This is the very basics and what I think will be useful to know when starting out. This is how I organise my day as a typical (surgical) FY1 ward day. (Still applicable to medicine tho). This may also help dispel the mystique for those who think being a junior doctor is exciting 😛
Disclaimer: This works for me and allows me to manage big workloads and get everything wrapped up on time. It may not be the most efficient way for YOU. Find what works. Plus, different hospitals organise differently and this may not be applicable everywhere.
7:45 am- come in 15 minutes early to prepare the list. You should have updated as much as possible the day before and usually just need to open it up on the desktop along with the hospital patient tracker system and check who has moved and read any outstanding scan reports. Print out enough copies for everyone who will be on the ward round. Master printing double-sided- this will mark you out as a good FY1 (I’m not kidding).
On the ward round, as well as writing in the notes and checking the jobs, you need to make sure you keep a jobs list. It’s best if EVERYONE aims to keep a jobs list- that way nothing gets missed. Write the jobs next to the patient’s name on your list. Don’t assume your registrar will have time to sit down and clarify jobs after the ward round- they often don’t. If you have queries about management plans (ie whether the patient will need follow up if you’re doing a TTO) ask then and there. It may be hard to get hold of your reg again once the ward round is over.
After the ward round, it’s tempting to immediately start doing jobs- especially when you’re new on the job the list just looks overwhelming and you want to get it done. Stop. Take a breath. Maybe get a coffee if there’s time. You need to organise the jobs. What I like to do is sit down with a piece of paper and write out the jobs I need to do by category. Ie I will put the heading ‘TTO’ and then write down all the TTOs I need to do, with a check box next to each one. I will star the more urgent ones- the people going home immediately or that day.
Once you have all your jobs listed it’s time to get cracking. First, get all the imaging, scans and procedure requests handed in. That way your patients will get their investigations done as soon as they can. Tick all the requests and jobs off as you hand them in.
Next you need to get the urgent TTOs done. I didn’t get this at all at first- I completely failed to realise that TTOs are a big priority. After all these are well people, ready to go home. Surely there’s more urgent things to do. But the hospital is an organic thing, and there are people coming in the doors of A+E all the time which means getting the well out is a major priority. Plus, if you get the TTOs done first the nurses will stop bleeping you about them and you can actually get on with things rather than having to answer your bleep every 2 minutes.
After that get any other outstanding stuff done. Bloods, cannulas, discussions with microbiology, referrals etc. You should now have most of the jobs done that need to be done that day.
At this point it’s probably a good time to get lunch. You can expect all the bloods to be coming back early afternoon so this is a sort of natural lull in proceedings. It’s a rude awakening when you realise there is no protected rest time for junior doctors and you will get bleeped throughout lunch to ask if scan results are back, double check management plans, ask for cannulas etc. (a common reason to be bleeped at this time is to find out if patients are allowed to eat lunch or need to be kept nil by mouth). If a request is non urgent it’s perfectly okay to ask them to wait half an hour before you come. You really do need to eat and drink and no one else will make sure it happens. Take twenty minutes and then get on with it again.
After lunch it’s a good time to sit down with the list and update the management plans and chase the bloods. Chasing blood results means looking at the results, acting on anything unusual (high inflammatory markers, drop in Hb, deranged electroloytes etc), it also means simultaneously writing these results into the list. It’s a real drag sitting down for what can easily take an hour and typing numbers into small charts, and it initially feels like you’re wasting your time, but your seniors will expect to see it there and it does need doing.
While you are doing this think about who will need blood taking the next morning to check on trends. If you think someone needs bloods the next day, print out the form then. Make a note on the list that you have put bloods out for them. Now is a good time to start looking out for scan results too. Speak to a senior if anything gives you cause for concern. While you are chasing, make a list of the jobs being generated (ie does someone need potassium prescribing, can someone else go home now the blood results are ok?) If some bloods aren’t back call the lab to check they have them. If not you will need to check with the patient if the blood got taken- if not you will need to bleed them. Add this on to your list of jobs.
Check the theatre list for the next day and add the inpatient stays onto your list. Print blood forms out for them too if necessary.
Go round the wards again, putting out the blood forms and doing the new jobs. Continue with the rest of the jobs on your jobs list- eg TTOs that need to be prepared for the following day. At this point everything is now sorted for tomorrow, and you can just keep dealing with problems as they occur.
It’s a good idea to try and get hold of your registrar either just after chasing or now (try to reach them by 3). See if they are able to go through the patient list with you and review results. Complete any further jobs.
Go over the list once more, checking you have seen all the blood results. Take off the people who have gone home.
Go home yourself.
- I hope that helps. Don’t feel bad if you can’t be on top of things from day 1. My first weeks were a struggle, I rarely managed to eat or drink during the day and usually finished at least an hour and a half late. It will come. It’s a tough learning curve, and sometimes even if you are very competent there is just too much to do. You will find your level.
Good tips for cannulas: http://theemtspot.com/2009/08/04/six-techniques-to-nail-the-iv-every-time/ – I found this advice extremely helpful during a rough ward cover shift especially number 5.