"You should make an appointment"

Medical students tend to have overwhelming schedules... so we think, until we meet the medical registrar on the evening shift. Finding the right balance is the most difficult part of my daily life, where like most people I want to fit in activities for study, work and leisure. Having the nagging thought of reminders constantly indicates that I don't seem to get the balance right and I seldom go to bed in the evening without the feeling of satisfaction.

Two weeks ago my colleague and I bumped into each other and he suggested we have coffee "some time." Both of us frantically looked at our schedules to see if we could squeeze in a quick espresso, but we quickly realised how unlikely it was to actually sit down and enjoy each other's company for 30 minutes. In the end, we ended up committing to a time, then postponing, then cancelling and the whole attempt ended up being a complete failure. We had a good laugh about it!

What keeps clinical medical students so busy? Putting personal and social commitments aside (unless you're a cohort's social representative), the clinical hours (rounds, clinics, theatres, wards), tutorial preparation, self-directed learning and extra-curricular research... all of which is quite different than examination preparation and thus requires a different approach to study (depending on the exam). Add on top that you are relatively poor (compared to other graduates our age), doubtful of your career path and constantly telling people who comfort you that you can't see them - you've got a pretty decent mixture of stress, low emotional state and a lack of motivation. This is obviously not a picture of all medical students.

Clinical responsibilities of medical staff are not confined to the walls of their respective wards. They extend into the emergency department, colleagues requiring expert consultation, outpatient clinics and meetings with other healthcare professionals.

But how are our lives any different from any other person in the world? We all have families, friends and responsibilities. We are looking after the sick, who are in fact being denied to carry out and complete their daily tasks, whatever they may be. Imagine being in a state where you are unable to be productive at your normal pace, where your inertia gets completely knocked off its chair.

It's a quiet Sunday at work. I received a phone call in the morning from a 48-year-old lady telling me she needed a CT scan of her abdomen because of "abnormal ultrasound results". She lives a fair way from here, but she was up here last month for work and was directed to the medical centre by a nurse, who thought she was quite unwell.

She wanted to arrange a CT scan in this area, but I arranged for her to have the scan closer to home by faxing the referral over to another department and setting up an appointment. The receptionist at the medical centre who was keeping the referral happily handed it over, saying "she looked very unwell."

Medical receptionists aren't trained medical staff and therefore could not reliably pick up subtle clinical signs, but when they say "this person is really sick," - it's a suggestion that the abnormalities are so obvious, that they're screaming at the trained clinician.

I dug up the ultrasound report:

History of jaundice, acute upper abdominal pain and ascites noted. 


There is diffuse fatty liver infiltration with no focal masses. There is no intra- or extra-hepatic biliary duct dilatation. There are multiple prominent veins in the epigastric region. The gall bladder was not seen. 


Further evaluation with a CT scan of the abdomen and pelvis is suggested to identify the cause of the patient's prominent epigastric veins.


When I called the patient back to emphasise the importance of getting the scan and following up with her doctor, she replied "I know I'm unwell and I can feel it in my heart that things aren't good. But I'm working almost 15 hours a day and I've got to look after my children. It can't be good that I've got bruises everywhere and that I occasionally bleed from my nose and ears."

I almost fell off my chair. This poor lady with fixed professional commitments was working ridiculous hours, almost every day of the week and also looking after her children. I presume she is a single mother as there was no suggestion she had a partner. She had convincing features of liver failure.

It feels very satisfying for a medical student to recognise patterns of illness and to confidently make a diagnosis. This was one situation where I was devastated to recognise what was going on.

We all carry on with life, all our commitments and may never consider how brilliant our functional capacity is. It's also quite interesting to know we usually feel no signs of good health compared to poor health, where it is reflected through symptoms and signs. We are working machines everyday, like clockwork. We work for our future and the future of our children; for financial commitment, to live comfortably and sometimes, to provide for those who were not so fortunate.

So I'm sitting in silence, wondering whether she'll make it to her appointment tomorrow.

The most I could do was as much as the GP could do: tell her this is one of the things you definitely want to follow up... and fast.