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Anyone know what a typical day for an FY2 doctor in geriatrics is like? I have a rotation coming up there . Will it generally just be ward round in the morning with the consultant/registrar and chasing up the jobs in the afternoon? I've never worked in the NHS so that's why I'm asking.
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No_fixed_abode
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Pretty much. Obviously every hospital could have its own idiosyncrasies but that seems more or less it.

The main difference from a 'standard' medical ward in my experience is that there will be a lot more discharge planning. Also compared to what I have seen in my limited time abroad docs here get a lot more involved in it than elsewhere.
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(Original post by uzzy18)
Anyone know what a typical day for an FY2 doctor in geriatrics is like? I have a rotation coming up there . Will it generally just be ward round in the morning with the consultant/registrar and chasing up the jobs in the afternoon? I've never worked in the NHS so that's why I'm asking.
You are likely to be doing your own ward rounds for most of the week, though it depends on where you work. Might have some clinics too, in addition to ward duties.
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nexttime
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That's pretty much the pattern yes. There will be a lot of variation in terms of how senior led it will be - I've seen consultant ward round daily, to consultant ward round once per week with SHO (which as an FY2 you would be) ward round the rest of the time. Probably will be some SpRs to support, but maybe not.

Are you doing on calls? Clearly they will be very different. Frequency is again, very variable.
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uzzy18
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(Original post by nexttime)
That's pretty much the pattern yes. There will be a lot of variation in terms of how senior led it will be - I've seen consultant ward round daily, to consultant ward round once per week with SHO (which as an FY2 you would be) ward round the rest of the time. Probably will be some SpRs to support, but maybe not.

Are you doing on calls? Clearly they will be very different. Frequency is again, very variable.
Hmmm, don't know how comfortable I'd be leading ward rounds on my own tbh given the complexity of geriatric patients. Most I could do is check their vitals (ABCDE) and investigate accordingly. I'm from the UK but graduated abroad so technically an F2 cos I did 6 years but in reality and F1 fresh out of uni! Should I just make it clear to the consultant/reg that this is the case and really should be supervised?

In terms of on calls it say N/A next to my post but I assumed that all foundation doctors had to do some on calls with how short staffed the NHS is? Not sure tbh.
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nexttime
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(Original post by uzzy18)
Hmmm, don't know how comfortable I'd be leading ward rounds on my own tbh given the complexity of geriatric patients. Most I could do is check their vitals (ABCDE) and investigate accordingly. I'm from the UK but graduated abroad so technically an F2 cos I did 6 years but in reality and F1 fresh out of uni! Should I just make it clear to the consultant/reg that this is the case and really should be supervised?
FY1s do ward rounds too you know.

I think you undersell yourself! You know the stuff you spent 6 years doing? Things like... pneumonia = antibiotics? High BMs = review diabetic meds? How to manage delirium? That kind of thing? No?

The patients will have a plan made already which you can follow. Its a common joke that an FY1 ward round is just 'Continue, OT/PT' for every patient! Try to be better but if you're not... well its not really your fault! Seek feedback, improve. You are in training, after all. In theory at least!

If there is something actually serious then there will be a method of escalation. There will be a consultant or SpR in clinic or on admin or something who you can phone. Make sure you know who this is and how to contact them. Mobile via switchboard is the fallback.

You can let them know you are new to the NHS and are nervous about it, and hopefully they should be supportive. Definitely arrange early educational and clinical supervisor meetings to discuss this too. I'm afraid you can't really ask to be always supervised though - its kind of your job. Its what you've trained for 6 years for!

In terms of on calls it say N/A next to my post but I assumed that all foundation doctors had to do some on calls with how short staffed the NHS is? Not sure tbh.
You might have no on calls then! They tend to make standalone type posts more attractive by removing on calls and instead dumping on the FY trainees, who have no choice in the matter (where else are they going to train?!). A common theme in the NHS I'm afraid.
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I agree if you're nervous about working in a foreign environment make that clear from day 1. Geriatricians are nice folk, they'll be supportive but you should expect to have a degree of autonomy as a doctor and that is healthy as long as it's supported

One of the key skills in training as a (medical) doctor is understanding the key issues around an inpatient admission. Why is the patient in hospital, what is the working diagnosis, why, how are they being treated, what are the other issues we're managing, what complications do we anticipate, what are the challenges to care/discharge etc. This is far far beyond just the symptoms that brought a patient in and takes years of experience to build up a framework of how to understand these things. Seeing patients independently is part of this.
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uzzy18
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(Original post by nexttime)
FY1s do ward rounds too you know.

I think you undersell yourself! You know the stuff you spent 6 years doing? Things like... pneumonia = antibiotics? High BMs = review diabetic meds? How to manage delirium? That kind of thing? No?

The patients will have a plan made already which you can follow. Its a common joke that an FY1 ward round is just 'Continue, OT/PT' for every patient! Try to be better but if you're not... well its not really your fault! Seek feedback, improve. You are in training, after all. In theory at least!

If there is something actually serious then there will be a method of escalation. There will be a consultant or SpR in clinic or on admin or something who you can phone. Make sure you know who this is and how to contact them. Mobile via switchboard is the fallback.

You can let them know you are new to the NHS and are nervous about it, and hopefully they should be supportive. Definitely arrange early educational and clinical supervisor meetings to discuss this too. I'm afraid you can't really ask to be always supervised though - its kind of your job. Its what you've trained for 6 years for!



You might have no on calls then! They tend to make standalone type posts more attractive by removing on calls and instead dumping on the FY trainees, who have no choice in the matter (where else are they going to train?!). A common theme in the NHS I'm afraid.
Haha thanks for your reply and yeah I think everyone who comes fresh out of uni undersells them self and worries tbh. We dont wanna cause harm to anybody!

Out of curiosity what would happen if an F1/2 doctor did end up making a mistake and seriously harmed or caused a death? That's like every docs worst nightmare 😔
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(Original post by fishfacesimpson)
I agree if you're nervous about working in a foreign environment make that clear from day 1. Geriatricians are nice folk, they'll be supportive but you should expect to have a degree of autonomy as a doctor and that is healthy as long as it's supported

One of the key skills in training as a (medical) doctor is understanding the key issues around an inpatient admission. Why is the patient in hospital, what is the working diagnosis, why, how are they being treated, what are the other issues we're managing, what complications do we anticipate, what are the challenges to care/discharge etc. This is far far beyond just the symptoms that brought a patient in and takes years of experience to build up a framework of how to understand these things. Seeing patients independently is part of this.
I will deffo make it clear that the first few weeks I might need extra support yeah! And of course yeah, I agree, experience of dealing with these things with support and then on your own is how you become good at it over time. Just don't wanna cause harm to anybody with inexperience tbh. There is one thing knowing everything in theory coming out of med school but another thing dealing with it in reality.
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(Original post by uzzy18)
Out of curiosity what would happen if an F1/2 doctor did end up making a mistake and seriously harmed or caused a death? That's like every docs worst nightmare 😔
It's difficult to say, as mistakes are very dependent on the details. However if you practice medicine long enough you WILL make mistakes. Most will be near-misses, or very minor. But the odds are that eventually you will make some kind of serious mistake. Very, very good doctors that you know have made serious mistakes. I made a mistake in F2 and talked to everyone about it - I was amazed at the stories I heard, including from seniors that I respected a great deal. Do your best, but being perfect is impossible. If something happens remember it's all about how you reflect and work to address things.

There's a good TED talk on this topic that you might find interesting:
https://www.ted.com/talks/brian_gold...at?language=en
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nexttime
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(Original post by uzzy18)
Out of curiosity what would happen if an F1/2 doctor did end up making a mistake and seriously harmed or caused a death? That's like every docs worst nightmare 😔
Firstly, you might not necessarily know. If you go through a case with a fine tooth comb you almost always find multiple mistakes. A commonly used estimate is that 10% of hospital admissions involve a serious mistake causing harm to the patient. That is not apparent from when you are working, in my experience, but when we do M&M meetings and spend lots of time over a case, suddenly you notice all these errors, most small, some not. So in reality I feel that if you did make a major mistake and the patient died... you might not even hear about it.

Secondly, there is a distinction to be drawn between a good judgement call which was wrong, versus a bad judgement call. For example, discharging someone with a low Wells score who actually had a PE, versus discharging someone with a high Wells score without investigation. Both are mistakes and both might kill a patient, but in one case you could not, arguably should not, have made a different decision, whereas in the other you did wrong.

Should things reach complaint and GMC level - which is very rare for someone below registrar level as although it might not feel like it seniors are the ones considered responsible - they highly value admitting mistakes and efforts to learn from them. What they do not respond well to, is arguing there was no mistake and you don't need to improve. That seems to make a HUGE difference in their judgements.
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