Why this patient is still in the ward?

This is one of the favourite questions asked during ward round, and HOs are also anticipated to answer it during round!

Some of the popular answers:

1. To complete IV antibiotics
2. Awaiting for operation / procedure
3. For pain management
4. For blood transfusion
5. Post major op day _
6. Patient developed complication from operation / an initially stable disease, thus requiring inpatient management e.g. septic shock, hypovolaemic shock
7. Logistic issue, no transport available yesterday
8. “Err … ” (Avoid this. It may indicate that you don’t know about your patient 😂)

Why the patient is NBM this morning?

This is one of the questions that you need to ask yourself during AM review, and you would need to anticipate that the same question will be asked again during ward round with MO / specialist later

Examples:

• For CECT this morning
• For OGDS / colonoscopy today
• For operation under general anaesthesia today
• The patient developed tachypnoea last night (KIV for intubation today if worsening)
• The patient had coffee ground vomitus last night

Miscellaneous

• One day when you are the only doctor in the ward, and suddenly saw a patient with this breathing pattern. This is not a normal breathing! This is gasping.
  • Gasping is characterized by short, labored breaths that often involve the throat, chest, and abdominal muscles.
  • If the patient is a case where imminent death has been anticipated and not for intubation / CPR, inform MO, KIV to start medications like IVI Fentanyl / IVI Morphine
  • If the patient is a case where death is not anticipated during current admission, it is a medical emergency!
    • Quickly call the MO in charge and give high flow mask oxygen.
    • Check vital signs.
    • Place the patient in the head-tilt chin-lift position to secure the airway while waiting.
    • The patient would need crash intubation for life-saving purpose

Introduce Yourself

“Who are you? Why are you here?” – asked by a ward consultant

This happened few days ago when my colleague, a new (senior) HO just started first few days of tagging in a new department. Subsequently the colleague was somehow ‘badly scolded’ for not introducing to the consultant in charge of the ward, and some more he/she is already a senior poster.

Moral of the story:
When you are new to any ward / any department, please put initiative to introduce yourself, especially to e.g. Staff Nurse, Ward Sister, MOs, Specialist, and Consultant.

They might or might not want to know exactly who you are. But your presence has to be acknowledged by them.

“If somebody who you don’t know before suddenly appears sitting in your house without permission, what would you feel?”

ASK

• Ask whenever you are not sure
• Ask the right person (for certain things you may ask your HO colleagues, while others you should ask the MO / specialist)
• Ask before complications had happened to the patients / to yourself

Unlimited Calls

Buy mobile plan with Unlimited Call (+++Internet data). You might be calling a lot to refer cases or to update cases to MOs of the same/other departments.
Some MOs prefer us to call using our own phone, so that they can easily contact us regarding patient’s update

Examples of Poor Attitude (that should be avoided)

• Consistently coming late
• Consistently taking MC / EL without valid reason and/or without informing other colleagues
• Back-stabbing others
• Being dishonest to colleagues / superior / patients