Anonymous #1
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Report Thread starter 1 year ago
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I really don’t wish to make a fuss about this and I’d like to remain anon.

I work on a medical ward with decent turnover, 4-5 new patients after the weekend and during the week, perhaps 4-5 discharges and therefore new patients however this does vary (i.e can be more). The ward has mix of sick patients and social patients.

I am a ST1/CT1/GPST1 (trying not to be specific) straight from F2. The consultant should do the ward round twice a week but very often it is once and when it is once, they might nip off here and there to “do something” during which time they ask me to carry on the ward round and then they return. This means that some patients are not seen by the consultant, ever. When I raise this, the consultant then “eyeballs” the patient - meaning that they literally just look at the at the end of the bed and that’s it.

Otherwise, so four times a week, I do the ward round incl outliers AND all the jobs as there is almost always only two doctors on the ward. The reg of the ward is present sparingly due to the heavy on call rota.

Please note that I’m not criticising the consultant, they are very approachable, I can call or text them about anything regarding the patients and I’ll get an immediate response or review.

The reason why I’m writing this post is because I’d like to know if this is how things are? I haven’t had a medical job in since F1 in a in a smaller out of London hospital which had consultant or reg ward rounds daily. So perhaps my experience is very skewed.

When I first started this job, I felt very out of my depth, having not done medicine in a year and never led a ward round. I was very unsure of my self with this new found “seniority”.

I’m just wondering, is it the basic standard in London hospitals for just the SHO to lead the ward round and do the jobs, board round, family discussions etc
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nexttime
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#2
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From my experience this is normal consultant presence yes. The lower end of normal, but normal. It was a bit worse than that on my tertiary centre cardiology and oncology jobs, which was a nightmare!

And due to understaffed rotas the reg being eternally on call is becoming very common also yes.

If you feel you need more support (as is very reasonable) ensure you ask for it in the right way. Its very easy for an SpR to pretend to help by asking 'are there any sick patients you need help with' (the answer likely being 'no') rather than actually coming onto the ward and offering to see patients do jobs and help. Ask for help with specific things, like seeing outliers or a review of a complex patient, and additionally do ask the consultants if they know the reg is never there - they didn't on cardiology and restructured the entire team system to help (but only after I left, obv).

You also need to not be afraid to use that phone number, even if its not an emergency.

You can additionally raise your concerns to your educational supervisor if you wish. They're there to support you.

PS: I'm surprised you had never led a ward round before CT1. I led ward rounds, albeit only occasionally, as an FY1, and very regularly as an FY2.
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Anonymous #1
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(Original post by nexttime)
From my experience this is normal consultant presence yes. The lower end of normal, but normal. It was a bit worse than that on my tertiary centre cardiology and oncology jobs, which was a nightmare!

And due to understaffed rotas the reg being eternally on call is becoming very common also yes.

If you feel you need more support (as is very reasonable) ensure you ask for it in the right way. Its very easy for an SpR to pretend to help by asking 'are there any sick patients you need help with' (the answer likely being 'no') rather than actually coming onto the ward and offering to see patients do jobs and help. Ask for help with specific things, like seeing outliers or a review of a complex patient, and additionally do ask the consultants if they know the reg is never there - they didn't on cardiology and restructured the entire team system to help (but only after I left, obv).

You also need to not be afraid to use that phone number, even if its not an emergency.

You can additionally raise your concerns to your educational supervisor if you wish. They're there to support you.

PS: I'm surprised you had never led a ward round before CT1. I led ward rounds, albeit only occasionally, as an FY1, and very regularly as an FY2.
Thanks for your reply, I feel more reassured. I spoke to my educational supervisor who basically told me that this is the way the hospital runs and I need to develop confidence. My other colleagues on similar wards are struggling despite having more experience than me in medicine.

Well, I have never had the opportunity to lead a ward round.

My F1 rotations were medicine (my first ever job on a very sick gastro ward, the regs were around all the time, didn’t even let SHOs lead the ward round), anaesthetics, psych.

My F2 rotations were A&E, GUM (clinic based) and paeds (everything is reg led in paeds, although I was able to do my own neonatal ward rounds but they are very different to adult medical ward rounds).
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nexttime
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(Original post by Anonymous)
Thanks for your reply, I feel more reassured. I spoke to my educational supervisor who basically told me that this is the way the hospital runs and I need to develop confidence. My other colleagues on similar wards are struggling despite having more experience than me in medicine.
Yep. At least there's two of you, rather than you and a new F1 or just you alone!

My onc job (as a new CT1) was probably my worst. You were allocated to 18 patients by yourself. Each patient could be under a different consultant and there was absolutely no regular registrar or consultant input at all. They would turn up sporadically to see their 1 or 2 patients and probably averaged about once per week doing that, but with zero predictability so you always had to act as if you were the only person seeing them ever. I actually quite liked the independence - sending people home when I liked, not having to enact dumb senior plans, but still able to just email a consultant for advice if i needed to - but the others really really hated it. As I allude to above, the most significant correctable problem for them was that they seemed to be scared to contact a consultant directly, even though it was their patient who they were failing to come and see. Just don't be that person!

My F1 rotations were medicine (my first ever job on a very sick gastro ward, the regs were around all the time, didn’t even let SHOs lead the ward round), anaesthetics, psych.

My F2 rotations were A&E, GUM (clinic based) and paeds (everything is reg led in paeds, although I was able to do my own neonatal ward rounds but they are very different to adult medical ward rounds).
Wow - only two of your rotations even had ward rounds!

I was doing an FY1 led ward round perhaps 1-2x/fortnight on DGH resp, then FY2 I was the most senior person to ever see the T&O patients after their operation was done (but they were 90% MFFD), AMU I would see up to two thirds of the patients alone (but some weeks I'd see zero - it was consultant dependent), then O&G the postnates ward was SHO led. So lots of ward rounds!
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Cheesychips1
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I think this sounds okay but of course as per the above advice escalate if you feel unsafe etc etc.

I'm an ortho F1 in a london hospital and do a ward round alone 3 x a week... quite enjoy the independence though, but was a bit stressful to begin with.
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Ghotay
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Now feeling that my own ward round experience is lacking! In F1 I only did my own round on gerries, and that was only on the weekend so perhaps half a dozen times total. None of my F2 jobs have rounds. I never thought about it that way before
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