(Prosthetics) Community - Hospital Placement Reviews

Week three, and I am living in my new house! Such a huge adjustment having my own garden and house (I no-longer live in a bungalow - result!) and the un-packing process was definitely not smooth, but here is my placement, yet again. So this placement was purely described to me as 'Prosthetics Mental Health' with no further information given. In-patients, out-patients or community? I had no idea what to expect, and this week was full of surprises.

Background
Again, I required 37.5 hours for my placement block, however I knew this was not possible. Monday was the bank holiday, and the clinic was open from 9 to 4 every day (except weekends and bank holidays). I was asked to arrive for 10am - a huge lie in! I spoke to my university placement contact who assured me that my hours would be made up (presumably with my ambulance placement).

Day 1
So I live approximately one hour from this placement, but due to its location being very close to London, I gave myself about 2 hours to get there. I knew where I was going roughly (I was on my motorbike so GPS is far more difficult), and I always leave slightly later than planned so I like contingency time in case I get lost. I left at 8.15am and arrived at 9.30am and was greeted by a receptionist who knew nothing about me and was extremely unhelpful. Most normal people would go and find out by asking someone but no, she wanted to argue and tell me I should not be here. I was right (I was in the right place). Someone overheard my frustration and knew who to point me towards (thankfully). She welcomed me in and told me what she does (psychotherapist) and what I do (in her words: Student Ambulance errr Trainee Thingy). She showed me round the ground floor clinic for people with long term conditions, mainly prosthetics but also a bit of orthotics in there too. The people were really lovely and it seemed like a chilled out centre. She told me that I should leave before 4, but for my 'welfare' I could leave earlier if I wanted to make sure I got home safe. Ah yes, definitely not a wise idea coming to a prosthetics placement on a motorbike! They were definitely shocked and worried to say the least.
I was taken to see the physiotherapist and watched them fit prosthetics with the prosthetist and assess and manage patients who already had experience with their prosthetics. Then I had lunch (a good 1+ hour lunch break) and found my mentor who wanted to talk me through different things she does with pain management. What I really liked was that instead of issuing pain killers, she works on the mental side of pain and teaches patients management techniques. She then introduced me to one of their volunteers, who works with the Limbless Association, and we discussed all things prosthetics, which was really interesting.
It was then just past 4pm, and the centre was closed, so I went home, ready for another day tomorrow.

Day 2 
Due to the prosthetics centre being huge on staff welfare (hello I need to work somewhere where they care about staff welfare) she told me to come in when I could, due to the awful traffic I had to endure on my journey, so I arrived at 9 and got to discuss some more theories on pain and different mental health conditions. I was able to sit in on one a consultant with one patient who had a lower leg amputation was abusing drugs and alcohol. He was really interesting to listen to and so was the psychotherapist. She had an another appointment after him, but they did not want anyone to sit into it so I was taken to the physiotherapist... Again.
It was interesting and I was able to watch some therapy sessions, after I had seen fittings the day before. I went to lunch, and then I went back to the psychotherapist. We talked about other things and we briefly attended a multidisciplinary meeting regarding referred patients (which there were none so it was extremely brief) and signed some things off in my POD and then I went home. Before I left we discussed how amputations and prosthetics affect patient's mental health, and although people with leg amputations do have mental health problems, finger and hand amputations cause a lot of mental health problems and actually struggle more (possibly due to how it occurs or because we use our hands for anything).

Day 3
My lovely female psychotherapist does not work on Thursdays as she has a job share, so I met a male psychotherapist who rarely works at the centre. He did my communications and was not the best; could not tell me about parking, did not tell anyone I was coming and was just really awkward. I met him and he was not as chilled, did not want to let me come and go as I please quite to the same extent, but was really lovely at the same time. I was able to sit in with him and a patient who has army related PTSD, and there was something legally where he could not discuss any details of a situation with anyone, and clearly this was causing him problems too. His memory of the events was incredible, and he only had therapy once a month due to the exhaustion that discussing different memories incurred. After that, again he had another patient that I could not sit in with, so I went to see the lady fitting orthotics, which was not hugely interesting as I had (and still do have) orthotics so I understand a lot of the process. But it was really interesting discussing her entry route, where she studied and other little bits too.
I then went and had my lunch, I popped back into orthotics for a while and then went back to the psychotherapist where we chatted for a bit and I went home.

Day 4
The final day! Woooooo! No more 50 mile commute! I was so happy! NHS England were doing an audit in the centre though, so everyone else was stressed. They seemed to have the best attitude towards the audit though, they were just friendly and knew they were not perfect (their building was condemned three years ago due to asbestos) so they were not too stressed, only slightly. When I arrived I was taken to the prosthetist's office where I spent a lot of the day with them, not doing very much. They had a few appointments and a difficult conversation with a young girl who was training in Medicine, who had previously had cancer, and now it had spread. I was able to go into the workshop (as all prosthetics were made on site and could be altered immediately which is pretty cool). The day overall was quite uneventful, but the people were lovely. At the end of the day I headed back to the psychotherapist who was really lovely, hugged me three times (yes, three) and said how nice it was to have me there. I then headed home, ready to surprise some friends with our new house.

Conclusion
Being frank, this placement seemed like a complete waste of time. Maybe one day would have been useful, but four days was unnecessary. The placement was down as mental health/community and yes I saw a bit of both, but very little relevant to me in the field. It was interesting to see how things worked in a different area of healthcare, but this was not particularly Emergency Medicine related. One thing I did notice was that the staff and volunteers could not understand how I was going to use the information I was gathering, they were convinced I would be telling a patient they required an amputation when they arrived at hospital (hell no) or that I would be amputating them myself (HELL NO). I feel like it was quite narrow minded from their viewpoint (not necessarily negatively) but I can take knowledge and apply it in a different situation, and it was difficult to show that.
On another note, a problem with psychotherapists is that when they talk to you, they always add in a 'and how did that make you feel...?'... I am here on placement, not for therapy!
To properly conclude though, I feel like I did get things out of this placement, but it was really dragged out. It affected my studying for my exams, my bank balance and the travelling time I was really tired, so yes I did learn from this placement but I do not think it needed four days. I was very lucky though as everyone in the centre was lovely so I did enjoy my week.

Read the others in this Hospital Placement series!
Acute Medical Unit
Maternity
Community Mental Health Placement - Prosthetics
Cardiac Intensive Care
Paediatrics



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