Owen Yang
You are a junior doctor in an NHS hospital. What if there are many things to do and you are rushed to complete all tasks, and all tasks are urgent?
A non-atypical day as a junior doctor in the NHS
Someone’s cannula is out and if you do not cannulate now, the patient would miss her intravenous antibiotics. Big time.
Chance is you have no idea how urgent the antibiotics is, and trying to gather relevant information from the nurse on the phone has never ended well.
On top of this, you realised the cannula was not ‘out out,’ It was out because it had been there for three days and one nurse on a random shift decided to take it out because of an unquantified infection risk. Most of the time, in my experience, they did not do it directly for the infection risk. They did it because there was an audit going on, and to meet the auditing criteria they will have to take the cannula out, as per ‘Trust Guidelines’.
You are thinking about going to the ward and see how urgent this cannula actually is, but you already have a long to-do list: on other wards there are heart failure patients with blood pressure of 70/40. There are cancer patients in pain. Someone asked you to review an X ray for the position of a nasogastric tube, without which the patient cannot be fed, as per Trust Guidelines, of course. Apparently there is a ‘discharge manager’ who bleeped you constantly to ask you to write discharge summaries so that all three patients on her list can be discharged. You have absolutely no knowledge about the three patients, but discharging them is the hospital’s top priority (according to her) so that patients in the A&E (accident and emergency) department can be admitted. All of these things are urgent in their own right, in the name of ‘Patient Safety’. The crash bleep will inevitably start at this point.
Coping
One can try to use own wisdom to prioritise these tasks. Sometimes I try to proactively go to other wards to see whether they need help, and hope they will ‘spread the love’ and eventually the love will be boomeranged back to me when I need help.
But there is a limit what a single junior doctor can do.
Escalation: earlier rather than late
If I feel overwhelmed I would not wait until the last minute. I would escalate at the earliest stage. At night sometimes there is a night manager, who has some sort of power to relocate or re-prioritise may task. In my experience there isn’t a manager like this during the weekend day-time, and this is usually when everything becomes chaotic. I would either try to bleep the registrar and explain the situation. Sometimes I have absolutely no time, and would just bounce back to the nurse on the ward and ask her to bleep the registrar directly, explaining that I am absolutely overwhelmed.
A smart registrar would assess the situation and act on it. Sometimes he or she will ask another doctor on a different ward to come to help. Sometimes all wards are asking for help at the same time, and that smart registrar would escalate to the hospital or to the consultant, who has ‘higher power’ to manage the human resource to prevent collapse of the hospital system.
Sometimes nothing needs to be done. This is because I escalate early in a sense that I am warning things might or might not happen (say 50% chance). It might not happen. But if the world collapses, I have done my part and given the notice. To me this is important, because I am a junior doctor and cannot absolutely be responsible for a retrospectively preventable incident in a situation like this.
I fear if I have not had time to attend to every patient in time, some of them will have severe safety consequences. This fear overpower any worry about being seen useless or annoying, although I am naturally not bothered about it. The registrar and the nurse should know this as well. You should not be surprised how replaceable a junior doctor is in terms of most tasks on the ward. Most of the time it is our job simplest because we are the cheapest (or cost-effective?) person to do it, I think.
Asking for help should be bravery, not weakness
As far as I know, no one has ever accused me of being lazy or useless when I asked for help early. The frustration is still there because I feel many of these tasks could have been avoided if the hospital is better managed, and everyone could have just been smarter. But hey, welcome to the NHS.
Be confident. But at the same time try to help others and keep the boomerang going.
If you are the registrar or a consultant, be prepared. You are the leader who runs the team, not the crisis manager or some sort of on-demand supporter. I feel for you, though.
