The Daily Life of a Junior Doctor on the Ward

Quite interestingly we are a mysterious bunch to the public, from time to time I received questions on the very entity of my job as a junior doctor. Which is totally understandable, unless you have worked alongside the doctors, it would be difficult to figure out what we do on a day to day basis. Hence I thought this would form a very interesting first piece on this blog.

The morning rush

I live in Preston myself but commute to Blackburn for work. You may question why I have decided to do so, mainly because I have more friends in Preston and it wouldn't hurt to have a circle of support to start my first permanent job.

I wake up early in the morning to prepare for the long challenging day ahead. The one thing I look forward to is a hearty morning breakfast - nothing beats a cup of warm coffee/tea and a bowl of cereals to keep myself energised. After that I leave my house to catch after the train, praying to God that it won't rain. As a countermeasure, I tend to bring an extra pair of shoes and socks in case the one I am wearing becomes soaked.

Upon reaching the hospital, I will change into my scrubs (Which is neon green, believe it or not). Our hospital policy states that we are not allowed to wear our working scrubs outside of hospital setting, which totally make sense since it helps to prevent the spread of infectious disease into and out of the hospital. Regardlessly, this neon green makes us stand out from our peers, definitely an easy target when delegating jobs to juniors!!

Preparing for the ward round

Getting into the nifty bits of our job - this is highly dependent on the department and hospital you work in but generally in Royal Blackburn Hospital, if it is a surgical department, you are expected to prepare and print out a document with all the surgical patients we need to see for the day. This is an important step as it ensures that we won't miss out any patients, especially outliers (patients in a different ward). Whereas, in an internal medicine job (ie. Endocrine, Cardiology, Respiratory..), you are not expected to do so and usually kick off with preparing the ward round notes before the consultant arrives. This also mean that surgical jobs tend to start earlier.

We usually work in a team of at least 2 people, which is generally "considered" the minimum safe amount of doctors to run the ward. But of course, if you are lucky enough, you will be joined by either a physician associates or advanced nurse practitioners. Their presence on the ward is highly important since they maintain a continuity of care and understanding for the ward patients and also provides specialist advice(s) to the doctors whom usually rotates around different departments continuously.

Once the consultant/seniors arrived for the ward round, we will start off pushing a portable computer around with all the notes prepared. It is a nightmare searching through different softwares and documents for information if you are not organised. We will use the computer to search for latest blood results, imaging results, previous clinic letters and special investigations whilst requesting bloods, investigations and referrals as we go along (If time allows). There are on average 20 to 30 patients on each ward round to see and sometimes more if there are a lot of outliers. Surgical ward rounds tend to be longer due to larger patient capacity. If lucky, most ward rounds should end around 10/11am in the morning. If not, well..., let just say that it can go on for quite a while in the hand of a super thorough leadership. The worst I have encountered personally is a ward round which starts at 9am and ends at 3:30pm.

Post ward round duties...

Soon after the ward round, we will gather together as a team to compile our jobs, prioritise and delegate appropriately. Keeping in mind that everyone in the team has their own strong points and weakness; some are better at negotiating, some are better at writing, and some are better with practical/clinical skills.

Praying for the rare chance that a wild phlebotomist will appear to help us with our bloods taking, if not the whole team will need to work together to make sure bloods are prioritised, if not we will not be able to view and act upon any anomalies (On average, routine blood results will take about 3-5 hours for it to be processed). In the odd chance that the consultant/senior wanted nearly every patients to have blood, this would be the most tasking job for the day without the help of a phlebotomist. Especially difficult if the patient have shy veins which require more expert skills such as anaesthetic help and ultrasound to find.

Once the physical labour is out of the way, we focus on more negotiation jobs, and what we would call intellectual admin job (Which includes writing out discharge letters, writing/rewriting, or reviewing medication charts, making referrals to other specialties and chasing investigations).

The most painful job would be discussing with radiologist(s) on why they should do your scan first, keeping in mind that most seniors/consultants would usually want their investigations occur in a snap of their finger. Which totally make sense, since they are the decision maker and if patient deteriorates, they will have to bear majority of the repercussions and consequences.

We plough through the rest of the day with all the jobs gathered during our ward round aiming to complete all our duties by 5pm. There will always be questions from the rest of the medical team (ie. nursing staffs, physiotherapists, dietitian, occupational therapists and pharmacists) on the care of the patients.

Once the clock hits 5pm, we would quite eagerly pack our bags and be ready. It is interesting to note that patient tends to deteriorate in the evening, especially after 5pm. If caught in the middle of the storm, it may take anything from 30 minutes to hours to ensure that patient safety is maintained. Of course, speaking of patient safety, before our shifts end, we will handover any unwell patients to the on-call team either for them to be aware or to ensure continuous monitoring.

The severity of the jobs varies each day, some days it could be light but usually it is moderate to heavy. In the event that there are minimum staffing in the ward with a lot of clinical responsibilities and no phlebotomist, sometimes it is normal to not have break and to work overtime. Working overtime is usually not recommended by the foundation team and should be "exceptionally reported". This allow the foundation team as well as your clinical supervisor to look into the reason "why you are working overtime" and to allow precautionary steps to be taken to prevent this from happening in the future.

Home after a tiring day

After reaching home, I will quickly disinfect myself with a nice warm shower (Given the situation with Covid, it is better not to risk it). Grab myself a good dinner whilst enjoying random videos on YouTube or Netflix. This is a good time to reflect on any errors or learning points which I have gathered through the day, be it for personal development or for clinical improvement.

The cycle continues...a vicious cycle on a day to day basis except the types of patient we see differs everyday. Tiring but nonetheless a very rewarding job, it never fails to make me feel happier and more satisfied to make a difference (be it small or big) in another person's life. Our responsibility does not just end here, as we as clinicians are a group of self-improving community, seek opportunities to overcome challenges and threats in our systems and our knowledge. We participate in other non-clinical activities such as audits, quality improvement projects, research, and more admin work to improve the care we provide to the community.

Thank you for reading!! Please let us know if you have any requests and questions. We are more than happy to answer them!!