A registrar survival guide ... surviving an out-of-hours centre

Contributed by Dr Pipin Singh, a GP ST3 in Northumbria

Arrive early
Arrive 15 minutes before your shift starts. This will allow you time to familiarise yourself with the layout of the out of hours centre, the administrative staff, your telephone booth and your allocated driver, if appropriate to your shift.

Your supervisor
Clarify your objectives with your supervisor and discuss any necessary housekeeping. It is important you know how to contact your supervisor at all times as you will speak to them frequently, particularly in the first few sessions. You may have to wait for advice, so be patient as your supervisor is seeing and triaging patients too.

Your computer
Ensure you are familiar with the software, how to document consultations, how to code the working diagnosis and save.

Telephone triage
This will be unfamiliar territory to most GP registrars. Familiarise yourself with the key theory surrounding effective telephone triage.

Always revert to basics (confirm whom the person is on the other end of the phone). Ensure that the history is detailed. You do not have their medical records, thus a detailed past medical history is crucial. Social history may influence your management.

Remember, you do not have the luxury of observation so be alert to cues over the telephone.

Have a low threshold for requesting an examination. Safety netting is critical. Clear instructions are necessary to the patient or carer on what to look out for and what to do if a change occurs.

The car
Ensure you know exactly what your diagnostic bag, drug bag and palliative care bag contain. Document accurate notes after your visit for typing up later - a BP from six hours earlier is easily forgotten.

If your shift overlaps a major meal, ensure you have food with you.

Time keeping
Ensure you leave enough time to debrief with your supervisor.

Essentials checklist

  • Familiarity with local hospitals admissions procedures and primary care centres.
  • A copy of MIMS.
  • Ability to safety net accurately.
  • Supervisor's phone number and whereabouts.
  • Diagnostic/drugs/palliative care bags.

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