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.'
- 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.
- 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
patient, relative or staff member either informally or as a formal complaint.
Don't forget to have regular breaks this will ensure you remain alert throughout the day.
- 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