In the UK, all doctors in training are employed by the NHS. Over the past decade, changes to the structure of the NHS and the subsequent loss of consistent teams within the hospital have made it much more likely for junior doctors to be practising in areas they are unfamiliar with. In addition, it is commonplace for doctors at this level to rotate through different areas of practice every 4 to 6 months; meaning they are almost constantly having to learn to work within a new specialty. Moreover, they routinely will provide overnight cover for multiple specialties, and may not have ever worked in those specialties during their day job. They will often be expected to deal with things they have never seen, and perhaps have only just read about during medical school. Further, their seniors may not be physically present to provide advice. As such, there is therefore a clear need for a text, a kind of survival guide, that will give these doctors the essential information required to deal with problems specific to the specialty they are working within
This book is written for Senior House Officers (SHO) working in the most common surgical specialties. Typically, these will be junior doctors with between 1-4 years of clinical experience. Those who have recently started a new rotation or are working in an area outside of their usual practice, and have periods of time where they will be expected to evaluate and treat patients with minimal senior guidance, will find this book most useful.
The book aims to be a survival guide for SHOs evaluating and managing patients while on an on-call shift. The book seeks to assist SHOs in acting autonomously, particularly as their seniors (Registrar) will be frequently unavailable on-site to help in the evenings or overnight.
- The text will guide the reader on how to screen referrals from other specialties - a process that usually takes months of trial and error to become comfortable with. It will suggest the key features of the examination and history that help make a diagnosis and differentiate cases from similar differentials.
- It will also suggest the immediate and overnight management for the patient, including when it may be appropriate to involve other medical specialties.
- Most importantly, it will support the reader by ensuring they have the relevant key information at hand when consulting with their senior over the phone.
The book is written assuming the reader is a competent surgical doctor, who is proficient in general management of patients, but assumes no specialist knowledge. The aim is to provide the reader, who has 1-2 minutes while walking to the emergency department to see a patient, with an overview of the condition they are about to deal with and the practical steps they can take in diagnosing and managing the patient overnight. It is not an in-depth exploration of the minutiae of surgical practice, nor will it teach the reader how to be a doctor. It is a reference text for competent doctors in need of specialist guidance; it will help get that doctor through the night using efficiently formatted practical advice from experienced senior colleagues.
The book will cover the most common areas of surgical practice; Lower GI, Upper GI, Orthopaedics, Thoracics, Cardiac, Urology, ENT, Plastics and Vascular surgery. In medical school, junior doctors seldom receive much practical experience in all of these specialties and often have minimal induction periods of prior to starting their new jobs. Further, the step up from a Foundation Year 1 doctor (House officer) to an SHO, is significant, and happens overnight. The purpose of this book is to give these relatively inexperienced practitioners direction and to help structure their thinking when they see new patients. Very specialist fields such as Neurosurgery or Paediatric Surgery have not been included in our book as SHOs working in these specialties are usually very well supported and supervised, and are seldom required to function independently.
For each specialty, the most common presentations to the Accident Emergency department will be discussed, as will common problems encountered on the ward, and where appropriate, a guide for performing simple procedures. As such, information is limited to the essentials required to manage the acutely unwell patient overnight.
STRUCTURE & CONTENT
The book seeks to act as an experienced senior colleague who can provide practical advice to the reader. Indeed, each of the authors wish they had such a book when they were new SHOs themselves. The collection of advice, suggestions and tips are a condensation of years of experience.
Each surgical specialty places varying degrees of responsibility on their SHOs - thus each chapter varies in the level of detail provided. The book tries not to overload the reader with information that is unlikely to help them in the middle of the night, and is distilled to the level of detail appropriate to their relatively junior grade.
Each entry pertains to a single clinical entity, diagnosis or presentation and is completely self sufficient i.e does not require the reader to reference other entities. This is an ideal structure for a busy surgical trainee out of hours.
To facilitate ease of use, every entry is structured the same way; a brief introduction, how to screen the referral, ‘red flags’, how urgently to discuss with a senior, history, examination, management. There are of course some variations where clinical practice would demand it.
The content of the book will be reviewed by Senior Registrars or Consultants in relevant specialties.