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There’s much confusion about the role of a SAS doctor (Staff and Associate Specialist), so I wanted to share a typical working day to show what my role involves.
8am - My day starts with a handover from the night doctors. We go through any serious incidents, deaths, patients waiting to be seen, bed status’s and staff sickness. We also check all equipment to ensure any failures are noted.
8.30am - The paramedics brought in a 67-year-old gentleman who was experiencing fits. The patient’s initial oxygen saturation was very low and had come up to an acceptable level after receiving oxygen. He also was suffering with chronic bronchitis and diabetes.
Blood gases showed that his carbon dioxide levels were very high - the reason for his fine tremors and sleepiness. We moved him to the resuscitation room and started on non-invasive ventilation. A chest X-ray showed he also had pneumonia, so we managed him for sepsis. It’s not unusual to have a tricky situation like with this patient, who presented with fits initially and actually turned out to be a respiratory failure.
10.30am - After doing all I could for the patient and once he had become stable, he was referred to the medical team. I took my next patient, a 61-year-old lady who had been experiencing a sudden and severe headache all morning. I did the necessary bloods for investigations, gave pain relief and arranged a CT scan. I explained to the patient that she might be having a bleed inside her head.
12.30pm - I considered taking my break when a 37-year-old gentleman was brought in with severe pain from his left loin to groin. It sounded like ureteric colic (stone in the renal system). As this is a very painful condition, I asked one of the nurses to get some painkillers. It took roughly 50 minutes to control the pain comfortably, after which I arranged for a CT scan of the renal system.
1pm - One of the junior doctors wanted some help in performing a procedure, incising and drainage of a paronychia - a collection of pus in the nail bed. I talked her through the procedure, the instruments needed, aided with local anaesthesia and helped her to set the trolley. I then did the debriefing.
2.15pm - I went up to the staff room for a break, had a cup of coffee and a few snacks and checked my emails.
3.15pm - I checked on the gentleman who had ureteric colic, and was pleased to see him lying comfortably with a smile. His results showed that he had a small stone of about 3mm in diameter. Usually, these stones come out by themselves. As his bloods were normal, I discharged him with painkillers and advised him to see his GP for a follow up.
Then, I went to review the lady with a headache. By this time, she’d had the scan, which showed a bleed. I requested an angiogram to find out more about it. I disclosed the news to the patient and relatives, and made arrangements to transfer her to a neurosurgeon at the University Hospital of Wales.
4.30pm - By this time, we were ready to do our 4pm handover. As I was about to leave, a nurse asked for my opinion on an ECG. It revealed a fast, irregular heartbeat, needing immediate attention. I advised for the patient to be moved to the resuscitation room and requested for one of my colleagues to manage them.
This is the beauty of the emergency department. There’s always plenty of variety and surprise, which is the main reason I enjoy it. Leaving the department at the end of the day, I was tired, thirsty, and wanted to sit down quietly. At the same time, I felt happy, fulfilled and contented with my role. You can’t buy that feeling.
Dr Ram Kumar is an Associate Specialist in Emergency Medicine at Prince Charles Hospital in Merthyr Tydfil.
very busy day... I am sure that SAS Doctors in NHS Wales are doing their best in maintaining a good quality of medical service. I thought it will be useful to reflect on your day as whether there are few other things that you could not do due to the clinical committeemen. The variety of clinical scenarios for patients attending the emergency department in our hospitals necessitate a dedicated and skillful doctors. This is exactly what the SAS Doctors are working hard to achieve.
this is from Amer Jafar, Associate Specialist in Medicine, NHS Wales
4 patients all day? Understandably all very sick. Did you leave out the countless others you had seen with minor ailments?
Sounds like a pretty piss easy day, with 3 patients for the entire shift. You see a poorly lady with a likely bleed in her brain at 10.30am, and you review her again at 3.15pm? And she actually had a bleed requiring neurosurgery! You diagnosed an arrhythymia on an ECG and got a colleague to deal with it. I really hope this diary is not an accurate reflection of your entire working shift!
4 pts all day is not true representative of what sas drs go through. In trauma and orthopedic I do nightoncall which is offsite but expected to have seen everybody admitted overnight. I attend morning trauma meeting /ward round at 8 am after that I travel to other site at 30 min drive to do fracture clinic of 40-50 pts alone. I am expected to be back to main site to do trauma list in the after noon starting 13:30. Usually l am late, having driven in a rush bothways and no break or time for lunch. Trauma list usually finishes arround 6pm. This is a typical day after night oncal which can itself be very busy with many phone calls and 1-2 visits to hospital.
I think more SAS doctors should write contribute their experience here in whatever speciality they are in.
NHS is not the same anymore.. Exciting for some frustrating for others. Although BMJ will not publish the account of each one of us in BMJ but there is no editing here and honest articles will be shared.
This gives us insight into what a normal working day of a doctor is like. Being able to manage diagnosing patients even with the fact that some of the diagnosis are life-threatening shows skill and how much of a challenging yet life-changing role being a doctor is
If any SAS doctors are interested in writing a similar account of their day, please contact [email protected]