A day in the life of a new House Officer.

2 of us on the ward today.. me and the harassed SHO..

Oh, and the Consultant.. who I think is thought of as Satan by many of the staff! He is "very particular" about how things are done for him. He talks in a really patronising voice and quietly. However, I can't really complain, I've not been yelled at much yet. With parents like mine I think I'll be able to cope with whatever happens.




A day in the life of a new (clueless) House Officer (aka Foundation Year One doctor Aka FY1 )

First came handover. Where we sit and hear about the patients admitted overnight. I tried really hard to listen as yesterday I looked like a muppet when my SHO asked me about 2 patients who I'd seen on the ward round with the Consultant who I totally went blank on and could remember nothing about. Resulted in me running back down to their respective wards to check the patient's notes. Waste of bloody time.

In handover, first we had a lecture on preparing the list about new patients and where they end up whilst on take, or else nobody can work out who to see the next day and grouping patients on the spreadsheet by ward so dosy Consultants on the post take ward round can figure out where to go and not run around returning to wards they have already visited to see forgotten patients. He went through where all this stuff was located on the computer but I zoned out and he was foreign with a complex accent so I hope when I am on take and this is my job someone else has a clue!! I have it written in my induction pack anyway.

Handover I wrote down all the patients in my notebook I thought might be coming to us.. ie we accept all the old patients with particular problems. Old being over 75 years old. It just the way patients are split. I wrote up the new patients on our master plan list on the computer.

SHO sent me to work. Spent the morning going to Radiology looking for a Consultant to "vett" the MRI I needed done- well that the patient with the nasty ankle wounds with diabetes needed done.. apparently! After false leads in a number of offices and asking 5 people where to go I located the Consultant radiologist who took one 10 second look at my referral and ok'ed it ( I think he was in a hurry) telling me it was probably going to be pointless unless the MRI ruled out osteomyelitis as oedema precludes from seeing it. At least I think that is what he said! This was a turn up for the books as last Friday I'd spent 10 minutes arguing with a different Consultant Radiologist who refused to do the MRI, stating that he didn't think it would alter our management. I have no idea.. but I argued my case as well as I could!

I then located the endoscopy area ( Day surgery) to check up on whether the OGD my SHO ordered last night on the fancy new computer system actually went through or not!

( the hospital is gradually switching to a computer system from a paper one, however some things are still in transit.. for instance sending stuff to pharmacy over the computer system won't work.. one needs to physically get the forms sent down- I think the nurses or ward clerks do it? ) I found the area, spoke to the nurse in charge who got all huffy about how I was never going to be able to book an OGD for today as other ppl would need to be cancelled from the list. Our patient had dropped her Hb overnight and had melaena, however, she seemed stable so I didn't bother chasing it up and annoying the Consultant.. The nurse was trying to herd me in there for a fight.. as if I wanted to usurp her lovely list and keep in another patient!


Then returned to the ward with my bleep going with requests from Nurses that I usually can't handle. What was it today? Gosh it feels like such a long day! I'm sure the pharmacist called me to query something!

I started a TTA / TTO ( to take away) for a patient and their in patient discharge summary. ie. a summary of their diagnosis, the follow up required. I know very little about this patient but shes been on the ward for ages, since before I started as a Dr. Luckily the previous SHO had started the summary as the patient had been expected to go home much earlier, so I just had to ammend the end bit about why she had been kept in!

In the middle I get bleeped from a different ward we cover about a patient, a lovely lady, who I'd stabbed 5 times the previous day, trying to get a cannula in and failing miserably. Yesterday she was febrile. I made a hash of things with the cannula, got all stressed and left my SHO to pick up the pieces. Today she had dropped saturations after having a cxr for the septic screen we .. ahem my SHO organised the previous day.

Today, I asked the nurse over the phone to give me all the observations ( Dr abcde mode eh!) then I said I' d come review the patient.. ( at this point I'm thinking.. shit... what am I going to do.) Being a bit cowardly I went to tell my SHO the plan ( she was reviewing patients herself on her ward round.. - this is the 2nd Consultant, who's patients will not be seen today except by us as the Consultants each have their own batch of patients and don't deal with the other's patients! They are all territorial and precious about the numbers of patients they have. Got bollocked today by the Consultant.. X patient should have gone to the other dr to even out the lists. "nod and smile" was my reply.. my new motto for medical practice :S Look as if I'm listening and interested.. ( I think I probably just look gormless.)

I digress.. sorry brain freeze, its been too long a day!

I went to the ward, checked the patient ie. ox sats ok, cap refill a bit slow, patient shaking (rigors) felt very hot. I listened to her chest.. its bloody hard to listen to a patient's chest you know! You have to heave them forwards and support them to get a good listen. She had wheeze and crackles.. I didn't hear that many crackles to be honest. I checked the bloods (raised CRP, WBC and a Neutrophilia) then I checked the cxr and tried to compare to old XRs.. The SHO appeared.. diagnosed the CXR as a pneumonia and asked e to do an arterial blood gas. Now, don't ask me why. But practical procedures can freak me out. True, I get a buzz when I can do them.. but my first reaction to them is AAAAHH why me. I think I made a face so she agreed to watch me put in the ABG> What am I , 5? Anyway, I went for the artery, hit it, collected a small but sufficient amount of blood and ran down to A and E to use the blood machine. Success :D

Patient wasn't acidotic, Ox sats ok, Bicar 1.5 ( apparently the magic number is 2) so she wasn't too bad. SHO tried to be nice ( she seems a little false though) apparently I was very calm and good preparation ( haha I found the tube and the gauze !) I think I made another face. I should have just said thanks, she was trying to be encouraging and helpful :D She told me to do ABG with the needle at 45 degrees.. mine had gone in more like 70degrees ( she said 90 degrees, but I think I'm not that bad!) Apparently something about not going through the artery,easier to withdraw if go in at 45 degrees and easier to pull the plunger of the syringe. I was just thrilled to have hit the artery at all!

Then carried on with TTA, called switchboard looking for a specialist who had reviewed a patient to get them to discuss management. After a number of incorrect leads I located the specialist.. they are found at another hospital ! Thats why they were not listed as having bleeps! I called the number and left a message. I also called the anticoagulant clinic to try to book a patient newly placed on Warfarin for follow up. Of course, this was preceeded by me reading through reams of illegible scribbled notes, trying to detect why we had put the patient on Warfarin in the first place! I left a message here too. Nobody present to answer phones it seems.

Then had FY1 teaching.. with.. dah dah dum.. free lunch! Me and my mate made it up there 10 mins early to nick the best food! To be honest, the drug rep lunch next door looked better but beggars can't be choosers. There was fruit salad with strawberries and blueberries amongst the other fruit.. yum! Lunch meeting.. education , FY1s need to be taught.. we were taught.. nothing today! Just to take out nasty dirty cannulas and to use all the stickers in the chart to document that they have been put in. Always carry small sharps bins to the patient for safe sharps disposal... great, except there are never any small yellow sharps bins on the wards! The sister concurred and promised to get supplies to produce sharps bins for us to use. She seemed to be talking sense. The other guy? I could barely understand what he was saying. Seems octopus attachments for cannulas need flushing before use!?!? Who knew.. shit.. I put in.. 1, already I think :S no matter. Patient was fine :D really fine!! ?!?!? Ok, note to self, prime equipment first. I wish they would tell us these usefull things.. they just tell us crap and obvious things.


Then, reluctantly went back to the ward for job as ward round dogsbody with consultant from hell. Its ok, I got my own back.. when he tried to walk off with the ward's tendon hammer- I asked him if he wanted to return it.. I also called him out when he tried to enter the wrong ward.. Erm.. excuse me sir.. don't you mean Paris ward? Not London ward? Ah, good, yes :D

He thinks he got his own back on me.. He calls me by a shortened version of my name, despite the fact I've never given him permission to call me that. I don't know if its too late to say Oi.. excuse me my name is... might not be worth the bother. If I do tell him and he still calls me the short name I'll just feel he's trying to wind me up. He told me off for drawing the curtains as he wasn't going to examine the patient's manky foot and chastised me for not being "proactive" enough at getting out the notes.. By this time, I just wanted to collapse from fatigue. I was sent off to write a TTA for a patient with cellulitis who wanted to go home, we discharged her on oral antibiotics.

Ward round "highlights," writing in big capitals for the deaf old dear on the ward ,.. then realised he couldn't see well either, had to fetch his glasses. Getting chastised for moving by the dr in the side room when he spoke to a patient. Honestly, being on his ward round I feel like I'm at home with my dad when he is one of his foul moods. From this I know I can cope with it :D This guy can't hit me or chuck me out or disown me. What do I care what he thinks of me? I'm doing my best. I write down what he says pretty much verbatim. I just need to get in the habit of being able to think a well as record the notes like a machine!!


Oh I was also bleeped to do an urgent TTA ( if its not filled in by 5 the pharmacists won't do it and the patient can't go home.) I bleeped the SHO and was told it wasn't my responsibility to do the TTA as it was for a post take patient who hadn't been handed over to us and we had not seen as the day after take the new patients are seen by the team that clerked them in. I then got in bad graces with the nurses who were pissed at having to find the house officer who was post take and responsible for doing the TTA. I started off trying to help them chase the doctor ( the notes had a bleep number written in them) but the Consultant came and had a go at me! Then the nurse nagged me saying they had spent an hour chasing up the right Dr! What was I supposed to do! I listen to the boss in this case! If the nurses hadn't chased the results, I'd have had to do it.

Finally finished ward round, Dr told me off for not trying hard enough when the computer wouldn't let me log in to view a patient's Xray. I couldn't be bothered to argue much more.
Ran down to write a TTA on a patient, had to talk to patient's family on the way (fun fun) to reassure them the patient's pain would resolve. Ran back to ward, took blood from patient, ordered bloods on the computer..

Then SHO told me to clear off. Which I did.. ( she was staying but told me I wouldn't be capable of doing any of the jobs she had left! I was going to protest, but the cannula she had was for our sick patient who I'd failed after 5 stabs yesterday.. I was outta there!) Also it was 6.52.... I'm meant to be finished by 5.30 according to the European Working Time Directive.. EWTD my ass. There were lots of my colleagues there at the same time with jobs left to carry out. I'm sure we will speed up when we figure out how to do the job, however, at the moment, its 830 am start and 7 o clock finishes.. I think its easier to just accept it and expect it than thinking we will be out by 5.30 every day.

Took bus home, took forever. Was pissed off. Went to parents for supper, brother and brother's girlfriend present. Had pizza, was yummy.

My throat is sore. Might be coming down with tonsillitis? Hopefully not swine flu. Argh.. I'm going to bed..


Hope that was informative. I never knew a day in the life of a house officer / Foundation year 1 doctor was so full of admin and thankless yet crucial tasks to the working of the team.

FOUNDATION YEAR ONE

Hello, I've just survived my first week ( well really 3 days, as 2 were induction) of being a House Officer, ie. FY1= Foundation Year 1. I think this is what the Americans call an intern.

Basically It is my first paid job in medicine, the first time I am permitted to use the title "DR" and the first time I have a role and responsibilities. I have a bleep too ( how exciting)

I've studied medicine in a big university in the United Kingdom for 6 years, involving 2 years of lectures, a Bsc degree year and 3 years of studying on the wards, I passed my finals and now I am qualified..

Qualified and terrified....
and learning how to be a doctor.

Unfortunately I don't feel very confident about being a Dr. You would think that after 5/6 years of training I would be ready. But no. I am shit scared. But I will cope!!

I must say, the system is crap. My shadowing week to follow around the person doing the job I now am doing was ruined by the fact the previous girl was on annual leave when I was supposed to shadow her. Great. All was not lost though, I followed 2 higher up drs- the SHOs or ST1s around instead. Also stupidly on our first day all the doctors changed over. This meant that on my particular firm no SHOs were around as they were in induction. They are also new, so have no idea how the system works in this particular hospital either or how to work the computer software. So it was just me on my first morning. The Registrar was in clinic, as was the consultant, and the SHos were away. So just me on the ward with a few nurses.!! It wasn't so bad in that the Reg started me off on the ward round. But crazy first day. Why don't they do sensible things like stagger when the doctors of different grades switch round. At least then someone on the team would know what they were doing!

As a student I followed around House Officers, but never for prolonged period of time, ie. I didn't have a month of shadowing. This meant that on starting my job in little district general hospital last week I didn't know what I was in for or what I needed to do! I've been making plenty of stupid mistakes, but I've survived so far ok. No patient has died ( I'm not being flippant!) No patient has complained about me and I'm coping ok- at least I hope so. Its helped that I'm employing stress relief mechanisms.. ie. exercise! At least an hour a day.

For any medical students out there, so far here is what my job seems to involve!

TTAs/ TTO ie. to take away/out. = form where write down the patient's diagnosis and hx, plus ix results and treatment received et.c, comorbidities and plans for after discharge and also the drugs they are on. This is so the GP knows what happened to the patient during their stay, so the patient gets the correct drugs and so in the future there is a simple document summarising what went on with the patient. These are really helpful in that they are typed, so easily legible. Thats cos some poor person ( ie. Me.. the house officer/ Fy1) has read through the illegible notes, deciphering to their best ability what has been written!

I've written lots of these TTAs this week, gauging from the notes the hx since I don't know who these patients are! I've only just turned up on the wards. Its guess work and detective work and an ability to summarise! Nobody has checke my TTAs, I have no idea if they are crap or not. I am trying to write them in the way the SHOs I shadowed showed me. I just hope they are ok!
Last week I screwed up by forgetting to merge the drugs document with the in patient discharge summary, so the TTA had no drugs on it!
Yesteday I missed out all the drugs from a patient's second drugs chart from their form. The forms must be done early or else Pharmacy is closed and they can't get their medications so cannot go home! This week I'm sure I'll be doing more of these forms. I only hope they are ok and the GPs and future drs seeing these patients find them useful!

Other tasks for me:

Rewritting drugs charts- they only have room for a few weeks of drugs. This is dull, just copying down things but I guess it helps to learn doses of drugs. It is also easy to make errors so I just check everything once I am done. I still get a thrill out of signing my name on drugs charts! After writing a new chart, one must put big crosses all over the old chart!


Also must write prescriptions and sign it. I had a surreal moment the other day. The head pharmacist asked me to sign the drugs chart for something she had altered for a patient as only the Drs are authorised to do this. Yet this woman taught me all the pharmacology I know the day before, and I had to ask her what she wanted me to sign and why cos of course, being a novice, I had no idea. Its crazy that I have the authority to sign and not the experienced, knowledgeable pharmacist!! Anyway, no matter, soon I will know what I am doing regarding drugs too :D

Writing up pain relief/ laxatives and fluids on drugs charts.


Vetting radiological investigations: ie talking to consultant radiologists and trying to persuade them to do the CT/ MRI/ US you require. They ask you about patient hx and won't do things unless you have a clear question you need the scan to answer. I had my first taste of this last week. I got one scan through the vetting! The other- had a heated discussion with the radiologist who refused to do the scan. Oh well. Its some crazy system where run around xray looking for drs, get them to sign the form, then drop it off with radiographers who try to undermine you further and say you don't need the form and why.

Putting in cannulas.. ie. drips. I was well chuffed as I put 2 in first time on Friday. Prob cause the SHO taught me to not bother pushing the tube in and pulling the needle out at the same time. He said just slide the tube down and leave the needle where it is to help guide the plastic tube. It worked great. Also only use one hand to put in the cannula. Use the other hand to hold the skin. It worked a treat!

The Registrar ( second in command) nearly lost it last week when after 4 attempts she got a cannula in successfully. She then told the nurse to remove the CATHETER ie. tube that goes into bladder to drain it of urine. Nurse misunderstood and removed said CANNULA instead. This woman has crummy veins and is really difficult to cannulate so the Reg was cross, although she managed to laugh it off. Nobody else on the team ( I didn't try as I'm the least experienced at this) could then replace the cannula. Without this the patient couldnt get the IV antibiotics she desperately required.

Chasing stuff- The HO gets ordered to phone people up such as secretaries and to fax inpatient consultant referrals. I've found that the hardest people to get hold of are psychiatrists- and they are often the people who are really needed.

Ordering blood tests on the computer.

Recording blood test results on sticky labels to be put in the notes. Checking blood results. Checking other results eg. radiology which can be checked early by running down to xray and looking at the "hot book " where the radiologist has written something before the official report has been produced.

Updating the patient list ( our list of all the patients where they are, their details, their problems ( ie medical and social) and plans/ jobs required.
Writing lists of patients for review by the weekend team and what requires doing and which grade of doctor would the patient require.. ie. house officer or proper Regsistrar.

Answering nurses requests :) Relaying requests of other staff to the team I work for.

Ward Round duties- ie. getting out notes for patients, wheeling the notes trolley around, recording patient observations ( as documented by nurses in the obs chart) an scribing everything the consultant says regarding the patient in their notes. Ie. you are the general dogsbody. Other role = to be patronised by the Consultant.


So far thats what I've had to do all week.

Other duties depend on being "on take" where have to clerk ( ie. find out whats the story) from patients down in A and E, examine them, come to a differential diagnosis and treat them there.


I cant wait.. :D

So tired now though.. European Working Time Directive insists we finish work at 5.3o as we can only do 48 hours work a week in the hospital. However, I finished practically at 7 pm for 2 days instead of 5.30. Hopefully this will improve when I get to know the job and get quicker at tasks.

For now.. must rest!