Mind the Bleep

Covid-19 is taking a huge emotional toll on everyone. The usual work-life balance tips don't work as well when you can't go out and everyone's emotions are on overdrive. Finding ways to support each other and help deal with the situation is incredibly important.

1) It is a marathon, not a sprint.
Nobody knows how long this will last. There's no point exhausting yourself too early. It is okay to be working in a quiet ward or a quiet hospital. Help your colleagues if you can, but don't overwork yourself and certainly don't feel anxious or guilty that you are not helping enough. Everyone will have their time at some point; taking it in turns and having fresh faces every few weeks is safer for staff and for patients.

2) Take breaks during work - Read the full article
It is easy to forgo breaks & food when your list of things to do looks endless. Know that missing out on these crucial components of your day will slow you down and will increase your risk of mistake…

This is a tricky area to cover as it can be challenging to us both personally and professionally when things don’t go well with a colleague, particularly when we know that this might impact patient care and/or our own mental health. The longer these negative interactions go on, the more likely they are to significantly impact on outcomes for our patients, our colleagues and ourselves.

From personal experience there are three golden rules to consider when you have a bad interaction with a colleague:

Bullying and harassment should never, ever be tolerated. 
It is hard to speak up sometimes. Especially when it is a singular episode with hierarchies of power involved and no witnesses. Your response may range from simply documenting the event somewhere secure, so that you have a contemporaneous record of what happened and who else may have been involved to support any future decisions you might make, all the way up to formally speaking up. If you do escalate, exercise careful thought. The f…

For new doctors, prescribing anticoagulants can be daunting. A few simple rules can make this easier. Ensure you use your local guidelines in the first instance, which often provides information on first line agents and dosing. The information below may be incorrect and so hence, as per our disclaimer, do use your own clinical judgement.

The anticoagulation agents
Low molecular weight heparin (LMWH)Adjusted by weight & renal functionShort duration of actionWarfarinCheap, easy to reverse & but requires regular INR checksLong duration of action (about 5 days to completely reverse)Other Vitamin K antagonists are rarerDirect Oral Anticoagulants (DOACs)Formerly known as NOACs  Includes apixaban, rivaroxaban, dabigatran, edoxabanMay require adjusting by weight, age & renal function Advantage of not requiring INR checks but they don't have as wide a license as the above two & have essentially no reversal agent (except dabigatran)Medium duration of action (a few days of cess…

As a junior doctor, you will frequently look after patients prior to and after their operation. You may be asked to clerk patients who are admitted to hospital the night before their operations. Here are some things to consider during your clerking & whilst you're considering pre & post operative issues.

Pre-Operative Clerking Before you see the patientWhat operation will they be having & when? Which consultant will be completing it? Read their last surgical & anaesthetic clinic letters as they often give important instructions about pre-operative careConfirm with the patient which operation they are expecting to have. Take a brief history.Take a brief pre-op assessmentAny previous surgery? Any pre or post operative complications e.g. nausea/vomiting, complications with anaestheticDrug history - allergies! Holding nephrotoxic agents (e.g. NSAIDs, ACE inhibitors), sliding scale for diabetics, holding of blood thinners. Drugs that must not be stopped: antiepileptics, p…

Dermatology is a vast topic that junior doctors often find daunting. Do read our article on describing skin lesions. Fortunately, there are only a handful of conditions that are important to know as a junior doctor on the wards. These will be covered below:

Eczema/Dermatitis
Dermatitis is a generalised term describing irritation of the skin resulting in itching, dryness, and erythema. It can be caused by a specific irritant such as nickel, creams or generally be caused by stress or conditions such as eczema.

Presentation
Patients will usually complain of itching of the skin which can occur at the flexural creases. The skin will appear erythematous, dry and itchy and lesions are usually poorly demarcated. Some patients may have very specific localised areas of dermatitis which may indicate that there is a specific irritant such as metal from clothing.


Management
Usually, dermatitis can be managed well with emollients and ensuring the skin is always well moisturised. In more severe cases a…

It is quite common for you to need to describe rashes for documentation purposes, to senior colleagues or to refer to various specialties including dermatology. Here is a refresher of the terminology to describe common skin lesions. For more detail, check our source.

Systematic Examination
Inspect – Observe the overall appearance of the lesion i.e. site, number, pattern of distributionDescribe – Inspect the individual lesions i.e. size, colour, morphology.Palpate – Feel the texture, temperature, tenderness, consistency and mobility.Expose – Thoroughly examine the other systems as appropriate i.e. nails, hair, mucous membranes and any other body system required.Distribution
Acral (distal extremities)Dermatomal (confined to a single spinal nerve)Extensor or flexuralFollicular (around the hair follicles)Generalised (not fitting any specific area)Photosensitive Pressure areasSeborrhoeic (around secretion of sebum) Specific body partsColour of individual lesion
Hyper or hypopigmentedErythemato…

As gynaecology issues uncommonly present on the ward, many doctors have difficulties with the standard framework for addressing these issues. The classic referrals to gynaecology are:
The nursing staff have noted vaginal bleeding. Could this be assessed?Could this abdominal pain be gynaecological?The abdominal scan has shown a pelvic mass or ovarian cyst. What shall we do? Having a framework will enable to you to provide a clear referral expediting care for your patient so bear in mind the important aspects listed below. Each section is linked to relevant resources for you to help categorise the exact condition your patient might be affected by.

Gynaecological History:
PV bleedingConsider whether bleeding may be from the rectum or urethraWhen does the bleeding occur? e.g. postcoital, intermenstrualAre they on anticoagulation? Do they have symptomatic anaemia?Abdominal painNever forget pregnancy in any woman of childbearing age (think ectopic)More detailed systems review of known gastroin…