RAPP (RETROSPECTIVE POST)

Semester 11 was the SHR (Specialty Health) Rotations. This consisted of RAPP, Psychiatry, Rural and Emergency Medicine. According to previous MBBS cohorts, the SHR Rotations is considered “slack” compared to the Semester containing Women’s & Children’s Health due to the much lower Attendance Requirements. Anecdotally and from my Observations, a lot of Students didn’t turn up to the Wards during RAPP and Psych. Sometimes it felt like I was the only Student there despite putting a semi-decent Effort to turn up.

Despite that, I didn’t clerk many Patients in this Semester which was a real shame as I was starting to feel emotionally burnt out (which was one factor towards my decision to defer Internship for 12 Months), and busy going through Past Recall Papers and memorizing the content.

RAPP (6 Weeks)

The RAPP Rotation comprised of Rehabilitation Medicine (2 weeks), Aged Care (Geriatrics - 2 weeks), Palliative Medicine (1 week) and Psychiatry of Old Age (1 week). It was said to be the “cruisiest” Rotation, and rightly so. Most people in this Rotation only turned up for the mandatory Tutes and Tours. Given that we started Final Year ridiculously early (January 7^th, 2013) to minimize the Clash with the MDs on the Wards, I suspect most of the Students treated it as a “gentle” introduction into the Year, as a “Semi-Holiday”.

We had tours of the Rehab Facilities for patients who’ve had Strokes and TBI (Traumatic Brain Injuries), and got to see a workshop where Prostheses are designed for Amputees. I got to check the TBI Ward where a lot of the patients had Memory Loss and seemed disoriented. I felt really sorry for them coz a handful were around my Age, and wouldn’t be able to function independently anymore.

I attended a few Ward Rounds in Aged Care, but was otherwise slack due to the distance to the Hospital I was rostered, plus the fact that I was planning to do an 8 Weeks’ Geriatrics Elective during my massive Break between Semesters 11 and 12. I did learn 2 commonly used Italian terms though “Dolore” (Pain) and “Respiro Profundomente” (Breathe Deeply). When I was at the Hospital, I did help the Resident by doing a few Mini-Mental State Exams on real Patients (first time ever).

Palliative Medicine was conceptually interesting. I was particularly interested in seeing how the Registrar would interact with Palliative Patients, but he actually communicated to them in a similar manner (as I perceived) as one would do with Non-Palliative Patients, but with a greater emphasis on somatic complaints (Pain, Thirst, Hunger). Strangely, I didn’t see any official Deaths that week, so didn’t have the opportunity to see the Reg certify Death. What bothered me however, was the notion that some relatives of Palliative Patients would insist that everything be done to prolong their life even though it was clear that there’d be no improvement in the Quality of Life, but merely a prolongation of Suffering. 

IIRC a Palliative Care Consultant actually told us in a Tute, that a family of a Palliative Patient was willing to complain about her on “Today Tonight” (an Australian Current Affairs Program, notorious for being sensationalistic) coz he/she wasn’t implementing every single Measure demanded to sustain the Patient. It felt to me some (or a lot) of the time in Practice, Doctors would be under Pressure to implement Measures not to comfort the Patient (giving IM Fluids instead of IV to create a visible “bump” of water), but to please the Relatives emotionally, who seemingly have a poorer Understanding of the Medical Issues and its Natural History. 

She said that the only reason why Euthanasia is in high Demand in Australia (currently illegal) is coz the current state of Palliative Care is inadequate, but I digress. My Belief was that terminal Patients who are still cognitively intact should be allowed to end their Life if they want to, after all they are consenting Adults and it’s their Choice. I didn’t think that they should be denied that Opportunity and be forced to go through physical or cognitive Decline, even if painlessly. What kind of Quality of Life is that? I didn’t want to argue with her so I kept quiet though. She did say that she’s had numerous requests for Euthanasia though, in which she had to legally decline, but offer Alternatives such as Advanced Care Directives (eg refusal to treat once Patient has deteriorated to X Degree).

My suspicion is that Euthanasia still isn’t legalized due to Political Reasons (along with Pressure from Conservative Christian Lobbyists), although I predict with the Ageing Baby Boomers, and the current Fat-Cat Politicians ageing (who mainly care about winning votes to maintain their plush Seats), who may also need Euthanasia for themselves or their parents, there’ll be a more progressive Attitude in about 10-20 years’ time.

Psychiatry of Old Age was a lazy Week for me. I just attended the Tutes regarding Psychosis and Schizophrenia in Old Age, along with Medication Regimens.