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Everyone. Um I think we'll just get started and we'll let anybody else just filter through. Um I'm Sabrina, I'm an F Y one at the Queen Elizabeth in Glasgow. And there's just a whistle stop tour through clerking and ward round documentation as an F Y one um as part of the zero to F Y one series. So what we're going to try and cover today is um is that the importance of accurate documentation in medical notes? Um Just a bit of a structured approach when you're clerking a patient um common abbreviations that you might see in the medical notes. Um Just an overview of a structure for when you're documenting your own reviews in the notes. Um Some important things that you might want to document when you're on a ward round and just a bit about making award drowned jobs list and prioritizing tasks. And I know some of you might not be from Glasgow Islamic, this is sort of generic as possible. So documentation, if it's not run down, it didn't happen, go stop. Um be mindful of what you're writing the notes because patient's can request access to this. Um You know, always document who you spoke to when you spoke to them and what was discussed, particularly if it's important decisions. So documentation, the most important bits and bits that you never want to leave out our one, one's the patient details. So that normally comes in the form of a sticker which is just put on the top of the notes and always just make sure that it's the right patient. Obviously, um you need to write your name and your designation, so write your name fy one and underline it and you need to put the date and the time that you're writing the notes and always complete your entry with a name, a signature, your designation, if you carry a bleep or a phone number is always quite good to put that down as well and your G M C number. So these are just some common um abbreviations that you might see in the notes. There's, you know, a whole bunch of them are not going to list them all. You can find quite a lot of them on things like minded rape and geeky medics and you know, other websites. But these are just sort of the common ones that you might come across as an F Y one and, and the number of times that you're right, you know, ask to see a patient in the medical notes and you'll forget um you know, when there are many, many more to these. So I'm not going to go through all of them and you get access to the recordings, you can put these up again later on, but you want to aim to be precise and efficient when you're writing in the notes. So think about the next person who's going to read the notes, they need to be able to understand what you're writing, but they also don't have time to read a book chapter. Um So when you think about clerking as an F Y one, unfortunately, you won't probably be doing a huge amount of clerking and this is very hospital and department dependent. But I would take every opportunity that you can as an F I want a clerk because this is, you know, it's such a good learning experience. Um It can be daunting at first, but, you know, this is the only time in your career that you're really be able to do this and, and get the maximum amount of feedback as your patient will have to be seen by a senior that day itself. And it makes the learning curve, much lips steep when you get to Fy too because suddenly when you're an F I to, you'll be overnight in receiving by yourself and you need to clerk, you know, all the patient's that come in and, you know, you won't have a senior to be looking over your shoulder the whole time. And so the the expectation is that you're going to be slow. Um but, you know, it's more important to be thorough and not to rush. And that's because that's when you make mistakes. Um And, and it's really the only time in a patient's admission that every, all the information from, you know, their notes and their history is all related um from, you know, multiple different sources. So working as a med student versus clerking as a doctor is very different. So as a med student, when you go to see a patient, it's mainly for your benefit. So you get to show yourself, you get to show your supervisors that you can take a history and that you can perform an examination. It's about, you know, learning about different conditions and how they present and its management. It's just this and it, it's just this uh recording, but it may be um so as a doctor when you're clerking, and this is purely for the patient's benefit and your, you know, you're trying to gather all the information and you know, carry out, you know, first line investigations and propose a management plan and then you present this succinctly to a senior, be that a reg or a consultant on their post take around. So in, in most places that you're gonna be clerking, which would be mainly in receiving. They're always be this, you know, a performer and it'll be different depending on the hospital that you go to. This is the one that we use in N H S G G C and, and it's, you know, it's exactly how you learn to take a history as you know, in, in medical school. It's just got different boxes for all the sections. So you go through the presenting complaint, the history, presenting complaint, past medical history, systemic inquiry, go through the drug history, the social history in the family history. And then you do a thorough examination, you write down all the key investigations. So they're imaging the bloods, you can write down some differential diagnosis. You propose a management plan, you think about other things like the resuscitation and and B T prophylaxis. So the past medical history of the background is, is actually very important and it tends to be the first thing that we do as doctors. When we pick up a patient, you'll see doctors. So you're trawling through, we have electronic notes. So clinical portal and looking through all the different sources. So discharge summaries, referrals from GPS Clinic letters when within a and you can ask the patient about the past medical history, but a lot of them, you know, wouldn't be able to tell you everything and you know, pent and miss things out. Um This also paints a mental picture of the patient. So before you or someone else reading your note schools to see the patient, they have an image in their head about, you know who this patient is and why they've come in and what are the things leading up to their admission. So, for example, this is, you know, fictitious patient, John Doe. It's a 75 year old presents with a one week history of intermittent chest pain. And just from his background, you can already, you know, you can imagine in your mind what kind of patient he is. So he's very, he's quite co morbid. It sounds like it is a vascular path. So you had, you know, he's had previous um cardiac events, he's got hypertension, what? COPD? He's got diabetes and previous trc's. And so it's likely that he's very cool morbid and you, you wonder what his functional status is even before you go and see him. Um One of the other very important aspects of, of clerking is a social history and we tend to gloss over this as med students or, you know, treat it as a tick box exercise. Um But these, these things are actually very, very important. So particularly with alcohol, you know, someone drinks in excess in the community and then they end up in hospital for a few days, they're going to end up withdrawing in hospital and that's not particularly pleasant or, or medically safe as they can go into seizures and things like that. But the only way you're going to know that is by asking them how much they drink. And in my experience, most most patients have to be quite up front and honest about the alcohol intake. So it's quite important to ask. Um, another very important thing is functional status. And so this affects decisions for investigations and management of a patient. Um, so, you know, are they independent with their activities of daily living? Can they dress themselves? Can they go out shopping themselves? What's their mobility like? Do they do, do they use a walking stick? Do they need a zimmer frame or they bed band? And when do they drive? This is quite important in place which present with stroke symptoms or seizures. And we think about a patient who has a new cancer diagnosis. So it was previously independent and still works, is very different from someone with the same cancer diagnosis but is bedbound and in a care home. So you would think about what's or investigations you would do for those two different patient and, and how you would manage them and whether or not you would offer the management for that. Um Also where do they live, you know, do they live in their own home? Are they in a nursing home and who do they live with? And, and that's important for functional status? And it gives an idea of the type of support that the patient has at home, but also relevant for things like um infections. And, and again, another thing is that's important as occupation, what do they do for a living? Um So this is just an example, Clarkin, this is, this is not a real patient and, but it is very typical of someone that you meet in the west of Scotland. Um So, so John Doe, he's presented with, you know, 75 year old man presented with a one week history of uh one day history of intermittent chest pain. Um Different people have different ways that they like to write out the presenting complaint. Some people write, you know, paragraph, some people, right, bullet form. I quite like writing bullet points so that when a consultant sees this, they can see, oh, they've had central crossing chest pain radiates down the left arm last for 10 minutes to an hour and nothing makes it better. And then you write a bit in the past medical history. Um I tend to write some of the drugs that they're on. If they're on, they've got hypertension, what anti hypertensives they're on if they're diabetic or they own Metformin or they're on insulin. Um If they've got a f it's always really good too, right? Whether they're on anticoagulations, the Warfarin oil do wax because that's really important as well. Um This is what we call them med rec and some hospitals do this online. Some hospitals you actually have to physically write it down. Um And sometimes the pharmacist will do this for you a lot of time you won't. Um So this is where you make, you know, you, you, you find out all the drugs that the patient is on when you came into hospital and then you make a decision as to whether you want to continue them or you want to change the dose or you want to withhold it or just stop it altogether and then don't forget the allergies. So I tend to, right. Um, if they do have an allergy, what reaction they had to it through the classic one being, you know, penicillin allergy, what do they get when they get penicillin? Some people just get an upset stomach obsessed. Um And that's not a penicillin allergy. Um So the next thing, once you've taken a history and you want to do an examination. So, you know, this is a top to, to examination, incorporating all the systems. So, you know, we're all taught in medical school by system. So you do a cardiovascular examination and do a spiritual examination. But then suddenly when you become a doctor, you're expected to examine everything in one goal and, you know, you can't take an hour to do that. Um So there are many different ways of doing this. So, uh you know, I'd advise you to find a system that works for you. And the one that you can remember, the important thing is just to not miss anything. Um I tend to do just an 80. So I look at the obs, I look at the, you know, stand at the bedside general appearance are the pale clammy, the yellow or the on oxygen. And medical campaign. Are they able to speak to me in full sentences? And then I go to a airway. If that doesn't work, then you know, stop what you're doing in polar buzzer be. So that's my, that covers my respiratory exam. See covers my cardio exam. D covers neuro G C S in the A M T E covers my ABDO exam and my skin exam and then I do motor at the end as well if it's, if it's relevant. And so these are just, you know, different ways of documenting your examination findings. You can find these on geeky medics and other websites. You know, these are the classic one, you know, chest clear, crackles, reduced air entry. Uh uh these can be misinterpreted sometimes. So what a lot of people do is they right at the side, what the diagrams mean as well. So, you know, the right chest clear or by basil crips and things like that. Um So this is again, John Doe. Um So we've got his social history at the top there and then, you know, this is just how the performer lays out your examination. Um So if you have this in your head, you know, you won't miss out different things that you need to examine. You don't need to examine everything for every patient. So when a patient comes in with chest pain, you know, I I wouldn't normally do a full neurological examination. I would make sure that they, you know, the pupils are equal and reactive to light or check that their cranial nerves are grossly intact, name of their eyes and things, but I wouldn't normally bring in a tendon hammer and start hitting their reflexes. Um So it's important to tailor, you know, your examination to be more focused on the different systems that, you know, are relevant to your presenting complaint. But again, try, you know, don't, don't miss anything. Um So then the next section of your Clarkin will be your issues differentials or, or diagnosis. And it can be quite daunting as a junior to write down your differentials or diagnosis or impression because you don't want to be wrong. And this is quite important because it gives the reader and insight into your thought process when you reviewed the patient and why you came up with your management plan and you don't need the diagnosis to start treatment. And so try and manage the immediate issues and propose a plan for further investigations if you're not sure. And so I always use this system called boxes. So when I'm thinking about my plan, so blood's normally this will be done by the time you've done your clerk in or when the patient when you go and see the patient. But do you think about whether you need, you know, different blood test? Um and then observations and things that you do at the bedside? So like a urine dip, chest X rayed other imaging. Do they need CTS or MRI S E C G s, which most people should get before you go and see them as well and then specialist things. So other tests, other referrals that you would need to make and then as an F Y one is a bit of a cheap, but you can always write senior review and actually make sure this is done. And so either you know, a register our mid tier or consultants to see your patient. Once you've, once you've seen them and always consider BTB prophylaxis, it might not be appropriate in every patient, but it's important to think about it. And most clerk and booklets have a flow chart of whether or not you should give in low molecular weight heparin or just Ted Stockings or, or nothing at all. Um So the plan, you know, it can be quite again daunting to think of a plan yourself and to make sure that you, you come up with an appropriate plan for your patience. Um but try and break it down and think about, you know, different aspects. So first of all, what treatment do I need to start to manage the immediate issues? You know, this patient's breathless, so immediate treatment, oxygen. Um What other investigations do I need to do to prove or rule out differential? So I think it's a a chest infection. I think it's a pneumothorax investigation I would need is a chest actually, what symptoms are bothering the patient and how can I help with these? Um, so they, you know, they're feeling breathless and they're feeling in pain so I can give them analgesia and give them nebulizers or inhalers and what else needs to be done to discharge this patient home safely? And this is maybe particularly more relevant towards the end of their mission or if you think that they could get home relatively soon once you've seen them, so do they need physio review? They need an occupational therapy review to get them a package of care, you know, do any carers at home, do they need um equipment at home to get them home safely? So these are all different aspects of, of your plan that you you should think about. Um But equally, it's important to consider that the plan can evolve as time goes on. And the most important thing is making a plan to manage, you know, immediate life and limb threatening things at that point in time. Um So this is just about about writing in the notes, whether that be, you know, for a review or, you know, when, when you're writing anything in the notes really? Um So I always start with, you know, why are you seeing a patient? So it's either, you know, ask to see the patient by nursing staff for blah, blah, blah or, you know, this is a daily review of. Um so and so or this is, you know, the word run review of. So and so um and then I always list out a problem list. Um So number one chest infection, number two, dehydrated, something like that. And then a lot of people use this format called soap. Um and this is, you know, subjective how the patient is feeling what the symptoms are objective, how you view the patient. Are they sitting up in bed or the alert? Are they orientated and then your assessment of the patient? So looking at their blood's throbs, what your examination findings and what you think is going on and then the plan. So you know, how are you going to manage this patient? Um So for example, your the F I one on call for medicine and you're called by the nurses to review again, John Doe and despite the temperature and he's now hypertensive, I'm not going to go through how you would go about um you know, reviewing this patient. This is going to be covering different session uh session for managing the unwell patient. This is just how you would document your review in the notes again, you know, there are many systems for this. So find one that works for you. And so again, this is John do you've seen before and again, not a real patient to always start off by writing a date in the time, write your name designation. Um So why are you seeing the patient to ask to see a patient by nursing staff, temperature spike hypertension. I write a bit of the background. So, you know, how old is he uh 75? When is he admitted? And why was he admitted with chest pain? So this is my problem list. So number one, he's had an end stemi treated him with aspirin and go on the paradox. He's had no further chest pain. Um Number two on the problem list, he's had an AK I when he came in. So we withheld his nephrotoxic six, you know, his AKI is improving, we stopped that food. So, you know, that's the problem list and that's the progress that we're um that we've got into with the problems. So now it's on to soaps. So subjectively, the patient's feeling quite well, he's feeling very tired. He's got a new productive cough objectively. So what can I see when I'm looking at the patient? So he's set up in bed. Um He's struggling to complete full sentences and he's, he's shivering. Um So that tells me that, you know, he's not quite right. If he was, you know, sitting up in bed, eating his breakfast, you know, alert, then, you know, and that gives me, you know, a different impression of him. So my assessment, I always, I normally look at the obs and then I'll look at the blood's the imaging and the micro and then I document my examination findings. So I, I always document any to eat so that you don't miss anything. Um And that everybody can see that I have a structure to how I document, sorry, I document the assessment. And then again, impression is, is kind of like a differential diagnosis. And I think that's really important so that people who read my review, they know what I'm thinking where they have an idea of what I'm thinking at this point in time. And then I document my plan in unnumbered format and then again, make sure you sign everything that you document in the notes with your name, your designation, if you've got a bleak number and then your G M C number as well. Again, this is, this is not the only way to document your reviews, but it's important that you come up with a system for it and that you, you know, you can chop and change and find something that works for you. Um So this, it was just a bit about the ward round. So your role on the ward round would depend on the department in the hospital that you're in. Um So my, my first job on geriatrics, my job on the ward round was to commandeer the laptop. So I reviewed the bloods request the scans and all that. But the consultant would write in the notes in my next job, which is a surgical job. You know, you had to write in the notes, you had to look at the laptop and you had to find the obs chart in the car decks. So it can vary from department to department. So when you go and shadow you're f one at the end of July, just, you know, ask them how does it work, what you expected to do again? But yeah, so like I said, medics generally writing the notes themselves. Surgeons quite rarely do. But again, it, it varies with department. So it's important to find that out when you get there, it can be quite difficult to keep up with the pace. Some ward rounds last, you know, they say 30 patient's in an hour. So it's just important to be organized and then have a system for everything that you need to do. Um So again, you've seen John Doe on the ward round. Um it's, it's kind, it's a similar format and when you a lot of time you maybe won't be able to write all of this is, is ideally what you could, what you would want to write on a ward round. And so again, date and time, it's what to write, who's leading the ward round or who are the, you know, the seniors present on the ward round. So, is a consultant, is it a registrar? It's more of an abbreviated problem list. I think when you're writing on the ward round just because you won't have the time to write a lot of things. Um, you know, but these are, you know, these are the major issues with, with John Doe. He's had a, an INSTA me when he came into hospital, he's had an AK I, but that's now resolved. And when you saw him last, he's had a hospital acquired pneumonia and you treated him with antibiotics and now he's off his oxygen. And so again, go to soaps. Um, so he is uh subjectively, he's feeling really well and he is keen to get home objectively and I've labeled that all wrong, but objectively, he sat in the bed and he's having his breakfast um assessment. So use of zero, I would, you know, a lot of time, right? The bloods and if you have the time for it um observations. So write down the examination findings, you know, most people don't do an 80 in the ward round, do fully take on the ward rounds to just write whatever you know, examinations and did and then your impression and medically fit for discharge pending, you know, whatever physio and then write the consultant plan and again, sign, sign your name and designation G M C number. And so this is just a little bit about award Jones Jobs list and prioritization. So there's no right or wrong find a system that works for you. Uh This is the box system. I think this is sort of semi universal for most F ones. So an empty box essentially just means the job is to be done when a job is partially completed, you put a line through it and these two things can mean slightly different things. So this one, for example, with just the line through the box, I mean, something like the scans been requested, but it's not done yet or the bloods have been requested, but they're in the lab. Um And then with a half shaded box, it means something like the scan has been done, but it's not been reported. So you can't, you know, it's, the job hasn't been fully been completed yet where the blood's have been done there in the lab, but you still got to chase them and, and then once the job is completed, you just shade the box. It's pretty simple that way. And then when you're making a jobs list. So especially when you're on call. Um, there's, there's different ways of doing that as well. So, you know, when I'm on call, I cover anywhere between 5 to 9 wards. And so I normally get a piece of paper, fold it in half and then fold it in half again. So I've got four sections on each side of the paper and they're right, you know, the, which one word on each in each column and that gives me a section for each word that cover. And some people like to just write a full jobs list on, you know, as they, as they pick up jobs, some people like to get uh different colored pens or the pen that has four colors and right important jobs and reds and less important jobs and another color and like um non urgent jobs in, do you know, green or something like that? And so just find a system that works for you so that you don't, you don't miss out on any jobs and you have a system at a way of getting through your jobs list. And the last thing to cover was, uh, prioritization. So this is just, you know, a list of things and that you might be asked to do, you know, once you've completed award and, um, I don't know how engaged people are feeling at the moment. But does anybody want to hazard and you know, I guess as to what the order of this list should be, you can either you can turn your mics or up in the chat. Uh huh. So somebody says CT head first. Yeah, that's not bad. That's not bad. Shout and two. Yes. So, so the news of six is, is the first person you want to go to. Um, so it's always, it's always, always, always unwell patients' first and, you know, you could look at the offshoring thing. Oh, yeah, the news of sex, you know, they're not actually that unwell. So you can go see somebody more and well before that, but you know, somebody that needs of sex, you've got to go and see them first. Um, I'll show you how I, you know, thought I should do this list. Um So I would go and see the news of six first, the unwell patient first and then, you know, you can either um with analgesia, I think it's, it's quite a simple thing to do and you know, a lot of patient and you don't really want to leave a patient in pain for too long. So I would just prescribe the analgesia first and after that, um and then I would go about requesting scans and doing referrals. So the CT head definitely has to come first because you're clearing an intracranial hemorrhage, which can be, you know, life threatening for the patient. Um And then I would refer, you know, somebody to a different specialty because specialties like to know about these patient's early on. So they have time to see them as well. And then I would request, you know, non urgent scans for other patient's. Um you know, as much as anybody will tell you a CT cap for malignancy is, you know, it's urgent but it's not, you know, it's not, it's not more urgent than things that need to happen on the day itself. Uh And then, you know, completing discharge letters. So about something that nurses will, you know, the nurses and, and word um you know, bed managers will get on your case about and we'll, you know, we'll try to bully into doing them before you do other things but it's, it's important to make sure that you, you know, keep patient safe, you know, see the animal patient's for us to do the jobs that will change the management of these patient's. And then, yeah, completing discharges is important. It's important to get people out of hospital and, you know, make space and then things like preparing discharges for tomorrow. Again, people will tell you to try and do that day before. But, you know, with your workload it's, it's quite often impossible. So, um you know, it's all about prioritization and, you know, handing over things that you, you can't do in things that need to be done that day. Mm. Oh, I think that's everything that I've, I'd say just now and if anybody's got any questions and feel free to uh schooling either in the chat or, you know, admit yourself and I would be very, I would very, very much appreciate your fun facts. Thank you very much. Mhm. And yeah, so somebody asked about the key things that you're asking um systems inquiry. So yeah, it's a, it's a huge list and again, it really depends on, on their presenting complaints. But if I were to go through, you know, all of them, I would, I normally start the head. So I do things like dizziness, headache, collapse. So those are the main ones that you think about from the head point of view and then I go down to chest. So I think about the cardio aspect of the chest. So chest pain palpitations and those are the main ones for cardio. And then I think about the respiratory system. So think about shortness of breath, think about cough and, and then I moved down to the abdomen. So think about abdo pain change in bowel habit and, and then I go to urinate symptoms. So just, you know, have they got any pain, burning sensation or passing urine? They going more frequently? Are they waking up the other night? And then I go to, you know, limbs. So are they, have they got any numbness or tingling? Are they able to move their arms and legs? They feel any weakness? I think those are the main things to think about in each different system. But again, you're right, the list is huge and, but once you get more experience and in terms of presenting complaints, then you'll be able to, to narrow down the number of things that you, you think you need to ask. Is that, is that all right? And she was slide. Is this the one that you're meeting? Hi. Yeah. Sorry. My, my connection cut out for a second. So I missed a little bit. So it was a bit after I eat. So you were talking about what two, including your plan. So you said like what two, what treatment to manage immediate issues and then what other investigations to rule in, out to French. So, I think I lost connection at this point. I was just wondering if you could share the next two slides just to see if I missed anything. Thank you. Um So you got the bit about the plans. Yes, I, I got this slide but it's just after that. Yeah. Yeah. So when you're thinking about when you're writing the notes and for, you know, a patient that you reviewed or some, maybe you've seen in the ward round, it's always important to have a structure when you're writing. Um So one that a lot of people using, the one that I use is I start off with, why am I seeing the patient? So I write, you know, ask to see patient nursing because nursing stuff concerned of. So and so or this is a, you know, daily review of, you know, heart failure or something like that where this is the ward round review of. So and so and then I write down a problems list. Um So a number of my problems 12345. And then um a lot of people use a system called soap. So subjective is how the patient feels. Um you know what their symptoms objective is, how, you know what you see when you're looking at the patient. So are they set up in bed? Are they lying in the bed in pain or they shivering at the recurring and then your assessment? So blood's obs examination findings and then the plan and then the next slide it was. Yes. So you've, you've been called to see John Doe. You're the f one on alcohol for medicine. You asked to review him because he spiked a temperature and he's now hypertensive. And then did you get the bit about? Yeah, I got this. But yeah, thank you. So when it comes to the problem list, how, how do you keep it kind of like short and snappy because I imagine like some patient's will have potentially a lot of different problems. But what do you, how much do you document on the problem list? Basically, that's a very good question. Um So yeah, keep it short and sweet because yeah, people don't have time to read um you know, a book chapter about it. Um It's mainly things that, you know, are pertinent to their management. So, um you know, I normally, right, you know what the problem is and you know, whether it's still ongoing or it's resolved and what, what sort of treatment has been given for it. Um So it's hard to give an example and yeah, don't worry, I appreciate. It's probably a bit tricky to think of the top of your head. Know, Dax, that explains that. Thank you. Can I ask, do you have any like any, is there any differences between like water around documentation from medicine versus surgery or how would you approach it differently if you had to? So again, for, from medics, the consultants will tend to write in the notes and their notes tend to be a lot longer. Um, this is for War drums and surgery. Yeah, you tend to have to be the ones to write in the notes and you won't have an awful lot of time to write in the notes. Um, so I think the main things for, yes, surgery would be, um, if, if you had an operation, what the operation was, how many days are they POSTOP? That tends to be all they want. Um Were there any complications from the surgery and then examination findings where they tell me soft and, you know, things like that? Um, so I think surgery tends to be a lot more succinct and much more to the point. So tends to be about, you know, the operation. So were there any complications? Uh, yes, to the plan from the surgeon, medicine tends to be a bit more in depth. So, again, a bit more of an extensive problem problems list a bit more about, you know, how the patient is feeling what their symptoms are. Um, and again, yes. So the examination findings, I know that sounds a bit, um, sort of stereotypical about, you know, certain is not really caring, but, you know, their wardrobes tend to be a lot faster and, you know, you don't, you won't have a lot of time to, you know, write a huge amount of stuff. Down. That's great. Thanks so much. Um, somebody's asked, do I write Edward, uh, to ask every patient or recreational drugs or just do I feel a bit relevant? Um, yes. Yeah. So I, yeah, I'll be honest. I, I don't tend to ask every patient I see about recreational drugs. Um, but you, you would be surprised at the number of people that, you know, you don't ask and that it actually does become relevant. But yeah, I think it comes with experience and, um, yeah, I would normally, yeah, probably only ask if it's relevant to the actual presentation itself. But yes, I think, yes. Ok. Sorry, I'm just gonna grab my chart implementations. So when I said the medical team will write in the notes. Insurgents don't what exactly. Uh, so on the ward round, um, normally if you're in a medical job, the consultants or the registrars who lead the ward round for medicine, they'll normally, you know, right in the medical notes themselves and you just look at, you know, investigations on a laptop or, you know, look at the drug card X and the observation chance surgeons, they tend to just leave the ward round and you know, us, the fy one will have to, you know, document in the notes. What's, what's happened in the ward round? Does that, does that make sense? So a card axes just the, sorry, it's just the list of medications that the patient is on wilder in hospital and it shows the administration and things like that when they're on the ward. Uh So the patient doesn't know the drug history and how do you find out? So, are you, are you working in Glasgow from Glasgow? Uh So uh the way it works here is that we have uh we have electronic um electronic system where and all the referrals and clinic letters and all that go onto and then there's a section for what we call an E C S. So it's emergency care summary where all the, all the drugs that have been prescribed by the GP that gets sent to their pharmacy and there's a whole list of that. So that's where I would normally get our drugs record. Um, I wouldn't be able to tell you how it's how it works and lead unfortunately, but I suspect they have a similar system where you can access um, a list of drugs that, you know, the GP would send to the patient's pharmacy for that to be prescribed. And then you can also actually just phone up a patient's pharmacy and ask them what, what drugs they're on if you know, if all fails. Mhm. If there aren't any more questions, it feel free to email me and if you have any other questions and again, very much, appreciate your feedback. Thank you very much for coming. Uh