About Me

Larbert, Scotland, United Kingdom

Monday, September 26, 2011

Nights... my thoughts

So we are hear again - the 'staying up late the night before'; the 'lying in as long as you can'; the 'fill the day with stuff that relaxes your brain'; the 'eat healthy food with carbs for long release energy'; the 'go to tesco and hoard sugary stuff'; and finally the 'large strong coffee as I head to work' - nights!

I like nights - it;'s when you as a junior get to make most of your critical decisions. You have less hassle of ward rounds etc (until morning). It's you, the patient and your clinical skills. It's very much dealing with what happens, very little planning and very adrenaline fuelled seat of your pants stuff.

In the simple world, when I am first on I deal with GP calls and A&E referrals of new patients, I clerk them and present them to ward round. The range of investigations I can get overnight is more limited than during the day, as are the senior opinion options. This is the relatively easy side, the part that relies on working through each patient, deciding what is wrong and commencing treatment. It's just like days, but with a bit more stress of not knowing how many you will need to see, and there only being 1.5 doctors, no FY1's and such like.

Being second on means ward cover. This is more daunting. 11 wards doesn't sound many it;s about 400 patients, including HDU, CCU, Renal, Haematology and such like. These are the complicated patients on huge list of drugs and for whom 'getting them to morning' may be the best your management plan can achieve. The specialist nurses on these wards frequently know far more about these patients than I do, and even more about their conditions. Their guidance whilst reassuring can also put you off the scent though.

We also have to act as a referral centre for regional services in some specialties where doctors at other hospitals will call and ask to refer a patient to us. We then call the consultant on call for that specialty and relay the info that the other doctor gave us. The consultant then gives us a list of more info they want and a game of phone call tag goes on with us as the centre!

All in all, where's that coffee!