Manage your thoughts
- Know the main issues with your patients and anticipate problems that may arise including non-response to treatment
- Have previously rehearsed strategies to deal with undifferentiated or defined problems
- Understand the thought processes of your seniors when they launch into a set of investigations or management strategy
- See patterns in your tasks
- Rehearse your referrals / discussions before calling someone so it is clear and succinct. Learn to get to the point
- Memorise the hospital Emergency number
- Memorise MET criteria
- Know how to deal with common emergencies and drug doses e.g. anaphylaxis, dyspnoea, shock, oliguria, seizures, agitation, altered conscious state, coma
- Be familiar with the common conditions and treatments/procedures on your unit
- Always think ‘have I not considered something?’, ‘Is there something I haven’t done?’, ‘What happens if this doesn’t work out?’
- Regularly get informal feedback from your seniors to recalibrate expectations. ‘How am I doing’, ‘Is there anything I do better?’, ‘What do you suggest would help me?’
Manage your skills
- Be efficient and proficient at common tasks e.g. venipuncture, IV access, ABG, NGT, IDC
- Refresh your BLS skills
Managing your time
- Anticipate tasks before you are asked
- Order bloods tests, discharge scripts the evening before.
- Finalise discharge summaries before day of discharge
- Anticipate the type of information required that will influence patient management and disposition
- Be prepared for important questions and decisions during the ward round
- Promptly instigate requests that require time to mobilise – e.g. ward consults, imaging requests, respite care, transport home
- Develop routines to deal with common scenarios
- Check results at the end of the day and keep seniors aware of significant changes or evidence of improvement
- Complete fluid orders and drug chart rewrites at the end of the day for the next 24 hour period
Manage your information
- Make a ready reference of cheat sheets – ward protocols, clinical guidelines, drug doses, therapeutic regimes. Begin memorising them
- Keep a list of important phone numbers – consultants mobile, registrars pager, lab and imaging results, radiology registrar, transfusion lab, HDU, ICU. theatre, anaesthesia registrar, ICU consults, PICC lines, theatre bookings, ward clerk, CSC etc
- Keep Important patient details, labs and imaging together
- Have patient’s results, nursing chart and case notes in front of you when you make a referral
Manage your team – i.e. seniors, nurses, allied health etc
- Know your team members by name
- Learn to communicate succinctly, effectively and respectfully with your team
- Keep your team regularly abreast of your patients’ condition and your thought processes
- Listen carefully to concerns, advice or suggestions and consider them appropriately
- Get assistance promptly if you are unsure of something
- Anticipate the needs and routines of your team. Don’t interrupt unnecessarily or let your disorganisation become a burden to others.
- Learn to deal with conflict professionally
- Learn to co-ordinate your team and capitalise on their strengths.
- Don’t delegate inappropriately or recklessly
Manage your bedside manner
- Apply everything as above with your patient and their relatives
Manage your social supports
- Maintain contact with your peers
- Make time for family
Manage your emotions
- Allocate time to regularly debrief about the day/week/month with a sympathetic ear
- Recognise when you are being pre-occupied with unproductive thoughts/feelings
- Learn to take ‘time out’ to gather yourself together
Manage your ‘outside time’
- Learn to ‘have fun’
- Make time beyond work
- Don’t ‘hover’ around at work once it is finished
- Stay physically healthy – diet, exercise
- Keep or start a manageable hobby
Common sources of stress for the ‘doctor in difficulty’
- Sketchy clinical knowledge > unfocussed clinical assessments
- Haphazard clinical skills > missed critical clinical signs
- Lack of practical application of knowledge and skills > inability to prioritise or identify key issues
- Unsystematic approach to problem-solving > incomplete assessments
- Lack of practise with procedural skills > time wasting
- Poor organisation > tasks not completed in time, frustrated colleagues
- Poor communication > frustrated and angry team members, colleagues, patients and relatives
- Isolationism > pent-up stress