I got to spend a whole week at the GUM clinic which was certainly interesting. The week involved clerking the patients that come in off the streets for appointments, presenting back to a Doctor, taking blood for tests and then observing any examinations and treatment. It culminated in an informal teaching session from one of the Doctors with a lot of cake a lot of pictures and a lot of stories of items where they shouldn’t be. The GUM clinic is where anyone can come, with or without an appointment and talk to a Doctor about symptoms of a genital or urinary nature. It operates completely separately from the rest of the NHS records system, so nothing you say will ever come close to your normal NHS records, nothing gets sent to your GP and the staff don’t even know your name. You are given a number, which I found really bizarre walking into a waiting room and calling a number not a name.
In terms of the history talking, that’s simple as there is just a sheet of paper with questions to be asked and boxes to be filled in for every person, no matter what they come in with. This way, asking questions of a personal nature becomes more of a box-ticking exercise, which helps to take some of the embarrassment away. The patient can see there are questions to be asked, so it isn’t personal what we ask them, it’s just matter of fact. It also means you don’t miss anything.
I got to clerk a few interesting patients. One was a fairly young homosexual man who was coming for a regular check up, to find out about the free Hep B vaccination course he was entitled too and because he wanted to speak to someone about erectile dysfunction problems he was having with a new partner. I was really amazed on several counts. Firstly, I had no idea they could have the Hep B vaccine, what a good idea that is. Secondly, he was whipped straight through to talk to a psychologist about his problems, who gave him some new thinner condoms to trial, a pep talk with some really good, down to earth advice from someone who sounded like she really cared and understood and wanted to help him and an open invitation to come back anytime for a longer, in depth talk if that hasn’t done the trick. I felt really sorry for the guy, as he was so nice to have agreed to me observing, especially as it was such a personal problem and he hadn’t mentioned what he wanted to talk to the psychologist about. I’m not sure I would be that brave.
I spent Valentine’s Day (I told you I was far behind) holding the hand of and distracting a uni student as she had her genital warts frozen off which she caught after a one night stand. I was meant to be observing the procedure, but she was close to tears, really upset about the consequences of one stupid decision and it is really painful and pretty undignified. I felt I would be of better use giving moral support. My last interesting patient of the week was a middle aged gentleman who came in to get someone to take a look at a mole on the tip of his penis. As I was taking the history it became clear that this wasn’t actually why he had come in. His long term girlfriend had died of cancer a year ago. He had looked after her right up to the end and was still grieving and depressed. He had gotten himself into financial difficulties, making poor decisions about his mortgage and wanted a doctor to come with him to the bank to help explain his situation as he never remembered what they said to him and thought a doctor would be responsible and professional and help him get things sorted. He was taking advantage of the fact that you don’t need an appointment at the GUM clinic, so he could talk to someone when he was ready and capable of doing so. I felt so awkward and out of my depth. This wasn’t something I could help him with, the questions on my sheet were completely inappropriate but I was touched that even though I wasn’t who he was expecting to see, he still felt able to open up to me and talk about his problems. It goes to show that sometimes, you just have to listen and be there as there may be something else they want to say that’s really important to them.
And as for the teaching session, the most interesting item pulled out of somewhere it shouldn’t be? A lady came in with a yeast infection she wanted treating. The lady had had a positive home pregnancy test and so had been attempting a homeopathic abortion. She had picked some organic parsley, bound it with organic twine, inserted it like a tampon and left it for a week. She was most upset to find that she was still pregnant and couldn’t see how the infection could possibly be due to anything she might have done.