Final week in London

Sigh...it is my final week at University College London (UCL) Queen Square Institute of Neurology. It is a bittersweet feeling. I can't believe four weeks have flown by so quickly. 

In the morning, I was on the ward and in the afternoon, I attended the Movement Disorders Outpatient Clinic.

I couldn't let the day end without sneaking to a bathroom to take a selfie!

Typical medical student selfie.

What are my hopes for this last week?

Well, there are three things.

1. I would really like to become confident in performing a neurological examination. It is a lot to remember. There are a lot of components. Without repetition, it is hard to get used to executing every step fluidly. I have been practising at home on my brother. Haha...He is not thrilled about being hit with a reflex hammer every evening, but it is helping me get better. The doctor that leads the weekly bedside teaching sessions encourages the other student and me to practice with our friends. He said it is a good way to ensure we know really well what normal reflexes look like and it will make distinguishing abnormal reflexes easier.

2. I would like to see more unique cases and rare illnesses. The National Hospital for Neurology and Neurosurgery (NHNN) receives secondary, tertiary, and quaternary referrals from across the UK and internationally. Maybe, this needs some more explanation. 

• Primary care is the first stop for most of your symptoms and medical concerns. A primary care physician would be someone like your General Practitioner (GP), for example. 
• Sometimes, your primary care physician will refer you to a specialist. This is considered secondary care. To get you the best treatment possible, your doctor has transferred your care to someone with more expertise in the illness you are experiencing. Examples of specialists include Oncologists, Cardiologists, Endocrinologists etc. 
• Tertiary care involves highly specialised equipment and procedures such as dialysis, plastic surgeries, neurosurgeries, severe burn treatment etc. Your local hospital may not be able to provide these services, and during hospitalisation, your specialist may transfer you to a tertiary care centre to receive the special care you require.
• Quaternary care is an extension of tertiary care. It is highly specific and some hospitals may only provide it for certain medical conditions or systems of the body. Types of quaternary care include experimental medicine and procedures, clinical trials, and uncommon/specialized surgeries.

NHNN sees all kinds of patients. Many patients are transferred from other centres and local hospitals, which simply cannot handle the treatment and management of the disease the patient is suffering from. The services provided at NHNN are highly specialised. Because of this, uncommon neurological illnesses are seen frequently. I have seen patients with Tuberculous meningitis, Neuromyelitis Optica (also called Devic's disease), Guillain-Barré syndrome, Neurosarcoidosis, Amyotrophic Lateral Sclerosis (ALS), Juvenile Myoclonic Epilepsy, Temporal Lobe Epilepsy, etc. The list goes on.

3. STUDY, STUDY, STUDY. Of course, I want to enjoy my remaining time in the UK, but I also still have a number of exam topics I need to cover before I return to Hungary to take my Neurology final exam. 

Looking forward to my last 4 days here.