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As an FY2, I had a registrar who was knowledgeable, pleasant and well-organised but who struggled with delegation. I don’t think he particularly mistrusted me, but he seemed only to be able to feel really confident about what he’d seen with his own eyes.
He would read through my most routine discharge summaries, flit back to check on stable patients I’d just reviewed, and ask anxiously after the result of every test, assessment or interaction, however trivial. No matter how unambiguous the instructions I’d been given (‘Go and prescribe Mr Jones’ amlodipine,’), he felt obliged to double-check that I’d carried them out.
After a while, it got a little irritating, and it was sometimes terribly tempting to tease him.
‘Did you prescribe the salbutamol for that brittle asthmatic?’ he’d ask.
‘No, I thought I’d leave that for the weekend team…’
However implausible the dereliction of duty, his eyes would briefly dilate with horror before he realised I was joking, and gave an uncertain laugh
It was an unkind thing to do but, if it’s any comfort to him, I was suitably punished the minute I became a registrar myself. Only then did I realise that delegation is one of the scariest medical procedures to perform, and requires considerable practice to do well.
Delegation requires you to entrust your goals, your reputation and, most importantly, your patient’s welfare to the hands of someone who is less experienced and, on average, less competent than you are yourself. It’s bad enough when it’s a junior you know well, and in these days of rota gaps, locums and four-month posts it very often isn’t.
There’s a fine line to walk between micromanagement and abandonment, and the pitfalls on either side are serious. Nobody wants to leave their house officer floundering with a complex patient and inadequate backup, but on the other hand, I remember only too clearly how frustrating it was to be checked up on every five minutes in case I’d forgotten how prescribe paracetamol.
Only long experience – and sometimes not even that – teaches a middle-grade how to teeter along that tight-rope without too many stumbles.
I remind every SHO I work with that it is far, far more relaxing for a registrar to know they’ll be called when they are needed – even if that means some calls about minor matters – than to sit in the mess wondering what horrors the juniors might be dealing with alone.
Most of them are kind enough to take me at my word, and humour what must often seem like quite unnecessary interference with their perfectly competent management. I wish I could apologise to my old registrar that sometimes I lacked the imagination to do them the same courtesy.
By the Secret Doctor. Read the blog and follow @TheSecretDr on Twitter and on Facebook
you should be thankful he's delegating and bothering to supervise you as a junior doctor. it could be far worse, if the workvwas handed over to non medical staff for no good reason other than he didn't like the look of you which is what is ahppening to several doctors these days
very interesting blog post. my most recent experience is of an absent SHO so the work has landed on me. i actually quite comfortable delegating when possible!