Anonymous #1
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Hello Guys, Had a tough first week as an FY1 and i think a lot of it has to do with my lack of organisation. So I Was wondering if i could get some advice.


Firsty , How do/did you guys layout your jobs list. I was printing out my patient list and just writing what jobs had to be done for them under their name. But i just read this book which mentioned writing jobs in category they have to be done so for exampple you can just sit down once and whack out all the prescribing that needs to be done , then when you are at radiology dpt you can sort out all the scans. anyone got any other tips on how to approach a jobs list. Also what order should i do jobs in , someone mentioned sorting out scans first for some reason.

Also , do you guys summarise patient info (why they are here , signif blood results , current problems) on a seperate piece of paper for your patients. I find I have to keep referring back to the electronic documentation to rememeber these details but it might be work having it on hand so i don;t have to be sat in front of a computer everytime when discussing a patient. Do you guys take time out just to summarize patients info



any other organisation tips?. we do everything electronically in our hospital so i don;t need to carry around forms , all requests are made online.
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junior.doctor
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Depends a bit how many people are on your team as to ideas for how to write it. If there’s a couple of you, try to tag team one person writing the Ward round entry whilst person looks at the charts and writes the jobs on the patient list initially.

After the round, sit down and make a separate list of jobs on a blank piece of paper. I find it helpful to categorise them as urgent, soon, and later. Generally things that are urgent are radiology requests and requests for review from other teams. TTOs and drug chart rewrites are less urgent. Reviewing bloods and putting forms out for he next day are generally later in the day tasks.

If you have a blank sheet with just names and jobs on, prioritised in columns, it makes it easier to see quickly what all the radiology tasks are, or what what all the TTOs are.

Ideally, if there are a couple of you, and all your requests are electronic, once things get a bit more familiar it should be feasible even for one person to do the ward round entry and one person to be simultaneously doing the electronic radiology request.

Learning how to prioritise jobs is something that will come with more experience. Generally, things that require other people’s input, or something booking - like CT scans, or a cardiology review, should be priority tasks. You’re not going to get that cardiology review today if you only call them at 4pm when you’ve known about it since 10am. Likewise that CT scan. TTOs are likely to be “soon” tasks because especially in winter, it’s likely to affect bed flow through the hospital. Tasks like reviewing blood results from earlier in the day - if you’re doing them because you’re anticipating an abnormal result that will need some action, don’t leave it till 5pm to look at it, but most blood results can be looked at in the afternoon. I often tend to think about it in terms of other people involved and subsequent actions.Bood forms for tomorrow - makes no difference if I do them at 10am or 5pm - they are for tomorrow. A surgical review that I want to happen today- I need to give the person I’m referring to as much time and notice as possible.

Out of hours when covering several wards, I write my jobs down geographically. I used to cover 8 or so wards, so would divide a blank piece of paper into 4 with lines, back and front, put a Ward name in each box, and as you get bleeped, write the jobs in the right box. Then when you have to go to Ward X for a more urgent task, you can look at the other jobs you also have on that ward and see if any of the other less urgent jobs can be done whilst you’re already there.

I’m not quite sure about your question on summarising patient info. You said you have a patient list that you print out - that’s what I would use to remind myself of my patients and working diagnosis etc - not sure why you’re needing to refer back to the computer, unless you mean you’re needing much more detailed info than is on your handover list? If you keep the patient list up to date and keep brief but important information on it, this should be all you need to refer to for a brief reminder - and we all do that, there’s no problem referring to your patient list.
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Anonymous #1
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(Original post by junior.doctor)
Depends a bit how many people are on your team as to ideas for how to write it. If there’s a couple of you, try to tag team one person writing the Ward round entry whilst person looks at the charts and writes the jobs on the patient list initially.

After the round, sit down and make a separate list of jobs on a blank piece of paper. I find it helpful to categorise them as urgent, soon, and later. Generally things that are urgent are radiology requests and requests for review from other teams. TTOs and drug chart rewrites are less urgent. Reviewing bloods and putting forms out for he next day are generally later in the day tasks.

If you have a blank sheet with just names and jobs on, prioritised in columns, it makes it easier to see quickly what all the radiology tasks are, or what what all the TTOs are.

Ideally, if there are a couple of you, and all your requests are electronic, once things get a bit more familiar it should be feasible even for one person to do the ward round entry and one person to be simultaneously doing the electronic radiology request.

Learning how to prioritise jobs is something that will come with more experience. Generally, things that require other people’s input, or something booking - like CT scans, or a cardiology review, should be priority tasks. You’re not going to get that cardiology review today if you only call them at 4pm when you’ve known about it since 10am. Likewise that CT scan. TTOs are likely to be “soon” tasks because especially in winter, it’s likely to affect bed flow through the hospital. Tasks like reviewing blood results from earlier in the day - if you’re doing them because you’re anticipating an abnormal result that will need some action, don’t leave it till 5pm to look at it, but most blood results can be looked at in the afternoon. I often tend to think about it in terms of other people involved and subsequent actions.Bood forms for tomorrow - makes no difference if I do them at 10am or 5pm - they are for tomorrow. A surgical review that I want to happen today- I need to give the person I’m referring to as much time and notice as possible.

Out of hours when covering several wards, I write my jobs down geographically. I used to cover 8 or so wards, so would divide a blank piece of paper into 4 with lines, back and front, put a Ward name in each box, and as you get bleeped, write the jobs in the right box. Then when you have to go to Ward X for a more ilirgent task, you can look at the other jobs you also have on that ward and see if any of the other less ilurgent jobs can be done whilst you’re already there.

I’m not quite sure about your question on summarising patient info. You said you have a patient list that you print out - that’s what I would use to remind myself of my patients and working diagnosis etc - not sure why you’re needing to refer back to the computer, unless you mean you’re needing much more detailed info than is on your handover list? If you keep the patient list up to date and keep brief but important information on it, this should be all you need to refer to for a brief reminder - and we all do that, there’s no problem referring to your patient list.
thank you for the detailed reply ,really useful advice. Regarding the summarising point. I feel like i would need to know a fair amount of detail about the patients care for example if discussing with the radiologist about a scan they need . or if discussing with pharmacy and microbiology about a change in their medication. And also when discussing with seniors about what to do with a patient they will want a fair amount of info as well. So i feel like i should have a good summary of the patients care written somewhere instead of having to refer to the computer all the time (where it gets annoying clicking eveywhere to look up signifcant blood results and scan results as well as finding out info about PMH, PC, HPC blah blah. )
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junior.doctor
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(Original post by Anonymous)
thank you for the detailed reply ,really useful advice. Regarding the summarising point. I feel like i would need to know a fair amount of detail about the patients care for example if discussing with the radiologist about a scan they need . or if discussing with pharmacy and microbiology about a change in their medication. And also when discussing with seniors about what to do with a patient they will want a fair amount of info as well. So i feel like i should have a good summary of the patients care written somewhere instead of having to refer to the computer all the time (where it gets annoying clicking eveywhere to look up signifcant blood results and scan results as well as finding out info about PMH, PC, HPC blah blah. )
If I need to speak to a radiologist / ask someone for advice that doesn’t know the patient, then yes it’s absolutely reasonable to need to know a bit more about them. Depends what the situation is:

With e.g. radiology, especially as a more junior person, one of the most useful things you can do is make sure you understand in your own mind why you’re asking for what you’re asking for. Ask the person who’s asking you to request it, if you’re not sure. “Can you just help me for my own learning, what we’re looking for with the USS / what the clinical question is / what the rationale is?” “I’m not sure I understand why we’re requesting this investigation, can you explain it to me?” Then, before you go to radiology, have a quick read through the patient’s notes , in a focussed way for things that would be relevant - important parts of HPC, significant PMHx that impact this particular request - things like renal impairment are important if contrast scam etc. Again relevant investigations will generally be renal function, and any previous radiology. As you gain experience, understanding why you’re requesting what you’re requesting, will also help you to pick out what information about your patient is relevant and useful in justifying that radiology request or whatever it is.

Be kind to yourself, you’re not going to be slick or necessarily be clear as to what the most relevant bits of information are, you’re just starting out. All of these things come with experience.

Again for routine requests for specialty advice, have a quick read through notes before you speak to whoever it is. They will almost certainly request some weird fact about the patient that you can’t remember - that happens to all of us - but try to remember the important details, and any significant obs eg have they been febrile, are they in oxygen etc.

If youve just reviewed a sick patient and you’re ringing your senior for some advice, it’s perfectly reasonable to have the patients notes and charts out in front of you as you call. Hopefully having just reviewed them, you’ll have a bit of an idea as to up to date obs and acute problems, but it’s perfectly reasonable to have to need to go back through notes to find answers to other questions your senior might ask.

At the the end of the day, remember that you’re learning, this will all slowly get easier with experience, and at the beginning you’re going to be a bit flustered and unsure of the full
details of your patient or what information might be useful. Don’t feel bad for needing to refer to notes. It’s much safer to do that rather than get things wrong. Also, you’re right at the beginning - all your patients are new to you at the moment. In a couple of weeks’ time, once you know your current patients a bit better, it will only be a few new patients per day and there won’t be such a fast turnover and you’ll have more time to get to know and remember more details about your patients.
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