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Thursday, March 12, 2009

Survival Tips for House Officers #1 : Handover

It's pretty scary, the first day of work, when you step into the hospital wearing your 'Doctor' tags, wielding your stethescope like a talisman. There's an awful pressure on your chest which is later identified as the Fear Of Screwing Up.

There are a few things you can do to try and mitigate the stress of the first week. The most important thing is to get a good handover from the house officer who is leaving.

If possible, try to visit your future workplace the day or week before you actually start working there. Get in touch with the house officer and get him or her to show you around. If you can't do that, at least call them and have a chat with them over the phone.

Here are the top five most important questions you must ask during your handover:

1. Where do you keep the patient list and how do you update it?

If you are fortunate enough, the houseofficer will have kept an up-to-date list of all the patients under the care of the consultant's team. The list is your lifeline- it will have important information stored in it, such as a brief summary of the patient's problems, a list of significant results and pending investigations, as well as a few notes on the care plan. It also doubles as a shield (just hold it up and pretend to scribble on it).

In order to respect patient confidentiality, most houseofficers will not only limit access to the list, but will also use a personal shorthand in compiling it - so it's useful to find out the relevant passwords and ciphers from them. This will save you from having to decipher the hieroglyphics of the patient case notes which can take HOURS.

2. When are the consultant ward rounds?

Not every consultant shows up for ward rounds every day at 8:30am, but all consultants will have a favourite time and day for showing up on the wards. Some consultants will arrive after clinic or before clinic. Some will insist that you turn up for the 7am post-call rounds even if you weren't on call that day. Some will expect you to attend breakfast meetings before the ward round. There will also be the evil consultant who will pop by at 5:05pm, just to check on your progress.

Finding out about how and when the consultant conducts ward rounds will give you an idea of what kind of person your consultant is. Is he a control freak? Is she too busy to give a care about the small stuff? Is he highly flexible? Is she so relaxed that she's almost asleep? The more you know about your consultant, the easier you will find it to adapt to your environment. I will write more about managing your consultant in another post.

3. Does the consultant have a pet care-plan for his patients?

All consultants, especially the ones who are working in very specialised fields, will have developed their own tried-and-tested methods of patient care. They will like to know that certain investigations are done, they prefer to use a particular cocktail of treatments and medications and they have good relationships with certain allied health professionals.

Some of their methods of treatment may not be as up to date as you would like...however, as a house officer, your job is to pre-empt the consultant's wishes and follow instructions, not to be a smarty-pants newbie and assume that you know better than someone who has had at least 10 years more experience than you and is clever enough to have passed all his post-graduate exams. If you want to change the way things are run and patients are managed, then do your job well, study hard and pass your exams. The best a houseofficer can do is make sure patient care is delivered efficiently and with finesse.

4. What are your consultant's pet peeves?

There are some things that are guaranteed to make your consultant grumpy. It is your job to avoid making gaffes. Angry senior doctors = grouchy nurses = sad, sad patients = It Is All Your Fault.

5. Where do you keep all your essential equipment?

It's useful to know where the crash trolley is, but it is even more useful to know where the equipment is kept for doing minor ward procedures. You won't end up running around the ward, wringing your hands and looking like a fool as you ineffectually try to find a nurse who knows where everything is, whilst your patients watch you from their beds with disgust (or amusement).

Of course, the most essential piece of equipment is the hot water dispenser. There is nothing like a robust cup of tea for rallying the forces, especially at 6:45pm on a very Long Day!


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