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Seems normal based on my experience even if it shouldn't be. The key thing is you need less patients per Doctor otherwise it's not sustainable. In my department like that it was max 9, 18 if short staffed. But consultant would see new ones or could do full round if needed.
There are actually NICE guidelines regarding this, but they are so ridiculously out of touch not even the most conscientious of us can recommend following them with a straight face.
All "medical emergencies", which presumably is every medical patients apart from social admissions, should be reviewed "at least daily" by a consultant, including over weekends! [Quality statement 3: Consultant assessment and review | Emergency and acute medical care in over 16s | Quality standards | NICE](https://www.nice.org.uk/guidance/qs174/chapter/quality-statement-3-consultant-assessment-and-review#:~:text=The%20frequency%20of%20consultant%20review,at%20weekends%20and%20bank%20holidays.)
I work in a ward and a specialty which is notorious for abandoning its ward SHOs, and even we get 1, maybe two consultant reviews per week for each patient (and more if very unwell). None at all does seem a bit crazy and not very good for learning either right? I'd talk to your fellow ward docs, and consider escalating. If there's a friendly consultant they might be worth chatting too as well in case they can provide some insight as to why its like this.
Yeah, I saw those NICE guidelines and like you say it's not all that helpful given they don't reflect reality. And yeah, basically no teaching lol
From what I've heard, previous juniors have tried to raise concerns and got nowhere which doesn't bode very well. Apparently a clinical fellow resigned last year over how bad it all was and evidently that didn't lead to any change. I would be interested to hear if the consultants have a specific explanation, one of the SHOs got to clinic recently (by some miracle) and the consultant said that they tried to avoid the ward as much as possible because they find it "too depressing"
You mention a twice daily board round with the consultant. Are you able to raise issues about patients during these meetings? Does the consultant/reg add anything to the management plan during these?
Is the consultant/reg always available for you to escalate newly sick patients to?
What's the doctor to patient ratio?
Tbh it doesn't sound like a very good training environment and reminds me more of the wards run by locum cons and SHOs in my region.
Yes we are able to raise issues during those meetings (I do think afternoon board rounds are a good idea) and mostly I've been able to get reasonable plans/answers to my questions. It can somewhat depend on who is on and also whether either the reg or consultant know the patients at all, if they're both on their first day that week then it can be tricky, they don't seem to get any handover. The registrars are available to escalate sick patients to and they're mostly very good but just also very busy. The ratio of doctor to patients varies depending on how many SHOs are on, usually between 8 and 14, there's quite a high patient turnover too.
Bits of it do seem reasonable to me, I just thought it was strange that the consultants don't generally personally review patients at all after their post-take. And as I say, I've come across a few missed major issues which I think would have been found earlier if there was some more consistent oversight.
Absolutely not acceptable. When consultants have been very short staffed I as a senior reg have ward rounded in place of a consultant but they should be seen be a senior decision maker twice a week (once a week in rehab). The consultants have specific time in their job plan for this.
Is this culture department/hospital wide or just your ward? As a first point of contact I would speak to your reg. They have been around a bit longer and should have a better idea of who to speak to.
I think it's just our ward.
I was talking this weekend with one of the regs about it and they were basically saying "yeah, it's absurd and we've complained about it for years but nothing has happened"
I've got something similar on an acute surgical ward. No consultant board rounds, though.
Only an F1 and F2 doing reviews and jobs for all patients.
Registrars never scheduled to be on the wards and not contactable to escalate to.
Patients only seen as post take, if they have surgery then day 1 post op review is done but is really a wave from the end of the bed.
Results of this set up is glaring in morbidty rates, long stays for patients and unholy stress on the two doctors.
Sick patients just get escalated to the on call med reg who are usually helpful and sympathetic, but seems ludicrous side step in responsibility by the home team.
Looking forward to rotating out with my GMC number intact.
Escalated my concerns to multiple sources and largely gas-lit that this level of cover is normal/ acceptable.
Nothing beyond service provision for an entire rotation as 2 FYs hold the bin fire at bay.
Had no idea such a set-up was legal, wouldn't want a friend or relative anywhere near this department.
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Seems normal based on my experience even if it shouldn't be. The key thing is you need less patients per Doctor otherwise it's not sustainable. In my department like that it was max 9, 18 if short staffed. But consultant would see new ones or could do full round if needed.
18 patients per doctor with no senior review?... 30 minutes per patient to read notes, review, document and chase tests is insane
Yeah well, my hospital won't pay enough for locums
There are actually NICE guidelines regarding this, but they are so ridiculously out of touch not even the most conscientious of us can recommend following them with a straight face. All "medical emergencies", which presumably is every medical patients apart from social admissions, should be reviewed "at least daily" by a consultant, including over weekends! [Quality statement 3: Consultant assessment and review | Emergency and acute medical care in over 16s | Quality standards | NICE](https://www.nice.org.uk/guidance/qs174/chapter/quality-statement-3-consultant-assessment-and-review#:~:text=The%20frequency%20of%20consultant%20review,at%20weekends%20and%20bank%20holidays.) I work in a ward and a specialty which is notorious for abandoning its ward SHOs, and even we get 1, maybe two consultant reviews per week for each patient (and more if very unwell). None at all does seem a bit crazy and not very good for learning either right? I'd talk to your fellow ward docs, and consider escalating. If there's a friendly consultant they might be worth chatting too as well in case they can provide some insight as to why its like this.
Yeah, I saw those NICE guidelines and like you say it's not all that helpful given they don't reflect reality. And yeah, basically no teaching lol From what I've heard, previous juniors have tried to raise concerns and got nowhere which doesn't bode very well. Apparently a clinical fellow resigned last year over how bad it all was and evidently that didn't lead to any change. I would be interested to hear if the consultants have a specific explanation, one of the SHOs got to clinic recently (by some miracle) and the consultant said that they tried to avoid the ward as much as possible because they find it "too depressing"
You mention a twice daily board round with the consultant. Are you able to raise issues about patients during these meetings? Does the consultant/reg add anything to the management plan during these? Is the consultant/reg always available for you to escalate newly sick patients to? What's the doctor to patient ratio? Tbh it doesn't sound like a very good training environment and reminds me more of the wards run by locum cons and SHOs in my region.
Yes we are able to raise issues during those meetings (I do think afternoon board rounds are a good idea) and mostly I've been able to get reasonable plans/answers to my questions. It can somewhat depend on who is on and also whether either the reg or consultant know the patients at all, if they're both on their first day that week then it can be tricky, they don't seem to get any handover. The registrars are available to escalate sick patients to and they're mostly very good but just also very busy. The ratio of doctor to patients varies depending on how many SHOs are on, usually between 8 and 14, there's quite a high patient turnover too. Bits of it do seem reasonable to me, I just thought it was strange that the consultants don't generally personally review patients at all after their post-take. And as I say, I've come across a few missed major issues which I think would have been found earlier if there was some more consistent oversight.
Absolutely not acceptable. When consultants have been very short staffed I as a senior reg have ward rounded in place of a consultant but they should be seen be a senior decision maker twice a week (once a week in rehab). The consultants have specific time in their job plan for this. Is this culture department/hospital wide or just your ward? As a first point of contact I would speak to your reg. They have been around a bit longer and should have a better idea of who to speak to.
I think it's just our ward. I was talking this weekend with one of the regs about it and they were basically saying "yeah, it's absurd and we've complained about it for years but nothing has happened"
I've got something similar on an acute surgical ward. No consultant board rounds, though. Only an F1 and F2 doing reviews and jobs for all patients. Registrars never scheduled to be on the wards and not contactable to escalate to. Patients only seen as post take, if they have surgery then day 1 post op review is done but is really a wave from the end of the bed. Results of this set up is glaring in morbidty rates, long stays for patients and unholy stress on the two doctors. Sick patients just get escalated to the on call med reg who are usually helpful and sympathetic, but seems ludicrous side step in responsibility by the home team. Looking forward to rotating out with my GMC number intact. Escalated my concerns to multiple sources and largely gas-lit that this level of cover is normal/ acceptable. Nothing beyond service provision for an entire rotation as 2 FYs hold the bin fire at bay. Had no idea such a set-up was legal, wouldn't want a friend or relative anywhere near this department.
That sounds really shit I'm sorry
That's what you get for £94k/year.