Working as a health care assistant

Emily Taylor writes about how her summer job will help her later

About halfway through the second year of my medical degree I started to panic. What if I could not cope with the smell of a hospital? Or could not bear to touch patients' skin? What if I entered the clinical years of my course and found that all the information I had painstakingly committed to memory was completely irrelevant? My own hospital experience was limited to some fairly hazy work shadowing and a couple of visits to elderly great aunts. Being on a traditional medical course I'd only had preclinical teaching and could not expect to encounter patients until clinical school in a year's time. I realised that I needed to gain a more useful insight into the environment that I would be working in.

The best way to do this, I thought, was to work on the wards, so I contacted my local hospital and asked for an application form for auxiliary nursing. My first mistake--auxiliaries no longer exist. There are now healthcare assistants. They were crying out for staff, so getting the job was not too hard. But they did check that I understood what the position involved and was not under the impression that I would be able to practise my catheterisation when things were quiet on the ward.

I enrolled on the nurse bank, which gave me the freedom to choose when and where I wanted to work. The medical wards had the most vacancies, so I spent a lot of time there, but I worked on surgical wards and in outpatient clinics as well. This gave me variety and insight into different specialties and the opportunity to work with many different people.

I had no idea what to expect

My first shift was completely draining. When I turned up, I had no idea what to expect, and no previous nursing experience. Although the staff were friendly, and the other auxiliaries patient when teaching me what to do, they expected me to work hard--there was none of the work experience type mollycoddling.

It was interesting to note the nurses' attitudes to doctors--which ones were generally liked and which were resented because of their supercilious attitude. The nurses were helpful towards the former, making the doctors' work easier and they withheld their valuable knowledge from the latter kind of doctor, who, as one nurse put it, acted as if nurses were only there to wipe the patients' bottoms. I made a mental note never to get on the wrong side of the nurses.

It was also fascinating to hear what the patients said about the doctors. Respecting the patients, even by something as simple as not assuming that patients feel comfortable being called by their first name, made such a big difference to the way that patients felt they had been treated. And taking the time to answer the patients' questions made them feel more certain that they were in good hands.

I began to realise how patients felt

However, it was the smaller observations which were the most valuable: the tissue paper fragility of elderly women's skin; the tautness of oedematous ankles; the appearance of a man so ill that his weight had plummeted to just three stone. At first I was wary of touching them, but time gave me the confidence to be self assured and capable, putting the patients at ease. Seeing someone die, actually taking their last breaths while I held the oxygen mask--now I have experienced this in a setting where I am assumed to have no responsibility. Realising how long the days seem in hospital, punctuated only by meals, cups of tea, and doctors' ward rounds, helped me understand how a patient can dwell on what was intended as a throwaway comment, and why it is so important to communicate well. The unmistakable smell of urine from someone with a urinary tract infection, the ability to spot the beginnings of a pressure sore, and many other useful things to be aware of, but not covered in textbooks.

All these things made me realise how much we are assumed to know, without being formally taught it. It felt as if I had the chance to gain some inside information, and I am certain that everything I have picked up will help make me a good doctor, one who is able to meet, as best I can, the patients' needs. Of course, there is a lot that I still have no idea about and will have to encounter when I start clinical school. But at least there will be some things that I already know and my chances of being eaten alive by a ferocious consultant on a ward round are slightly smaller. This summer has renewed my enthusiasm for the subject, and helped me to set my focus on the goal of being a doctor, not just on passing exams.

Emily Taylor, third year medical student, University of Cambridge
Email: emilymtaylor@hotmail.com


studentBMJ 2001;09:399-442 November ISSN 0966-6494