{"id":80701,"date":"2017-09-27T10:39:02","date_gmt":"2017-09-27T08:39:02","guid":{"rendered":"https:\/\/www.erasmusmagazine.nl\/en\/?p=80701"},"modified":"2025-12-19T11:22:51","modified_gmt":"2025-12-19T10:22:51","slug":"if-i-shoot-wrong-the-patient-has-a-problem","status":"publish","type":"post","link":"https:\/\/www.erasmusmagazine.nl\/en\/2017\/09\/27\/if-i-shoot-wrong-the-patient-has-a-problem\/","title":{"rendered":"‘If I shoot wrong, the patient has a problem’"},"content":{"rendered":"
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\n\t\n\n<\/svg>\n<\/span>\n\tImage by:<\/span>\n\n\t\t\t\n\t\t\t\t\t\t\tLevien Willemse<\/a>\t\t\t\t\t<\/span>\n\t<\/p>\n<\/figcaption><\/figure>

Medical students taking a job in the hospital during their studies is nothing new. But taking the place of the doctor is something else. A day in the Lithotripsy department at Erasmus MC, where the students seem to rule the roost.<\/p>\n

Bang! Bang! Bang! Bang! For the unsuspecting visitor to the Lithotripsy department in Erasmus MC, it comes as quite a surprise to hear such loud noises coming from the operating theatre every other second. But medical student Gyan Ramsingh (24) remains unruffled. A room further down the corridor \u2013 appropriately known by doctors and students as the \u2018Steenweg\u2019 or the Stone Road \u2013 he\u2019s watching calmly and confidently with his colleagues. Just before that, he\u2019d been exploring the patient\u2019s kidneys and urethra with a type of \u2018canon\u2019 looking for a large white mark: the kidney stone. Using that same canon, the kidney stone is now being attacked with shock waves. That\u2019s what causes the loud bang. In just thirty minutes, the stone should be history. If you\u2019re waiting for the doctor to appear in this story, you will wait in vain. Because Ramsingh is not just a student, but also \u2018a type of doctor.\u2019<\/p>\n

It works both ways<\/h3>
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Gyan Ramsingh <\/span><\/p><\/figcaption><\/figure><\/div>

The fourth year medical student very consciously uses the words \u2018type of\u2019. Calling yourself a doctor before you graduate is obviously sacrilege. But for everyone else who comes across him during the course of the day, from patients and their parents to colleagues, Ramsingh is the duty doctor. Patients know that they\u2019re being treated by a medical student, but one who is just as experienced in lithotripsy as the doctor. \u201cI would never say so myself, I\u2019m still very low in the pecking order,\u201d says Ramsingh. \u201cBut it does involve quite a lot more work than is expected of the average student here in the hospital. It\u2019s far different from bringing round food and drink.\u201d<\/p>\n

Giving students responsibility is exactly the reason why five years ago, urologist Willem Boellaard and his colleagues started employing medical students in the department where patients were treated for their kidney stones. \u201cResidents were given a different rota, which meant they had less time for lithotripsy,\u201d Boellaard explains. \u201cSo we had to find a new solution.\u201d That solution came in the form of medical students. \u201cIt works both ways. The students learn more about medical practice, meaning they become better doctors faster. It\u2019s better for the hospital too. Residents can be used in other locations, while students often stay around longer, so that you have a more stable base.\u201d<\/p>\n

Not afraid of mistakes<\/h3>\n\t
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\n\t\t\u2018You have to learn really fast here and you immediately get given a lot of responsibility. So students don\u2019t do this for the money\u2019\n\t<\/blockquote>\n\n\t\t\t
\n\t\t\t\t\t\t\t–<\/span>\n\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\tGyan Ramsingh\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/figcaption>\n\t<\/figure>\n\t\t<\/div>\n\t<\/div>\n

Ramsingh agrees with his boss. As team leader, he\u2019s not only worked in all the jobs in the department, he\u2019s also responsible for the intake of new students. \u201cYou have to learn really fast here and you immediately get given a lot of responsibility. That\u2019s not the case in many other places. So students don\u2019t do this for the money \u2013 neither do I. It\u2019s purely for the experience and the challenge.\u201d<\/p>\n

Boellaard isn\u2019t worried that Ramsingh or one of his colleagues will make a mistake. \u201cIt\u2019s not unusual for students to be involved in the medical process. They get a three month training before they gradually start their first treatments, under the supervision of a urologist. So when they eventually start on their own, they\u2019ve already got a lot of experience. And every treatment is also under the direct supervision of a urologist. As long as they consult the doctors if anything seems out of the ordinary, we never have an undesirable situation. As long as they don\u2019t think: I won\u2019t call the doctor in case I look stupid.\u201d<\/p>\n

Keep talking<\/h3>

That\u2019s not a thought that seems to have occurred to Ramsingh at all. As he looks through the files for the rest of the day early in the morning, he\u2019s already put a question mark by one of the patients and he contacts the doctor. \u201cYou can\u2019t say in advance how the treatment will go, so you must always be on your toes.\u201d<\/p>\n

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Tim Offringa (l) and Gyan Ramsingh<\/span><\/p><\/figcaption><\/figure><\/div>

Nor does he panic later on when he finds it a bit more difficult than usual to find the kidney stone during a treatment. He calmly consults his colleagues, weighs up the options and finally \u2013 like a \u2018real\u2019 doctor \u2013 takes a decision himself. His predecessor Tim Offringa (now doing his residencies) looks pleased, as Ramsingh turns on the canon again. Offringa: \u201cThat\u2019s what I taught him to do and Gyan will later teach other students to do the same. As long as you keep talking to everyone, you\u2019ll be fine.\u201d<\/p>\n

Source of inspiration<\/h3>\n\t
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\n\t\t\u2018But we\u2019re well prepared so, touch wood, nothing ever goes wrong.\u2019\n\t<\/blockquote>\n\n\t\t\t
\n\t\t\t\t\t\t\t–<\/span>\n\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\tGyan Ramsingh\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/figcaption>\n\t<\/figure>\n\t\t<\/div>\n\t<\/div>\n

At the end of the day, there are only happy faces on \u2018the Steenweg\u2019. The patients can pass the fragmented kidney stones and so Ramsingh can go home feeling satisfied. Does the success of this team mean that students will be doing more operations in future? \u201cNo,\u201d he says. \u201cThis is the maximum that you can do as a student. Assuming the role of the doctor is one thing, but cutting into someone is quite different. That doesn\u2019t mean that these treatments have no risk, because if I shoot wrong, the patient has a problem. But we\u2019re well prepared so, touch wood, nothing ever goes wrong.\u201d<\/p>\n

Boellaard doesn\u2019t think that more responsibilities will be put on the doctors of the future either, but he does hope that Ramsingh and his colleagues will be a source of inspiration for other departments at Erasmus MC. \u201cMore departments should do this. You work with young, enthusiastic and fresh people. Why wouldn\u2019t you be positive about that?\u201d<\/p>\n\t

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Extracorporeal Shock Wave Lithotripsy<\/em> (ESWL) is a technique for treating stones in the kidney and ureter from outside the body using shock waves. These target the stone, which creates cracks. Eventually the stone breaks into fragments which the patient can then pass from the body along with the urine. The stones are located using ultrasound or X-rays, depending on the type and composition of the stone. The whole treatment takes around 45 minutes.<\/p>\n\n\t<\/div>\n\n\t

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De redactie<\/h2>\n\t\t\n\t\t
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