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Sunday, 27 January 2013

Ward rounds - a survival guide


Surviving a long ward round can be tough, especially as a medical student. You are expected to stand there drinking in every detail of what is going on and at any given instance be able to recite the full textbook entry for any given disease.  I remember doing my very first ward round during my work experience in sixth form, not knowing what to expect. After 4 hours of trudging round the hospital, understanding very little, we ended up in a warm stuffy room and that was when I started to wobble. I somehow managed to stop myself from fainting completely and one of the junior doctors took me outside, sat me down and gave me a glass of water. I will never forget how embarrassed I felt at that moment.


More recently I have been back into the long ward rounds, the longest one lasted from 9am to 3pm with a five minute break for water, that's longer than it takes to run a marathon! This being due to the fact it was monday, the wards were busy and there were lots of very complicated children that needed detailed management plans drawn up. This time I got away without fainting, instead recieveing only aching feet and a rumbling stomach. Sometimes it can seem like ward rounds are a test of endurance rather than a learning activity, so to help you survive I thought I would come up with a few practical tips.

1) Know the speciality. It doesn't matter how hard you try, if you don't have a reasonable knowledge of the speciality then you aren't going to be able to follow what is happening.

2) Find out about the patients. If you know a little bit about every patient on the ward round then you will feel more involved, and hopefully it will help you learn as well. If there is a morning handover then go to that because they will discuss all the new admissions from the previous night and anything that happended to the inpatients during the night.

3) Get invloved. Find something to do. Some consultants are very good at getting the students involved, asking questions and getting them to do little jobs, others aren't. If that is the case then create a niche, be the person who goes and gets the observations charts or finds the notes for the next patient. If you make yourself useful then at least the junior staff on the round will appreciate your presence and you will have something to do.

4) Ask questions. Ask lots of questions, if you think something isn't right or you can't see the reasonaning behind doing something then ask. An astute question can impress a consultant much more than a good answer to a question.

5) Be prepared. This sounds really simple, but this is what I neglected on that first fateful ward round.
    • Have breakfast, you might not feel hungry in the morning but if you are anything like me then your stomach will start to rumble after an hour or two.
    • Make sure you are well hydrated, the round probably won't stop for a drink so make sure you are topped up before you go (although not too much or you might need the toilet).
    • Wear compression socks, I'm not kidding! A lot of the nurses wear compression socks because it helps keep the blood circulating rather than pooling in your feet, put some on and I guarantee you will notice the difference after three hours.
    • Make sure you've got everything with you. Pen, paper, stethoscope, watch, ID badge for when the consultant forgets your name.
6) If you can sit then do it. If you get the opportunity to sit or even perch on a desk then do it. Anything that takes the weight off your feet will work wonders.

7) Just ask. If worst comes to worst, or you are having a bad day then just speak to one of the doctors. You might be worried about approaching them, but they were probably in your position once, just ask if you can go and sit down for five minutes then rejoin them. It is nothing to be ashamed of, the doctors on the round have years of practice of being on their feet all day, you've just been sat in a lecture theatre for the last three years.

8) Take a snack. If you think that number 7 is going to apply to you then just take along a snack. It's amazing what sucking on a small mint or boiled sweet can do for you, just make sure its the type with plenty of sugar and not those sugar free ones. Don't be ridiculous though, pulling out a bag of crips and munching on them loudly will not be appreciated.

9) SMILE! It is amazing how much a smile can do. The nursing staff will help you find the next set of notes. The consultant will be more likely to answer your questions. And arguably the most important person  there is the patient. All too often a large group of people crowds round a bed, talks about someone in third person and then leaves with barely a nod in the direction of the patient except to prob them a little bit. If you stand there and smile at them then they will remeber that lovely young doctor* for the rest of the day, especially useful if you want to take a history or do an examination later.

I hope that helped a little bit, I wish someone had imparted some of this sage advice to me before my first ward round. If you have any other tips for surviving this endurance sport by then just let me know below.

* It doesn't matter how many times you tell them you are a medical student they will still think of you as a doctor, so just take it as a compliment.

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