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TO keep your energy and enthusiasm on the boil beyond the summer, I have compiled a top ten checklist for avoiding rookie errors.
Talk to your patient
It’s so easy to get caught up in administration, filling in forms, sitting at the computer and talking to your seniors that you, in fact, forget to talk to the most important person of all: your patient.
Eighty per cent of your work will be done by establishing a rapport and getting a good history. The simplest questions often deliver the biggest rewards: how are you?, why are you here today?, how can we be of help to you?
If you’re on the patient’s wavelength, all the medical questions and paperwork become simpler and more likely to be correct.
Try not to be a rookie whose patient tells your boss important stuff that you did not elucidate.
Touch your patient
Point 1 was 80% of your work and this is 15%.
The radiology department and pathology laboratory are not physical examinations.
I remember in my first intern rotation, an elderly woman was sent in for admission by a rheumatologist for back pain. I looked. She had shingles. Problem solved.
Bosses can be rookies sometimes.
Veins – be vain or in vain
The cannulations and blood tests will often be on your shoulders, so become guns ASAP!
Strap the tourniquet nice and tight about halfway up the humerus so as to nicely compress the cephalic and basilic veins. All veins distal will then have the best chance to reveal themselves.
A rookie error is to put the tourniquet too low so that you cover some of the veins or not give good veins a chance to fill.
Be familiar with different types of cannulae and different ways to take blood. The old-fashioned straight needle and syringe still gets an old dog like me out of trouble most of the time.
Charts
I have previously waxed lyrical about charts but again, this will be a job passed down the food chain, so know your forms and shortcuts.
A rookie error is omitting the clinical reason for a drug on the medication chart. When something goes wrong, you’ll be asked why you signed for the drug. By inserting the reasons, it will make you learn therapeutics faster and save your backside.
Vitals
They’re not called vitals for nothing. Disregard them at your peril … A deadly rookie error.
Time
Don’t waste time or time will waste you.
Excessive coffee breaks, social media on the job and mobile phones are the rookie errors that will annoy your seniors and see you falling behind.
That said, if you put in a hard day’s toil, don’t be ashamed to claim all your hours on your time sheets. Bosses and administrators who do not pay you for what you work are not rookies. They’re jerks.
Nurses
A nurse can be nice, or a nurse can be your noose. It’s the rookie’s choice.
The ink drying on your medical degree does not confer the experience of a senior nurse. If you show some appreciation and listen to the nurses, the ward is your oyster.
Be sharp
… in every respect, but especially with sharps.
You not only need to protect yourself but those around you. Even with the best of care, accidents can and will happen, as this cautionary tale illustrates.
Tests
Don’t order a test that you do not understand and cannot interpret. If a senior asks you to do so, research fast or ask the senior to order it instead.
A test you order is a test you need to chase and action … Rookies beware.
Back yourself
If the first nine points were scary, they weren’t meant to be.
You’ve entered the most rewarding of professions that will deliver unending fulfilment and stimulation. Use all the knowledge and skills you’ve worked so hard to acquire. Apply them diligently to do the best you can for your patients.
Believe in your knowledge and ability.
Dr Aniello Iannuzzi, FACRRM, FRACGP, FARGP, FAICD, is a GP practising in Coonabarabran, NSW, and a clinical associate professor at the University of Sydney.
To find a doctor, or a job, to use GP Desktop and Doctors Health, book and track your CPD, and buy textbooks and guidelines, visit doctorportal.
These comments are all very valid.
Would also add -treat patients as you would like your mother/father/child to be treated.
-don’t be afraid to ask stupid questions.
-ask the patient what they think is wrong.
-” when were you last perfectly well “is often very enlightening!
-anger and aggression often mask extreme anxiety
I would not recommend telling your supervisors to order their own tests. By all means ask what the test is for, or research it yourself, but in the same way you should be polite and respectful of the experience of the nursing staff,
you should extend the same courtesy to your medical mentors.
Excellent pieces of advice Nello. These points are reminiscent of a treasured rural placement we spent with you which sealed the deal of becoming a rural GP!
I would underscore everything you mentioned with, tell the truth!
This is good practical advice for clinicians of any level of experience. I’d like to add that it’s not ok to work with a latte in one hand. It’s become a common complaint from my fasting pre op patients that they don’t appreciate the residents eating and drinking in front of them or being able to smell coffee in theatre. This shows a lack of empathy for your patient. Have breakfast before you present for work, turn up at least 15 minutes early and be ready to work straight away. If you are not early you are late. Eat and drink in the resident’s lounge or in a food service area, never in clinical areas.
A very good article’; I would add ; if in doubt, ask ! – don’t blunder on when unsure
write legibly and have an ink stamp of your name to use in case notes ( I
realise that many notes are now electronic)
include appropriate clinical information on request forms ; radiologists and
pathologists can be much more helpful if they are given details of the case
if you feel overwhelmed, write a list of outstanding tasks, rank them by priority
and then steadily work through them. Ask for help if necessary
make sure you eat regularly and gets sufficient sleep
How refreshing to read and to promote the basics of good medical practice. Remember what William Osler said: ‘listen to your patient; he is telling you the diagnosis.’
In relation to getting cannulas in – get the tourniquet on early. The longer you give it the better. And the best advice I’d give is to go where the veins are. Which probably sounds stupid and obvious, until you are struggling to get a vein and try based on hope. If you cant see the vein and cant feel the vein, there isn’t much point sticking a needle in there on hope alone. Also, gravity is your friend. If you are looking on the back of the hand, try letting it dangle down instead of having it upright.
Another thought: Your stethoscope is for listening to hearts, chests and abdomens. It is not a clothing accessory, neck brace or status symbol.
Very sage advice. The only addition I would put to your first point is “listen to your patient”.
And not listening like a teenager listens to parents’ advice, but listening the way a mountaineer listens to a weather forecast, as if lives depend on it. Thinking about the implications of every statement the patient makes.
Insightful and practical, this article is a ‘must read’ for the interns commencing this year