A Week of Being On-Call

I’ve realized that being “on call” at my hospital as a first year doctor is different than what my other friends are doing in the UK, and it’s a whole lot different than what my friends in North America are doing. In North America, being on call usually means you are supposed to be around and available for 24 hours, if not longer. My other friends in the UK are usually on until 10pm, and if they’re on call, it means they’re on call from 8am-10pm, or something along those lines.

For me, being an on call first year doctor in surgery, means that I only answer my pager from 5pm until 9pm. I come in in the morning and work with my regular team from 7:30 until 6pm. At 5pm, I pick up the on call pager and I have an hour overlap between both jobs, which is usually manageable.

Since most of the surgical teams work until 6pm, I don’t often get paged anyway, unless it’s a nurse from one of the wards that needs medications prescribed. I really enjoy being on call because it’s where I get to pick up a lot of my practical skills.

This week in particular. I’ve successfully taken ABGs and analyzed them. I’ve perfected my cannulation skills. Taking bloods is a breeze. And this week, I’ve changed my first suprapubic catheter. These are things I don’t often do when I’m not on call, as breast and endocrine surgery usually has relatively stable patients that don’t stay in the hospital for long.

And now after a Monday-Friday of working from 7:30 to 9pm, I am off for a full week. Hello vacation =)

Job Satisfaction

The other first year house officers I work with despise the job! Like, they genuinely loathe breast and endocrine surgery. And I would normally understand because they have no interest in surgery at all. But now I’m starting to realize that they don’t hate the job because they don’t like surgery, but it’s because of the type of work we’re doing.

We’re not learning. We’re not managing patients. We’re often doing odd jobs that could be considered secretarial. Hence why we started calling ourselves glorified secretaries. We’re calling bed managers to arrange beds for patients. We’re calling couriers to deliver patient notes between hospitals. We’re calling secretaries from other hospitals in order to have operation notes from a surgery in 2013 faxed over for our consultant. I guess it can be stressful, but my two colleagues seem to stress over it a whole lot more than I do.

And at the same time, I guess they’re failing to realize that there is plenty of opportunity to learn and gain experience. We see patients twice a week during our own pre-op assessment clinic. While they focus on co-morbidities and ordering every appropriate test they can think of to make sure the patient is clear for surgery, I spend my time taking a full history and conducting a thorough physical. So a person has diabetes, but they’re not on insulin and it’s relatively well controlled just on oral metformin. I’m not going to freak out and email everyone about this patient asking whether they are to come in a day early.

And so what if I get yelled at by a senior doctor?! I take this as a natural process that it supposed to happen during your career training, and to be quite honest, Brits are super, super, super nice when they’re telling you off. It’s absolutely impossible for me to be offended by anything they say. Maybe it’s my thick skin? But I’m able to take getting yelled at with a grain of salt and learn from it. And luckily, I don’t get told off too much either.

Overall, I am somewhat satisfied with my job. There are a lot of things to learn, and it’s not the medical knowledge I’m talking about, it’s the practicality of the job – what to do and when; when to call for senior advice; who to call for senior advice. I’m fairly confident that I know my limitations on the job. And every day is a time to learn. Unfortunately, agreeing with my house officers, there isn’t much opportunity to learn patient management on this job unless you’re on call because we barely have ward patients with breast and endocrine surgery. And when we do, they’re (thankfully) complication-free.

Never Events

When I started working at the hospital, I heard mentions of “never events” here and there, but I was never formally taught what they were. Of course, one could intuitively predict the types of instances that are classified as “Never Events.” I figured I would go ahead and post them up here and discuss a few which I’ve encountered thus far during my training. Never events are considered serious but preventable incidents that occur in healthcare because the available preventative measure where not considered.

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  1. Wrong site surgery (excluding wrong site anaesthetic blocks) – This is actually one that I pay close attention to. There has been an incidence a few weeks ago where a pregnant patient was going to undergo a parathyroidectomy on her left side, and she was consented for the left side, but the program that listed the operations had her down for a right parathyroidectomy. I managed to rectify that issue before the patient went into the operating room. There was another instance, again to do with technical issues, where the patient was consented for a procedure in her left breast, and all correspondence and imaging identified the lesion in the left breast, but the OR program had the right breast listed.
  2. Wrong implant/prosthesis
  3. Retained foreign object postoperation
  4. Wrongly prepared high-risk injectable medication
  5. Maladministration of potassium-containing solutions
  6. Wrong route administration of chemotherapy
  7. Wrong route administration of oral/enteral treatment
  8. I.V. administration of epidural medication
  9. Maladministration of insulin
  10. Overdose of midazolam during conscious sedation
  11. Opioid overdose in an opioid-naïve patient
  12. Transfusion of ABO incompatible blood components
  13. Transplantation of ABO incompatible organs as a result of error
  14. Misplaced naso or oro-gastric tubes – This is why I order a chest X-ray for every patient that gets a naso-gastric tube. The amount of patients I see who get an NG tube placed and then commence with feeds before radiographic confirmation baffles me. I mean, I haven’t witnessed any incidences where the NG tube was in the wrong place, but I would be wary to commence feeding before being absolutely certain.
  15. Wrong gas administered
  16. Failure to monitor or respond to oxygen saturation
  17. Air embolism
  18. Maternal death because of post-partum haemorrhage after elective Caesarean section
  19. Misidentification of patients
  20. Inappropriate administration of daily oral methotrexate
  21. Suicide using non-collapsible rails
  22. Escape of transferred prisoner
  23. Falls from unrestricted windows
  24. Entrapment in bed rails
  25. Severe scalding of patients

At this stage of my training, I am not solely responsible for many of these yet, and I always discuss things I’m not comfortable with with my seniors, but I hope I that I am NEVER part of a Never Event.

I Resolve To…

It’s that wonderful time of New Year’s Resolutions.

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And I realize that this has fallen around the time when I finally have time to hunt for a gym because I’m on annual leave (aka, vacation) this week. I have to admit that walking into a gym and asking about memberships and such makes me feel like one of those people who:

  • have made a resolution to start working out this year;
  • are looking into joining a gym; and
  • will stop working out within a month from now because that seems to be the natural order of things for most people.

It really makes me feel self-conscious about it, especially considering that I’ve been putting on weight ever since I’ve moved away from home, and I haven’t been inside an actual gym in a good 5 months now. Just to clarify, I am looking for a gym again, only because my existence requires me to attend a gym regularly. Without it, I feel like … Well, I feel different. I have no resolution to start working out this year because working out is just a natural way of life – there’s no need to resolve to start something you’ve already been doing.

So if we get back to New Year’s Resolutions – what are mine, you ask? Reflecting back on the last year, I have to admit that there are a few things I would like to change/maintain this year.

  • iPhone: less gaming, more social media. It’s time for me to resist the urge to play Candy Crush and Bubble Witch, and get back into the habit of checking Twitter and Instagram once again.
  • Designerskin: as always, I’d love to get back into the habit of blogging on a regular basis. I’m not making this a “new year’s” resolution, but more of a life goal (if there’s a difference between the two).
  • Debt: nothing new here, but to maintain repaying my debt with $1000/month, and a bit more here and there if I have the funds for it.
  • Food: healthier snacking and less eating. I blame moving to a new country for this one. It has been much easier (and cheaper sometimes) to go buy a greasy meal from the chicken shop on the corner than to walk to the grocery store for some fruit and veg. Stores here close early too. But both Vince and I have slowly adjusted to the way of life here, and we’re able to budget ourselves without overspending, so this is becoming more manageable.
  • Book club: maintain my monthly book club with my friends and continue with reading at least a book a month.
  • Zumba: become an instructor (there is a beginner’s class at the end of January, but I think I’ll try to save some money and perhaps do the class mid-February or March instead). No rush, but this is something I really want to do.

I guess that’s the short-list. Actually, that’s pretty much all of it. What are some of the things you’re hoping to start up or maintain this year?

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Vacationing Already

It’s completely weird, but I feel like it’s much deserved – I’m on vacation this week.

I’ve only recently started in surgery, and I have to say that it feels good to be able to take a break away from work already. Mind you, my leave was fixed in my schedule and I just didn’t feel the need to change it to another time.

Bearing that in mind, I’ve been off for four days now. I hate to say that I wish I had accomplished more in those four days. So what have I been up to?

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I ordered (and received – quite quickly!) a cat scratch post for our newest family member, Londyn. It arrived Monday, so I spent the morning putting that together for her. And she loves it!

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Vince and I took advantage of a free entry pass and went to the gym. Fitness First. For £40, it would definitely not be worth it. It was a really small gym, and they didn’t have too great a selection of equipment. But it did feel good to run inside again.

Vince and I also started exploring other gyms in the area. He was actually signed up with a really great gym in the city, but that was close to his old work, and it’s inconvenient for us to go there now.

For the rest of the week, I need to find my old supervisor and have a chat with him this week, while I have the free time to do so. It would also be great if I could sit down and work on this new theme I feel I’ve been working on for years. I also need to do some research for a journal club I’m going to be presenting for in a few weeks time.

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