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tbhstudying1 · 6 years

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Tips for new junior docs:

In honour of impending changeover day, here are some tips I thought our new generation of juniors might find useful. Feel free to share your own… Before you start:

Get your paperwork, living accommodation and IT/security privileges sorted early. You don’t need that kind of stress.

Find out where the ward lists live.

Learn how your team’s list can be found and updated.

Invest in your wardrobe. No need to be a supermodel, but after 4 days on call you are so bloody tired that the last thing you want is to be forced to wash the 3 outfits you have practically daily just to have something to wear. Smart dressing doesn’t have to mean expensive.

Wear comfortable shoes. Brogues or loafers are generally more comfortable than pumps, which are more comfortable than most heels.

The most comfortable things are either theatre clogs/crocs or plimsolls but the scope for wearing either is usually limited.

Sort your finances. Microsoft Excel is your friend.

Set up any of the necessary bills, taxes etc when you move.

Looking after yourself:

Don’t skip breakfast, even if you’re running late. The only thing worse than running late is still running late and being hungry on an endless ward round.

Every time you sit down to write a discharge summary or re-board a drug chart, or some other paperwork, pour yourself a glass of water. Like a hydation drinking game.

There is always time for tea.

Learn where the hospital mess is. Often it contains food and drink paid for by juniors.

You will be tempted to put off lunch so you can do ‘one more job’. Don’t. Routine jobs can wait. The only thing that should delay lunch is sick patients; everything else can wait.

Don’t be afraid to ask for help from your peers. Give help freely; if you see a colleague looking frazzled always offer to lend a hand.

If you have a needlestick, follow needlestick protocol and get yourself seen ASAP. This is very common but must NOT be ignored.

If you are sick, follow your hospital’s protocol for calling in sick They won’t ask you why (you can self-certify as sick for up to 7 days). Do NOT be a martyr! If you feel that terrible, you are not safe to look after other people’s lives.

If you are stuggling with things, you have mentors, tutors and peers. There are also nation-wide doctor-doctor support networks out there. Do not suffer in silence. Your mental health matters as much as your physical health.

Do not suffer alone.

Do not let anyone else suffer alone. We have one rule: nobody gets left behind.

For taking bleeps:

Keep a spare sheet of paper handy.Write down the number of all bleeps you recieve as soon as it rings. You may get more bleeps in a minute than your pager can hold.Answer them all in turn.

If someone bleeps twice, it is usually serious. Prioritise this call.

If they are still on the line so you can’t get through, call again in 2 minutes.If the person paging has walked off and their colleagues can’t find out who it is, don’t panic. They will page again.

Encourage the person on the other end to use the SBAR framework. They may be panicked; do not be mean!

Always ask for the name, hospital number, DOB, ward, observations and background before you hang up. At the bare minimum.

Triage your bleeps in order of piority; seeing a patient who may be septic is much more important than siting a cannula for tomorrow’s procedure.

You will sometimes be bleeped about silly things. People make mistakes; do not hold it against them.

It is acceptable to tell the nurses that you can’t do something non-urgent now (because you are with a sick patient). It is not acceptable to be horrible about it.

For ward cover on calls:

Many hospitals have a ‘ward doctor list’ sheet, or list document so that the day team and nurses can leave a list of jobs for you. Know how to find it.

Take a good loook at the list before you do any of the jobs.

Do any patient reviews first. You really should be paged about reviewing patients rather than it being buried on the list but this can happen.

Once you’ve reviewed any sick patients and dealt with them appropriately, you can move onto the less urgent jobs.

Check bloods around the time you usually expect labs to be back (in most NHS hospitals this will be in the early afternoon, assumingthey were taken in the morning. FBC takes around an hour if non-urgent, biochemistry takes a bit longer. Don’t waste time checking bloods too early.

Make sure all the wards known which bleep you are contactable on.

some hospitals employ night technicians to do things like taking bloods, cultures etc. Find out if yours does.

For sick patients:

ABCDE. Always.

Examine them properly; never treat someone you have not examined.

There is usually time to look through the notes. This is important, too.

There is an on-call safety reg. You will have senior cover; do not panic. All you need to do is ask for help. They have all seen sick patients before.

Most hospitals have an outreach team of critical care nurses who are excellent. Know how to contact them. Do not forget to ask at morning handover who your seniors will be and how to get a hold of them.

You can contact any member of staff through switchboard if you ask for them by name. They will put you through to their mobile. Do not be afraid of using this if necessary.

Your reg will want you to do as much as you can first. Assuming they are relatively stable, this means things like an appropriate level of oxygen, taking bloods/cultures, running an ABG and actioning anything it shows, starting antibiotics and fluids if necessary, and requesting blood if necessary.

It is usually a good idea to have done all the above before asking for senior advice, or they will just ask you to do it and call them back.

But if the patient is really sick, and you are worried they are in serious trouble, you can absolutely call them earlier.

Earlier is always better than late.if you think they are about to arrest, there is nothing wrong with calling an arrest or peri-arrest call. This is usally by dialling 2222 in most hospitals.

You will also usually have dedicated on-call microbiologists and haematologists which are contactable by phone. They are saviours.

Many nurses and HCAs can do bloods, run ECGs and generally save your life. They want to help; ask them nicely.

Make sure the nurse stays close whilst reviewing a sick patient; you may need all hands on deck. If you feel cofident you can do it alone, let them know, but don’t be afraid to ask them for help if necessary.

If you think it is urgent, let the nurse know; they are not mind readers and they have other jobs too.

if there is more than one sick patient, make sure to get enough information from the referring nurses so that you can triage the order you need to see them in.

Let your med reg know if you have more than one sick patient to deal with at once; they or outreach may be able to see one of them sooner.

Essential kit:

clipboard folder containing all the paperwork forms you need to request things at your hospital. Whether it be bloods, investigations, reviews by other teams, etc.

A spare ABG or butterfly does not go amiss either.

plenty of black biro pens. By the bucketful.

spare continuation paper for notes.

cough sweets. Any kind of sweet.

Simple analgesics for yourself, and any of your usual medication. Set an alarm on your phone to remind you to take it regularly.

Sanitary products at all times.Stress can do funny things to the cycle.

pentorch

spare tourniquet

sachets of lubricant for examination purposes

a crib sheet with all the most important extension numbers and bleep numbers written on it.

You may need to note down your GMC number

Door codes for all the clean utility/treatment/equipment rooms

the ‘induction’ app by Podmedics. Users upload all the extensions and bleeps from their hospital; very useful!

The Microguide app (for microbiology guidelines), if it is used by your hopitals.

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