Resident Medical Officers
Diagnose, treat and prevent human physical and mental disorders and injuries under the supervision of senior Medical Practitioners.
A night shift in emergency
You are a junior doctor, a Resident Medical Officer, working your first night shift in an emergency department, with senior doctors available but busy. It is 9pm. The department is filling up, the day team has gone home, and the night shift has just begun. There are more patients than beds, and you are expected to start seeing people.
Choose what you would do. Then see what happens. There are often good reasons for each choice.
Doctor, the man in bay six has been getting quieter over the last half hour. His numbers haven't changed much but I don't like how he looks. I'd feel better if you came and had a look.
Finish what you're doing first, because his numbers are stable
By the time you arrive, he has become drowsy. The nurse had been right to worry, and you now need to call for help urgently. Trust an experienced nurse's instinct.
Go and see him now, and thank her for speaking up
You spot a change that's easy to miss, and call your senior. Between the three of you, you act early. The nurse tells you later that she'll always flag a worry to you.
Ask her to recheck his numbers and call you if anything changes
It sounds sensible, but the nurse has already told you what worries her. A short visit would have been better than a message.
That patient with the minor injury can go home. I looked at him earlier. Just write him up quickly. I know you're not sure, but I'm rather busy, and I'd like the bed for someone sicker.
Do as she says and write him up for discharge, since she is the senior doctor and has already seen him
He goes home, and you remain uneasy. It turns out to be fine, but you've learned that being unsure is worth saying out loud.
Say politely you have a concern, explain it in a sentence and ask if she wants you to recheck
She pauses and agrees to look again. A quick recheck finds nothing worrying, and she thanks you for saying so. You both move on without tension.
Refuse to write him up for discharge unless she comes and examines him again herself before he leaves
You may have a point, but demanding a re-examination creates conflict at a busy moment. The senior becomes defensive and less open to your questions.
I've got two patients to hand over. The first is straightforward. The second is a bit of a puzzle, but I'm exhausted and I've got to get home. I'll leave a quick note. You'll be fine, won't you?
Agree and let him go, because you don't want to keep him after a long day
The note is thin, and at 2am you can't work out what was planned. You have to track him down by phone and wake him up.
Ask for a few minutes to go through the second patient in detail, and note down any questions
He stays for ten minutes and clarifies the plan. It's a small cost, and you're far more confident later in the night.
Ask him to walk you through both patients briefly, then let him go
You get a clear picture in five minutes, including the one thing to watch. He heads home, and you handle the night with fewer surprises.
How it went
The sun is coming up as you finish your last note. The first month as a junior doctor is mostly learning when to act, when to ask and how to say I'm not sure out loud. How would you feel about the learning curve of a night like that?
This is a simplified, fictional situation to help you explore. It is not professional instruction or a test of your ability.
Case study: The patient who looked fine on paper
A fictional case set in the emergency department of a fictional hospital, on a night shift.
The situation
Dr Wen Chen was in her first month as a Resident Medical Officer, a junior doctor, working a night shift in the emergency department. A man in his sixties named Mr Barrett had come in with vague stomach pain. His tests came back mostly normal, and the waiting room was full. A nurse told her that Mr Barrett was fine to go home. Wen wasn't sure. He looked pale, and something about his answers made her uneasy. It was three in the morning and her senior doctor was dealing with another patient.
What they did
Wen didn't want to look like she was making a fuss, but she went to find her senior. She told him briefly what she knew, what she'd found and why she was uneasy. She said exactly what she needed from him, which was a second opinion before the patient went home. He came and examined Mr Barrett himself. He asked a few more questions, found a detail that had been missed, and ordered a further test. Mr Barrett was kept for observation.
How it turned out
The extra test showed a problem that needed treatment, and Mr Barrett was admitted to a ward. The senior doctor told Wen that asking was the right call, and that being unsure at three in the morning is when you should speak up. She later said it was the moment she stopped being scared of asking.
What would you do?
- Why might it be hard to ask for help when you are new?
- How can you say I'm not sure in a way that helps the team?
- What did Wen notice that the test results did not show?