Prioritising
We have all heard about the importance of prioritising tasks while at medical school. Many, like myself, thought it would be an easy skill to develop on the job and that, once we had the knack of it, it would be plain sailing. At medical school you get taught how to prioritise tasks between an unwell patient, a phone call and a patient who has suddenly dropped their Glasgow Coma Score – easy, right? Wrong! What awaits you as a doctor is something unimaginable. The sheer workload, gradually increasing levels of stress, lack of sleep and the constant interruptions can make even simple tasks seem very difficult.
Just to paint you a picture,imagine the following scenario:You are currently in front of the computer ordering some urgent blood tests for an unwell patient and are due to see another unwell patient who seems to have become septic. While you are ordering the blood tests, a nurse comes in asking for you to write up a medication for a patient. Then the dietician walks in asking for information about the patient they are going to see. In addition to this, the phone is going off and you know it's the radiologist you bleeped earlier to discuss a patient. While all this is happening, in the background you see a nurse who earlier asked you to do a TTO (to take out) for a patient due to go home later, but unfortunately you haven’t had the time to do it.
In the above scenario, you could pick up the phone (after pardoning yourself) to talk to the radiologist. If you're able to multitask, you mightbe ordering the urgent bloods at the same time. Once you have finished talking to the radiologist, you can ask the dietician if you can speak to them in a few minutes and ask one of the nurses to get the drug card for the TTO. In the meantime, the drug can be prescribed and you can talk to the dietician while you wait for the drug card to finish the TTO.
As a junior doctor, it is important to be able to prioritise tasks well and efficiently. This will help you work within your remit in a safe manner. Here is an overview of the most common things you may have to juggle:
Unwell patients
Unwell patients are always the first priority. If there are multiple unwell patients, then the one with the highest Early Warning Score (EWS) should be seen first. If possible, get one of your colleagues to see the other unwell patients. It is important to know that septic patients will often keep scoring even after treatment has been initiated. Use your own judgement (based on EWS) to decide whether they need to be reviewed again. It is important to always ask for help from seniors if you need it.
TTOs
You will constantly be asked to do TTOs and it will feel like they are never ending. It might not seem like it, but TTOs should be one of your top priorities. If beds are being blocked because someone hasn’t been discharged in a timely manner then other people’s care will be compromised. A handy tip – if you don't have time to do the whole TTO, just do the medications part so that the pharmacy can start processing it; you can come back to the discharge summary when you have time.
Bloods
Bloods will normally be taken by the phlebotomists but sometimes you may be required to do extra during the day. Depending on the urgency of the bloods, these can be lower down on the priority list. It is worthwhile to consider whether it is necessary for the bloods to be taken on the same day or if it could wait until the next day (when the phlebotomists can take them).
Referrals
You may be asked to discuss a patient with a different team or get hold of other services. Unless you need to speak to them urgently, this can be done after unwell patients have been seen and the TTOs completed. If you require the team to review a patient the same day, you will want to do the referral in the morning so that the other team have sufficient time to be able to see the patient. A handy tip – if you are able to multitask, consider doing the TTOs while discussing patients with other teams/services.
Ordering tests
Urgency of the required investigation will dictate when you should order the tests. For example, if a computerised tomography head is required to rule out an intracranial haemorrhage then this would obviously take priority and you should get this arranged as soon as possible. If it's an investigation that is not required or is unlikely to happen that day (eg a renal ultrasound scan to assess the cause of haematuria) then this can be requested later in the day.
Gowrav Gowda, foundation doctor representative for the RCP's Student and Foundation Doctor Network.
