nhs, Uncategorized

‘What’s the one thing you know now that you wished you’d known at the start?’

I asked the team this at the start of this weekend’s on call.  It was met with groans and comments of ‘don’t do it!’

Yes its changeover on Wednesday! Its like a second Halloween to the media.  There are stories designed to terrify the public of how you’ll meet a grizzly end if you are unfortunate enough to be admitted to hospital on the first Wednesday of August.maxresdefault

There are also emails reminding the senior clinicians that we run a service and targets are key during this time.

Somewhere in amongst all that are people.  While we focus on ‘people not patients’ could we perhaps extend that to ‘people not the FY1’?

There have been great improvements over the years to move away from the traditional baptism of fire on your first day.  There are now preparation for practice or shadowing courses.  On social media there is a great hashtag #tipsfornewdocs (my top tip was ‘when on call eat at every opportunity/like you’ll never eat again).

We are much more supportive of our new doctors than ever before.  There is growing recognition that to run a safe, efficient service you have to do the proper training and education.  I say growing recognition as at times it seems we still can’t see the blindingly obvious inefficiencies.

I listened to http://www.bbc.co.uk/programmes/p041svjg this week by Dr Kevin Fong. It was all about ‘Lean’ in healthcare.  This has been about for years in management circles – standardise the process to make it more efficient.  Which is fine if we are making cars but we are caring for people.  A point acknowledged in the program.  I then thought about our Chief Medical Officer’s report on ‘Realistic Medicine’ which also talks about standardising process http://www.gov.scot/Resource/0049/00492520.pdf



Just at the point my head was about to explode from the buzzword bingo of management language it all became clear.  Strip away the language and what you have is blindly obvious.


Time to spend with patients. Time to gain experience. Time to spend with families. Time to talk to your colleagues. Time to finish on time.



I would therefore argue that we are missing a huge opportunity during changeover to uncover the blindingly obvious.  As our doctors move hospitals, departments and wards we should be asking them ‘what do you know now that would save you time when you started?’.

You then get a different response:

‘A map of the hospital so I know where to run when the cardiac arrest page goes off’

‘What time the phelbotomist is in and where they leave forms for those that they couldn’t get. It means you don’t discover mid afternoon some bloods haven’t been done’

‘The Treatment Room: Prepared ‘Procedure specific’ trays‘ This was beautifully presented by Dr Yesmin Karapinar an FY1 at the Women’s Medical Federation Conference in May 2016 .


‘Where’s the nearest place for coffee?’  Ok that was mine.  Where’s the nearest toilet is my second question.

Starting a new job is an exciting time for most doctors – lets ensure we uncover the time to make changeover process enjoyable as well as efficient.

1 thought on “‘What’s the one thing you know now that you wished you’d known at the start?’”

  1. I’ve just changed job for the first time in 15 years. It’s still the same: get your ID badge, IT training & passwords, find your way round, learn where to get coffee/lunch/empty bladder.
    I’ve seen somewhere else that wards should have identical layouts in the clinical rooms so ward cover juniors don’t spend ages looking for 20 ml syringes or 14F catheters

    Liked by 1 person

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