Skip to content

My first evening shift - Junior Doctor Vlog #01

2018-08-19 · Vlog or day in the life · Ali · recording, 18:10 · watch on YouTube

Topic: Medicine and his doctor years · mode: Personal story

In his first junior-doctor vlog Ali talks through his first long day and evening on-call shift in Cambridge: ward jobs and a referral that went badly, covering wards from 6 to 9 pm, a blood transfusion, a nauseous patient he could not help, a deteriorating patient handled by the rapid response team, and his relief that he seems to enjoy the job.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — First long day shift; becoming a doctor versus being one; how a long day works

  • ★★★ Ali, a junior doctor in Cambridge, has just had his very first long day shift and talks it through, hoping to give applicants and medical students a raw look at being a doctor. — 00:00:00 · Cambridge
  • ★★ For Ali and most people in his year, the idea of becoming a doctor was much more glamorous than actually being a doctor. — 00:00:29
  • ★★ At Ali's hospital a long day runs from 8.30 in the morning to about 9.30 in the evening, with general ward duties until about 6 pm. — 00:00:29

00:00:58 — Day jobs on the cardiology ward, referrals and the vascular surgery call, the electronic system

  • ★★ Making a referral means phoning a registrar, a doctor probably five or six years older, and selling them the story of why the patient is worth their time; it can be stressful. (hedged) — 00:01:27
  • ★★★ A few days earlier Ali referred a patient with leg ischaemia to the vascular surgery registrar without reading the notes in depth, could not answer whether he smoked, his signs or why he was in hospital, and was destroyed over the phone. — 00:02:12
  • ★★★ Prepare before a referral: tell the registrar exactly why you are calling them and exactly what you are asking for, a specific question on the clinical picture; since doing so, Ali's referrals have gone less badly. — 00:03:01
  • ★★ An F1 doctor's day job is the ward round with the team, then jobs such as discharge summaries, transfer letters to the adjacent cardiothoracic hospital and referrals to other teams. — 00:03:30 · Foundation Programme
  • ★★ Because Ali's Cambridge hospital is entirely electronic, its junior doctors do much less of the admin other UK doctors do: drugs, X-rays and blood tests are requested from a computer. — 00:04:00 · Cambridge
  • ★ Ali has used the hospital's electronic system for only a few days and already loves it. — 00:04:29
  • ★★ From 6 to 9 pm four F1 doctors cover all the medical wards of Ali's hospital, keeping patients safe until they hand over to the more experienced night team at 9 pm. — 00:04:29 · Foundation Programme

00:04:56 — The evening shift: handovers, warfarin, a blood transfusion, the nauseous patient and the palliative care call

  • ★★ On his first evening shift Ali covered the cardiology, respiratory and gastroenterology wards, taking handovers from day teams of CT scans and blood results to check. — 00:04:56
  • ★★★ On how much day teams should hand over to the night team, Ali says only genuinely urgent or emergency things should ideally go to the night doctor, who covers many wards and is there to make sure everyone survives the night. — 00:06:13
  • ★★★ The evening shift was probably the first time Ali felt like a real doctor: on the cardiology ward he is the most junior person and the consultants and registrars make the decisions. (hedged) — 00:06:37
  • ★ Ali's Cambridge hospital is a tertiary centre that takes the most complicated patients from all around the region. — 00:06:37 · Cambridge
  • ★★ Asked to prescribe warfarin on the evening shift, Ali decided for himself without calling a registrar, having done it and seen it done a few times. — 00:07:06
  • ★★ Giving a patient the wrong ABO blood type is quite likely to kill them, because the whole immune system targets that blood. — 00:07:35
  • ★★ To prevent ABO incompatibility, two blood samples are taken from two different places and the patient's details are checked against the blood four times. — 00:08:22
  • ★★ Blood transfusion is never fully safe: even with a matching ABO type, minor antigens can cause an anaphylactic reaction. — 00:08:22
  • ★★ Ali reviewed the notes, asked the patient and family about past transfusion reactions, and signed for two units of red blood cells, which he found quite scary. — 00:08:55
  • ★★ Nausea is arguably worse than pain, as one of the palliative care consultants once said: pain you can deal with, but nausea is debilitating. (hedged) — 00:09:26 · Palliative care
  • ★★ Antiemetics are complex: there are six or seven types, each acting differently, and the right one depends on the cause of the sickness, such as morphine, chemotherapy, an electrolyte problem or an abdominal issue. — 00:09:26
  • ★★ Choosing anti-sickness drugs needs a long conversation and the whole history, so it is the remit of the daytime team, not of the night on-call doctor. — 00:10:01
  • ★ Palliative care specialists are experts at prescribing anti-sickness medication, since patients in their last weeks of life often take it. — 00:10:48 · Palliative care
  • ★★★ Unsure how to help a tearful patient nauseous for five weeks, Ali phoned the palliative care specialist, who agreed he could not decide in ten minutes at night; he gave a sleeping tablet and some morphine and explained the antiemetic was for the morning team. — 00:12:02 · Palliative care
  • ★★ Ali writes each job he is bleeped about on his iPad Pro in an encrypted document with no patient-identifiable information, only numbers and initials, and crosses them off when done. — 00:12:31 · iPad Pro
  • ★★★ Three minutes before handover a nurse bleeped Ali to a patient with fever, high heart rate, low blood pressure and a NEWS of 12; the rapid response team was already there and stabilised him. — 00:13:01

00:13:22 — A patient with a NEWS of 12, the rapid response team, and handover to the night team

  • ★★ The National Early Warning Score (NEWS) is a numerical way to assess quickly how sick someone is, for example points for a heart rate above 100; the higher it is, the more worried you should be. — 00:13:22
  • ★★ Quite a few hospitals now have a rapid response team of very experienced nurses and intensive care doctors on call for anyone who is acutely unwell. — 00:13:52
  • ★★ The rapid response nurses were calm under pressure and knew what they were doing, so that Ali became the backup; he found it inspiring. — 00:14:21
  • ★★ Dealing with an acutely unwell patient is very different in real life from simulations and seminars on a simulated patient. — 00:14:54
  • ★★ The night doctor Ali handed over to had been at his Cambridge college three years ahead of him; both into photography, they chatted about the new Sony A7 III camera. — 00:15:23 · Cambridge
  • ★★ Another night doctor had been a medical student at Emmanuel College, Cambridge, and supervised Ali in neuro in his second year; the handover felt like a family reunion. — 00:15:23 · Emmanuel College, Cambridge

00:16:04 — Time flies, enjoying the job, admin and the chain of command; sign-off

  • ★★ Ali's first twilight shift lasted 13 hours but did not feel like it, because when you are doing things the time flies. — 00:16:04
  • ★★★ Ali's biggest worry about medicine was whether he would enjoy it; a few days into the job he thinks he does. (hedged) — 00:16:47
  • ★★ An F1 has a lot of admin, discharge letters and electronic paperwork, but making decisions on the evening shift showed Ali he does vaguely know what he is doing. — 00:17:16 · Foundation Programme
  • ★★★ A junior doctor who does not know what to do can always call the rapid response team, registrars or consultants: escalating as soon as you get stuck is a safety net for patients and doctors. — 00:17:16
  • ★★ Ali calls this first junior-doctor vlog very rambly and asks viewers what they think of the format. — 00:17:54

In the description and comments

  • ★★ Ali opens season 2 of his vlog: he has graduated from medical school, is a few days into his job as an FY1 junior doctor and is placed in Cambridge for the first year. — video description · Cambridge, Foundation Programme

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Foundation Programme

Also: Cambridge · Cardiology · Costa Coffee · Emmanuel College · iPad Pro · National Early Warning Score · Palliative care · Sony A7 III

← Previous: University Freshers - 5 Top Tips · Next → Studying Medicine in Eastern Europe - A comprehensive guide