This week, several of my colleagues and I had a flu-related sick days. Others decided that they'd bust through the snotty nose, sweats and fatigue and pull regular days on their Clinical Rotation.

Later a debate ensued regarding whether, as a med student, it was ethical NOT to take a sick day. My key point was that as students, we're there to learn, not to work. The learning experience is ostensibly a selfish one; we're not necessarily helping the people we see today, we're studying and experiencing in order to help future patients.

For sure, it's important that med students, and particularly doctors (in this time of shortage), not take frivolous sick days because of either self-induced illness or lack of motivation. It is generally seen as a strength in docs who "take one for the team", and work long shifts, irrespective of their physical health.

Whilst the "80-hour work week" debate rages on, with those who survived their 'trial by fire' with fond memories of comradeship and galvanized experience disagreeing with those whose common-sense and desire for work-life balance is branded as 'soft' and shying away from the vocation, I remain undecided on the issue.

One thing I'm more confident of, however, is that it's not appropriate to make sick people sicker for your own 'selfish' needs. Chances are that if you're sick, you're not going to be particularly focused or absorbing all those clinical pearls anyway. And you're putting your patients at risk.

As students, we have responsibilities to our patients of today; hence, when we come down with a cold, the 'flu or some other contagious URTI, we should steer clear of the hospital, the general practice and other clinical settings. We're far from essential employees; things work just fine without us. Summarily, the risks outweigh the benefits. So take that sick day, sit at home, wait it out; your patients will thank you.

Besides, we can't infect out books.

He comes because his wife told them to, or because his boss is sick of that hacking cough.

I sit quietly in the far corner, watching on. Mentally, I tick off the constitutional symptoms, and inspect the patient. I can tell this fella is sick, if not dying. The diagnosis is as obvious as a red light.

The GP's words suddenly dawn on him; "So, you think I've got... cancer?" He's terrified. The patient feels like he's jaywalked in front of Craig Lowndes' Falcon.

It unfolds as sinister, slow-motion poetry. It's fifteen minutes that will change his life.

Usually, the next question is "So, are you going to be just a GP or will you specialise."

Today, though, it was different.

The question was "Are you the nurse?"

Certainly a first for me. Unlike female peers who've doubtless endured the question hundreds of times to this point. Mostly, though, I was surprised that I got asked the question in General Practice. I even had a stethoscope on. Worse, I'd met the bloke before.

He looked confused when I said I was a Training to be a Doctor. As others have mentioned, Medical Student is a confusing term. Especially with all the Students of Natural Medicine and Students of Osteopathic Medicine out there. And, I'll be honest, I'm not the clearest speaker on the planet.

I sometimes hesitate to use the term 'Trainee Doctor'; it implies Intern/RMO too easily for my liking. My preceptor introduces me as the "Senior Medical Student"; I think that fits well in General Practice. It adequately conveys that whilst we're not actually leading the charge with clinical decisions and management planning, our input is educated relatively well respected. It is, after all, important to induce a good sense of knowledge and achievement in students

I pondered all this whilst doing the bloke's wound dressing. There weren't even any wrinkles in the Hypafix. He'll be back on Monday.

The first few times I work with a new shop assistant, I usually give them a bit of a workout. I'm not seeking to exact some 'trial by fire' but it is a kind of challenge.

As I explain to them, when a shop assistant gives advice, it's effectively the pharmacist talking. Also, when a shop assistant recommends a product, or does pretty much anything in a pharmacy, they're acting as a proxy for the pharmacist.

So, when I'm working with new people or training up someone fresh, I'm particularly fastidious when it comes to WWHAMM or WHAT-STOP-GO, or whichever algorithm is en vogue. That whole awkwardness that comes with asking about pregnancy, breastfeeding needs to evaporate pretty quickly.

This means that when you, as a patient, get asked those 'annoying' questions by my fifteen year-old assistant, they're coming from me. Because I want to help you, by making sure the medication is safe and appropriate for your condition and symptoms.

To a point, I expect shop assistants to be pretty cluey, and certainly to think about what they're doing. Some questions will often catch out inexperienced assistants, such as; "What's the strongest painkiller you've got?"

Other, seemingly soft requests, such as; "I need something to sleep." or, "I'd like some St. John's Wort.", will almost always need pharmacist interaction, ditto requests for Pharmacist-only medication.

Unsurprisingly then, an unquestioning assistant is a dangerous assistant. With time, pharmacy assistants pick up on the clues and subtleties of when to ask for help. If there's any doubt, the best thing an assistant can do is take a bit of your time, ask the pharmacist, ensure their advice is both safe and effective.

A much, much worse scenario is lay-person dishing out advice in my store. When I say "my store", it's because whilst I have few issues with a health problem being discussed by the public outside the store, in a pharmacy there's the potential for the advice to sound like it's coming from me. And hence, a there could be confusion over both veracity of advice, or even liability. Seriously, the kind of person who dishes out advice to someone they've never met in the pharmacy queue is likely to be completely wrong; the chances are they're here for advice too!

Next time you're in a busy pharmacy, I'd back the advice of a cluey fifteen year-old over some random. Especially when she's covered by my insurance. Remember, this is not amateur hour; shop assistants are trained to ask the right questions.

Within three seconds of my 3:55am alarm going off, I thought to myself; Is this really what I do for fun?

Coming off a challenging week in General Practice and sociable Friday and Saturday nights, I was heading to the start line of a 100km charity bike ride. In itself, that's not a huge distance, but a 5:00 kick-off and a 45minute ride to the start - in the dark - made for a bleary start to the day.

The ride was fantastic; I met up with Rocky and we headed into the wind. Then the rain came. I hadn't ridden in rain before, and luckily had only a single greasy-road-related unwanted adrenalin rush. Nonetheless, completed the ride including a very pacey last ten kilometers.

Then we headed our separate ways, and I rode across town to the railway station. I was thoroughly ready for a snooze. Upon returning to base I was famished. So, after a bite to eat and a cat-nap, I planned to head back to The Coast.

Ten minutes into the drive, two thoughts cross my mind;

1) I need some caffeine. This is odd, because I'm not big on coffee for anything other than a twice weekly social tilt. Nonetheless, I had the pangs.

2) I have hunger pangs. Tummy grumbling, dry mouth, gotta have chocolate and carbs and sweetness.

The Service Centre provided delicious doughnuts and energy drinks, and I wolfed them down. I dead-set smashed them back, and in pretty big amounts. I'm talking half a dozen doughnuts and two cans of energy drink badness. Yep, it was a total post-exercise binge. It was sweet. On the road again.

Quarter of an hour later, I'm heavy headed. My mouth is dry. Face flushed and thinking about sleep. There's an hour left to drive. I need a sleep.

I pull off the highway, heart racing in a mix of caffeine, adrenaline and pure pure glucose.

Parked by the sea, I edge the windows open and suck back some fresh air.

I feel nauseous and sleepy. The sickly sugar is pounding my temples. I set an alarm and float into sleep.

A binge-induced, post-prandial, parasympathetic overloaded state of zombiedom.

I wake up dry and flushed, chew down enough water to actually whet my lips unaided, eat some mints and fire the aircon up to full. I drive home, charging. Still nauseous, of course, but alert and focused.

As of tonight, I'm swearing off doughnuts.


.

Thank heavens for the deep end.

Earlier this week, I was sitting in a consulting room having a yarn to an old duck about her poorly controlled diabets and the phone rings with an internal page. It's the practice nurse with twenty-five years experience;

"Capt. A, I've got a difficult bleeder in the procedure room. Could you please come and do a venepuncture."

Gulp. "Sure, I'll be there in 3 minutes."

I wind it up with the duck, and through I trot. The patient looks pale and nauseated, not suprising considering they're massively immunosuppressed. He's also got about six visible spot bandaids in popular places for taking bloods.

Tourniquet, wipe, anchor, "sharp scratch". Two tubes, no worries. Not bad for the first time in five months.

GP's been a bit like that, thus far; much of the counselling and diagnostic paradigms echo that part of the Rural rotation. Rolling into the groove of the fifteen minute consult. Even the odd emergency or minor procedure. Someone experienced watching your back.

It feels good to be back; paddling hard, getting stronger, a bit of confidence, still bobbing about in the deep end with a lifeguard on duty.

The spring and summer have begun to unfold on The Coast, with planning for 2010 well under way.

In the annual (perhaps monthly) debacle of mal-administration, the cohort has been allocated to Clinical Schools for the final year. Substantially fewer people have been "shafted" as a whole but, as The Coast was vastly oversubscribed, quite a few of my friends have been spread across Queensland. Luckily, the SOM has assigned me to The Coast again for 2010.

The reduced time pressures of the last few months have allowed me actually get involved in the place where I live. Now, in addition to working several nights a week, I spend up to five hour periods outside, either sitting (on my road bike) or standing (on a cricket field).

It's about this time of the post that I prattle on about work/life/study balance, but honestly, the last week's been holiday, so there's been little study. There has, however, been ample opportunity to do all that goal planning and reassessment for the next six months.

There's one rota left this year, General Practice. The summer promises a good chance to travel, exercise and recharge before diving head-first into O&G and then Paeds as my first two rotations. My elective will likely include some more overseas travel, and then the specialties run to the end. Just like that!

The holiday has served as a chance to glance up from the books and assess the path ahead; It's very exciting. Being Saturday, my week's holiday is almost over; General Practice rotation begins on Monday. I can't wait!