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Tuesday, March 24, 2009

Survival Tips for House Officers #3: Preparing for war

As a brand new House Officer, one quickly realises how fast time just seems to slip away. I know that I used to wish that there were more hours in an afternoon for me to finish all the jobs from the morning ward rounds.

I used to have 2 goals for each working day which helped me to be a more efficient doctor:
1. Eat a decent lunch
2. Leave work on time!

In order to accomplish these goals, I would have to be prepared for each day and try my best to minimise time-wasting events. The easiest way to waste time is to wander around the wards looking for paraphenalia. Thus, I set out to make sure that I well-equipped with the appropriate battlegear.

Unlike the medical student, who has the luxury of carrying a massive survival kit with them everywhere they go, the house officer has to be able to travel light and look professional (we're not playing the Legend of Zelda here!). The House Officer's equipment cannot be carried in a backpack as this looks sloppy, and a briefcase is too bulky and liable to get misplaced. Additionally, the House Officer may need to run to attend emergencies, so it is imperative to limit the weight of the gear.

I recommend carrying only 3 items to fit all your inventory - all of which can be worn on the body or carried under the arm and should be able to get you through the day:

1. Stethoscope: worn around the neck
Even if you do not tend to use your stethescope much, you should still wear this as it helps your patients identify you as their physician.

2. Hardcover file or binder with clear pockets: light enough to carry with one hand, slim enough to tuck under the arm.
On the front of the binder is where you will carry your patient list for quick and easy access.
Inside the binder is where you will keep the following:
a) Request forms for common investigations - especially the ones that need to be signed by the consultant.
b) Referral forms specific to your speciality eg. If you are in gastroenterology, you will carry referral forms for endoscopy or abdominal surgery. Similarly, if you are in vascular surgery, you will carry referral forms for doppler studies and anticoagulation clinic.
c) Patient labels to save you having to write all the details down onto forms
d) Blank sheets of label stickers. Try to beg these off your ward clerks. These stickers are especially useful when you have to take telephone reports of results or if you have to take down notes when the patient records are unavailable - saves you having to copy everything out again!
e) Daily record of patient blood test results - you should probably have one of these per patient, espeically if you have patients who need daily blood tests (eg. patients on new medication, on dialysis etc.). It is useful to keep a trend table of results so that you can see, at a glance, if the treatments are causing any subtle changes in the patient's biochemistry. Additionally, you can whip out these tables during the ward round and save everyone the trouble of flipping back and forth through the notes trying to find the recorded results.
f) Spare patient history sheets or drug charts in case you happen to run out midway through the ward round
g) Anything else that requires a consultant's signature or can be filled out whilst walking in between patients (eg. discharge forms, GP followup letters)

3. Utility belt (or small bag that can be slung across the body) containing the following:
a) Extra pens - you will always lose the pen you came to work with.
b) External brain or pocket reference book. I personally preferred using the Cheese-and-Onion (so named for the colour of the bookcover).
c) Small notebook for writing down useful information relevant to your specialty - eg. contact details of multidisciplinary team, outpatient clinic dates, treatment regimes and dosages.
d) Disposable gloves - you never know when your consultant wants you to feel the femoral pulse of an unwashed groin.
e) A set of phlebotomy apparatus and bottles - this is especially useful if you have to take blood during the ward round or if you have to see a patient on an unfamiliar ward.
f) Pen torch - you will be using this quite alot, especially if you have to access an unconscious patient whilst on call.
g) Examination materials relevant to your speciality (eg. if you are in neurology, carry neuropins. If you are in ENT, carry a disposable nasal speculum. )
h) Optional items - water flask, coins for the drink/snack machines, sweets

Other survival tips: #1, #2


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