to come back and check things are progressing/improving as they should.  This makes it almost more like a clinic or GP appointment system - in regular A+E if a doctor told a patient to bring themselves back into the A+E department to be rechecked they would probably receive some very harsh words from colleagues and hospital doctors!  But I suppose the eye is such a specialised area that there no point telling the patient to get their GP to recheck them in a week because without the special equipment the eye hospital has and years of specific expertise in that area, a GP wouldn't stand a chance of picking up any reasonably subtle but important eye changes.

Saw quite a few interesting patients today but also had a lot of waiting about in between patients due to the nature of A+E and amount of refering to other departments the poor overworked registrar had to do.  Here are the top three most interesting patients:

1. A patient who had herpes zoster (aka shingles) and had been unfortunate enough to get eye involvement with her shingles and was first seen by the eye team last week and now was being followed up..  She had whats called "Herpes Zoster Opthalmicus" which simply refers to the  region that her shingles had appeared (it is in the opthalmic division of the trigeminal nerve) - over the right hand side of her forehead going down to below her eye.  The worrying possible complication of when shingles affects this area is that it can cause eye problems such as uveitis, conjunctivitis, keratitis and ocular nerve palsys although these are reasonably rare.  This patient when she first presented to her GP the previous week was recorded as having something called "hutchinson's sign" which is where there are shingle vesicles on the tip of their nose.  This is significant as the nerve which supplies this area (the nasociliary branch) also innervates the globe of the eye, so patients with this sign are twice as likely to develop eye involvement with their shingles (where as having herpes zoster opthalmicus with vesicle on the eyelids does not increase risk from herpes zoster opthalmicus where the vesicles are just on the foreheard).

Herpes Zoster Opthalmicus

 Unfortunately for todays patient she had got eye involvement and had developed anterior uveitis a week ago.  Uveitis is inflammation anywhere in the uveal tract and the anterior part just means it was affecting the front of the eye.  However after a weeks treatment the patient was actually doing a lot better, but has to slowly come off the eye drops over the next 8 weeks to try and prevent worsening/ recurrence.

2.  A patient with a coldsore (herpes simplex causing a dendritic shaped corneal ulcer) in his eye!! Another unlucky chap as this is reasonably rare as well.

3. An eleven year old who came in with the most swollen eye I have ever seen outside of medical pictures.  Poor poor boy it looked so painful.  Apparently it is an infection probably from within his body although he feels systemically well at the moment.  He was referred straight across the road to the childrens hospital to have IV antibiotics because the doctor wasn't sure if he had slight orbital cellulitis which is serious as it can be both sight and life threatening as it can enter the meningeal cavity (in other words there is a small risk of developing meningitis from it).

The boys eye looked pretty similar to this but without the red scabs this childs eye has

Wednesday afternoons are usually off for "sport", I am probably one of the rarer medical students who does actually use them for this but as I said yesterday BUCs matchs are finished now so this time is now available :) 

12.45- 4.30:  Had a nice lunch out in the sunshine with my rabbit hopping about, met the new next door neighbours because they were peering over the wall watching their cat who was out in this area for the first time.  Made friends with the next door neighbours quickly when they spotted Chunks and exclaimed that they had rabbits too and held theirs over the wall to meet me!

Wrote some of this blog out there and did a little ophthalmology reading but then actually got too hot (remarkably for march!) so I've headed back inside and am ready to do a serious amount of essay work! (I did do some yesterday, but lots more to do).

Till tomorrow!


Tuesday, 27 March 2012

An average week of a fourth year medical student: Monday

An average week of a fourth year medical student: Tuesday

So what actually happened after my committee meeting yesterday? Yeah, the room didn't get tidied and no work was done, oppsy.  Instead my partner came round and we ate pizza and chatted to my housemates, oh well!
Still new day, new chance for that essay to get written....

8.15: Actually get up despite having the morning off! (The advantages to dating a final year who does not have mornings off!).  Its a lovely day here in my part of the country, feels almost like summer :). 

09.00 ish : Get showered and changed and start being constructive in the form of emails and phone calls I've been putting off for a while.  Oh and of course : Coffee!

This isn't my picture but sums up my day today pretty well :), happy halfadoc!

10.30-12.30: Got my room back to spotlessly tidy, looks much nicer now :)

12.30: Coffee and toasted teacake break :) then a quick spot of ebaying (I need a desk chair - house came unfurnished and still haven't got one and haven't had any room in bedroom for said chair until recent tidying spell ;D)
1.30: Head to afternoon clinic, take a textbook with me because last time the doctor didn't turn up for ages....

1.45-2.30: *Read textbook*

2.30: See an interesting patient with one of the nurses, he is virtually blind in one eye (can only see light and movement) and has extremly bad vision in the other eye due to a cataract which was due to be operated on a few weeks ago but they discovered during the pre op assessment that he had an eye infection so the operation had to be postponed.

When the nurse got him to read down the eye chart with his "good" eye, it wasn't immediately obvious which line he was trying to read as what he was saying didn't resemble any of the lines in the slightest, the nurse asked him again to read the top line multiple more times before she was sure that that was the line he was trying and his eye sight was simply that bad.   This means this patients vision at SIX metres was so bad that he couldn't see a letter which was sized so those with normal vision can see it at SIXTY metres, so pretty bad!!

I wasn't too impressed with the nurse in general with this patient though because he was a fairly confused elderly gentleman and she was quite grumpy/ rude with him just because sometimes he took a bit longer to understand her instructions.  I know she must be busy but I do hope that however busy I get in the future I don't lose patience with those who for no fault of their own take up a little bit more time than the average patient.

My patient couldn't read the top line of a "snellen chart" like the one shown in this cartoon

2.40ish: Doctor arrives
The first thing he asks me is what clincal skills I still need completing which saves me the awkwardness of asking him, so this is quite nice :).  The patients are for the most case pretty bog standard follow ups and mostly all patients with glaucoma who have to be monitored once/twice a year.   I get to do my clinical skills though and rather than it just being a matter of getting the sign offs, the tips he have definitely helped my actual ability so this part of the clinic was useful.

The doctor quizzes me on a various things throughout and for the most part I actually do pretty well as they mostly happen to be the bits I read whilst waiting for him. WINNER!!

4.30 ish: Clinic still on going but Doctor signs off my clinic and suggests I see if theres anything more interesting going on in the A+E department but if not tells me I can go home because "you have above average knowledge about the eye anyway" - wooo never has bringing a textbook with me ever been such a good idea before!  There were other students in A+E so I couldn't get in and headed home.

4.45: Have somehow bought FOUR desk chairs for £5.98 (all together!) second hand from ebay. Interesting.... I wonder if I can sell the other 3 using the Friday ad and make some profit?!

Fortunately I didn't buy *quite* this many chairs

5.00- 6.30:  Been sitting out in the garden enjoying the surprisingly warm weather with my lovely rabbit Chunks (he's erm a sturdier build than most rabbits) running about while I type this and sort out a few other internet things.  Its been a pretty good day!

Action shot of chunks in the garden
Chunks tired after all that hopping about

Normally at this time on a tueday I would be at sports training, but we had our last "BUCS" (the university league) match last week and also the rest of the uni are now on their easter holidays (damn them!) so I'm free to get on with work, joy! So time to conquer some more of that essay... wish me luck!

Halfadoc x

Monday, 26 March 2012

An average week of a fourth year medical : MONDAY

An average week of a fourth year medical student: Monday

Well this series of posts will literally do what they say on the tin.. I'm going to tell you exactly what I've been up to this week, it probably won't be in much reflective detail (unless I get carried away...hopefully not, I've got work to be doing!) but it will give all of you out there thinking of doing medicine a realistic idea of what clinical years are like.  I have to say though fourth year is our easiest clinical year so maybe I will do the same next year when I am a final year just so you don't think its too easy ;)


7.00: First alarm... *snooze*
7.10: *reset alarm for 7.30*
7.30: *Snooze*
7.40: *Manually snooze for another 5 minutes*
7.45: Finally sit up, and grab energy drink placed next to bed last night (I was finally being constructive late last night and stayed up till 3.30am as a result as I know me and if I didn't then the task I was doing would remain half done).

Lidl energy drink, dragging me through medical school since 2009 (the year I moved to a house ridiculously near my local lidl ;)

8.05: Finally make it out of bed, grab some passable clinical clothes, quick wash and get ready.
8.15: Boil kettle! Yep, more caffeine.
8.17: Discover milk gone off, *swear*. Put cold water into coffee and drink it black *bleurgh*.

8.22: Running late! To the hospital!!

08.35: Arrive at eye hospital (currently on ophthalmology)
08.40: Get into scrubs - this mornings session is watching eye surgery.
0.9.00- 12.10
Watch 3 x Vitrectomys - these are operations to remove the vitreous humor (a gel between lens and the retina which should be clear) from the eye.  These patients were having this operation because an "Epiretinal membrane" had formed on their macula and they needed to have the vitreous removed and then this membrane removed (membranectomy), there are other causes for this operation though such as retinal detachment.

I got to watch one of the operations through the "spare" microscope head, which made me feel totally badass and like I was on greys anatomy (even though a) It was eye surgery not neurosurgery and B) I wasn't doing anything just watching and making sure I didn't touch the surgical field!).

I'm totally this cool, honest...

You get an unbelievable view down the microscope compared to the screen where I watched the other two operations, and you really get to appreciate how skilled and impressive the   ophthalmologists are - they have to be able to make the tiniest movements ever, no room for those with shaky hands here!

We received quite a lot of teaching during the morning from both the consultant and the scrub nurse, a very welcoming team :).

An interesting morning but I have to say I do find eye surgery quite gross, though that's partly due to watching Final Destination 5 recently, regret seeing that before my ophthalmology rotation!!

The eye lasering scene from final destination.... the instrument holding her eye open is the same as is actually used, fortunately nothing else was the same as in the film!!

12.10- 13.45: A quick trip to lidl (milk!!) then lunch and a nice coffee with milk made from coffee I bought from the plantation near where I was on elective in Tanzania.  Its is AMAZING coffee and normally properly wakes me up but today I was too tired for even that to combat the midday sleepiness.  Grab another lidl energy drink to take to lectures in case I'm falling asleep.

14.00-15.30: Lecture on back of the eye pathologys, its ok and quite well taught but theres quite a lot to get through and it does drag a bit, energy drink was a good call!!

15.30- 16.15: We go down to the clinics to be taught fundoscopy and practice on each other.  Unfortunately this was a bad clinical skill for her to choose to teach us as probably is one of the few skills we have got to practice quite a bit recently, so this wasn't amazingly helpful.

16.15-16.45: I still need most of my clinical skills signed off in my dreaded logbook and this is the last week of ophthalmology (we only have 3 weeks its not like I've been incredibly lazy!) so I manage to grab a nurse who had previously said that he would help us get these skills signed off.  I practice on another student and her on me (she already had the skills signed off but he was a very good teacher so hopefully this was still useful for her!) and get a couple of them  signed off but more importantly actually do learn quite a lot, he was brilliant.

17.00 - 17.35: Back home and writing this blog!! Have a committee meeting at 6pm which will probably be a couple of hours, and then I plan to come  back home, tidy my room quickly (I'm trying to turn over a new leaf and be all tidy and organised...this is very unnatural for me! I was doing quite well at keeping my room tidy but then I was ill at the end of last week so fell a bit behind on everything, need to get it sorted now before it becomes a tip which will take hours to sort out again!)  whilst pizza is in oven and then after dinner get some work done.  Will see ;).

So that's my Monday :), tune in tomorrow for my Tuesday...

Halfadoc x

Friday, 23 March 2012

Blonde medic moment: number 1

Blonde medic moment: number 1

Ok, I've been thinking about how I can make sure I blog more even when I'm busy, and I've come to the conclusion that sometimes it might be better to write short posts about amusing moments even if they are not necessarily recent events or coming in chronological order with my main longer posts...

So here starts a new series of posts that I will slot in whenever I feel like it (and whenever they happen) "Blonde medic moments".

So, yeah, I'm pretty blonde in both a literal and metaphorical sense (however much I argue against the blonde stereotype when everyone else suggests it..), so sometimes on the wards I do some pretty stupid stuff, bad times perhaps but good blogging stories? Maybe :).

Blonde medic moment: number 1

An elderly care teaching ward round in third year...

So we are round an elderly lady's bed being taught by the consultant, there are only three of us and one of the other students is examining the patient who is sitting in her chair; I am the only student standing on the far side of the bed.

Now unfortunately the elderly care ward has a tendency to be very hot and whenever we  stand around a patients bed with the curtains pulled on that particular ward for some time I suffer from feeling really faint and like I'm actually going to faint or be sick (neither would probably be deemed particularly professional!).  So whenever I can I try to lean/ prop myself against things on the ward (eg. half sit on a radiator), perhaps not particularly professional either but when I feel like I'm about to faint I'll go for anything that might ease the faintness slightly! This ladies bed was unfortunately lacking in anything I could lean against and was incredibly hot and I was feeling awful, which is what lead to the first blonde moment (and probably chronologically was my first on the wards though certainly has not been the last!)....

As the patient was sitting in her chair, I decided to subtly lean slightly onto my hands which were on her bed (and yes I know, infection control wise I probably shouldn't have been but I promise that a) I had used alcohol gel on entering that patients bed area and b) It was that or potentially be sick on her bed..the greater infection control risk!).  Now what I hadn't realised as I did this was that firstly the patient had a special air mattress (not sure what her reasons were but special mattresses tend to be for reasons like stopping bed sores) and secondly that the valve was right near where I was standing...

Yes, you guessed it, suddenly there was a loud raspberrying sound and the bed started deflating rapidly before our eyes.  The other students were not touching the bed...
I didn't actually even try and say this... that probably wouldn't have gone down well!
The consultant was actually a very nice consultant and looked at me with a mixture of amusement, exasperation and pity as I turned beetroot and frantically (and unsuccessfully) tried to fiddle with the valve and stop the bed from deflating.  In the end he continued teaching and I had to sheepishly ask a nurse to re inflate the patients fully deflated bed after we were finished.  Not my finest moment but probably not my worst either... more to come in the future :p.

Patients bed didn't look dissimilar by the end...

Tuesday, 20 March 2012

Physician don't heal thyself

Physician don't heal thyself

As well as having hospital rotations this year, I also have 8 morning GP practice visits.  A couple of months back one of my visits was postponed a week before it was due to happen because the GP was ill which I remember thinking was quite worrying because to be able to give a weeks notice of illness the GP was clearly suffering from more than just a mild infection.

When I did have my visit with him I wasn't going to ask what had been wrong with him but he quite happily told me what had happened of his own accord and it was a good warning story about the dangers of self diagnosing when you are a medical professional...

Basically he had been having a very stressful few weeks and had been feeling quite tired and rundown and noticing periods where his heart skipped beats but as he didn't really have time to get checked out he just ignored these until one day at work when he got angina like pains.  So not feeling he had time to get to his own GP surgery (and fortunately doctors cannot prescribe medication for themselves) he asked his gp to fax him over a prescription for GTN spray (the reliever of angina) and said he would get to the surgery for an appointment later in the week.  His GP quite rightly refused to do so unless the GP came in immediately for an ECG.  So the GP moodily agreed to do this but was annoyed at having to when he was so busy.  A good thing he did tho......

On having the ECG it was discovered that the gps chest pain was not due to the traditional cause of angina (the hearts own arteries getting "furred" up with fat gradually over the years causing a narrowing artery and so reduced amount of blood being able to get through causing the hearts muscle to not always get enough oxygen especially at times when the hearts muscle is having to work harder eg when the patient is stressed or exercising) but because he had such severe bradycardia (slowing of the heart) that his heart was simply beating too slowly for enough oxygen to reach the hearts muscle for it to undertake even this reduced level of work.  He was having up to 7 second gaps between beats. GTN spray works on angina by dilating the constricted arteries to an extent, as this was not the priniciple cause of the GPs pain it was unlikely to relieve his symptoms and bits of his heart muscle will have started to die off (not to mention the fact that other vital organs such as the brain will also have been depleted of oxygen).   So thanks to the GPs own GP refusing to be persuaded to prescribe without seeing him, the GP was rushed in to have an emergency pacemaker fitted, something which actually would fix his heart problem, and now he admits he feels better and has more energy than he has for years.

Whilst doctors undoubtably have the knowledge to technically diagnose and treat themselves, when it comes to their own symptoms they can be blinded and biased by their own beliefs about themselves and health agendas.  Self diagnosis...not a good idea!

Interestingly I've noticed that when it comes to adult doctors they are likely to be quite dismissive of potentially serious symptoms whereas medical students are the complete opposite (at least based on my housemates, close friends and self) and even a simple  2 second itch is proclaimed to be pruritus secondary to kidney failure.  Honestly we've all probably used our stethoscopes more times to listen to our lungs  when we have a cold than to actually examine patients!  Sometimes we do get it right tho..or at least describe our symptoms in such a correct way that persuades the doctor we are right or leads them to treat us accordingly just to shut us up!

  I wonder when the hypochondria wears off and the apathy sets in ?  

Halfadoc x

Friday, 16 March 2012

The eternal struggle to get into clinic

The eternal struggle to get into clinic

Everyone knows getting into a secondary care clinic as a patient can be difficult, what with the occasionally massive waiting lists etc. But sometimes it feels like its just as hard to get to sit in a clinic as a student!

One of the main problems is often persuading whoever is sitting on reception to allow you to even find out from the doctor if they are happy letting you sit in on their clinic. My year at medical school is massively over sized because lots my orginial year intercalated like myself but very few of the orginal year below intercalated meaning that when we dropped back down into the year below the new year group was suddenly massive. As a result the medical school had to find a way to squeeze us all in to clinical sessions somehow.  The result of this has been having clinics that are further away, clinics which have more students in than ideal and some lectures where we have literally had to share seats! 

The doctors running clinics have agreed to take a given number of students per a clinic which is higher than normal in order to try and prevent us losing out on clinical experience, so this year clinics that traditionally only took 1 person now take 2 and some 2 people clinics now take 3 students.  Unfortunately news of this either hasn't reached nurses/ person manning reception desk or they just don't approve of so many students in one clinic and make it difficult for us to get in there anyway.  Its a difficult position for us to be in because on one hand we as medical students to do not want to get on the wrong side of the nursing staff and they do have the power to stop us from getting to clinic, on the other hand if we don't get into the clinics we are timetabled for then we will fall down on attendance as it is very difficult to get into another clinic as a different student will be timetable for that one (and whilst there are an irritating subset of students who will happily steal a clinic from you by turning up a lot earlier than the scheduled time meaning when you get there on time you get told "No sorry theres already too many students here", I am proud to say I am not one of them).  

So clinics become an exercise in diplomacy just to get into them, and then if after all that struggle you end up with a doctor who doesn't teach you and entirely ignores you, it certainly doesn't leave you in a particularly great mood by the time you've wasted a multitude of hours learning nothing....

I've just started ophthalmology and so because its not a particularly sensitive area, I have been scheduled to sit in a clinic every wednesday morning for four weeks where there are 3 students in the room.  The corner where us students were crammed was tight (i was quite literally hugging up to the sink) but the patients side of the room was still spacious and none of them seemed to mind us being there and the doctor was more than happy to have all three of us and said he was used to having so many students on a wednesday morning. Yet you wouldn't have thought this was a weekly occurrence from the response I got from the nurse when I turned up 5mins before the clinic was scheduled (and standardly 30 mins before the doctor actually appeared!):

Me: Hi I'm a fourth year medical student, i'm due to sit in a clinic with Dr x *winning smile*
Nurse: *Impatient shake of head* No there's already two students here, you will have to come back some other time.
Me: Oh ummmm we are timetabled to have three of us here every wednesday.....
Nurse: *tuts* That too many.
Me: Oh ummmm err its just thats what we are timetabled...* apologetic look*
Nurse: *sigh* Do we really NEED three of you??
Me: Resists urge to say that we are students and the department never really needs us but we need to be here for our education and are due to be here and the hospital recieves extra funding for taking students and being a teaching hospital
Me: ummm errrr timetable errrr errrrr ummmm :/ 
Nurse: SIGH, fine follow me, will see if the doctor lets you stay when he arrives.
Me: *scuttles after*

Fortunately this particular clinic ( if I had a pound for every time I had had this conversation this year I could probably stop renting and buy my own house, sadly sometimes we never get into the clinic we are meant to be attending) was good (I finally managed to see the Optic disc through an ophthalmoscope, wooooop!) and the doctor very kindly taught us lots despite being busy.  Good thing it was good as I predict the same struggle this wednesday, and next and next and then it will some other poor group of students turn :p.  So spare a thought for the poor student (s) huddling in the corner next time you see the doctor they may have had more of a struggle to get to be there than you! 

I'm not saying I think there should be quite as many students in clinics/ theatre as shown  here mind you!