It's that time of year where my current group of F1 doctors are all desperately trying to get our paperwork signed to get us into F2. It's irritatingly tedious but for me it's mostly done.
So for those of you about to start F1 in August there is something you will need to know - you need to know the rules of the list.
1. DO NOT LOSE IT
2. DO NOT TAKE IT OUT OF THE HOSPITAL (see point 1)
3. Your boss will want a copy of it so keep it reasonably up to date
4. Have most recent blood results and investigations on it
5. Go through it regularly with colleagues and divvy up the work.
6. As an F1 you will often be doing mini ward-rounds on your own. Initially this is terrifying but sometimes the list is all you have without reading the notes.
7. Most importantly see points 1 and 2.
Your list is your life as an F1
14 June 2012
08 June 2012
Support from colleagues
The topic of industrial action came up again today at work. It was discussed amongst my team to ascertain who would and who wouldn't be taking action.
It turns out that despite a large vote in favour of action, no one else in my team is taking action. Sadly they also do not seem to support the action.
Given the representation of members from the BMA ballot it would seem possible that my team colleagues may not have voted. In fact I know of several people who not only didn't vote, but who cancelled their BMA membership out of principle.
While I respect that everyone has a right to their own opinion I think it's incredibly rude to slag other people off due to their decisions. While I haven't been at the receiving end of verbal abuse yet, some colleagues have made scathing remarks about shirking work and putting patients at risk.
When we're all screwed over our pensions and working lives then we'll all be in it together, whether we agree with each other or not.
It's nice to feel supported by your colleagues
It turns out that despite a large vote in favour of action, no one else in my team is taking action. Sadly they also do not seem to support the action.
Given the representation of members from the BMA ballot it would seem possible that my team colleagues may not have voted. In fact I know of several people who not only didn't vote, but who cancelled their BMA membership out of principle.
While I respect that everyone has a right to their own opinion I think it's incredibly rude to slag other people off due to their decisions. While I haven't been at the receiving end of verbal abuse yet, some colleagues have made scathing remarks about shirking work and putting patients at risk.
When we're all screwed over our pensions and working lives then we'll all be in it together, whether we agree with each other or not.
It's nice to feel supported by your colleagues
07 June 2012
48 hours
The European Working Time Directive says that we should work no more than 48 hours per week. Doctors can opt out of this if they want to, but my rota isn't written beating this in mind.
The hospital gets around this by saying that the 48 hours is worked as an average over a month. As much as I would think this was normally amazing I reckon I'm due a week off soon.
Last week I worked my rota of 70 hours in 7 days but never managed to leave on time. I ended up working closer to 80-85 hours in that time.
While you might think this is a rare occurrence I have the hell period coming up again where I work 12 days in a row. That's 107 hours if I manage to leave on time every day for 12 days. It won't happen. It has nothing to do with time management or prioritising, it's just that patients seem to get sick at the most inopportune moments.
I can't speak for other hospitals and departments but this is how my rota runs.
And as a result of this doctors have no social life and make mistakes due to exhaustion.
This is why there is burnout and compassion fatigue amongst NHS doctors.
Roll on 21st June
The hospital gets around this by saying that the 48 hours is worked as an average over a month. As much as I would think this was normally amazing I reckon I'm due a week off soon.
Last week I worked my rota of 70 hours in 7 days but never managed to leave on time. I ended up working closer to 80-85 hours in that time.
While you might think this is a rare occurrence I have the hell period coming up again where I work 12 days in a row. That's 107 hours if I manage to leave on time every day for 12 days. It won't happen. It has nothing to do with time management or prioritising, it's just that patients seem to get sick at the most inopportune moments.
I can't speak for other hospitals and departments but this is how my rota runs.
And as a result of this doctors have no social life and make mistakes due to exhaustion.
This is why there is burnout and compassion fatigue amongst NHS doctors.
Roll on 21st June
15 May 2012
10 May 2012
Who knows best?
I know that the days have passed where doctors know the best for their patients, but I am so bloody fed up of relatives shouting at me. I have had over a month now of relatives yelling at me because I'm on the ward and know the patient in question.
Sometimes you just can't win- I've been yelled at because we were still investigating the cause of an illness, and then also yelled at (sometimes by the same person) for solving the problem (or at least identifying it) and trying to discharge the patient.
The problem is that although the relatives know the patient infinitely better than I do, they don't understand the disease (usually).
On the plus side, my communication skills have got better, as have my instincts about when to get out of the way or call security!
03 May 2012
Bleep etiquette
I'm not going to claim to own this, but I saw a copy pinned to a doctors office wall this week and it reminded me to post it here.
Most of these have happened to me....
1. Bleeping is not a spinal reflex. Please take a few seconds to breathe, think and organise your thoughts, and stop flapping about. Half the time you may realise you didn't even need to pick up the phone.
2. Mention what ward you are on. I don't have the whole hospital directory of numbers memorised. This is called the 'bingo-bleep'.
3. If you bleep someone, please wait by the phone. How can there be no-one picking up the phone at your end when I ring back?! This is called the 'bleep-and-run' and is exceptionally irritating.
4. Have the notes, obs chart and drug chart in front of you. Chances are I need to know what the obs were without waiting for you to run over to the bed and look, then run back over to the trolley to get the notes when I ask the next question. This is called the 'relay-bleep' and is probably not fun for you.
5. Please mention the name, age, and working diagnosis of the patient. The following is not acceptable: "Hello doctor, please see patient in 4, 6, she has chest pain". That is 'bleep-spam'
6. All patients with chest pain need an ECG. Don't bleep me until one is being done or there in front of you.
7. If I'm in theatre (surgery), leave a clear message. The following is not acceptable: "Can you come to the ward afterwards, there are a few things to do". This also counts as 'bleep-spam'
8. Once in a while I will not respond to my bleep. This is because I am jumping on top of someone's chest trying to save their life. I am NOT 'on break'. Doctors don't have these.
9. Please check with the other nurses that you aren't asking the same question as them. I really hate being bleeped from the same ward from two phones and two nurses for same patient. This is called the 'déjà-bleep' and is distinctly un-fun
10. You spend twenty times as much time with each patient than we do. We appreciate your opinion and pertinent information. The following is not acceptable: "Well you're the doctor, you should know". Well actually I'm on call and have never met this patient who has spent 5 weeks with you.
11. Please be cheery on the phone and perhaps even flirt a little. I've just spent 12 hours running around the hospital doing mundane tasks, talking to angry relatives, putting my finger up bums, taking blood and ordering xrays. You will get your way far easier by making me smile.
12. When I answer the bleep please don't say 'Oops, sorry I had a question but not any more". This is called the 'fart-bleep' and gets on my nerves (See also point 1).
13. Please don't ask me to see virtually every patient on your ward. That's called a ward round.
14. If you do cannulae on the ward regularly you will be my favourite nurse and I will do anything you say.
15. If I answer my bleep and the line is engaged because you are bleeping me from that phone again, I may well explode. This is called the 'torpedo-bleep' because of its incessant battle with my morale. Three hits and the boat may sink.
16. If a patient has died, he/she no longer cares how long it takes me to get to the ward. That's a medical fact. Chances are I can do a few other jobs on my way there. If you bleep me again for this patient it better be because they have miraculously come back to life. This is called the 'Lazarus-bleep'
17. The 'MEWS / EWS / EWSS / PARS' score is a trigger for you to call me and is useless after that. I don't give a crap what the score is. Tell me WHY the patient has scored it (e.g. respiratory rate? BP? heart rate?).
18. Please don't start a sentence "Just to let you know..." or "Just so you know..." I hear this 50 times per shift. This is called the 'zombie-bleep' and you have just inadvertently disengaged my brain.
19. Please don't make the person who picks up the phone have find to you from the other end of the ward. This is called the 'bleep-and-hide' (See also point 3).
20. Don't have someone else (e.g. a student) bleep for you. It's cruel to them, and they are not your secretary. This is called the 'kamikaze-bleep' (see also points 4, 5 and 19)
21. Dosing a patient's warfarin (whom you have never met and don't know their history) at 4am is horrible, tedious, legally dubious and just plain bad for the patient. Please slap the day team round their faces when they arrive the next morning and don't let it happen again.
22. Sit down! You may be surprised with how much this helps points 1, 2, 3, 4, 5, 9, 11, and 19
23a. If you happen to have a spare moment, eavesdrop when a doctor bleeps another doctor. The majority of the time you will see how it should be done.
23b. Sometimes point 23a doesn't work because the doctor is a week old and still learning the 'etiquette'. He/she will learn very quickly as their senior on the other end shouts them down!
24. When a patient is in an ACUTE confusional state, please do not repeatedly ask me for, or demand sedation. This is not the year 1912. I might give sedation AFTER ruling out an infection, over-medication, drug withdrawal, metabolic cause, trauma, neurological, hypoxic, endocrine, and vascular causes, and AFTER using every other method of calming down the patient.
25. Read the latest entry/entries in the medical notes. Your question may be answered already (see also points 1, 4, 12, 13)"
Most of these have happened to me....
1. Bleeping is not a spinal reflex. Please take a few seconds to breathe, think and organise your thoughts, and stop flapping about. Half the time you may realise you didn't even need to pick up the phone.
2. Mention what ward you are on. I don't have the whole hospital directory of numbers memorised. This is called the 'bingo-bleep'.
3. If you bleep someone, please wait by the phone. How can there be no-one picking up the phone at your end when I ring back?! This is called the 'bleep-and-run' and is exceptionally irritating.
4. Have the notes, obs chart and drug chart in front of you. Chances are I need to know what the obs were without waiting for you to run over to the bed and look, then run back over to the trolley to get the notes when I ask the next question. This is called the 'relay-bleep' and is probably not fun for you.
5. Please mention the name, age, and working diagnosis of the patient. The following is not acceptable: "Hello doctor, please see patient in 4, 6, she has chest pain". That is 'bleep-spam'
6. All patients with chest pain need an ECG. Don't bleep me until one is being done or there in front of you.
7. If I'm in theatre (surgery), leave a clear message. The following is not acceptable: "Can you come to the ward afterwards, there are a few things to do". This also counts as 'bleep-spam'
8. Once in a while I will not respond to my bleep. This is because I am jumping on top of someone's chest trying to save their life. I am NOT 'on break'. Doctors don't have these.
9. Please check with the other nurses that you aren't asking the same question as them. I really hate being bleeped from the same ward from two phones and two nurses for same patient. This is called the 'déjà-bleep' and is distinctly un-fun
10. You spend twenty times as much time with each patient than we do. We appreciate your opinion and pertinent information. The following is not acceptable: "Well you're the doctor, you should know". Well actually I'm on call and have never met this patient who has spent 5 weeks with you.
11. Please be cheery on the phone and perhaps even flirt a little. I've just spent 12 hours running around the hospital doing mundane tasks, talking to angry relatives, putting my finger up bums, taking blood and ordering xrays. You will get your way far easier by making me smile.
12. When I answer the bleep please don't say 'Oops, sorry I had a question but not any more". This is called the 'fart-bleep' and gets on my nerves (See also point 1).
13. Please don't ask me to see virtually every patient on your ward. That's called a ward round.
14. If you do cannulae on the ward regularly you will be my favourite nurse and I will do anything you say.
15. If I answer my bleep and the line is engaged because you are bleeping me from that phone again, I may well explode. This is called the 'torpedo-bleep' because of its incessant battle with my morale. Three hits and the boat may sink.
16. If a patient has died, he/she no longer cares how long it takes me to get to the ward. That's a medical fact. Chances are I can do a few other jobs on my way there. If you bleep me again for this patient it better be because they have miraculously come back to life. This is called the 'Lazarus-bleep'
17. The 'MEWS / EWS / EWSS / PARS' score is a trigger for you to call me and is useless after that. I don't give a crap what the score is. Tell me WHY the patient has scored it (e.g. respiratory rate? BP? heart rate?).
18. Please don't start a sentence "Just to let you know..." or "Just so you know..." I hear this 50 times per shift. This is called the 'zombie-bleep' and you have just inadvertently disengaged my brain.
19. Please don't make the person who picks up the phone have find to you from the other end of the ward. This is called the 'bleep-and-hide' (See also point 3).
20. Don't have someone else (e.g. a student) bleep for you. It's cruel to them, and they are not your secretary. This is called the 'kamikaze-bleep' (see also points 4, 5 and 19)
21. Dosing a patient's warfarin (whom you have never met and don't know their history) at 4am is horrible, tedious, legally dubious and just plain bad for the patient. Please slap the day team round their faces when they arrive the next morning and don't let it happen again.
22. Sit down! You may be surprised with how much this helps points 1, 2, 3, 4, 5, 9, 11, and 19
23a. If you happen to have a spare moment, eavesdrop when a doctor bleeps another doctor. The majority of the time you will see how it should be done.
23b. Sometimes point 23a doesn't work because the doctor is a week old and still learning the 'etiquette'. He/she will learn very quickly as their senior on the other end shouts them down!
24. When a patient is in an ACUTE confusional state, please do not repeatedly ask me for, or demand sedation. This is not the year 1912. I might give sedation AFTER ruling out an infection, over-medication, drug withdrawal, metabolic cause, trauma, neurological, hypoxic, endocrine, and vascular causes, and AFTER using every other method of calming down the patient.
25. Read the latest entry/entries in the medical notes. Your question may be answered already (see also points 1, 4, 12, 13)"
18 April 2012
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.
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.
21 March 2012
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/
18 March 2012
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?
11 March 2012
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
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