Dissection of a working day

Well, since brown wednesday has been and gone I thought I'd let you in on what my normal-ish daily life is like.

0815AM - wake up. Not impressed, alarm clock not working well. Decide to snooze again for another 14 minutes. Fiancé somewhat confused that I should be at work at 0900 and am still in bed.

0845 - leave house. Damned traffic and ambulances slow me down further. Arrive on to site at 0900 exactly and get on to ward 3 minutes later. I still haven't got used to working for a medical team and start at 0900 rather than 0800. Despite having more of a lie in, the school run traffic is a nightmare.

0903 - handover with team. I was on late last night and need to tell them about the patient we have inherited from surgery who has a surgical problem. We are a medical firm and everyone is generally confused.

0910 - take some bloods from a difficult patient. Patient is a little unusual and I'm glad that the nurse stays in the room.

0930 - start ward round. No consultant to come with us so our core trainee divides the patients up for us to see. I have an amazing medical student with me who is final year and keen to learn. She does most of the work while I scribe.

1030 - have seen 2 patients from the list. They are both complicated with lots of medical and social issues to deal with. Liaise with nurses a lot regarding their care.

1100 - have to do an investigation on a patient myself. It feels a bit like House. This ties me up for 70 minutes and in between doing things I fill in a lot of my ePortfolio and do some e-learning for healthcare. It's surprisingly productive but means that I don't have a clue what is going on with patients on our list.

1250 - quick stop via the canteen for a can of something diet and fizzy in a can before heading off to a departmental meeting. Lunch goes with me. Thankfully this is generally acknowledged as acceptable and munching away on an apple while someone is talking is fine.

1400 - regroup as a team (juniors) to work out what the strategy for the afternoon is. We have a barrage of investigations to order for a patient so we split up and sort them out. Half of medicine is talking to various people (microbiology, haematology, radiology, the lab, physios, nurses, psych liaison, pharmacists etc) to explain why we want certain things done, and that we aren't just trying to waste everyone's time for the sheer hell of it. This takes up most of the afternoon.

1630 - after running around the hospital all day chasing things that other people have already done (we aren't massively great at communicating with each other yet...) it's time to do a final handover with each other to work out what jobs the 'on call' person needs to do. I am the on call person.

1645 - I take the on call bleep and prepare to head to the medical assessment unit (MAU) to do a ward round for all the new patients. Thankfully my team only has 2 jobs for me to do.

1700 - MAU have no patients for me, which is marvellous. Manage to speak to the consultant before she runs up to the ward and relate the good news. She is happy, this makes my life easier. Told to liaise with specialist registrar (SpR) regarding outstanding jobs.

1730 - manage to find the SpR and realise that she has done all except one job - prescribing a complicated medication regime. She dictates what she wants me to do and I head off to do it. No further jobs are given to me.

1740 - find the complicated patient. Prescribe the appropriate complex regime and hand over to the nurses, who, as always, are more clued up than I am.

1745 - grab my bag and head to the canteen and the doctor's mess. Eat a nice healthy salad and find a comfy sofa to deposit myself on. I check that my bleep is actually working (it is) and settle down to watch something trashy on Sky.

2020 - still sat in the mess. Have checked bleep a further 4 times - it is working well and I'm being paranoid.

2025 - go to night handover and report that I have nothing to hand over. Time to go home.

Whistleblowing: V2.0

S: (n) whistle blower, whistle-blower, whistleblower (an informant who exposes wrongdoing within an organization in the hope of stopping it) "the law gives little protection to whistleblowers who feel the public has a right to know what is going on"; "the whistleblower was fired for exposing the conditions in mental hospitals"*

 

I'm going to start by asking a fundamental question: is whistleblowing ever unacceptable?

You would think that the answer should be 'no', and in the interests of the bigger picture it should be the case. By raising concerns the theory is that someone more senior than yourself investigates the issue and how it is affecting the services offered, especially if the outcome is detrimental to the public.

 

But allow me to ask another prudent question: would you ever report your concerns about patient care in a training hospital where you were receiving training?

 

This question is purely hypothetical in its current context, but I have had my fingers burnt in the past, as have several of my colleagues.

I've heard tales from close colleagues where they found themselves excommunicated by not only nursing and other allied health professionals, but also by other doctors and senior managers because they dared to ask the question: 'hang on, I'm not sure that I'm happy with this situation, something here isn't right.'

The GMC recently published a policy called Raising and Acting on Concerns in Patient Safety. The theory should solve all of my concerns, but I bet it won't make one iota of difference.

F1 doctors (foundation year 1, first 12 months post qualification) like myself have to be signed off by a supervisor to be granted full GMC registration (as opposed to the provisional registration that we have for the first year). Is the signing off process likely to be affected by any previous concerns that have been highlighted by that F1?

Medicine shouldn't be a network of archaic attitudes and closed doors and closed ears, but my experience so far has shown me that it has been. Please don't misunderstand me, I love my work and I'm still very happy to be ploughing my way through my F1 year. This hasn't actually happened to me while I've been qualified, but I do know that it's happened to some of my close friends.

I can't help but thinking 'what would I do?'

 

 

 

* http://wordnet.princeton.edu/

 

What should a doctor look like?

How a doctor acts plays an important part in how patients perceive the care they receive. It's commonly expected that a doctor should be compassionate, polite and have excellent communication and interpersonal skills. We (and I) expect doctors to explain things in a way that patients understand. We expect them to take the time to explain diagnoses, prognosis and management plans in a way that a patient in a vulnerable position will be able to take in and make informed decisions.

But if a doctor fulfils all of these requirements, then should it matter if they dress appropriately but happen to have bright blue hair and a nose stud?

Do sick patients have less faith in doctors who don't look the same as their colleagues?

In my time as a doctor and a health care assistant I've seen many nurses and ancillary staff with unnatural hair colours, piercings and tattoos, but it's rare to see a doctor who makes a similar statement.

Have we all become so stereotyped that we have to become clones of each other?

Should a job or career affect who we are in our personal lives?

While I have no problem in stepping outside of the stereotype 'doctor' box, I can't help but feel that I will never truly be able to express myself until I reach a much more senior position and my external appearance is less likely to affect my career progression.

Should it be like this? Isn't this a more subtle type of discrimination?

So for now, unless someone else is bold enough to make a statement in my deanery, I guess I'll just have to stick to hidden tattoos, discrete piercings and 'natural(ish)' hair colour.

*sad face*

But what do you think?

Is a change as good as a rest?

It is just over 3 weeks until job change again and I'm back to feeling anxious about starting yet another new post.

It seems that as soon as you feel you're getting the hang of something you get moved on. This time at least I don't have to move hospital, which is a massive benefit.

The problem is that I don't especially enjoy my current post, yet I suspect I'm going to detest the next one, and the banding is lower (40% vs 50% at present).

I'm just going to have to see where it takes me...

Best of luck to any current final years due to sit exams soon.

Merys

Sent from my iPhone

Just a bit of good news

As all at work is going slightly bonkers at the moment, I thought I would share some good news with you.

I am now engaged!

Complete surprise and wonderfully happy.

Help!!!

Does anyone know how to fix a sewing machine?
I seem to have lost a lump off mine when I moved back from the last hospital (and yes, I did take my sewing machine with me....) and can't find it and don't quite know what I'm looking for to replace it.

It's a Janome if that's of any use to anyone knowledgeable!

The Maplin Game - a deviation from medicine

This game can also be played in any hardware, model or otherwise 'manly*' shop.
1. Enter shop alone, or ditch any boys at the entrance and let them follow you in.
2. Go and look at something. It doesn't have to be anything in particular, but generally the more obscure, the better the result.
3. Wait
4. Wait a bit more, it usually won't take long before someone (almost always male) approaches you and asks if you're OK.
5. Observe that as you move around the shop this will happen more than once.
6. Laugh that it never seems to happen to male counterparts in the shop.
7. See if you can beat my personal best of 3 in 5 minutes!



*I'm not saying that these shops are just for men, I often frequent them to look for arts and crafts tools.

Changing times

Christmas this year brought the usual strife with my family, but thankfully my in laws are wonderful and seem to have adopted me.

The new job is going well, although much less stressful than my previous post - it's proving hard to get used to leaving at 5 and on time rather than 3 hours late!

I promise to try blogging more this year and wish all final years the best of luck with impending exams!

It's beginning to look a lot like Christmas.

...except that it isn't really.
My ward doesn't have any Christmas decorations and the seasonal spirit is a little lacking among staff.
Christmas day is just another working day for most doctors. We do the shifts the rota tells us to and pray that it's not busy, or that if it is busy then the day goes quickly.
So to all the NHS and frontline staff working over the festive period, I salute you and wish you a decent working shift.
Merry Christmas

Stage fright

In summer I was a medical student.
This week I'm doing formal teaching with medical students.
This scares me immensely