KBW’s need to know: making me happy on the ward round

Do you know what fluffers are? I am sure you do. For those of you who are sweeter and more naive, Fluffers are professionals in the adult entertainment industry whose job it is to keep the male “stars” in a state of perpetual readiness for when it is their turn to be on set, as it were.

Fluffers should be the inspiration for every FY doctor about to commence a ward round; the observation chart, the drug prescription chart, the fluid chart and the blood sheet should all be to hand for every patient, the notes immediately to hand and the nurse for each bay identified and informed that the ward round is about to begin. The aim is to keep the consultant ward round moving and keep them happy, in a state of perpetual readiness and contentment. The senior person doing the round should flit from patient to patient, like the Queen being manoeuvred through the crowds at a royal gala film premiere, or Putin on a tour of a power plant.

Keep them moving, keep the information coming and give them what they want.

Tell them what they like to know, find out their little peccadilloes and peculiarities. It may be serum phosphate, it may be the antibiotics, it may be nasogastric tube aspirates; find their thing and make sure you humour them.

My things that I like to know from the juniors, without me asking, are all abnormal bloods, the potassium level (even if it’s normal), the C-reactive protein change since the last time it was checked (not just the meaningless value), any antibiotics and for the emergency admissions the urinalysis. Why do they never remember to check the urinalysis? They make it so easy for me to seem clever when they miss all the UTI’s and renal colic.

Ward rounds are your chance to show how smoothly you are running things. Bring gloves, be prepared, make sure you know who has done a poo and who hasn’t, who is burping non stop and who is passing flatus every hour on the hour.

When I was a girl I used to come in at 6am to prepare for the professorial grand round and I would conduct a mini pre round ward round to make sure I knew what I was talking about. I don’t expect anyone to do the same but if you do, you’ll get some teaching on the ward round instead of us spending all the time checking up that you are doing your job properly.


This man doesn’t look well at all, have you passed wind today sir?

God for white people

God for white people

Am I alone in being a little bit disgusted with the male American doctor who has survived Ebola thanks to being evacuated to hospital in Atlanta, Georgia and being managed in a state of the art ITU? “God and prayer saved me” he has just been on the news saying. Yes mate, because God just couldn’t be bothered to save the 1200 other people he has just let die in Africa.

Money saved you. Being a westerner saved you. Your female colleague who was also infected, evacuated and survived has rightly refused to be interviewed about this.


Saved by God

You lot are fucked

Change over day

Change over day

I blogged last year about the challenges facing the newly qualified doctor on Black Wednesday, their first ever day at work and today sees a new batch take their first leap into a lifetime of being a doctor. One of the joys of getting older is that I have a marvelous sense of perspective that was lacking when I was in my twenties. I am struck by the contrast between school students hoping to become medical students and medical students. One group is eager, enthusiastic, even desperate to get into med school and those that are there seem lethargic, pissed off and desperate for the day to finish. They certainly seem to lose that lethargy on day 1 as a doctor and the ones I have today are keen to impress, work hard and not fuck anything up. 

They are scared of getting it wrong, as of course they should be. They are scared of the consequences of getting it wrong too, including being told that they have cocked up. There is an art to this, I tend to tell them something they have done well and then talk about what they have done wrong, which seems to work, this technique is known informally as a shit sandwich. Other colleagues are more forceful. It is very difficult to know where correcting and pointing out errors tips into bullying. Bullying has no legal definition in the UK, but is of course the use of force, threat, or coercion to abuse and intimidate or aggressively impose domination over others. The behavior is often repeated and habitual. One essential prerequisite is the perception, by the bully or by others, of an imbalance of social or physical power, which in medicine and our hierarchy, is inbuilt. 

One of my bosses used to rap me across the knuckles if I did the same thing he didn’t like for a third time. He had a three strikes rule. It was light hearted, it was fun, it was done so he didn’t have to say for a fourth time “don’t grab the suture material with your forceps” and it made me stop doing it. I like him, he likes me, we have a great working relationship and he is not, in my mind, a bully.  

The problem is that bullying is in the eye of the beholder, one persons friendly knuckle rap is another’s physical assault. How we teach and encourage trainees in a setting that is not designed for this (there is no time to go slowly, to allow mistakes, to debrief) and avoid allegations of being a bully is very difficult. Apparently it is a huge problem in surgery and perhaps we need to separate service from training and have those that are good at teaching and training doing so and those that can’t keep their temper delivering only the service. 

I am heading back to the ward now, where I am always nice and never get angry with anyone. 

I said "make sure you take out the right kidney you little shit, not take out the right kidney"

I said “make sure you take out the right kidney you little shit, not take out the right kidney”

Inspiring Blogger Award

The Inspiring Blogger Award









Thank you Surgeon in Kicks and Surgeon in Heels for nominating me for the Inspiring blogger award! For those of you who haven’t read their work, check their blog out at http://heelskicksscalpel.com/. I love reading what these 2 girls get up to, it is amazing to think that there are other fashion and exercise obsessed mummy surgeons all over the world.

Here are the rules;

  1. Thank and link to the amazing person who nominated you.
  2. List the rules and display the award.
  3. Share seven facts about yourself.
  4. Nominate 15 other amazing blogs and comment on their posts to let them know they have been nominated.
  5. Proudly display the award logo on your blog and follow the blogger who nominated you.


7 facts about me, this is difficult because my employer prohibits me from doing this sort of thing (a blog in which I do a lot of public moaning about the NHS) and the GMC take a dim view of doctors blogging anonymously.

1. I suppose that the first thing about me it that my WordPress name, Mrs James Barry, is clearly a pseudonym and Miranda James Barry was a woman who disguised herself as a man in order to be a surgeon.  Some women used to behave like men in order to fit in but I am resolutely a girl, complete with heels and lipstick and handbags and I make no apologies for it.

2. I absolutely hate the Daily Mail, which I confirm to myself regularly by looking at their website until something makes me angry. For those of you in America, it has the same editorial policy as Fox News albeit slightly less pro-guns.

3. The time I spend doing this I should really spend either studying or writing papers.

4. I have 3 children and lots of lovely friends and family as well as my wonderful and supportive husband, Mr KBW.

5. I love my job, I am amazed when people enquire if it is hard or difficult to be a general surgeon. It’s totally wonderful, there are hard aspects but it’s a pleasure and a privilege and great fun.

6. I love cooking and baking. If I could go on a reality show it would be The Great British Bake Off.

7. My other obsession is exercise, previously this was just the gym and road running but then I discovered that one sport was not enough and I now spend about 10 hours a week swimming, cycling and running and competing in triathlons.

The ladies at kicks and heels follow quite a lot of the same people I do, so I am double nominating people like Tiff and the urban dr mom. Sorry to nominate you guys twice but you can’t have too many awards! I also am nominating the person who got me into this in the first place, who thought that I was going insane and needed a diversion and suggested I start a blog…





http://wordpress.com/read/blog/id/42227011/ (stilletos and salt)