I’ve been working

I’m back. I suppose. Whatever that means. I’m back in work. I’m back in my own house. I’m back, for the first time for two years, to what counts for stability and doing the same thing for perhaps slightly longer than a few months at a time. Not exactly the circumstances i would have wished for but it is what it is.

I’m now a fully paid up full-time, permanent contract member of staff in the chaos of the emergency department (as the kids are calling it these days…). It is chaos. It is horrible, it is wonderful. It is what i do.

I’ve made a list of about 20 or 30 things to change in the department, from knocking down walls to bits of equipment i’d like on order. The sisters told me to write a letter to Medical executive Satan Santa and see how i got on.

I’ve come up with a list of new rules i need to follow. I’m one of those people who likes rules. I like these little self-imposed commands that seem to represent some ethic or moral that goes with the conduct of each shift. I’m better at obeying some more than others.

– Be thorough in all aspects of history, examination, notation, treatment and disposal [though this would be supposed to be elementary, the temptation to be slack is constant…]

– Work slower [I work manically and far too quickly, i see a lot of patients. I’m not convinced this is a good thing]

– Fight for the patient [in the sense of annoying and if necessary pissing off other doctors if it’s in the patients interest – how not to make friends or influence them…]

– Always go and see the patient you’re asked about [when you’ve been woken at 4am for advice over the phone, you will almost inevitably say something stupid]

– Pee [15 hour shifts no problem…]

– Eat [easy to forget]

– Do not be afraid to follow up patients on the phone

– Keep a list of all the interesting patients

– Copy x-rays/CTs/ECGs [useful for teaching and remembering the interesting ones]

– Remember dual pathology on X-rays [just cause you’ve seen the broken clavicle on the x-ray doesn’t mean that’s the only break]

– Think laterally, always reconsider the differential despite what may seem obvious [just because the patient, GP and nursing staff are telling you they have appendicitis, does not always mean they have appendicitis]

– Ignore any pressure that is not in the patient’s best interests [4 hour target nonsense etc…]

All very noble and honourable ideals. We’ll see how long it lasts.

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4 Responses to “I’ve been working”


  1. 1 meinmysmallcorner October 24, 2008 at 1:00 am

    Blogposts by doctors about doctor things scare me. Think I’d rather live under the illusion that you’re all infallible. I have a GP friend who blogged a list of the biggest annoyances in GP surgery visitors. I reckon if I had’t already hit 60% of them, I would have sometime in the near future.

    Now I know to avoid the ER as much as the GP surgery… 😉

  2. 2 Nelly And I October 24, 2008 at 2:40 am

    this is like doctor’s dirty laundry that we don’t want people to know we’re fallible! though just cause we’re fallible doesn’t mean that we don’t know more than joe public…

  3. 3 meinmysmallcorner October 24, 2008 at 7:28 pm

    Lol… reassuring, thanks!

    I just discovered your blog (having made the link that we met at New H blog seminar) – your honesty and way with words is inspiring. Thanks for sharing…

  4. 4 Roads October 31, 2008 at 12:18 am

    Fascinating stuff, Nelly. I hope that every Emergency Department doctor is as diligent as you, and to be fair, most of the ones I have come across have proved to be, despite in every case looking and behaving as if they were completely knackered.

    Maintaining good notes and paperwork is a fundamental for any scientist, and as you say the temptation to be slack is constant and inevitable.

    That said, if I make a wrong diagnosis in geology, it may be enormously costly, but it will not (that often) cost lives.

    In the past few years, I’ve been much more involved in meeting people to get things done, rather than working strictly technically. This is a different skill involving different challenges (perhaps like your future meeting the Emergency Department Santa/Administrator). I’m sure you’re good at this, since you talk to people, sick ones and well ones, all day long. As a mere rock-crusher, my patients are rather more static, but I digress.

    What I’ve found in this kind of project / team / finance meeting is that the obsession to take compulsive notes is not always as helpful as I assumed it would be. It’s always good to have a record, but lately I’ve been experimenting with taking no notes at all. This runs the risk that I might (very rarely) want to refer to them, but on the huge upside, it really forces me to listen very carefully to what is being said.

    And, here’s the rub, to what is not being said as well.

    To solve this last but often even more critical part of the equation takes enormous concentration of a type I can’t routinely manage when my head is stuck down in my notebook. Deciding not to take notes frees me up to really take note of the atmosphere within a meeting, the body language and the less obvious hints about what is ,em> really going on.

    When it’s important, I’ll write up a summary of the meeting afterwards, as a record, and send it to my two most immediate colleagues. Even better, if at all possible and if the meeting is crucial, I’ll try to ensure that one of them attends the meeting as well.

    This is because I’ve found that not only is it hard to pick up these clues whilst notetaking, but actually it’s even hard to do this when you’re just actively talking. Because when you’re already constructing your next answer, you’re inevitably not so live to listening, or to picking up the non-verbal signals as someone who has time to look around more freely.

    Anyway, thanks for this post. Good luck with your work. Your patients are lucky to have you.


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