I had opportunity to visit gastrointestinal, cancer and renal outpatient department during my secondary visit.

To be honest, I didn t have so much opportunity to talk to patient during the visit, however, I noticed several interesting incident during the visit. Throughout my learning process, I understand that informed consent is a legal and an ethical requirement. However, from my experience, I found that obtaining patient consent is not an easy job especially when your patient is already set negative perception on the medical procedure. During my first visit to gastrointestinal outpatient department, I came across a registrar consultation with a lady, Miss A, who is having diarrhoea problem for quite a long period of time which is about 6 months. During the consultation, Miss A is trying to avoid recommended endoscopies out of fear of the procedure, or of what the procedure will find. At the same time, the doctor felt that gastrointestinal endoscopy is the best way to find out what is actual cause for his patient problem. However, the lady kept refusing the procedure and continuously asked the doctor if there is any available procedure rather than endoscopy. I observed that the lady avoid the procedure due to his anxiety as s result of misunderstanding and lack of information regarding the actual procedure. She thought that the procedure are risky and can harm her life. When this situation happened, I can see clearly how the registrar deals with his patient anxiety and how he convinces the lady to undergo that procedure. GMC stated that a doctor must work in partnership with patients to ensure good care. Realising about her patient perception, the registrar is trying to maximise patients opportunity and their ability, to make decision themselves. He shared the information regarding the procedure, and trying to help the patient understand the procedure better. I found this method is useful as miss Y starting showing her interest as well as demonstrate acceptance to undergo that procedure throughout the consultation. This incident, taught me on how a doctor apply the GMC guideline about principles for good practice in making decisions in real life. Personally, I felt that it is a very challenging for a doctor when dealing with patient who is already set negative perception in their mind. Convincing and educate people are not always an easy job but our effort are so much appreciated so that we can help our patient to decide the best for themselves. I am also having opportunity to talk with a man who is coming for his chemotherapy treatment in the cancer department. Mr. B is diagnosed with throat cancer about 2 years ago. When talking to him, I found that his view about his condition is quite interested. From the conversation, I found out that he is a binge smoker since his teenage age. As a medical student, during that time, the first thing that spontaneously comes out in my mind is that his cancer is strongly associated with his smoking habit. However, throughout the conversation, he keeps denying that his smoking habit is the cause of his cancer. His continuously expressed his believe that this cancer is nothing to do with his smoking habit. He perceived that it is just a normal for people at his age to get such disease. I discover that until now, he is still continuing his smoking

habit. At first, it is really surprising for me after listening to his opinion. Personally, I felt quite shock with his confession and start to questioning either it is worth it for NHS to take responsibility for the medical burden created by such conscious self-abuse? For months, I kept questioning myself about this issue until I came across a symposium which discussing a kind of similar issues recently. I realized that as a doctor, I should never judging and questioning whether someone deserve my treatment or not because as a doctor our job is to provide the best treatment for those who seeking for help regardless their gender, races, religion as well as their lifestyle. Besides, I do felt that although everyone accepts that tobacco consumption is linked to a number of illnesses, none of these illnesses are only caused by smoking. So even in the case of a heavy smoker, we cannot be sure that the cancer definitely resulted from smoking rather than some other cause. Denying medical treatment to people by treating these possibilities as certainties is very unfair, and will lead to great inconsistencies and hard cases. Besides, we should not easily judging and blame them because we need to consider the effective force of peer pressure, the increased likelihood that children with parents who smoke will also smoke, or other stressful condition. It doesn t mean that I support smokers to continue their habit but this somehow taught me that in real life, the best things that I can do is helping my patient to quit smoking but if it doesn t work, it doesn t mean that I should deny their right to get access to treatment and health services that are available. Despite realizing that changing people behavior is not an easy job, as a medical student I believe that I should work harder in improving my skills especially when dealing with this type of patient who has strong instinct of self denial. Personally, I felt that Mr. B case has given me opportunity to reflect more on my personal belief as well as taught me to think always think rational and never ever simply judging other people. I found that this lesson is really useful in preparing me to deal with more complicated issues that I will come across in my practice in the future. As a conclusion, I felt that my secondary visit has helped to improve my understanding about some issues that I learned throughout my first and second term in this medical school. Some situations required me to think out of box as I need to challenge my own personal belief.