Acute Medicine Specialty Review - My Life as a Doctor

What is up guys, Karma Medic here, and welcome back to another dose. I guess it's time for my acute medicine specialty review. My name is Nasser, I've now been a doctor for a year and four months-ish, and the latest specialty that I rotated through, the first one of my second year as a doctor, was acute medicine. Now before we dive into this specialty review, I think you need a little bit of context. The first thing you need to know is that this year, as my second year as a doctor, I'm working in a smaller district general hospital, Just to put things into perspective, last year we had 12 floors. Each one of those floors had four wards on it, and each one of those wards had something like 40 patients or so. And then in this hospital, I think we have a total of eight wards. So very big difference. In the entire hospital now, we have about 350 patients, whereas in the previous hospital, there's something like 850. Things are so, so different in my new hospital. Everyone knows each other on a first-name basis. You know, you need a cardiology referral? Let me just call Bob on my personal phone. You need a resp referral? Oh yeah, I know his favorite lunch spot is over here. Let me just go meet him when we're both having lunch. Everyone is so, so friendly because you actually have time to meet people and get to know people, and it's like a smaller community. It feels like a little bit of a medical family. I've talked a little bit about this before, but I can't describe the number of truly horrible phone calls that I had on my previous hospital when calling other specialties. People who are just downright rude, very unnecessarily mean over the phone. Probably because they were really stressed and had had a long day. The environment in my previous hospital was just so busy, busy, busy, stress, stress, stress. Loads of patients to see every day. So much to do. Whereas now at this new hospital, things are a little bit more relaxed for once, which is really, really nice. Honestly, what a great change. Now, the second little bit of context that you need to know is that I've now finished being an F1 doctor or a first-year doctor. I've now moved on to becoming an F2 doctor or a second-year doctor. When you become an F2, you join what's called SHO ranking or senior house officer ranking. And a senior house officer is anyone from F2 up until being a registrar. So that includes F2. And then a lot of people take additional years. So F3s and F4s. And then when you enter specialty training, you have core training years one and two. So anyone in that long gap is termed an SHO or a senior house officer. And you're all placed on the same rota or the SHO rota. So needless to say, the kind of jump up in responsibility, hours, number of on-call shifts, and the type of work that you do between F1 and F2 is quite a significant jump. Okay, so that's the context within which I started acute medicine. So acute medicine is the specialty responsible for exactly what it sounds like. Patients that are acutely unwell and also those who we think we might be able to turn around, which means they come into hospital and we can turn them around and get them out of hospital within 24 to 48 hours. The acute medicine specialty consists of three main departments. So you have the medical take, ambulatory care, and then the acute medicine wards. So if you're not in the medical field and you're watching this just kind of as a lay person, as a normal civilian, so to speak, and you don't know what patient flow looks like in a hospital, let me explain. So a patient comes into the hospital either by an ambulance or they walk in by themselves into A&E. They get triaged at the front desk, which means someone quickly assesses them and decides how urgent or serious their current presentation is. And then they get sent either to A&E minors if we think you have a minor issue, A&E majors if we think you have a major issue, we ask you to go home if we think this is not an appropriate place for you to be, or we can schedule you in to come back into ambulatory care in a few days time or tomorrow, something like that. In A&E, the emergency department, the specialty of doctors who deal with you are called emergency medicine doctors. And the main job of these doctors is to see these patients and diagnose them, figure out what it is that's going on with them and start the initial treatment and management for them. So basically, patient comes in, you explain what's going on to the emergency medicine doctor, they figure out what the problem is and start performing procedures or giving you initial treatment that can often save your life or improve your current condition as it is. But that's kind of what they do, diagnose and initial treatment. If the patient gets better, then they can go home. But if the patient is sick enough or unwell enough that they need to come into the hospital, then they have to be seen by the medical take team. That's me. This team is staffed by doctors that work in the acute medicine specialty. So when I'm working on the take shift, which can be during the day or during the night, but it lasts for 13 hours, we see all of the patients that need to be admitted into the hospital. They will have already been seen by that triage person when they first came into A&E. They will have then been seen by an emergency medicine specialty doctor and then they will come and see us if we think they need admission. And if we agree that they need admission, then they come into the hospital. If we think they don't need admission, then they might stay in A&E or they might go home after we do some more treatment. Now, I said that the emergency department's kind of main job is diagnosis and initial treatment. For us on the medical take, our main job is continuing that initial treatment, but also thinking more forward about the patient's treatment management. For example, if someone comes into the hospital septic, which is a state where the body has an inappropriate and exaggerated response to an infection, leading to all kinds of problems, A&E might have given them initial antibiotics, IV fluids, oxygen, taken blood samples, and sent the patient for a chest x-ray. When I go see the patient as part of the medical take, I might request more imaging, add on additional blood tests that are maybe a bit more niche than the general ones that A&E sent, change their antibiotics based on maybe previous cultures that they've grown or escalate them if the patient's not getting any better. I would take a more detailed history from the patient, maybe call their family members or the care home to get additional collateral and basically get a better and more holistic overall picture of what's going on with this patient. I would also do things like take a full medical history, write up their usual medications, and make a plan for what should happen to them in the rest of the day and the days moving forward whilst they're in the hospital. In addition to starting additional medication and treatment and management, I might call different specialties and ask them for their advice. I might ask them to come and see the patient. For example, if someone presents with an acute oncological problem, I might call the oncology department, I might call cardiology, resp, you know, I might ask the speech and language team to come and assess their swallow, etc. And then this patient will receive my treatment and management plan until they are post-taked by the consultant. So like I said, I know it's getting a little bit confusing, but just bear with me. So coming through triage, get seen by emergency medicine, and then you get seen by the medical take. After we've seen them, the next step is to get seen by the post-take consultant. So after-take consultant. The post-take consultant is an acute medicine consultant who is wildly experienced in these particular types of patients and the initial kind of 24 to 48 hours of having a patient in hospital. And they will see the patient again with me to try and fill in any holes or plug up any of the things that I might have missed when seeing that patient and adding on all of the things that, you know, I might have missed or they think are necessary. Or they can just look at my plan, give me a big thumbs up and tell me I did a great job. Either is fine with me. Now, I really enjoy this job. This thing of being on take is completely new to me. I didn't do any of this when I was in F1. It feels like a big step up in responsibility. You're seeing patients on your own, examining them, treating them and managing them, making plans and decisions for them. It really makes me feel like a proper doctor because I am a proper doctor. This was one of the biggest steps up in responsibility from F1, where when I was in F1, I would always run pretty much every single one of my plans past a senior or a consultant. They would want to check my work. I would want to be safe and make sure I was doing the right thing. So I would run my plans by them. Whereas now a patient can come into the medical take. I can see them, make treatment and management plans, admit them or send them home and no one else might check that work. So all that responsibility kind of falls on me. Obviously, if I have any questions or if I'm unsure about anything, I will always ask and there are always seniors to ask. But if they trust me and they know me well enough, they would let me do all those things by myself. I remember the first time there was a patient who I saw, I think it was an ambulatory care or the take, I don't remember. But I decided that I thought they were well enough to go home. We had a good plan for them. They were going to be followed up in a few days. They were on oral antibiotics. I didn't think they needed IVs, et cetera, et cetera. And I wanted to send them home, but I didn't feel like I had the power or the authority or the clinical knowledge and ability to send someone home. So I remember running the whole scenario past my senior and they were like, yeah, cool, send them home. And it just felt so weird to like have that responsibility of me being the person to decide this patient is well enough to not be in hospital, they can go home. Another big step up for me. Being on the medical take has really increased or built up my confidence in my examination skills, in my handovers to seniors and in my ability to generate and initiate a treatment and management plan. Deep breath. Okay, long explanation, but we're almost there. So going back to our flow of patients moving through a hospital, the patient has now been post-taped with myself and the post-take consultant, and they're probably still in A&E at this point. So now it's time for them to move to the ward. So some patients will have specific problems that make them suited to go immediately to a specific ward. Let's say you come in with, I don't know, an acute exacerbation of heart failure on a background of chronic heart failure. You probably need to go to the cardiology ward. Or if you come in with a severe bilateral pneumonia and you're requiring an IV, you can go to the respiratory ward. But most patients just get admitted to the acute medicine ward. So remember I said we were made up of three components, the medical take, ambulatory care, and the acute medicine wards. Let's talk about the acute medicine wards. So in this particular hospital where I work, we have two acute medicine wards. Let's call them ward A and ward B. They effectively serve the same function. On these wards, we are seeing and treating patients that are acutely unwell before they are safe or stable enough to move upstairs to a specific specialty ward, or patients that we think we can turn around and get out of hospital within 24 to 48 hours. With regards to the job on the wards, I don't think there's too much to say that I haven't said in previous videos. Sometimes we're really well-staffed and the day goes by incredibly smoothly. And sometimes we're not that well-staffed and it can be very hectic. But regardless, it has been so much more calm and just chill than the previous hospital I was in last year. Here on the acute medicine wards, we have something like 14 to 18 patients on the ward. Whereas in my previous hospital, on any of the jobs that I did, we had about 40 on the ward. And that didn't exclude outliers that were all over the hospital that we had to go see as well. So we were just way more busy, more tasks to do, more drugs to prescribe, more specialties to call, more scans to protocol. And some days it was just unachievable, even working from 8 a.m. till 6 p.m., just getting all the jobs done and you'd have to hand over something to the evening or night team. I go into way more detail about my previous jobs in my F1 in my previous hospital in a bunch of videos that'll appear on screen over here. Please feel free to go watch those if you're interested in learning more, but back to acute medicine. The days spent on the ward here can be quite independent or dependent and consultant-led, depending on the consultant that you're working with. But since I'm an F2 now, I'm sometimes the most senior person on the ward, but mostly the second most senior person on the ward. And so the consultants usually go around with the F1s and the advanced nurse practitioners to see most of those patients. And then they leave myself and the registrar to see patients on our own and make decisions on our own. But obviously consulting them if we need anything, or they might just do like a verbal handover and review with us at the end of the day. And of course, if we think we want the consultant to see the patient, we think they're unwell or we need some additional help, we can always ask them. Okay, and finally, the last kind of arm of the acute medicine job is ambulatory care or SDEC, which means same day emergency care. They're the same thing. So to ambulate a patient means that they are able to walk from place to place independently, i.e. they are well enough that they can walk around on their own. And the general rule of thumb or the idea is that if you're well enough to walk around on your own, then you don't need to come into A&E and you don't need to be admitted to hospital. Obviously, this isn't always the case, but that's the general idea of ambulatory care. So these shifts are really cool. You sit in your own office with a desk and a computer and an examination bed, and you see patients one at a time who have been booked into ambulatory care. There are some specific conditions or diseases that have a special pathway in ambulatory care. So things like cellulitis, which is a superficial infection of the skin, commonly affecting the legs and the calves between the knee and the ankle. There's also special pathways for DBT or deep vein thrombosis, which is a blood clot in the veins of the leg. But you also get a lot of patients who are coming in for clinical reviews or chasing up of bloods or scans, or maybe they were discharged from the hospital a few days ago, and now we're checking in on them to see if their symptoms have improved or if their blood markers have changed, things like that. This is a really cool job because you're kind of doing a similar job to GPs or general practitioners or family medicine doctors if you're from the US, except you've got the entire hospital at your disposal. Let's say I see a patient and I think they need a blood test. I can just have them do a blood test right now. If I think they need an x-ray, they can go get one. If I think they need an ultrasound or a scan, they can usually get it done same day. If I need specialty advice from cardio or breast or gastro, I can pick up the phone and I can call them. So you are kind of like a GP, but you have all of the resources of the hospital at your disposal. Whereas when you're in a GP, it's much more difficult. All that kind of responsibility is on you. It's much more difficult to get specialty advice or it takes a lot longer. You don't have access to scanners, imaging, immediate blood tests, things like that. So it's a much more difficult job. Ambulatory care is like being a GP, but with everything that you need in the hospital. I also really like these shifts because you have so much independence. It's just you in a room with the patient. You read up about them. You see them when they've come in. You talk to them. You examine them. You decide if you think they're well enough to go home or if they can go home with further follow-up or if they need scans or if they need admitting to the hospital. All the decision-making is done by you. This was a really big step up for me when I first started because there's just so much independent decision-making, which previously in my F1 jobs where I'm basically on the ward following around a consultant and doing what they tell me, you didn't really have a lot of that. And this was also the first times where I had to decide do I think a patient is well enough to go home without further follow-up or do I think they need admission to hospital, et cetera, which can be a really scary decision. So sending someone home, you're saying that in your professional medical opinion, you think that they don't need to stay in hospital. They don't need any further tests or imaging at this time. And you think they're well enough to go home. If they go home and something happens to them or they're unwell again, there's always the question of did you miss something? Should you have done something, et cetera. Sometimes you do everything correctly and patients still become unwell. That's just life. But you know, there's an additional responsibility for when you send someone home. Now, again, if you're unsure or you have questions or you need to run something by someone, there's always seniors around. There's an ambulatory care consultant. And then the other doctors working there are more senior than me. So one of the more junior members of the team. So there's always more senior doctors and a consultant that you can ask, you know, hey, I want to send this patient home, but I'm not sure about X, Y, and Z. What do you think? So always very helpful. And then sometimes you see patients which are really, really sick in ambulatory care, which is the absolute wrong place for them to be. So something's gone wrong somewhere along the pathway of patient flow that we talked about before. And if that's the case, and you do think they're very sick, you need to go talk to the medical take team, the same ones who we talked about before, and tell them you want to admit this patient. And if they agree, the medical take team has to see them. So kind of similar to what we talked about before, where patients go from A&E to the medical take, but in this case, they would go from ambulatory care to the medical take. That's pretty much it. I've talked a lot about the three main arms of acute medicine. I feel like I'm about to be out of breath and this coffee is almost finished, but there's still a few things that I want to talk about for this medical specialty. Now, being a doctor inherently comes along with additional stress. Lots of high pressure situations, emotional stressors, and serious conversations about life and death. Because of this, keeping my mental health in check has been a top priority for me. I've been doing this with BetterHelp. This next segment is a paid partnership with BetterHelp. If you don't already know, BetterHelp is the world's largest therapy service, and it's 100% online. Their mission is to make therapy accessible. With BetterHelp, you can tap into a network of credentialed and experienced therapists to help you with a wide range of issues. To get started, you answer a few questions about your needs and preferences in therapy, so that BetterHelp can match you with the right therapist from their network. Then you can talk to your therapist however you feel comfortable, whether it's via text, chat, phone, or video call. You can message your therapist at any time and schedule live sessions when it's convenient for you. If your therapist isn't the right fit for any reason, you can easily switch to a new one at no additional cost. With BetterHelp, you get the same professionalism and quality that you would expect from in-office therapy, but with a therapist who is custom picked for you and with more scheduling flexibility. Personally, doing therapy has completely changed my life. It's taught me to approach life more slowly and meaningfully and better deal with the emotional stressors that come along with being a doctor. Honestly, I couldn't recommend it more, and I think talking to someone is one of the most important things you can do for yourself. Click the link in the description down below, betterhelp.com slash karmamedic to get 10% off your first month and help support the channel. So this being my second year as a doctor, this is the first job and the first time that I've not been the most junior member on the team. Big round of applause for me. Thank you, thank you. Very exciting times. We're leveling up in the game of medicine, and it's just been so nice to have F1s, people who are exactly one year behind me. So a lot of the questions that they have, a lot of the things that they're worried or anxious about, I remember being worried and anxious about, but now it's just, it's completely normal, completely fine. Such like basic, simple things that I don't even think about anymore. But I remember one year ago, it was like, it was scary and it was nerve wracking to do. And so it's been so wonderful to help provide that reassurance and that information and that safety net to the F1s whenever they have any questions. I'm able to teach them, offer them guidance, you know, help them with simple things that are so basic to me now. And it's just really satisfying to kind of have come full circle from being that scared new F1, asking my F2s for support. And now I'm the F2 giving support to the F1s. It's honestly excellent. And the F1s that I've worked with on acute medicine here have been so good. Honestly, very competent doctors, hardworking, motivated, et cetera. And I think probably much smarter than me when I started as an F1. So that's really wonderful to see. They've exceeded every expectation I possibly had. Yeah, great bunch. As part of the acute medicine specialty, we take part in the main medical handover of the hospital. So handover, I've explained a few times before, but let me just give a quick recap in case you guys don't know. When the team that's working in the day is gonna go home, they hand over all the important medical information to the night team. So the night team is aware of sick patients or patients that need reviewing, follow up of their scans or blood tests, et cetera. Then the night team works their whole night shift. And then when they're about to go home, they hand over to the day team. And the day team is now aware of all the sick patients and blah, blah, blah, blah. In all of my previous specialties as an F1, when we would do handover, it would be just within the specialty. So I would go home from my day job and I would hand over to the evening team or I would hand over to the night team of that specialty, not to the general medical handover. I would sometimes in rare occasions, but generally no. So now as part of the big medical handover, you kind of sit in this big lecture hall and you go through all the patients that need to be handed over and the consultants are there and they're just listening. And you're telling them about the patients that you've seen, what you've found, what you think needs to be done, et cetera. Now, when I started this job, I was so nervous during these handovers. I've talked about this a few times before, but I get very anxious when talking in front of groups of people. And it's something that I've been working on quite a bit over the years. But this was particularly nerve wracking because it was part of my job in a professional setting where I was expected to give a good handover and know a lot of information about my patients, which was really kind of tough at first. And I remember I would like write down little notes about each of my patients before handover so I could try and remember all the information. The thing is, there's a lot of patients to go through and you need to be succinct enough to not bore everyone and give them lots of useless information, but also detailed enough to give them all the most important bits of information that they actually want to hear and actually want to know about. And different consultants will have different quirks where they want to know specific things about a patient and you kind of have to get used to that because they're always going to ask you, what was the line standing blood pressure for this patient, which no one else would ever ask, but that consultant always, always, always asks, so you should know, et cetera. You're also expected to know quite a lot about the patients and rightfully so. The consultants are taking handover from you and they want to know a lot of information and you should know that information. The trouble is, you are remembering a lot of that information from your head. So you need to know, what was their sodium? What was their white cells? What was their CRP? What did they come in with? What were they presenting with? Who lives at home with them? How do they mobilize? What's their family like? Do they smoke? Do they not? And when you've seen, you know, 10 patients in a shift, people can start to blur together a little bit. So it's definitely a skill to learn how to handover well and how to give the appropriate, concise information for each patient because each patient is different, not only obviously in like what they've come in with and what their home situation is, but depending on the medical problem that they have, there's different pieces of information that are either more or less important for that patient and figuring out which ones you should know and should tell takes a little bit of time. But honestly, I'm quite proud of how far I've come in this section of my medical skillset. It was definitely a weak point for me in my F1 and I feel like being forced to do this handover on a weekly basis has really trained that muscle for me. Oh my gosh, all right. Where do I start with medical nights? Medical nights have been an absolute disaster. So on a medical night shift, you work for 13 hours from eight o'clock at night until nine o'clock in the morning and you do one of two things. You're either on the medical take, which is the exact same job that I described before for the medical take, except you're doing it at night where there's less services available, less people available, but generally speaking, it's the same type of shift. Or you do medical ward cover. Medical ward cover is the worst. And when I say it's the worst, I mean, it is the absolute worst. You are the one doctor responsible for something like 150 or 200 patients. And all the nurses who are looking after those patients, they only have one number to call if something goes wrong or if they're worried about something. And that's your number, which is truly horrific. And we don't even have bleeps in this hospital. We have like little mobile phones. So, you know, you just dial the number and it immediately rings me. So there's no kind of, you get a bleep and then you wait five minutes and then you call back. There's no like separation. It's just as soon as they call, your phone rings and you pick up the phone. And I have had some truly horrible experiences on my night shifts in acute medicine. And these aren't like the worst experiences of my night shifts as a doctor. These are the worst like nights of my life, like period. With inside and outside of medicine, these shifts can be really tough because in our hospital, you are alone as an F2 covering all of these patients. In other hospitals, you have yourself plus a registrar, which is quite a senior doctor and sometimes even an additional SHO. So there's usually two or three of you covering the wards. But at this hospital, it's literally just one doctor, which I think is absolutely nuts. If nothing goes wrong, which never happens, but if one patient is sick at a time, it's manageable. So if one patient gets sick, I can go see them. I can deal with them and then I can move on. And then another patient gets sick and I can go see them, deal with them. It'll be okay. But if two patients get sick at the same time, you're in a lot of trouble. So I remember one time on my first set of medical nights, I was seeing a patient who had a major hemorrhage. So they were bleeding profusely in front of me. And I obviously needed all of my hands and my mind and my attention on this patient. And at the same time, I was getting calls nonstop on my phone, nonstop, nonstop, nonstop, literally just ringing, ringing, ringing. I couldn't even pick it up because I was so busy with this person in front of me. And when I eventually got a break to pick up the phone, I was getting told about patients who had had seizures, patients that had chest pain and ECG changes, which is worrying for a heart attack, patients that had falls and it hit their head and were bleeding. All these things happening at the same time when you're one person is a very big problem. Honestly, I remember being in the doctor's office and I almost burst into tears. I was just thinking to myself, what am I supposed to do here? How am I supposed to see all these people who urgently need my help? Trying to sit down and figure out how to prioritize these patients and escalating them to my seniors and saying, hey, like, I actually, I need much more help on the words. Can one of you come and assist me? Like, blah, blah, blah, blah. That was unbelievably stressful, extremely, extremely stressful. And these are like nights that have really shook me. And I remember going into night shifts for the next few times. I felt like I had PTSD. Honestly, I was walking to the hospital. My heart was racing and I was nervous and I was scared because I had just had such an incredibly stressful experience. You know, I wouldn't wish it on anybody. It's just, it's horrible being the only person responsible for all of these people who are really unwell. It's very, very difficult. So yeah, so that was one experience. And then last week on my set of nights, I had like three patients die in one night when I was like taking care of them, all three throughout the night and some of them in really traumatic ways. So I've had some horrible, horrible night shift experiences as have, you know, any other doctor that has worked on nights in similar situations. They're just really, really tough. The only silver lining I can see from these shifts, it's twofold. One is how much you bond with the other two doctors that are working on the night with you whilst you're on the medical ward cover. The other two are on take. So you have the medical registrar on the medical take with an SHO on the medical take. And you build a really strong relationship with these people because you alternate days between medical ward cover and take. So we each know what the other person is going through. And when you meet up for lunch at like 3 a.m or whatever and you sit down and you tell each other about what's been going on, like you just really bond because you're all going through such a difficult experience together. And it just really, it hits really deep. The mutual understanding and respect that you have for each other is big. And then the other thing is you learn a lot of skills and you learn how to manage very unwell patients on your own and think critically and prioritize and talk to other hospitals and request transfers and all these things that you wouldn't really do during the day because during the day, there's a lot more staff around. Things can happen in a less kind of stressful manner. But when you're by yourself and you need to do all these things, you learn a lot of skills. I wish we would learn these skills in a less stressful way, in a more safe environment. But this is just the way the NHS is, unfortunately. Anyways, every now and again, you get to take a 10 minute nap. It's extremely rare, but sometimes you get to take a 10 minute nap and that's blissful. So these medical nights are extremely different to the surgical nights that I did as an F1 last year. Most F1s don't do nights. Most hospitals have rules where F1s don't do nights. But the particular hospital that I worked at, we did do nights. So that at least gave me a bit of training before coming to do these medical nights as an SHL. But they've been really, really tough. Not much else to say. All right. And the last thing that I want to talk about is the ROTA, the Medical SHL Acute Medicine ROTA. So if you don't know what the ROTA is, it's the working schedule for any doctor in any specialty. It's called the ROTA. And it differs depending on what specialty you're in, differs in how many weekends you work, how many night shifts you have, how many on-call shifts you have, this type of stuff. The acute medicine ROTA is absolutely horrific. The main reason it's horrific is that all of the night shifts are done by the acute medicine team. So F1s don't do any nights in this hospital. And then all of the SHOs working in cardiology, resp, gastro, whatever specialty, you name it, they don't do nights. The only people doing nights are the doctors on the acute medicine ROTA. So we do all the nights for the medical patients in the hospital, which means that we do a lot more night shifts than we otherwise would in a normal ROTA at a different hospital. So I've had six sets of nights on this rotation, which is so many. For context, I had two in each of my previous jobs that I've done as a doctor. So this is a significantly larger amount of nights, a lot more weekends as well, a lot more 13-hour on-call shifts. The ROTA is horrible, and it's notoriously known for being horrible. Every time I meet someone and I tell them, oh, I'm doing the acute medicine, they're like, oh, I heard the ROTA is really bad. Yes, yes, it is. It's really bad. There's not too much to say. It's just different specialties have different ROTAs. And this particular specialty in this hospital has a really horrible ROTA for the SHOs. I feel like I'm working all the time. I'm tired when I leave work. I have a lot of shifts on the weekends, a lot of nights. So I miss out on a lot of activities with my friends, et cetera. It's not the best. Okay, so conclusion time. Ambulatory care and the medical take are two new types of shifts or jobs that I hadn't done before up until this rotation. And I've really enjoyed them. Again, because you get a lot more independence and responsibility. And I feel like I've grown a lot as a doctor in these two particular jobs. So I found that very, very, very helpful, actually. And it feels good to know that, you know, I'm improving as a doctor. I'm being given more responsibility, gaining more trust from my seniors and just becoming a better and better doctor as time goes on. The few things that sucked about this job though, really sucked. So the amount of nights that we have sucks. The rota sucks. Like I'm just, I'm so tired and I'm so done with this job. I cannot wait to finish. I have, I think, a few weeks left and one of those weeks I'm on night. Surprise, surprise. But I'm about to be done with this rotation and I cannot wait. I'm also not the biggest fan of medical specialties anyway because I want to be a surgeon and I want to do surgical specialties. Yeah, there was no surgery on this placement as you might imagine. Not very fun for me. And also I literally never want to do a medical night in my life again. Like I'm done. You know, I've had enough. This was enough for me. I'm good. If I'm going to give this rotation a rating, maybe I'll give it a seven. A seven seems fair. It didn't have any surgery so it can't go above an eight. And then the rota really sucked and nights really sucked. So I deduced a lot of points for that. But overall, like the learning and the experience and the take, the medical take and ambulatory care shifts kept this specialty really exciting because when I was on geriatrics, when I was in renal medicine, you know, every day it was the exact same thing, just doing the wards, ward round on the wards, which I hate. It's my least favorite part of medicine. Whereas here, my shifts were split between the medical take, ambulatory care and the wards, each of which was completely different. So there was a lot of variety, a lot of independence and seeing patients on my own, which I found really, really fun. So yeah, let's give it a seven. And then my next rotation, I was supposed to be on palliative care, but there's been a few things going on. So I requested to be moved to a surgical specialty. I'm actually going to be in orthopedic surgery, which I'm extremely excited about and I cannot wait for it. Can't wait to put some broken bones back together and reduce some broken ankles and shoulders and all of that. It's going to be very fun. Keep you up to date with it. And I'll make another video just like this for that rotation when the time comes. But in the meantime, I need to go. So I'll catch you in the next one. Peace.