Just like GPs hospital doctors work long hours. Most of their work takes place on the ward, in the outpatient clinic or in an office. The day usually extends from about 8.30am to 6.30pm at night. Often, when ‘On Call’ hours may be much longer. Occasionally hospital doctors travel to help out in outside clinics, outpatients in nearby hospitals or occasionally working with GPs in their surgeries.
Medicine in hospitals falls into separate divisions. Medical specialties include general medicine, lung disease, kidney disease, liver disease, allergy, diabetes, or infectious diseases. Surgery tends to be organised separately into specialist subjects such as orthopaedics, gynaecology, ear, nose, and throat, (ENT), neurosurgery and urology.
The responsible doctor is the consultant who heads a team of trainee and staff doctors and works closely with nursing staff. His or her working week is divided into sessions of 4-6 hours depending on the circumstances. Often the day starts with a multidisciplinary team meeting, continues with a ward round seeing 40-50 inpatients, followed by lengthy administration carrying through the decisions made on each patient on the ward. Later will come the outpatient clinic seeing 30-40 outpatients followed again by dictation of notes and letters, phone calls and emails.
Doctors need to communicate. They need to talk to patients and their families, share information and instructions with other healthcare staff, both junior doctors and nurses, discuss cases with fellow consultants, write or phone GPs, and work with administrative staff, secretaries, and receptionists.
A pivotal part of the work of any team in hospital medicine today is the multi-disciplinary team meeting or MDT. Once a week (and sometimes more) the whole team of involved specialists and their staff assembles to review the new cases, examine the pathological findings, share the scans and x-rays, discuss the case management, make decisions about treatment, and discuss the personal or family background of the patient. The sharing of expertise and experience from each different discipline educates all the participants and ensures that standards and guidelines are upheld in each case.
The doctor in charge of your case in the hospital has many responsibilities. He or she must read and keep their knowledge up to date, must work well in a team in the best interests of each patient and adhere to professional standards.
Ward rounds differ in their organisation. Some teams meet in the ward meeting-room and discuss each inpatient before going to the bedside. Others progress steadily round the patients in their beds discussing the cases as they go. For patients this can be quite intimidating. But be prepared. Have a friend or family member with you, if possible, make notes and ask questions. Everyone present has your welfare in mind and you are an important member of the ‘team’!
After the ward round if you have any questions make sure you check with the senior nurse or a junior doctor as to what was agreed and what happens next. Doctors take it in turns on a rota to be ‘on call’ and offer advice and support to the staff working in Accident and Emergency (A&E). Usually for one full day per week the consultant and their team attend the clinical problems in A&E as well as their daily workload. Delays are almost inevitable unless this work pattern changes. Patients who need admission to the hospital come in under their care. When A&E is busy it can be a real challenge to see everyone who is ill and sort out their care under tremendous time pressure. The doctor who sees you in the evening has probably been working all day. If you are kept waiting spare a thought for them too!