Friday, 7 December 2007

Ward cover

Today was my first evening of ward cover. It's exactly the same as weekend ward cover - being asked to make decisions about patients you don't know and constantly being asked to review patients for no good reason. Here is what I spent my evening doing:

1. Bleeped to go and review a patient with severe abdo pain. Didn't bother trying to get any other details on the phone since the nurse could barely speak english. Arrived to find that the patient had metastatic bowel cancer, she had had the same pain since admission and had been seen by palliative care who had advised PRN tramadol. Looked at the PRN section of the drug chart only to find that no analgesia apart from paracetamol had been give for two days despite the fact that tramadol, diclofenac and morphine had all been prescribed. When I asked the nurse why she hadn't given any of the painkillers that had been prescribed she just looked at me blankly. Wrote tramadol up regularly since the patient just won't get it otherwise. Poor woman.

2. Asked to review a post-op patient with a swollen calf (alarm bells ringing at this point). Arrive to find the patient had knocked her leg on something and has a bit of a bruise on the side of her leg but no swelling, no tenderness, not hot etc. Not in any pain. No action needed. What's more the (lovely) registrar had already seen her a few hours ago and told her that it was just a bruise.

3. Asked to review a patient's regular medication because the doses had been prescribed wrong. Looked for the patient's notes to try to find out the correct doses only to discover they had gone home two days ago.

4. Asked to consider changing several patient's antibiotics from IV to oral despite never having met them and not having a clue why they were even on antibiotics.

5. Asked to prescribe vaccinations for a patient who had a splenectomy and needed them sometime before going home next week.

5. Asked to write TTOs for a patient who might be going home on monday.

6. Asked to rewrite 2 drug charts.

The surprising thing is that this is all within a couple of hours of the normal teams leaving. I'm sure the nurses wait until 5 before looking to see if any fluids need prescribing, drug charts need rewriting etc. I wrote "No - this is a job for the normal team" on a couple of the notes left for me. I was very very close to writing "Fuck off"

Wednesday, 5 December 2007

Miserable Bastard Registrars

There is a huge difference in the way different registrars treat F1s. There are some absolutely brilliant regs who are patient with us when we don't know all of the answers and even take the time to teach us about what we could have done differently when they come to review our patients. This usually earns them the prefix "lovely" before their names when we discuss them between ourselves.

There are also some absolute bastards of regs. I had to deal with one of them today when I wanted to make a referral to another team. I've started a new specialty today so I don't really know the patients but the SHO asked me to refer one of them to respiratory. I spent about 20mins reading the patient's notes, looking up the results of their investigations and checking their obs chart etc so I would know what to say when I called. The patient had pneumonia, they had been started on IV antibiotics and had started to improve.

Thinking I had a reasonable handle on the case I bleeped the respiratory reg and asked if I could make a referral to him. His reply was "well to start with, no you can't make a referral to me, you can only ask my advice and I'll decide whether to see the patient or not" - ok, I thought that was pretty much the same thing but never mind. I then asked very politely whether in that case I could ask his advice about a patient. He then asked where my registrar was and why they weren't calling him. I explained that there are no registrars in this specialty, only me and an SHO who was busy. After a lot of sighing and tutting he agreed to listen to the case.

I actually summarised the case pretty well since I'd prepared myself and could answer all of his questions quickly but as soon as I had finished he started going on and on about how this person didn't need to be referred to respiratory and could be managed by my own consultant. He was annoyed that I had called him when I was only an F1 and seemed to be under the impression that the referral had been entirely my idea (when does that EVER happen?).

It's so annoying because I don't know how the hell medicine works. This is my first day. I can only assume that if one of my seniors asks me to make a referral then this is the right thing to do. I don't know that arsey respiratory regs will only accept referrals from other regs or that not all people with pneumonia are referred to respiratory. When I explained that it was my first day and I was just doing what I had been asked to, his response was "That's not good enough. You're wasting my time". Thanks for the understanding.

Anyway... what a pompous wanker. There is absolutely no need to be so rude. I bet he's either short or ugly. Probably both.

I want to go back to surgery :(