Dr Doctor you're on call.

So it's back to the wards, and I've been thrown back in on the late shift on call. This entails starting at 1430 with my usual ward team, then attending a 1630 handover from the elderly care wards and the medical wards about sick patients and jobs that the day team havent managed to do, picking up the on call bleep and waiting for it to go off. After 1800 the day team have mostly gone so the elderly care wards are looked after by the F1 (me) and two SHOs.

First job, believe it or not, was to do a PR examination on one of the new patients who had a falling haemoglobin level to check that he didnt have any malaena (altered blood in the stools) that might indicate GI bleeding before giving him high dose aspirin. Now my experience of PR examination from medical school is limited to one hour in the clinical skills lab with a plastic model arse, the rubberised arse section of which got stuck on my finger and came off when I tried to withdraw, resulting in the prostate falling out and bouncing around the room. My only previous attempt on a patient ended rather messily with a proctoscope being farted vigorously back out at me (the patient was quite unharmed I can assure you).  So of course I didnt quite relish the idea of performing this procedure on the dear little old man in front of me. Despite having never met him before I had to gain his trust, gain his consent, put him at ease and perform the procedure competently and professionally.

My tips - make sure the patient is fully informed about the procedure and why it needs to be done (not only does this build rapport but is a legal necessity), take a nurse to chaperone, talk through what you're doing, be quick but thorough, and for heaven's sake double glove (take the first glove off when you withdraw so that you can clean the patient with a clean gloved hand). Document everything in the notes afterwards, especially that you gained consent, who the chaperone was, and your examination findings.

Other jobs included reviewing an outlying patient on warfarin with an INR of 5.0 (this means she's over-anticoagulated and the warfarin dose needs changing). I went to see her, asked if she had noticed any bleeding from anywhere, examined her and changed the dose according to Trust Guidelines.

I also had to review a couple of x-rays and a heap of bloods (normally this is done by the day team but thanks to the phlebotomists not bleeding the patients on some of the wards till 1600 none of the results were back. I found only one interesting result - a sodium level that had dropped overnight from 133 (normalish) to 126. The patient was well and not confused, and none of the medications she'd been started on recently could have caused the drop so I wrote the results in her notes with a plan to repeat the sodium next day.

Handed over to the night team at 2200, fairly uneventful shift.