Prioritising your jobs on call
BMJ 2014; 349 doi: https://doi.org/10.1136/sbmj.g6315 (Published 30 October 2014) Cite this as: BMJ 2014;349:g6315
- Emma Grennell, medical senior house officer1,
- Steven Alderson, core trainee, acute care common stem: anaesthetics2
- 1Warwick Hospital, South Warwickshire Foundation Trust
- 2Airedale NHS Foundation Trust
Most medical students are familiar with the “day job” of being a junior doctor, which includes organising ward rounds, booking tests, and writing discharge summaries. However, fewer students are aware of the other side of the job and the realities of working on call. If you have followed the advice in the series so far, you should now be well prepared for your first on call, and know how to receive and give a good handover by highlighting sick patients, concerns from the previous shift, and outstanding jobs. Now it’s time to get to work.
In the daytime, you might be responsible for every medical patient on a ward; on call, you might be responsible for every medical patient in the hospital. One of the most important skills of being on call, then, is prioritising effectively. This article will help you to understand how to prioritise your on-call jobs.
Your jobs list
After starting your on call, you are handed over the following jobs:
Please take some routine bloods (a full blood count, biochemistry, and clotting studies) from Mrs Adams. She is well, but the day team find her difficult to bleed
Please speak to the family of Mr Brown. They want to ask some questions about his care
Please review Mrs Clark. She is complaining of a headache, but is otherwise well. Her observations and Glasgow coma scale score are normal
Please review Mr Davidson. He feels short of breath, and hot and sweaty. He also has a fever
Please write a discharge summary for Mrs Edwards. She is due to go home first thing tomorrow
What do you do first?
Prioritise sick patients
Fundamentally, the on-call team should provide medical cover for emergencies. As such, your priority on call should be recognising, managing, and escalating unwell …
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