The Hands-on Guide for Junior Doctors

Anna Donald, Mike Stein, Ciaran Scott Hill

• Publisher: Wiley-Blackwell
• Year: 2011
• Print ISBN: 9781444334661
• eBook ISBN: 9781444398953
• Edition: 4
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Are you about to start the Foundation Programme? Do you know what to expect and how to thrive?

The Hands-on Guide for Junior Doctors, Fourth Edition, is the ultimate, practical guide for junior doctors and medical students. It helps you tackle the emotional, intellectual and physical demands of being a new doctor and allays common insecurities to help you make the most of your time in clinical practice.

This book tells you how to prepare for the daily rigours of hospital life, and will help you meet the required standard. It provides advice on getting started in placements, and helps you develop confidence, with tips on what to do as a junior member of the hospital team, and how to deal with common calls and emergencies. There is also an invaluable chapter on how to perform the practical procedures you'll be assessed on.

With the Foundation Programme such a demanding process, both physically and emotionally, this book also provides the kind of information you don't get at medical school, for example, how to look after yourself throughout your training.

Take the stress out of the Foundation Programme with The Hands-on Guide!

Chapter 1

STARTING UP

Day one of your first job is rarely the nightmare you think it will be. Half of it is taken up by firm meetings and introductions to the hospital. During the other half you will be introduced to the wards. It’s all over before you know what’s happening. You are finally a real doctor. And then it’s day two and you have to get on with the job…

Panic?

Never panic. The thing that strikes terror into the hearts of day-one junior doctors is the thought that they, alone, are expected to battle with disease and death when they have never given an IV drug in their life and don’t know how to plug in the paddles of the cardiac arrest trolley. That’s if they know where to find it. The ward and hospital are often unfamiliar. The whole thing is enough to give you a nasty rash, which many junior doctors do get.

The one thing to remember is: YOU ARE NOT ALONE. You are a modest, essential cog in a vast machine which churns away quite happily whether you know exactly what you’re doing or not. You soon will. Nobody expects you to know much on the first day – or even in the first month. And everyone will show you what to do.

People to help you

You are surrounded by people who can help you. All you need to do is to ask them. They include:

1 Nurses who often know more about what you are doing than you do, as they have watched and done it for years.

2 Patients who want to be treated kindly, properly and with as little pain as possible.

3 Other doctors who love to demonstrate their skill at just about everything and are always open to requests for help.

• Problems arise when junior doctors do NOT ask for help. If you feel panic rising in your throat, just ask for help. This is counter-intuitive for self-reliant medics, but it saves lives (yours and the patient’s).
• Attend orientation day for junior doctors if the hospital has one. It is useful for finding out what the hospital can do for you. They can be painful and bureaucratic at times but there are often sources of important information.
• If possible contact your predecessors before their last day on the job. They can give you invaluable information about what to expect from your new job (the idea for this book originally came from a request for help from a new junior doctor). In particular, ask them about what your new consultants do and do not like and how to access the computer systems.
• Most people find that they are physically exhausted during their first week of work. Such fatigue passes as you get used to the hospital and new routines.

Three basic tips

1 Always take the initiative in hospitals. If things are not working, do something about it. Big institutions can become bad places to work in just because no one bothers to address things that are clearly going wrong. Figure out a solution and contact whoever is in charge of the problem, whether it be a doctor, nurse, manager or the porter.

2 Similarly, take initiative in managing patients. Present seniors with a plan for your patients rather than just asking them what to do. Don’t be afraid to look beyond what is asked of you. If you feel that a patient has a problem that your team is not interested in then don’t just ignore it, take the initiative. Thinking strategically actually makes work more fun and prepares you for more responsibility.

3 Order your work. When tasks are being fired at you from all directions, priority-setting is really important. Try to learn early on which things are super-urgent and which can wait for more peaceful moments. Despite the hype, there is quite a lot of down time in your junior doctor year (unless you are very unlucky or disorganized!).

Other useful start-up information

Dress

It is worth bearing in mind that patients often dress up to the nines to ‘visit the doctor’. I once watched an elderly woman with deteriorating eyesight, high-heeled shoes and lopsided make-up hobble over the hospital lawn to visit the diabetes clinic. Having always dressed casually, I dressed my best from then on.

Changing from student to doctor mode can put grave dents into your early pay cheques. If nothing else, buy good-quality shoes which will look good and will stay comfortable on your 36th hour.

You may get stained with all sorts of unmentionable substances as a junior doctor. Stain Devils from supermarkets and household stores can remove most things. Soaking garments in cold water and lots of soap, followed by a normal machine wash removes blood stains.

A few hospitals will reimburse you for dry cleaning bills associated with work-related accidents, such as major blood stains on suits. Phone hospital personnel through the switchboard.

While wearing theatre scrubs (‘blues’) on the wards can be all the rage, doing so is an infection risk and frowned on by some hospitals. If you have to wear them outside theatre, remember to change regularly and return them to the hospital laundry to be washed! Wearing them outside hospital grounds is definitely not acceptable.

Equipment

Always carry:

1 Pen (more than one). Black is the only acceptable colour unless you are a pharmacist.

2 Notebook/PDA/piece of paper.

3 Stethoscope.

4 Tourniquet (if you are happy with the hospital’s disposable ones this may not be necessary).

5 Torch.

6 Pager/bleep.

7 Cash for food/drink/newspaper.

8 Ophthalmoscope (if not readily accessible on wards) or at least a torch for papillary reactions and looking in mouths.

9 You should ...

Table of contents

• Cover
• Title page
• Copyright page
• Introduction
• How to use this book
• Acknowledgements
• Dedication
• Abbreviations
• Chapter 1: STARTING UP
• Chapter 2: GETTING ORGANIZEDOR ‘THE FOLDER’
• Chapter 3: PAPERWORK AND ELECTRONIC MEDICAL RECORDS
• Chapter 4: ACCIDENT AND EMERGENCY
• Chapter 5: BECOMING A BETTERDOCTOR
• Chapter 6: CARDIAC ARRESTS AND CRASH CALLS
• Chapter 7: COMMON CALLS
• Chapter 8: DEATH AND DYING
• Chapter 9: DRUGS
• Chapter 10: HANDLE WITH CARE
• Chapter 11: APPROACH TO THE MEDICAL PATIENT
• Chapter 12: PAIN
• Chapter 13: PRACTICAL PROCEDURES
• Chapter 14: RADIOLOGY
• Chapter 15: SURGERY
• Chapter 16: GENERAL PRACTICE
• Chapter 17: SELF-CARE
• Appendix: USEFUL TESTS, NUMBERS AND OTHER INFORMATION
• Index
• Further Resources
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