Juggling it all – the pre-reg view

Sitting in the hospital eye department casualty ward, yawning away and nearly falling off my chair is not the best way to start the day, especially when it’s almost lunchtime…

It probably comes as no surprise that my supervisor had foreseen such events and had already recommended I take some reading material with me to the hospital. So there I was, looking down into my half (baked) opened bag beside me and seeing the immense back binding of ophthalmology books that was the initial cause of my painful shoulder earlier on in the day. Thankfully, this happened the once. Thankfully, my knowledge of ocular disease has been wonderfully ignited. The sheer joy of seeing conditions first hand rather than from pictures and descriptions is fantastic stuff. The smiling excitement at seeing Herpes Zoster Ophthalmicus (someone with half baked looking face – not the technical definition of course) was both compelling and surreal, though at least I put a smile on her face, if only for the wrong reasons. She smiled back of course with genuine happiness. I got to ask the patient questions! Everything I always wanted to know while the Ophthalmologist was busy jotting information down. After all, who better to ask? I strongly recommend everyone to get hospital experience. It really is great stuff – uveitis, preseptal cellulitis, subconjunctival haemorrhages and a patient having a needle being rammed down her punctum so that the Ophthalmologist could have the pleasure of unblocking the passages with salt water and to see the gulping expression seen on the patients face – classic!

Dashing back and fourth between hospital clinics, my practice and the glaucoma shared care clinics has been very hectic indeed. No one told me I was going to be on a six-day working week for the whole of my pre-reg year. Somewhere along the stitching of this hazy, crazy schedule, everything I have learnt so far seems to slowly amalgamate together and make a lot more sense. Contemplating on what I have learnt and done, only during those spare moments when sitting on the Piccadilly line, trying to figure out how to pronounce terms, let alone trying to fathom the meaning and more to the point, its relevance. Daydreaming is my only personal time it seems and even that I had not realised until now.

First quarter assessments have been a real eye opener and certainly set the bar on what is to be expected for Q2. Speaking to friends and colleagues, the general consensus is that the new pre reg system has been very positive, certainly from my experience to date and from many discussions with people involved in the academic process, who often compare it with the ‘old’ style system. The list of positive reasons for the new system greatly outweighs the old, even from the viewpoint, or should I say, especially from the viewpoint of a pre reg.

Contact with other pre reg students seem to come along like a rare luxury and an issue, which all pre reg students seem to discuss a great deal, is the inevitable pressure of consultation testing time. Even the most hardened conscientious pre reg have experienced the need to reduce their testing time in order to fulfil their ‘requirements’. I guess all parties benefit from a smoother more efficient and hopefully more effective form of approach. Patients can talk on for the world but really, let us get to the point guys. The best way to improve is to learn from those who are better. Trial and error is one thing, but to make an informed choice from the best ways - trial and better, is what I say. Having the opportunity to sit in on other supervisors and examiners has been a huge influence on my own techniques. Someone once said that if you have nothing else to say, steal it from someone else to say, whether it be a masterful poem, the best way to make tea or simply a cover test technique.

Today was my paediatric clinic day at work and the most memorable patient was this little 11 year old boy who came in and his parents were worried about why he was “blinking and squeezing��? his eyes together constantly. From my experience, it often comes from a habit, which children inevitably lose during the years (or so the ophthalmologists tell me). As always, after finding out that he had no problems with distance work or reading when taking his history, I asked the child why he does this so often and he replied “everything is fine. No reason why, I just do��?. So I continued the examination and eventually found a small myopic prescription. The parents were amazed and the child replied “wow!��? to a pair of -1.00DS R&L when stood outside my consulting room. Poor little boy had not realised how good his vision could be (6/4 R&L). So there I was, explaining myopia and possible reasons why this little boy has it – feeling ever so brainy. His father would not stop shaking my hand afterwards and the mother ever so pleased. I can feel the grip now as I type. And this was an easy one, which we should all be able to handle.

I will post more out of the bag later and believe me I have plenty – some difficult cases too.

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