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Tuesday, March 17, 2009

Survival Tips for House Officers #2: Managing your workload

The consultant and the other senior doctors, who have to run the hospital and outpatient clinics, will not be spending as much time on the wards as the the house officer. Therefore, the house officer is expected to know the wards better than anyone else on the team.

The most difficult part of the house officer's job is keeping track of patients, especially if your patients tend to be spread out over the entire hospital or if your hospital has a merry-go-round system of patient organisation. It is just too easy to get things confused, especially if you work in elderly care, where one crumbling old lady is almost the same as the next. During ward rounds, however, you will be expected to update the other members of the team as if you have thoroughly memorised the entire life history of each patient.

If you are unable to give a running commentary on each patient, you will end up looking like a clown as you mumble to yourself whilst frantically flip through the patient notes with one hand, whilst and at the same time, juggling the other 30 sets of notes in the other hand. Despite what you might think at this stage of your medical career, you are NOT sideshow freak - you are a doctor. And doctors have to appear to know everything.

The patient list will be your cribsheet, your lifeline. A key part of your job is to manage and maintain the patient list. If your team does not have a computer generated list, then it is up to you to create one and make sure that it is updated daily.

Your list should contain the following information:
1. Patient's name, initials or preferred nickname
2. Age of patient
3. Location of patient - your list should be organised by ward and bed number
4. A brief summary of patients current problems and current therapy (updated daily)
5. A brief summary of patients previous or underlying medical problems
6. Results of pertinent investigations (updated daily)
7. Investigations or referrals requested but still pending (updated daily)
8. A space to jot down notes from the ward round (this will probably turn into a 'to do' list of jobs)

If you are worried about not being able to maintain patient confidentiality (this only happens if you lose your patient list - in which case, you will be totally screwed anyway), then write your list in a shorthand code that is understandable only to you and the rest of your team. In any case, the information on your list should have very few patient identifiers - you are not writing a biography here! In fact, the total amount of patient information on your list should not exceed 2 sides of printed paper (you should probably aim to fit it all on one side of paper).

The purpose of this list is to serve as a memory aid in a world where the patient turnover is high and it is easy to get your patient details muddled up. One glance at the sheet should be sufficient enough for you to be able to recall the rest of the patient details clearly enough for you to discuss the case with another health professional. This helps especially if you are dealing with anxious relatives or if you are unable to access the patient notes.

Additionally, if you are on a particularly fast-paced ward round, it helps to only have ONE sheet of paper to write notes on instead of having to run around balancing 30 sets of patient files on your stethescope (remember, you are not a clown - you can always go back and write legibly in the patient notes at your leisure!).

The best part of the patient list (apart from helping you appear competent) is that it is very useful for making patient handovers. At the end of the day, before you leave the hospital, you should update the list and mark out the patients who are particularly ill and need to have special attention from the night staff. Give this list to the poor soul who is on-call that evening - it'll help them out tremendously if they are asked to review one of your patients at night.

(Other survival tips: #1)


OpenID weestories said...

The house officers I've met all seem to be pretty capable of staying up to speed just by looking at each patients' ward file. Of course, there's a lot of flipping back and forth, but generally I've not encountered any instances of blurness because of inadequate notation. I've also noticed that doctors' scrawls are a bit more legible these days, even to laypersons like me. Maybe there's a collective conscientiousness about handwriting at work...but of course my experience is limited to just one particular hospital here.

12:14 am  
Blogger tscd said...

weestories: The ward file is definitely required reading - but it should not be done during a ward round or by the patient's bedside. Most consultants will expect the house officer to provide an adequate presentation about each patient - otherwise they would just read the notes themselves during the round.

I think that having to flip through the notes during the ward round or in front of the patient is an example of sloppy housemanship. 1 minute of aimless flipping x 30 patients = 30 minutes that you could have spent doing some real work. If there is something significant in the notes which the consultant needs to read, then it should be bookmarked.

Additionally, some consultants prefer to hear about the patients whilst travelling inbetween wards - so you won't have access to the notes then.

10:51 am  
Anonymous Anonymous said...

wish my HOs would read this!

10:04 pm  

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