Hi, I am Neenu, an NHS doctor from India working as a junior doctor in Colorectal Surgery. This was my first job in the UK, and honestly, it was quite overwhelming in the beginning. The system, the multiple referral pathways, and the community/GP involvement were all new to me. I had to learn to fit into the system, and with this blog, I hope some of you will be able to understand the workings of this department. In today's blog, I will be discussing the following:
1. Introduction to the department
2. What the day looks like?
3. What are the jobs we have to do?
Introduction to the department
In our hospital, general surgery mainly consists of colorectal, upper GI, urology, and breast surgery. Among these, I was working in the colorectal department. In colorectal surgery, we see everything lower GI, that is, large intestine, sigmoid, rectum, and anal pathology. Most of the patients have varied symptoms, from abdominal pain to PR bleeding and conditions ranging from appendicitis and hemorrhoids to rectal carcinoma.
What a normal 8 to 5 working day looks like?
We start our day at 8 am in one of the surgical wards starting with a ward round. F1s or junior doctors print the patient list for the Ward Rounds. In the ward rounds, a surgical registrar, along with the junior doctors, see all the patient admitted under colorectal surgery and review them, making a plan for the day. Most of the cases that we see are patients who get admitted to the wards post major surgeries such as hemicolectomies and low and high anterior resection.
During the rounds, we get the patient notes in the computer system, see what post-op day they are in, check whether their vital signs are normal and, whether their blood tests are normal, whether they had any imaging done - if so, we review them. Once we know the patient details, we review the patient, examine them and address any concerns that they might have whilst also formulating a plan for them.
We go through all the patients and finish the ward round at around 10.30-11 am. After that, all the junior doctors make a job list, and each junior doctor is allocated a set number of patients. We then carry out the jobs for the patients prioritising according to the most urgent task.
Towards the end of the day, we do a run-through, which essentially involves reviewing the patient list once again with the registrar. We discuss the results of any investigations that were not discussed previously, review bloods that were not seen before, and create a plan once again. At the end of your shift, at around 5 pm, if there are any pending tasks that need to be done, we hand them over to the twilight/on-call team, making sure they are aware of any unwell patients in the wards and also if there are any urgent investigations that need chasing up.
Occasionally, if there is a staff shortage or if one is particularly interested in the specialty, one may get to scrub in the theatres, helping the registrars or consultants. Every Friday, we have a grand board round, where consultants and the rest of the team, including a dietician, nurses, and other specialties, go through the patient list and review each case. Each patient is reviewed, bloods are discussed, images are reviewed, and a management plan is formulated. After that, we do a ward round along with the consultants and carry out the jobs accordingly.
On-calls/Nights: As an FY2 doctor in my Trust, I don't normally do surgical on-calls; instead, we are posted long days (8-8 shifts) in the post-operative ward reviewing and managing patients who had elective surgery.
What are the jobs we have to do on a normal working day?
Prescribing – We may have to prescribe fluids and medications depending on the clinical status of the patient.
Ordering investigations- CT, USG, PICC – Depending on the clinical status of the patient, patients may need certain investigations that need to be ordered. For e.g., an unwell patient with a tender abdomen may need an urgent CT scan to rule out bleeding/anastomotic leak.
Liaising with different specialties – Sometimes, the patients may have other conditions co-existing that may need input from other specialties. For e.g., some patients may have cardiac conditions which may need a review from a cardiologist.
Take bloods – Most of our patients require daily monitoring of their inflammatory markers, and sometimes the phlebotomists do not collect them (For e.g., some phlebotomists do not collect bloods from PICC lines). In that case, we may have to collect the bloods.
TTOs (To Take Outs) – Discharge summaries – Briefly outlining the events that happened from when the patient was admitted to the hospital.
Speaking to the NOKs (next of kin) – Often, we may have to talk to NOKs to update them about the patient’s care.
Sometimes, we get bleeped by the nurses for seeing patients who are unwell, and we have to review them and manage them, escalating as deemed appropriate.
A brief knowledge of these will help you in this rotation:
- Difference between colostomy and ileostomy
- Common presentations: pain abdomen, pr bleeding
- Management of the post-operative patient and peri-operative nutrition
- Common surgeries: anterior resections, hemicolectomies, abdomino-perineal resection
- Common conditions: Crohn’s disease, Ulcerative colitis, Diverticulitis, Bowel obstruction, Bowel perforation, Bowel cancers
Overall, working in general surgery is a good start to your career in the NHS. You tend to learn a lot about the NHS and how everything works which will help you get adjusted to the system faster.
Need some help?
TrewLink has an amazing website which will help you in your journey to the UK. If you need any help or guidance with regard to your exam preparation and journey to the UK, you can always approach us here: https://www.trewlink.com/. You can register using this link https://trewlink.com?referrer=nee420214. I hope my post will help those of you who are starting as a junior doctor in the NHS.
Good luck,
Dr Neenu