=
> Once or twice A NIGHT! All depends on your method of working and job
> planning, of course, but I doubt I could sustain that for 
> long. The problem
> is often the subtle patient, whose physical signs are not 
> picked up and who
> doesn't have a MEWS score that ripples the surface. Keeping 
> an eye out on
> the shop floor is still the best way of catching those early.
> 



Surprisingly sustainable. I appreciate some departments get fewer sick patients than we do, but certainly most nights there's a patient or two who'd benefit from consultant expertise, so either you go for night shifts or you go for being called in. My own view is that night shifts are probably less sustainable: I'd guess I'm in the department between midnight and 6 am about as much as I would be if I was doing night shifts (with shift work I'd be doing nights less frequently, but would be there the whole night). The difference is that the patients I'm seeing are the interesting ones. Stimulating rather than tiring. Also has the advantage that because you get to see more sick and complex patients you get more learning experiences- means that it's more likely you've met up with a problem before which can make it less stressful.

What you do have to accept with this though is that if you're going to come in for the sick patients that doesn't mean you work longer hours than in a department where the consultants don't. It means you're not there in the evenings and weekends working through the less sick patients. 

All horses for courses, though. Personally I find it less tiring than working solidly through unselected patients when I'm there but rarely getting called when I'm not, but that doesn't mean it would suit everyone.

Appreciate the point about the subtle patients. Only way to pick them up though would be for a consultant not just to be present 24/7 but to see every patient coming through the department. And if you've got enough consultants for that, then each one won't see as many sick patients. Pros and cons of both. Some will work in some departments, some in others (also down to individual consultants: some are better at quickly making a decision whether the patient is sick or not then moving on).


Matt Dunn

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