Dr Doctor starting surgery.

So last Wednesday was another Black Wednesday, when all the FY1s and a significant proportion of the SHOs swapped rotations. in my hospital, all the FY1s from medicine swapped to surgery and vice versa.

This was quite a shock to the system. I've started in Upper GI surgery, which was my first choice of surgical rotation, partly for the variety and partly that I prefer vomit to faeces (colorectal) and gangrene (vascular), and there might be less need to stick my finger up people's backsides.

So myself and two other equally clueless FY1s were thrown in at the deep end for morning ward round with an exceptionally stereotypical, dragon-like Glaswegian female consultant surgeon who barked things at us.

Surgical ward rounds take approximately one tenth of the time a medical ward round takes. By the time you have found space to write in the notes the surgeon has already seen the patient after the patient after the one you thought you were seeing. Having to scribble down words like "oesophagogastrectoduodenostomy" at lightning speed while remembering all the jobs like requesting CT scans, X-rays, chasing biopsy results etc and trying to understand just what on earth the surgeon has done and why that drain is coming out of there and what the brown stuff/green stuff/black stuff in it might be is pretty challenging.

Afternoons are spent pre-clerking patients prior to their operations. For some reason, somebody thought it would be a good idea for the doctors with the least experience to decide whether a patient is suitable for their operation in a few days time. This involves a comprehensive proforma asking a variety of questions about the patient's past medical history and then examining the patient, sending them for routine bloods including a group and save and reviewing things like ECGs, echo results and chest x-rays, and telling them which medicines to stop prior to their operation.

If anything untoward pops up in the history, exam or investigations we're supposed to find the anaesthetist who will be putting that patient to sleep (difficult as the anaesthetic rota for each week comes out on Thursdays, and is subject to change) to discuss the patient. We have had no real guidance as to what needs discussion and what doesnt, I mean how do I know whether an ejection fraction of 60-70% would preclude someone from having a particular operation. I dont even really know what most of the operations actually involve. Quite a lot of responsibility.

My first pre-clerking came with no ECG, and no echo report, but helpfully informed me that when he had them done that morning his heart had been going really really fast.

- How fast?
- Oh, about 160.
- Do you have any heart problems?
- Dont think so.
- But you're on warfarin, and bisoprolol, are you sure you dont have atrial fibrillation?
- Oh yeah I've got that.

Having spent a good while trying to obtain a further ECG (problems encountered included an inability to stick the ECG dots to the gentleman's chest that was so hairy he looked like a yeti) I ascertained he wasnt in fast AF, or even in AF at that point. Still discussed him with an anaesthetist.