Preparation 

Fail to prepare, prepare to fail. Preparation is key in a lot of situations, and Medicine as a whole is one of those situations. Having a solid plan, thinking it through and making sure you have everything ready beforehand will save you a lot of trouble. A good way to do this is through visualisation […]

Instructions

Like it or not, as a medical practitioner people are going to take what you say seriously. They will look to you for advice and reassurance during their most vulnerable moments, and will often follow exactly what you say to the letter. This means you have to be careful about what you say, and how. […]

An exercise in Optimism 

  The problem Facebook and Instagram, and various other forms of social media, are amazing. They let you keep in touch with friends and relatives around the world, organise events and share photos, you can even make a living from them. However I’m pretty sure they are absolutely terrible for your mental health. Remember at school when […]

“So I’ve got this patient…”

What to do when taking a call about a patient on the ward…

Who, what and where are they?

What’s the patient’s name, hospital number and which ward are they on? What is the reason that they’ve come into hospital and why is the person calling about them?

What are their obs?

This tells you whether they’re decompensating and need to be seen immediately. What’s their NEWS score, and what’s the trend? If they’ve been sat at NEWS 5 for three days and now are NEWS 4, that’s a lot less worrying than jumping from 0 to 3 in the last two hours. If they’re clearly very unwell then ask the ward to bleep your senior as well.

Are you worried about them?

Asking the caller how the patient is clinically, and whether they as a healthcare professional are concerned about the patient is a good guide as to the urgency of the situation. Trust the nurse’s instinct…

Is there a time limit?

When does this job need doing by? Can it wait for you do do a few of your other jobs first? Prescribing insulin that is going to run out in 2hrs can wait until after you’ve reviewed the ECG for the other patient that has chest pain.

What’s your name and number?

Know who you talked to and how to call them back if you need further information.

While I’m on the way…

Ask for a repeat set of obs/ECG/urine dip, while you’re headed to the ward. This will speed everything up and help you get your head clear on the way over.

 

The Calling

The pleasure of a physician is little, the gratitude of patients is rare, and even rarer is material reward, but these things will never deter the student who feels the call within him.”

  • Theodor Billroth (1829-94)

 

 

Gunners

 

Urban Dictionary – A person who is competitive,overly-ambitious and substantially exceeds minimum requirements. A gunner will compromise his/her peer relationships and/or reputation among peers in order to obtain recognition and praise from his/her superiors.

It’s good to be good…

It’s always good to want to improve your own ability, build upon your existing knowledge and broaden your knowledge base. Medicine is a continuously evolving subject that requires by law that you do the same. I’d be worried if I knew my doctor wasn’t at least trying a little bit to learn more about the subject they’d chosen for their career…

However, comparing yourself to others can be dangerous. When we go out in the world we put on our public face, our public clothes, and our public attitudes. We don’t reveal our inner fears, our problems, our weaknesses. And since everyone else is doing the exact same thing we don’t ever see theirs. This combination of caging away our own issues and not witnessing those of others gives us the false impression that they’re finding everything so much easier, or that they’re so much better off than we are. This is further perpetuated online, as Facebook and Instagram give the opportunity to sell yourself to the world as that perfectly happy, exciting and fulfilled individual that couldn’t possibly exist in real life. It’s not exactly a recipe for sound psychological well-being.

But there is a limit…

Medical schools rank their students. Presumably it’s intended as an incentive to work harder, as a higher rank apparently brings the tantalising promise of a better job, more research opportunities and greater respect. Maybe it produces better doctors, maybe it doesn’t. What it definitely does do is discourage students from helping each other out. The stakes are raised, forcing us to show that we’re not struggling, that we know the required information, that we can hack it in this apparently brutal world of medicine. People become so preoccupied with that centile rating that they will give up relationships with their peers in an attempt to make excruciatingly small gains over them, be that by hiding information or learning opportunities, or even misleading them deliberately in the hope of sabotaging this ‘competitor’ and boosting their own ranking.

WTF?

I once asked someone what topics were covered in a teaching session that I had missed through illness, and they said to me, “It’s your fault you weren’t there”Turns out it was the Krebs’ cycle…

I’ve also heard rumours of students sabotaging the computers/iPad available during OSCEs to disadvantage those yet to complete that station.

It’s crazy!

The qualities we want in our doctors are compassion, teamwork, communication and integrity. Healthcare is never done on an individual basis, it’s always a team of teams of teams, each with their own area of expertise and interest, cooperating and communicating to ensure the best outcome for the person that really matters most – the patient. You can only gain by communicating well with others. Either you find out something you didn’t know before, you deepen your own understanding of a subject, or you have that satisfying feeling of helping someone else understand something just a little bit better, and knowing that you’re helping their patients as a result.

So I ignore the rankings. Always have, always will. I don’t care if the person I’m talking to is going to score higher than me. In fact, I’m happy if they do. Why? Because I’m determined to be a good doctor – it’s what I’ve always wanted to be – so anyone scoring higher than me in the rankings has to be pretty good as well, and they might be looking after my Mum one day.

 

Don’t be that guy – help each other!