Your first day as a doctor

eta: sorry, I didn't read your post properly

Any results?

CASE 6

You are a few weeks into your first job as a surgical F1, and are about to start your first weekend on-call. You are waiting for your senior registrar to turn up so that you can start the morning ward round together. She is a few minutes late but that's okay - you are closely acquainted with her, as when you attended medical school together, she, then in her final year, mentored you as a fresher.

Running on to the ward, she apologises for being late and starts to prepare for the ward round. She looks a bit of a mess - scruffy, dishevelled. She smells of cigarette smoke and is not acting her usual self, she keeps sniffing and wiping her nose before she examines her first patient, a young gentleman 2 days post appendicectomy. His blood results show that his potassium levels are dangerously low. Appearing rushed and stressed out, she grabs his fluid chart and writes him up for a litre of IV saline with 40mmol of supplementary potassium to be given stat.

What would you do next?

CASE 6

You are a few weeks into your first job as a surgical F1, and are about to start your first weekend on-call. You are waiting for your senior registrar to turn up so that you can start the morning ward round together. She is a few minutes late but that's okay - you are closely acquainted with her, as when you attended medical school together, she, then in her final year, mentored you as a fresher.

Running on to the ward, she apologises for being late and starts to prepare for the ward round. She looks a bit of a mess - scruffy, dishevelled. She smells of cigarette smoke and is not acting her usual self, she keeps sniffing and wiping her nose before she examines her first patient, a young gentleman 2 days post appendicectomy. His blood results show that his potassium levels are dangerously low. Appearing rushed and stressed out, she grabs his fluid chart and writes him up for a litre of IV saline with 40mmol of supplementary potassium to be given stat.

What would you do next?

Query the prescription with her.

Tell her to go away (politely) and calm down / collect herself before going near a patient surely?

She ignores you - "Don't be silly" she says. "Let's get on with the ward round shall we?"

Well if you know her already you can surely ask her if everything's alright, saying that she doesn't seem herself.

I'm guessing those are the wrong fluids to prescribe? Probably should know the answer to that

She says "I'm fine."

Giving someone 40mmol of potassium rapidly would induce a cardiac arrest and probably kill them.

She says "I'm fine."

Giving someone 40mmol of potassium rapidly would induce a cardiac arrest and probably kill them.

ahh - this explains why potassium chloride's used in lethal injections

Right, had no idea of appropriate concentrations for stat doses.

Well, tell her she's obviously not - stating what she's just done. Should certainly rectify that one quickly.

She says "I know that was a bit bad. Thank you for pointing that out to me. I'm just a bit tired. The nursing staff would have picked up on it anyway."

Report her to the GMC board.

She's a reg, she should certainly not be making mistakes like that (neither should anyone!); and who says you can rely on the nurses to notice (), and of course if that fluid goes up she's absolutely accountable.

Rectify that mistake - continue on the ward round with her but keep an eye on her? Not sure contacting a senior here is appropriate just yet - try and get her to talk and ask why she's tired.

You ask her what's going on. "Nothing." She replies. "It's really none of your business, but if you must know, I went out last night and I haven't had much sleep. Can we drop it alright?"

The next patient is an elderly lady 1 week post-cholecystectomy. She is complaining of chest pain and has a temperature of 39.5c. Your registrar says "She can go home with some paracetamol" and moves on to the next patient.

Tell her that of course what she does is her own business, but you can't drop the fact that she's not safe for the patients. Reiterate the point on the lady spiking the temp, saying those aren't mistakes you'd be expecting her to make. Suggest she goes home sick? Perhaps now being a time to call a consultant and see what they suggest?

She's getting quite angry now. She raises her voice. "Excuse me?! What the hell do you know?! You're a newly qualified F1! I have years more experience than you so just button it and let's finish this ward round."