A registrar survival guide... surviving out of hours

Gain familiarity 
Arrive at the base in plenty of time so that you can familiarise yourself with the computer system and your colleagues.

You should always be adequately supervised when doing any out-of-hours work.

Familiarise yourself with the department’s policy pertaining to drugs of abuse, for example benzodiazepines, so that you can confidently deal with such requests from patients.

Do not leave valuables or prescription pads lying around; these are prime targets for thieves.

Do not skip meals and have a cup of tea occasionally to recharge.

Beware of dangers 
When doing home visits always ask the person opening the door to you to take you to the patient.

Trust your instincts. If you don’t feel safe leave early. Make the excuse that you have to get something from the car.

In most cases you will not have the benefit of notes so always take a careful history and listen to the relatives.

Be extra thorough with examinations and do not cut corners. Have a low threshold to admit or seek advice for patients you are not quite happy with.

Many medical conditions (especially respiratory complaints) will deteriorate overnight, therefore ask yourself if it is going to be safe not to admit the patient to hospital.

Use the phone
When consulting over the telephone, introduce yourself, try to speak to the patient or if you are speaking to the patient’s representative ask to speak to the patient as well. Ask them to repeat the advice you give them back to you.

It is best to take care with issues of confidentiality when speaking to relatives.

Again, while on the telephone, if you feel that the patient would be better seen, have a low threshold and ask them to come to the premises if they can.

If a patient insists on a visit that you deem unnecessary and a confrontation seems likely, then agree to the visit and save yourself stress. You could make it clear in the notes that the patient insisted.

In every case make sure that you take comprehensive notes should there be a complaint.

Debrief
After the session, debrief with your supervisor, make notes of interesting cases and skills you have learnt and do not forget to ask them to sign your form.  

Dr Elisabeth Croton is a GP registrar in Birmingham

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