Junior doctor Overseas qualified doctor Life and work in the UK

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Your first week

 

Get your bearings

  • The first week at work involves getting orientated and getting to know the service processes and procedures – for example, how to fill in hospital notes and request forms, drug charts and discharge summaries.
  • Find out where clinics are held - use your hospital map if you need to - and make sure you know what time to arrive for each of your rota’d duties – eg. 9am for morning clinic, 13.30 for afternoon theatre.
  • Wear your name badge at all times (this may double up as an access card).
  • 'Despite my experience of training in Europe, I was still taken aback by the level of paperwork in the NHS – for the first few months, that is what overwhelmed me.'

    Konstantinos Andreou,
    Greece

  • Find out if wifi is available in your hospital and locate the “hospital mess” to meet other junior doctors. This is no longer available in every hospital, but is invaluable for discussing everything and anything – from what to do with a difficult patient, to what to do on Friday night!
  • Find out and familiarise yourself with the different types of software you will have to use. You may be overwhelmed with the number of passwords you may need to keep – if so, think of a generic system - for example London01 - which you can update monthly by simply changing a digitd to secure wards.
  • Find out whether there is a formal teaching programme within your department which you can attend, if so, when and where it is held. Check whether there is a register of attendance
  • Get to know the format of drug charts and the medical notes – always make sure you are happy prescribing any medication you are asked to and make sure you know that the patient is fit to receive this treatment. Fill in all sections of the drug chart and make sure you check whether there are any allergies.
  • Consider carrying a folder to hold a jobs list, spare clerking paper, drug charts, theatre lists and spare request forms. If this contains patient information, make sure you store this in a secure place in your department.
  •  

    Introduce yourself

    • Get to know the staff on the wards, clinics and all the areas you will be working.
    • Start developing your own network of contacts – for example, a Whatsapp group for junior doctors, so that if you are late or need to swap a shift, you can contact and negotiate with your colleagues.
    • Make a list of your team’s activities so that you know their timetable of activities and where to find other members of the team if you need to speak to them about a patient.
    • Remember that part of the medical team in the UK includes pharmacists, physiotherapists, speech and language therapists and social workers, whom you may contact regularly in the care of your patients.
    • Check the ways of doing things for your team (eg. Does your consultant prefer all patients to have antibiotics prescribed prior to a hysterectomy?)
    • When greeting a patient introduce yourself.
    • When taking bloods, ask the nurses where the equipment is kept, how to dispose of it once used and how to send the blood to the lab. Get to know the layout of the wards and the general process of doing things, which the ward/clinic/theatre staff can fill you in on.

     

    Find out what is expected of you

    • Find out your role within the firm – for example, during ward rounds, are you expected to write in the notes, look at observations or identify what medications the patient is taking?
    • Find out when your consultant performs a ward round.
    • If you have any questions, ask members of the team or the nurses, who have often been working in the department for many years and therefore are fully able to answer questions.
    • You will be expected to speak to all members of the team, regardless of their seniority. If you feel nervous about approaching them, simply ask whether they would mind you asking a question about Mrs X’s plan/care/discharge etc. If busy, they may redirect you to another colleague.
    • Try to answer your bleep in a timely manner; if you get several calls at once, go through them systematically and apologise if you miss one.
    • Don’t forget to have regular breaks – this will make sure that you remain alert throughout the day. Use the time to get to know the other members of your team or other doctors within the hospital.
    • If you are expected to attend multidisciplinary meetings, find out where and when they occur and whether you are expected to present any cases
    • If you are unsure about what to do with a patient, pick up the phone and speak to your senior. If you are unsure about how to order an investigation, check with the ward staff, but if they cannot help you, ask a colleague. Make sure you are polite and friendly to everyone, as you never know who will help you on a nightshift.
    • Before you go home, make sure that you have completed the key tasks for each patient you have seen (eg. investigation requests). If you are worried about any of your patients deteriorating, discuss them with a senior member of the team and hand them over to the oncall doctor.

     

    Find out how things are done

    • Read your departmental guidelines so that you are familiar with the policy of antibiotic prescribing.
    • Get to know common abbreviations within your department – for example TTA or TTO are commonly used to refer to 'To Take Away' or 'To Take Out' , which is a discharge summary sent to the GP to highlight why the patient has been admitted.
    • Check whether the patient needs a follow-up appointment, which means he or she needs to be seen in clinic by your team after discharge and if so, when. This needs to be put on the discharge summary, which is sent to the patient’s GP so that they are aware of the patient’s hospital admission, what happened and any new treatment such as new medication.
    • Before examining or taking blood, make sure you wash your hands and wear gloves where appropriate. If you do not, this may be reported by a

      Don't forget to have regular breaks this will ensure you remain alert throughout the day.

      patient, relative or staff member either informally or as a formal complaint.
    • You may see different coloured bins next to sinks on the wards, find out what coloured bin is used for clinical waste, non-clinical waste (eg.food) and if present, recycling. There is usually a “sharps” bin for the safe disposal of instruments.

     

    Keep plenty of spare pens

    • Ideally, you should always write your notes and requests using black ink. When writing in patient notes, note the time and date of the encounter, sign at the end of your proposed plan, printing your name, role and bleep number. Some hospitals will provide you with a personalised stamp which you will be expected to use after any entry in patient notes.
    • Get the useful small textbook the Oxford Handbook of Clinical Medicine
    • Find out where you can keep your belongings, where you can have lunch and where you have access to computers.
    •  

      What could I be asked to do in my first week?

      • You may have to clerk patients – which includes history taking and examination. Make sure you document your findings in the notes clearly, so that others

        Know your limitations - for example if you have not taken consent previously, check whether you are able to do this safely by asking a member of your medical team .  

        do not have to repeat your work and know what you have found
      • You may have to speak to patients to update them on their progress, or their relatives. If you are unsure of the plan, be honest. Make sure you do not release confidential patient information without the patient’s consent – eg. HIV status.
      • You may have to update patient lists which are relevant for your team, and find out where patients are after your team has been on call
      • You will review your team’s patients on ward round and potentially be asked to request investigations or chase their results. To make sure you do not miss anything, spend a few minutes at the end of the ward round to review the jobs and task allocations within the team, so that you are clear on who is doing what.
      • You may be asked to contact other specialties or healthcare professionals
      • You may be asked to undertake practical procedures; if you are unfamiliar with doing these unsupervised or would prefer to be supervised, make sure you ask for a senior colleague to be with you. Do not put your patient at risk of an unsafe procedure if you are not confident in performing it safely
      • When you are on call, always take a careful handover from your colleagues so that you are sure you understand who are the priority patients are for review, their key issues and any outstanding investigations or jobs which need to be chased.
      • Common administrative tasks include writing prescription charts, death certificates and discharge summaries.

       

      Manage your patient care

      • Before seeing a patient, always read through their notes and look at any relevant investigations.
      • When reviewing a patient, write a brief background history if you have time: how the patient is feeling, their observations, examination findings

        If you are unsure of what to do with a patient, pick up the phone and call your senior for advice. 

        and investigation results, together with your clinical impression and plan.
      • Always time and date your entries and make sure the history sheet has the patient’s name and date of birth on it. File it correctly so that people know you have reviewed the patient. This is a legal document and may be referred to in court in the future if problems arise
      • Make sure you let the rest of the team know of your plans and handover any patients you are worried about at the end of your shift, by contacting the on call team so that they are not missed. Discussions with patients and their relatives should also be documented.
      • If you are unsure of what to do with a patient, pick up the phone and call your senior for advice – make sure you present the history, examination findings and relevant investigations in chronological order, particularly if speaking to them late at night.
      • Be aware that patients in the UK may want a greater say in their care, so take time to explain all the relevant options of treatment together with their benefits and disadvantages where relevant.
      • Don’t forget to ask them if they have any questions and address the concerns of their relatives. If you are busy, simply organise a more mutually convenient time to speak to them.

       

      Maintain patient confidentiality

      • Don’t forget that patient information is confidential, so any identifiable information should be stored on a secure email network (usually nhs.net) and written information should not leave hospital grounds.
      • When disposing of confidential information, make sure you use the confidential waste disposal bin. Make sure you fax patient information to a confidential fax number (check it before dialling) and do not openly discuss patient details on the phone in an open area or indeed outside hospital grounds.

      Next... What to expect in your first month on the ward