Skip to content

General Surgery - A Day in the Life - Junior Doctor Vlog

2019-08-02 · Vlog or day in the life · Ali · recording, 21:18 · watch on YouTube

Topic: Medicine and his doctor years · mode: Demonstration and walkthrough · tags: Aimed at students

Ali talks through a Friday on his general surgery placement with the upper GI team: the ward round, ten discharges, ultrasound bookings, bleeps, a coroner call and a transfusion. He concludes that being a junior doctor rests on being organised and knowing when to ask for help, far more than on memorised medical school knowledge.

What is said

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

00:00:00 — Why the day is told from a list instead of filmed

  • ★★★ Ali, a junior doctor in Cambridge, talks through a day on his general surgery placement, the rotation he is on now. — 00:00:00 · Cambridge
  • ★ Because hospitals are wary of filming on site for confidentiality and consent reasons, Ali wrote down everything he did that day and talks it through instead. — 00:00:00

00:00:29 — What the upper GI team does and what junior doctors do on it

  • ★★ On general surgery Ali is with the upper GI team, which covers the oesophagus, stomach and small intestine; the colorectal team covers the large intestine. — 00:00:29
  • ★★ On a surgical team the consultants and registrars operate; the foundation doctors manage the medical problems of the team's patients. — 00:00:58 · Foundation Programme
  • ★★ Ward rounds on surgery start at half past seven, so Ali gets up at half past six; he has got used to it and wakes then even on a day off. — 00:01:27

00:01:45 — A Friday on the ward: ward round, discharges, scans, referrals, bleeps, teaching, a venous blood gas and a transfusion

  • ★★ On the ward round Ali logs into the hospital computer system on his iPad, which saves waiting for a computer on wheels to load. — 00:02:55 · iPad
  • ★★ Ali puts each job in the patient's electronic notes and also keeps his own jobs list in GoodNotes, so he need not open every patient's notes to see his jobs. — 00:03:53 · GoodNotes
  • ★★ What Ali likes about the surgery placement is that there is much more to do than on his medicine placements, so he constantly juggles, triages and prioritises his to-do list. — 00:04:40
  • ★★ Junior doctors on the team carry a bleep that goes off many times a day: nurses call about unwell patients, pharmacists about errors in discharge summaries. — 00:04:40
  • ★★★ That Friday the ward round ended around 11am with 33 patients, more than the usual 20 to 25 (as heard); 10 went home, so Ali and fellow junior doctor Joe wrote 10 discharge letters and 10 take-out prescriptions. — 00:05:09
  • ★★ A simple discharge after an appendicectomy with no follow-up needs about a three-line letter to the GP, and GPs are said to appreciate brevity. (hedged) — 00:06:04
  • ★★ For a patient in hospital two or three weeks, working out from the notes what happened and writing a decent discharge letter takes 20 minutes to half an hour. — 00:06:51
  • ★★ A complex discharge also means choosing the painkillers to send home, such as codeine, morphine or meptazinol (as heard), and how many days of heparin injections to prescribe after the operation. — 00:06:51
  • ★★ Discharge letters and take-home drugs matter, Ali says, and mistakes on the take-home drug chart are a big source of errors. — 00:07:28
  • ★★ Ultrasound slots are scarce, so booking a scan means walking about three quarters of a mile to the ultrasound department and waiting to speak to a radiologist who may be scanning. — 00:08:27
  • ★★ To get a radiologist to prioritise an ultrasound, Ali says, come prepared with a story and understand how urgent each request is. — 00:08:56
  • ★ Ali's team referred a patient to gynaecology when a CT done for abdominal pain showed an ovarian cyst. — 00:09:25
  • ★★ A perforated bowel leaks bowel contents into the abdomen and, untreated, causes infection and death, so it is a surgical emergency. — 00:09:55
  • ★★ A patient with a suspected bowel perforation could not survive surgery, so the team referred them to the palliative care team. — 00:10:24 · Palliative care
  • ★★ Ali was glad the consultant told that patient nothing more could be done; he does not think he would have done the conversation well. — 00:10:52
  • ★★ Discharging a patient on controlled drugs such as morphine or oxycodone needs a printed form physically signed by the doctor, because those drugs are more regulated. — 00:11:26
  • ★★ An ambulance crew will not take a Jehovah's Witness patient who refuses resuscitation home without a signed form, in case of a cardiac arrest on the way. — 00:12:21
  • ★★ Ali went across the hospital to sign such a form for the first time; the nurses explained how, and the ambulance crew took the patient home. — 00:12:50
  • ★★ A death within 24 hours of admission has to be referred to the coroner by default; Ali phoned the coroner's office before issuing that patient's death certificate. — 00:13:39
  • ★ Every Friday from one to two all F1 doctors have mandatory teaching, required for their educational portfolio. — 00:14:36 · Foundation Programme
  • ★★ With no trained nurse free on the ward, Ali's team did a venous blood gas on an unwell patient themselves. — 00:14:58
  • ★★ When the patient's haemoglobin dropped to 74, Ali phoned the on-call consultant about a blood transfusion. — 00:15:46
  • ★★ A blood transfusion sample cannot carry a printed label: the form is filled out by hand, the request made on the system and the sample taken to the lab in person. — 00:16:44

00:17:14 — Being a doctor is about being organised, not about what you know

  • ★★★ Very little of a doctor's day-to-day work needs extensive medical school knowledge, Ali says: the vast majority is being organised, efficient and quick. — 00:17:14
  • ★★★ To students worried that not being top of their year or only scraping through exams means they will be bad doctors, Ali says not necessarily. — 00:17:14
  • ★★★ What matters in a doctor, Ali says, is having the basics down, knowing when to ask for help, being organised and communicating decently with families. — 00:17:43
  • ★★★ It surprised Ali that almost anyone can be a doctor: being a doctor is not that hard. — 00:17:43
  • ★★ The culture of medical school admissions says you must be amazing, with amazing grades, because medicine is so hard; Ali says it is not that hard and very doable. — 00:18:19
  • ★★ Ali thinks medical students become too fixated on knowing everything in the textbook and on competing with their year for the top prize. — 00:18:19
  • ★★ Even with an unwell patient, Ali says, a junior doctor follows the standard systematic ABCDE approach rather than recalling knowledge. — 00:18:48
  • ★★★ With every drug on a smartphone, Ali says doctors need not memorise drug doses, mechanisms of action or interactions, though he calls knowing the adrenaline dose very useful in case the emergency setup is not ideal. — 00:19:24
  • ★★ Being confident, or arrogant, that you know things off the top of your head is one way doctors make mistakes, Ali says. — 00:19:48
  • ★★ Ali says looking a drug up in the official British National Formulary app takes about five seconds, and every hospital has its own drug guidelines too. — 00:19:48

00:20:13 — The placement never drags; triage when work piles up; sign-off

  • ★★ Ali's general surgery placement never drags: there is always enough to do that he is surprised when the day is over. — 00:20:25
  • ★★ When there is too much to do and too little time, Ali says, triage: decide what can wait till tomorrow and do the urgent things first. — 00:20:25

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Discharge planning · General surgery

Also: ABCDE approach · British National Formulary · Cambridge · Foundation Programme · GoodNotes · iPad · Jehovah's Witnesses · Palliative care

Also centred on Discharge planning: My Geriatric Medicine Placement - Junior Doctor Vlog #02

← Previous: How I Manage my Time as a Doctor + YouTuber - 9 Time Management Tips · Next → Smart Passive Income + The Third Door - Monthly Favourites #11