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.

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

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

  1. SO true ! As an aspiring surgeon there is nothing I hated more back when I was shadowing in surgery than ward rounds who take ages but a reason or another and especially no one knew what was going on or what happened ! In the hospital I went to, ward round usually started at 7am on the dot so 6am is good when there isn’t a big list or patient who didn’t do so hot. As a medical student I took matter on my own hand because in some firms the juniors are MIA so I try to compensate a little bit. It makes everyone life easier and I get to not stroll along too long in an activity I just don’t like that much.. The way I see it: the longer the ward round, the less time as a med student I get to prepare myself for operations and read about it if I did not have the time the day before (especially when it is a new one or one which is expected to be difficult).

  2. (That being said, FY1/FY2 explained to me that they were not paid before 8am so from their point of view it wasn’t fair to ask them to come earlier to get ready for surgical ward rounds. The more I think about it, the more I am wondering if it wouldn’t be a good idea to opt out of the hour regulations for FY because imho if you don’t put the hours in – at least as a junior trainee – too many things will not be learned/done properly).

      • Those did not have a life pre med school and are blissfully unaware of the life an banker, lawyer, politician assistant etc. My fiance was in investment banking and a lot of my friends work in corporate law. They d ont even get to have the quasi certainty of becoming a partner like those in medicine with a training number have to become a consultant.
        Even doctors from other EU countries work much more for a lower salary.
        I often talk about that with consultants and fellows and everyone agree that most juniors just don’t spend enough time at the hospital and despite increasing training time, they still reach consultant post needing additional substantial training…

        I am really thinking of migrating back to France once I am done with medical school here. Despite the lower pay and worse hours (even at consultant level), I feel like when you care about your craft in the UK it is really hard to follow through. Partly because of this new culture but also because of all the regulations and the administration…

  3. I’d just like Doctors/Surgeons to treat patients as though there human beings and not visitors from another planet?

    On a recent admission to hospital I was seen by no fewer than 5 doctors/consultants etc in the space of two days, every time I saw one of them they asked me what was wrong with me and asked for tests to be done, the tests that were requested were all previously asked for by the previous consultants/doctors etc, how come none of them seemed to talk to one another to know what was going on with me?

    • Not sure. I can’t really comment on what happened in your experience. It would be an unusual occurrence here to see 5 people in 48 hours and none of them to have read the notes. I have to say that generally my patients are treated well and like me. I have far more thank you cards than complaints. Sorry your experience has been so bad.

      • Please don’t get me wrong, the NHS is a wonderful thing and the majority of the people who work in it are good caring individuals it’s just that I think many have become embittered by the job they do and maybe some should quit?

      • I agree that some people lose site of the caring part of our job. I don’t. I love my job, I hold my patients in the highest esteem and regard and I care deeply for them. I certainly couldn’t function properly if I didn’t. I have some colleagues (see post throwing things in theatre) who are lost sometimes but they are in a minority.

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