The saying goes “what happens on tour stays on tour”, but when posting online bear in mind that what happens on Twitter stays on Google forever. Doctors should exercise caution when making entries on social networking sites – the internet is not a private space and nothing is truly anonymous.

Photo by Florian SEROUSSIMPS is aware of cases where junior doctors have discussed patients on social networking sites, assuming that they would not be identified – but they were exposed and those involved were disciplined.

The Journal of the American Medical Association uncovered many online breaches of patient confidentiality on social networking sites. The study found explicit postings from trainee doctors that revealed private patient information. Most were in blogs, including one on Facebook, containing enough clinical information that a patient could be identified.

Social networking sites blur the boundary between an individual’s public and professional life. Be wary of posting inappropriate material on social media sites, such as photos that may bring your professionalism or that of colleagues into question, even if they are taken in your free time.

However, tight privacy settings can create a false sense of security. Comments about your day-to-day work and the patients you have seen, even if anonymous, still pose a risk, as the information may be identifiable and so may breach confidentiality.

Protect yourself

Follow these tips from Sophos to protect yourself when using social media:

• log out when you move from one terminal to another
• check what levels of privacy you have set up
• enable secure browsing using https. This can be found under the account settings tabs of most social networking sites.
• choose a password with a mixture of upper and lower case letters and other characters, and change it as regularly as is practical.

Things to remember:

• Your ethical and legal duty to protect confidentiality applies equally on the internet.
• Do not accept current or former patients as friends/followers.
• It is inappropriate to post informal, personal or derogatory comments about patients or colleagues on public internet forums.
• Defamation law can apply to any comments posted on the web made in either a personal or professional capacity.
• Ensure that you do not inadvertently breach your contract of employment, by being aware of your local commissioning body or health board’s policy on blogging, etc.
• Be conscious of your online image when posting images on the web and consider how it may impact on your professional standing.
• Doctors and medical students who post online have an ethical obligation to declare any conflicts of interest.

The appetite for social networking can only get bigger, so doctors should take advantage of its many benefits, as long as they are balanced against the risks.

This is a summary, read the full article here. The BMA has also produced useful guidance here.

Top time for Hot Water in 2012?

“Personal profiles on Facebook and other social-networking sites are a trove of inappropriate and embarrassing photographs and discomfiting breaches of confidentiality. You might expect that from your friends and even some colleagues — but what about your doctor?” Time Magazine

This is current news in 2012, but if you look at the date of publication of this time article, it’s September 2009. Although this was published over two years ago, we think medical students are going to be coming under increasing scrutiny as the year unfolds.

It’s happened before, in the UK…

Remember people playing the lying down game? Roll back to Swindon, UK. A number of junior doctors were suspended for what many medical students and doctors considered hijinks: posing for photographs whilst lying down in unusual places. See our example of the latest MRI-PET scanner here:

It’s happening now…

A research paper from 2010 looked at a small group of medical students in Liverpool, UK. Over half had witnessed unprofessional behaviour by their colleagues on social media.

Dr Amy Cunningham, a lecturer from Cardiff University recently highlighted on Twitter and her blog about doctors using slang on social media, e.g. referring to ‘mad-wives’ instead of midwives. For her efforts, both she and the doctors in question were both applauded and criticised by healthcare professionals and different elements of the national press.

Help is at hand…

If things seem a bit blurry and you dont know who to turn to for advice, fear not – as we have compiled a handy list of references:

• From Your Institution – Check if you have guidelines at your University, and follow them!
• From Professional organisations
• From the MPS: The pitfalls of social networking
• From the BMA: Using social media: practical and ethical guidance for doctors and medical students
• From the AMA: Social Media and the Medical Profession: A guide to online professionalism for medical practitioners and medical students.
• Help From Within – We think ‘use your moral compass’ is a great adage. See the moral compass example of one experienced GP below.

Advice from an experienced user of social media

One of our medical professionals says this:

“I use this principle. If I wouldn’t be happy with any of: my mother, friends, work colleagues, peers, nurses, receptionists, patients, friends of patients, children of patients, professional licencing bodies, line manager seeing it, don’t post it. Do not post anything relating to your workplace, patients, or patient care online. If you have a grievance, use formal channels.”

What about anonymity online, protected tweets, protected postings?

“Just be careful. Is it worth risking your professional status over such minutia? The security of these areas is becoming increasing difficult to police. Don’t go there.”

Happy – and safe – tweeting in 2012!

Photo by upsuportsmouthPoorer medical students’ debts have also soared. Those from low-income backgrounds graduate over £13,000 more in debt than better off students – graduating with a projected debt of £37,588 (up from £26,324 in the past 12 months).

The survey from the BMA also reports that the number of medical students from the lowest income brackets is in decline over the past 12 months.

Co-chairwoman of the BMA Medical Student Committee Elly Pilavachi said:

“Medical students are now facing extremely high levels of graduation debt. Many are clearly heavily dependent on financial support from their families and friends to get through the intensive, five to six-year medical course. However, the picture for those from low-income backgrounds is particularly alarming with their debt levels a staggering £13,000 higher than those from higher income brackets.”

Clearly there is a lot to think about if you are planning on becoming a medical student, or already are one. What do you think about the current financial plight of med students?

The more traditional “communication skills” teaching has focused on the doctor–patient relationship, yet communication between colleagues in hospital and primary care settings is equally important.

Photo by Skype NomadMPS’s experience over many years is that some of the biggest mistakes in hospitals are the result of poor communication. Although there are often many factors leading to adverse outcomes, it is undoubtedly the case that poor communication and handover can result in inappropriate prescriptions, incorrect diagnoses and patients lost to follow-up. These have clear potential for patient harm, and an associated impact on the team arising from complaints, claims and disciplinary investigations.

Developing both your teamwork and communication skills at medical school will stand you in good stead as a doctor. The GMC emphasises this in its guidance, Medical Students: Professional Values and Fitness to Practise, stating that: “Medical students need to be able to work effectively with colleagues inside and outside of healthcare in order to deliver a high standard of care and to ensure patient safety.”

Communicating well in a team demands more than merely listening and passing on messages. Doctors must work within their competence, seeking advice and assistance from senior clinical colleagues where appropriate.

On occasion, doctors may need to act to protect patients from potential harm caused by inadequate systems or procedures, or as a result of a colleague’s behaviour, performance or health. MPS recognises that this is never an easy decision. If you need advice on the appropriate action to take, you should usually raise this with your educational supervisor and you can always access expert medicolegal advice via MPS’s helpline.

Survival tips for good communication

• You may feel as if you are at the bottom of a long chain – but in fact you are part of a wide communication network within primary and secondary care, including the voluntary and social sectors. Try to think about your individual role – what information should you convey to assist in protecting the patient’s health?
• As a student, the GMC expects you to demonstrate that you are developing teamwork and leadership skills. Be willing to work as a team and take on appropriate responsibility.
• However, never work outside your competence. If in doubt, always ask.
• If you are concerned about a fellow student, colleague or other health worker, raise your concerns with the appropriate person – this is usually your educational supervisor, consultant or GP trainer.

The first night shift stalks you, you see it coming from a distance, creeping closer along the rota and suddenly it’s the weekend before your first shift. Monday to Thursday night, 4 days, and then a day off. How hard can it be?

Honestly, it can be anything from a breeze to a true beat down. That will largely depend on where in the hospital you are covering – Medical ward cover, Surgical Admissions and Ward Cover or A&E. All have their benefits – ok, maybe Medical ward cover doesn’t!

Photo by icatusAs an F1, I found A&E the best place to do the night shift. Please note I didn’t say it was the easiest, nor did I enjoy it, but it is certainly the BEST place to do a night shift. Yes I was SHATTERED by the time morning came around, but I had been SUPPORTED through the night.

In A&E, whenever there is a problem, you can lean over; have a quick chat to a senior, get some advice or reassurance and carry on. The work is constant, but it’s varied and you stand a good chance of learning, and learning a lot if you’re lucky.

Note again, I’ve not actually said it’s hard. Yes you are doing a 12 hour shift, and that is always tiring, however the work is pure back to basics medicine, even down to the opening line “Hello what’s brought you to A&E tonight?” Ok to be fair, that line is not quite what I’d call chirpy at 3am, but still.

In terms of surviving the night shift, I’d advise yet again, make sure you have plenty of food, but there is something that I’m not going to advise, but might give a health warning to, Caffine.

In my experience it doesn’t work. Well not how I’d hoped anyway.

My first night shift, I’d not been able to sleep during the day, which made for a very difficult second half of a shift. 4am had rolled round and I was monumentally tired. Even my eyelids feel tired. But I’d come prepared, or so I thought. Two cans of RedBull, to see me through the night. The work load lessened, and I look towards my caffeinated saviour.

I downed a can, 30mins later, I’m still feeling dead on my feet, no effect, second can, no effect, and then it started. I began to feel very unsettled and agitated. Not a pleasant feeling, but the worst part – I was still half asleep, but now the half of me that was wake felt terrible! So remember, caffine isn’t always the answer.

Plus A&E also has a fantastic sense of camaraderie that’s hard to fault, as everyone fights/works through the night together. To put it simply, even from someone who doesn’t want to have a career in A&E, it is a very unique place in the hospital, and if you approach your night shift with the right approach, you’ll do final – especially if you’ve worked out how to use blackout curtains and sleeping pills to help you sleep through the bright summer days!

Our guest blogger James Gill is an F1 doctor writing about his personal experiences of starting out on the wards as an F1.

F1 is luck of the draw – F2 is up to you!

By now, three weeks into the job it seems that most of our F1’s, whilst they may not have found their feet completely per se, have managed to work out the various tricks in order to survive, and most importantly serve the particular whims of their consultant.

Photo by barelyanythingAlthough in my experience, and my brief presentation to the new surgical F1’s yesterday, when I say working out the tricks to survive… what I mean is how best to divide their time between making sure that Mr Philips, their one and only patient, has had enough paracetamol to cover his headache whilst he waits for his op, and more importantly how to switch on the TV in the mess.

The surgical F1 jobs in the hospital can be really mixed bags, and it entirely depends on your consultant. One surgeon will micro manage his patients down to individual drug doses, whilst another will be content to NEVER STEP ON THE WARD, only interacting with patients when they are under anaesthetic. The point of this being that as a surgical F1 you need to address how best to use your time.

The Firm system is still in place for surgical teams and that gives the week to week ward work a different pace to medicine. In surgery you can be snowed under with patients and jobs one week, but until your surgeon is “On Take” next, every patient who is discharged is off your list and won’t be replaced. Thus its quite feasible you may end shortly before the next “On Take” of having only one remaining patient to look after – USE THIS TIME!

Surgeons love an audience, if it is your thing use the time you have when the wards are quieter to get into theatre, ask can you assist, of if an exceptionally complex op, just ask to observe, its unlikely they’ll say no. Talk to your consultant as a human being (they might not be, but give it a try) there will always be opportunities, whether it’s getting in on a paper, or helping with a simple audit, but you’ll have to go hunting for them.

Your surgery rotation is a great time to plump up your ePortfolio

Now I’ve banged on about this hellish piece of electronic dictat before but it does have its uses. You might find yourself loath with an unearthly contempt your present job, be that colorectal surgery, respiratory or dermatology. If so your ePortfolio is your golden ticket out.

If you get enough bells and whistles hanging off this electronic annoyance you will be able to have your picks of the jobs for F2, and I cannot emphasise this enough. As a medical student, when you selected your jobs, you chose things you thought might be interesting, or that you might possibly want to have a career in.

Now you know the reality of those jobs good or bad. A well filled ePortfolio is your ticket out of your personal Hell onto the ward you wish you were working on – Remember a bad job on F1 is the luck of the draw, getting the best job for you and your career is entirely down to that electronic hoop jump, so learn how to make it work for you, and grasp whatever extra time you have.

Finally take heart, its payday next week – but more on that later!

Photo by Special Collections

Writing reports shouldn’t be a daunting task, says MPS Claims Manager Hilary Steele. Here is everything you need to know.

At some stage in your career, you are likely to be required to write a report following an adverse incident. An incident can be investigated in many different ways. For example, as a complaint, a clinical negligence claim, a criminal case, a disciplinary matter by an employer with referral to the GMC, a coroner’s inquest (England and Wales) or fatal accident inquiry (Scotland).

Your written report may be the starting point of an investigation into the circumstances leading to or surrounding an incident. This article sets out how to provide a detailed, clear and objective report.

Circumstances when a report may be required

You may be required to provide a report:

• for your employer as part of an internal investigation
• for a solicitor
• for the police
• for the procurator fiscal (Scotland) investigating either a criminal matter or death, which might result in a fatal accident inquiry
• for the Crown Prosecution Service (England and Wales)
• for the coroner (England and Wales)
• for the patient’s employer or insurer.

Disclosure of information – are you authorised to disclose this data?

While it is tempting to discuss an incident with your colleagues, even those of the strongest character will be influenced by the views of others.

The first point to consider is whether you are authorised to disclose the data being requested. Disclosure of personal data is subject to the Data Protection Act 1998. The legislation applies regardless of age, format or origin of the information. It covers files, letters, databases, reports, photographs, etc. A report will, more often than not, involve the disclosure of confidential information about a patient.

Before disclosing information you must be satisfied that you have the necessary authority to do so; for example:

• you have obtained the patient’s consent – check they are clear about the extent of the disclosure
• you believe it is in the wider public interest (for example, assisting the police in preventing or resolving a crime)
• the disclosure is required by law (statutory obligation or to comply with a court order).

Fact vs opinion

It is likely that you will be asked to provide a statement of fact, ie, giving your account of events leading up to and including the incident. This is not an opportune time to criticise your colleagues. You should only report the facts as you know them. If, however, you are asked to give an opinion, you must only comment within your area of expertise.

Basis of your report

Your report should be based on:

• your own recollection of events
• the medical records
• your usual practice.

Honesty is the best policy

You must write your report honestly and take all possible steps to ensure that you are not influenced by anyone else. It is therefore important to write your report as soon as possible after the event, while the incident is still fresh in your mind, and ensure that you only include details of events in which you were personally involved. If the report is required because of a complaint or claim, make sure that you have seen:

• A copy of any correspondence detailing the allegations surrounding the complaint or claim
• Details of any court proceedings before writing your report.

What should your report include?

• Your personal details. Include your full name, date of birth, address and contact details, graduating university, qualifications and relevant clinical experience.
• Relevant local factors. If, for example, your hospital is on two sites and this has affected time taken to get to the incident, or if the incident has occurred in an environment where it has been difficult to assess and treat the patient, for example a police cell.
• Details of other healthcare professionals involved. Where possible, include your colleagues’ full names and discipline, eg, staff nurse X, the nurse in charge, and Dr Y, lead consultant.
• The patient’s details. Name, date of birth and age
• When recording the patient’s presentation, include the following:
  • Dates and, where possible, times using a 24-hour clock.
  • Findings on examination and other relevant factors – if the patient was very difficult to examine because he was agitated and aggressive, provide details of how that behaviour was exhibited, eg, “The patient was lying on the trolley and attempting to punch and kick staff nurse X and me. He shouted: ‘I’m going to come back at the end of your shift and kill you’.”
  • Diagnosis and whether a differential diagnosis was considered.
  • Investigations and subsequent management, including dates.
  • Follow-up arrangements and information given to the patient and relatives.
  • Other relevant facts. Your opinion is only relevant if the person requesting the report specifically asks for you to provide an opinion. You must not comment on behalf of others. You can, however, include statements made by your colleagues such as “Dr Y said….”

Providing a good impression

• When drafting your report, it is important to consider who will be reading it and tailor it accordingly. However, a good rule of thumb is to address the report to an intelligent lay person.
• Write your report in the first person singular: “I did this….”
• It is advisable to avoid the use of abbreviations and jargon. If you do use them, use only approved abbreviations.
• Bear in mind that the patient or their relatives are likely to see the report and, therefore, you should avoid personal remarks. A flippant remark might be the deciding factor in persuading a judge that you did not take a professional clinical approach to the care of the patient.
• Ensure that your use of medical terminology is correct. Inaccurate terminology, such as describing a surgical wound as a laceration, might have serious consequences for the outcome of a criminal trial.
• Check spelling, punctuation and grammar before submitting your report. A sloppy report may reflect badly on your clinical practice.
• Your report should be typed, signed and dated.
• Keep a copy of the report in your notes and a note of how, when and to whom you submitted it.

Changing your report

It may be necessary for you to provide a supplementary report to deal with issues that come to light after you have written your original report. Before commenting on these issues, review your original report, the medical records and any new documentation.

A second opinion

Finally, you should strongly consider showing your report to MPS before submitting it.

Hilary is a solicitor based at the MPS Edinburgh office. If you need urgent medicolegal advice, or help with writing a report, MPS has a 24-hour medicolegal helpline that is available to all its members. Become a student member for free

Well we’re now 14 days into our new F1′s and so far no one has sunk, there have been a few have fallen overboard from the boat, but they have all been successfully pulled back into the boat by either seniors or other F1′s.

Photo by chrisinplymouthI say boat, but I think tiny little dinghy is more appropriate. For myself even two weeks after being spat out of our sociology focused GP Factory Ship, sorry I mean Medical School, I still felt thoroughly unprepared, and every day it seemed as if there was more work piling up, and that I was going home later and later.

With regard to the progressively worsening home time, I remember the feeling of absolute astonishment and amazement after, having been there alone on the wards for about an hour after everyone else had left, one of the SHOs came up to me and said “What are you still doing here! Right, let’s see what jobs you’ve got left and we’ll sort them together”.

Now why could I have practically hugged this SHO for all he was worth because of those simple words of kindness? Well up until that point, I had been having an astonishingly bad day.

I’d been lambasted by El Diablo for not being the Registrar, yelled at for not knowing where the Registrar was, and finally, talked to in his quietest, angriest voice, with little bits of spittle escaping the corners of his mouth, because it was apparently my fault that the nurses had not weighed any of the new patients, who  were admitted last night after I’d gone home. (I think he was also trying to insinuate that the deterioration in the NHS in general was also my fault, but he was having a slightly harder time making that conclusively my responsibility).

I think it’s important that I point out that I didn’t hug the SHO, largely because he was a massive Rugby player who I recognised from the year above me at the medical school – frankly I don’t think it would have gone down too well. But i was more than pleased, that after two weeks of fighting to keep my head above water, and surviving El Diablo’s daily torment, someone had actually noticed I was about to sink, and pulled me back, into the metaphorical dinghy.

Life didn’t improve magically over night, but I did know that there was help. The SHO showed me how to organise things slightly better, and he also told me to try and stand up to El Diablo – but that wouldn’t happen for another week…

So… tips from week 2

• It will take time, but learn to prioritise.  You’ve been taught a lot about prioritising, but importantly what things can, at the end of the day, be left until tomorrow morning. Such as writing up bloods for tomorrow’s ward round, they don’t need to be done before you go, come in early and have them prepared for the round. Even if you have to come in 30mins earlier, it’s important to go home and get some rest.
• Make sure your getting enough sleep. I recall one of the “Big Dogs” in our year, I was talking to his house mate on our first Friday out after starting work, and asked where he was, to be told he had been passed out on the couch since 7:30pm.
• Make time for your friends, it’s very easy to get isolated in a cycle of work, home, eat and sleep. Even if it’s just organising to eat lunch together in hospital, it will maintain your support network, as horribly sociological as that sounds.
• Recognise that being on call in the evening is not the same as normal ward work. On calls you do not “treat” patients, you fight fires. As terrible as it is to say it your patients have to “survive” evening and weekends, before Norma service resumes in the morning.
• Finally I’ve said it many times, but it is especially true for on calls – take plenty of food, making sure at least part of it is health, and whilst on call, make time for yourself to stop and eat. You need the break, and you’ll function more efficiently after your return.

Well we survived week 1, and (almost) as importantly so did all of our patients! Congratulations, and if you felt that you (almost) didn’t survive that first week – DON’T WORRY TOO HARD. IT WILL GET BETTER

Now I’m not going to tell you that soon life will be grand, consultants will come to love you, and they will invite you to their summer BBQ and introduce you to their eldest daughter – they might, but that would be unlikely (and rather irregular to boot!).

The biggest issue I had when starting as an F1, and I have seen it repeated in the new F1s this week, was a lack of confidence. Let’s all be honest, despite being absolutely no different from 2 weeks ago, you now are, at least to the outside world, a real doctor.

But what does this actually mean? – basically now, when someone, probably a nurse, asks you what drug you would give to a patient for problem x, rather than just being an academic exercise, that person will then ask you to write it on a drug chart AND THEN ACTUALLY GIVE THAT DRUG TO A LIVING, BREATHING PATIENT.

Photo by Carter ComicsI think I must have checked the dose of aspirin at least 10 times in my first week as an F1!! Oh heck I knew it was 75mg once daily, but was I sure, was I completely confident? Thus I kept on checking – what was I expecting I don’t know? It wasn’t as if it would have changed since the morning!

I found that it is was lack of confidence, combined with the realisation that this isn’t just a paper test anymore which made me very tired by the end of my first month – getting it wrong now matters!

When I started on the ward as an F1, I very quickly made friends with our ward pharmacist, largely because of the number of errors I would make on the drug charts. She would come and find me – and putting on her best “stern and disapproving face” would ask if I really meant to give the patient a certain dose, and ask what I thought might be better – she was (and still remains) absolutely fantastic and couldn’t maintain her “stern” face for long, simply because she knew that I was new, and although I wasn’t getting it right as often as a I should – I was TRYING.

REMEMBER AS LONG AS YOU’RE WORKING HARD, THE WHOLE WARD TEAM WILL SUPPORT YOU! You are not alone, despite what it might feel like.

Ok… this week’s top 5 tips

1. Trust the nursing staff. Some have been there longer than the consultants, they will help steer you and guide you when you find yourself alone on the wards – this will be particularly important when you are on nights or on call – remember the nurses control the flow of biscuits and chocolate so be nice, and say PLEASE and THANK YOU.

2. Don’t be frightened of leaving the ward. Sometimes a department (mainly radiology) will be exceptionally busy, and no one can answer the phone – everyone hates a ringing phone, so walk round to the department. You’ll get to know the people on the other end of the line, and I guarantee you that you’re scan requests will be more easily accepted.

3. Call for help often and early. Try not to get stressed when you don’t know what’s going on. You might be a doctor now, but for the first couple of weeks you’ll be barely more than a grunt. Your job is to carry out your seniors instructions. If nursing staff are telling you that a patient as a problem and you don’t know what to do, call for help. No one will expect you to know everything from day one – Ok Dr Satan the Consultant might – but he is in the minority.

4. Accept you WILL make mistakes. You are human, and you will learn through trial and error, but don’t worry, the nurses, and the “stern looking” ward pharmacist are normally exceptionally, and they’ll normally catch things, and show you where you went wrong. Don’t beat yourself up when you do.

5. Start work on your ePortfolio NOW. It’s a pain in the neck, many would describe it as a waste of time. Personally I don’t do well with reflective learning either, BUT IT IS COMPULSORY. In several months you’ll have to think back over the things you have done, and try and remember what was important, if you do it now – i) its easier, ii) you’ll forget less things, iii) life will get more stressful when you are trying to fill in the other parts of the ePortfolio, so start the reflective bit NOW.

Look our for james’s next blog post – the trials of week 2.

Congratulations, you’ve made it! The revision is done, the exams have been passed, and the celebrations rolled. Congratulations once more!! Now it’s time to step up, and take the mantle you have been working for, possibly since a child, and step out onto the wards, as a new Junior Doctor.

Now before you get much further, I want you to picture how happy you felt getting into medical school – make very sure that you remember the elation of passing Finals, how proud you were. Most of all remember the specific reason you went into medicine.

You’ll need these memories – why?…. You are now about to enter into, what, in all possibility, could be the worst two weeks of your life!

Now, you might be lucky and have a pleasant, easy job, with a nice consultant and a supportive team. A team which will have plenty of time for you, which will carefully tutor you and show you the ropes, all the time whilst supporting your progress through your new job.

However it’s equally likely that you’ll end up like I was, stranded on a busy medical ward, with the Registrar and SHO on annual leave and with Satan himself as one of the Consultants on your team!

In which case, this blog has been written for you. It will detail the first few weeks of the new F1s working on a busy General Medical ward in Midlands Teaching Hospital. Their trials and tribulations, and solutions to some of the problems that they faced.

To start things off however 5 tips for your first day on the Wards:

1. Take plenty of food! Snacks of all sorts (for your waist line I might suggest healthy snacks, but in those first two weeks you’ll be doing plenty of running as you work out where things are, so just make sure you like and enjoy whatever you take.) now once you have packed all your food, including your extra snacks, throw in some extra EXTRA snacks, as in all likelihood you will not be finishing on time and having an additional pick me will be a useful fall back.
2. Unfortunately you will probably not be finishing on time for the first couple of days, maybe even a week, so prepare a couple of evening meals in advance and freeze them, so that you won’t have extra work to do when you get in the from the hospital
3. Carry a small box file, available at most stationers, and across your first few days, collect additional copies of any forms that you use – it will save you time later if you cannot find a particular form in a hurry, most likely when on a ward round. In addition to these forms, always carry at least 5 continuation sheets with you. There will be many times that you will open a patients notes on a ward round to find there is nowhere to write, if you have extra sheets to had it will save considerable time and hassle on the round
4. Buy A4 sticky labels, and at the END of your FIRST day write down your patient’s blood results from that day. Keep them safe and tomorrow, they will save you time when on the ward round, as you will aleady have te blood results to stick into the patients notes.
5. On any blood result write down i) the date, ii) the result iii) the trend. The trend is very important, and if there is a significant change, write the previous blood result in brackets. Your consultant will likely not ask what the trend is, but will want to know it, and will be pleased if you offer it, before being asked. Having the trend in the notes will also help anyone who reads the notes after you have written in them.

Look our for james’s next blog post – surviving week 1.