Being a Med-reg AKA "The dream killer"

I think a sensible start is to say why did i become a med reg.

My background is haematology, always loved it and don't see myself doing anything other than that, luckily haemtology doctors in training or non training jobs don't do med-reg on-calls, that was kind of the silver lining that kept me going. The problem is, as i was trying to run away from my first shitty post as SHO (i have a huge blog entry about, that i am still contemplating whether to publish or not, given how negative it is), the only offer i got straight away as i had no intention to wait or look around was medical registrar in acute medicine. I was a bit scared to take that up in the UK given my perceived notion of the massive amount of responsibility attached to that post. I say perceived as a med-reg in my previous trust does a lot more and has way more responsibilities and duties, than where i am now. Also looking at haematology applications, having a background in Emergency medicine or acute Medicine was highly valued.

There is a big difference between normal daily job as med-reg and being a Med-reg on-call. I will be talking more about being med-reg on-call which i personally think is an inhumane job with a lot of stress, responsibilities and juggling too many things. My impression is it's a system too frail, that there is always something about to go wrong and just misses by a hair (called near miss in more quality improvement terms), a system that is setting whoever is carrying the med-reg oncall bleep to fail and then blame him or her for the shortcomings.

Here is the list os duties that should be carried out by the med-reg:

1. Answer the bleep! (Quite challenging right! LOL)

2. See all sickies inpatient in the hospital and coming through the take

3. Manage the take and by that prioritize who to be seen first or if there is some intial management to be done

4. Take the referrals from ED, and all other specialities

5. Take referrals from GPs in the community or discuss cases with them if they seek advice

6. See or discuss patients escalated from the teams whether clerking or ward cover

7. Clerk patients (scoff!)

8. Take handeovers from all the consultants

9. Attend to nurses who don't want to bleep junior doctors for whatever reason

10. Admit surgical patients because there is "no surgical issues" now

11. Procedures

12. Be asked about patient movements to other wards or out of certain areas

13. Shit gold and fly!

1. Answer the bleep!

Sounds pretty simple, right? What can be difficult about answering the bleep when it goes off? It's a very difficult question to answer, but it has to do more with the kind of bleeps you get and the timing for those. In my last on-call for at least 4 hours i was unable to go pee just because bleep and jobs are piling. I ended up coming with my own smart technique to prevent that from happening, no eating or drinking at all when i am on-call. I only allow myself coffee and at certain intervals so that I won't need to use the toilet at all. I read the NHS rules about being allowed 30 minutes of uninterrupted breaks every 4 hours and i want to either hysterically laugh at how stupid that rule is or cry my eyes out at the sheer differentiation in being treated as less than the rest. It is second to impossible to interrupt a nurse's break which i think is fair but unfair when i tell that same nurse, i am on break and she would scoff at that (obviously that was when i was SHO, never had the audacity of even thinking about taking a break as med-reg)

Bleep can go simultaneously at same time and lo and behold if you don't get back to whoever did bleep you, you get told off as if i was sitting around picking my nose and not wanting to get back to them, just for them to tell you about some mundane job for a patient looked after by another doctor from the team, just for me to tell them to bleep that other doctor! A question arises here is why don't they bleep that doctor straight away, and i am still looking for an answer to that one. The amount of non sensical bleeps that i get, that i honestly see no point to is massive, i get interrupted hundreds of times, how am i supposed to focus and see the sick patient, process whatever is going on and make a plan if i am getting interrupted? Why then i am held accountable for everything and anything that possibly could and will at some point, go wrong?

2. Seeing the unwell patient.

I enjoy Medicine, i love the thinking process and trying to figure out what went wrong and have differential diagnosis, I just hate doing that under pressure. I hate being rushed to do it. I particularly hate when i got the right diagnosis or was about to do something that was going to put me in thr right direction of reaching the diagnosis but then i get interrupted and then i forget what i was about to do and then one of the consultants gives you this look, like how more stupid could you be to miss this! It takes away the only bit i enjoy......

3. Manage the take.

Managing the take initially sounded the most simple job and to be honest it is not that difficult, but just it gets lost in the frey of the battle and can have really serious repercussions. The problem with this, it is not noticeable or appreciated or rewarded except in retrospective way and only by the med reg so most people don't really consider it a thing. Although it can be really tricky, for example you have a busy take, 3 or 4 really really unwell, ITU discussion patients, potentially unwell, couple of angry patients, GP referrals which some times u have no recent bloods or any clue whats wrong with them, someone who has been waiting for ages and you get a couple more referrals. The question is who gets seen first and by whom, ideally you would need to know your team and their capabilities (scoff again!). Bed manager and some consultants don't care about this bit and only care about clearing the list. My impression is, taking some time to think it through and allocate patients is 2nd to taboo or maybe do it when you are going to pee (which we already agreed on, is not allowed)

4. Take the referrals

Integral part of being med-reg oncall. Most of the time no issues or there might be some regarding who needs admisison and who can be sent home with ED but I don't argue with them, if i feel that the patient needs to go home and they are reluctant to do that, i would see the patient and do that myself. My issues are usually with surgical specialities who are most of the time call me with the phrase "that patientis referred to us but has no surgical issue" and if i asl so what kind of issue does she/he have? Answer is either don't know or no issues!  Why not send her/him home then if there are no issues? "Oh yea will do" and that reply is the closest thing to give me a stroke.

5. GP referrals

I see no point for me to take referrals from GPs and luckily in my current trust they took this mostly off our backs. I think they should refer to ED particularly that mostly they refer for Ix that if normal patient will be sent home, which i find easier done through ED but i can appreciate it's a stretch to the department

6. That's reasonable, interesting andnnot really stressful. The only reason i dislike it is you are in this mess and the bleep doesn't stop and then you have to stop and clear ur mind for a new patient discussion and make sure nothing is missed.

7. Clerking, again we all enjoy the investigative work, thinking and coming out with the diagnosis. It is the constant interruptions and the expectations of the team and consultants that you are expected to see as many patient, do the full clerking , do the jobs and do a damn good job of reaching the right diagnosis and Investigations, otherwise u r an embarrassment to all the medical registrars. Common things we hear all the time, why are there so many patients waiting to be seen? Or consultant coming to me every 10 minutes and asking "so who have you seen?"? And i would be like !

The rest is self explanatory. Just something to add, i definitely feel a bit overwhelmed being out of the system i am used to. I am under more stress and still trying to make sure i fully understand the systemor the conditions that in my previous "life" was managed by other specialities.

I think medreg in the NHS is expected to know everything in medicine, surgery, obs and gynae, not to bother the consultants, shit gold and fly 😂. If not then you are useless, an embarrassment and probably should quit medicine. No wonder everyone who i come across says to me, it is the shittiest job in the hospital.