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right. Good evening, everyone. Um, I think we're live now. Welcome to today's mind. The BLEEP seminar today. We're very lucky to have Dr um add Masumi with us and he's going to be discussing, um he's going to be discussing discharge summaries and ward rounds today. Uh, is an F four feeling hospital? Uh, if you just want to go to the next side, please. So we're very lucky to have the m d u supporting us today. So as you know, the MG, you are an indemnity provider and then make sure that, you know, if you have any issues during the course of your career, they're all sorted out. You need to make sure that you're registered for indemnity insurance, whoever the provider is. And remember that your student membership expires in the summer. So you need to have this sorted out before your before your shadowing period begins. And unless you filled in an application form for the foundation program, your student membership will expire in the summer. So what I'm gonna do is I'm just gonna drop the links to sign up in the chat, so please do use those. We've also got Lausanne Stevenson from the M. D u here today. She's going to be answering some of the questions you might have about membership or medical legal issues. And I'll also drop her her email address in the chat as well. So over to you up. All right. Thank you very much. Near Are you hearing me? Okay. Perfect. All right, so Hi, guys. My name is about one of the doctors working around the healing area right now in my F four in my F one in Brighton F two in East, Born in Hastings. Um, and I've done working in a couple of different places, a couple different kinds of warts, and we'll go through that in a second before we begin the garage. I actually wanted to ask you something. Um, I wonder if you've ever had that dream where you go to school without trousers or you look at your trousers or any clothes on. Have you ever had that? What kind of question is that? I think I think we've all had that dream at some point. Yeah, exactly. I had that funny enough. It actually comes from the idea of of a fear of rejection, because if you were socially rejected, then maybe get kicked out of the group when you're in the wilderness and the animals would eat you alive and stuff like that. So it's it's founded in something important, but there is an idea of the fear of rejection in there. Right, when I was just about to start being an F one, I had a massive fear of rejection that, you know, my boss was thinking that I wasn't good enough to be an F one or being judge is inadequate. Um, I really had that fear. Um, and that's why I actually came to this talk four years ago, and it really put me in good step. Now, the reason why I start that is because the war drowned is the point where you're gonna be having the most interaction with your seniors. You're if you're in control of the war drowned. It makes your seniors think that you're just in control as a doctor and they're gonna have more confidence in you and, uh, much like systems that work in the background. The seniors noticed more. If the war drowned goes wrong, then if it goes right. So in this talk we're going to try and make sure that we go through stuff that will give you tips to make sure things go right. So as a overview, we're gonna go through a little instruction, a couple types of ward rounds, some pre war drowned prep what you do on the ward itself. And how do you, uh, do you do after the war drowned as well? Uh, the post war and stuff is going to be a little bit vague, because prior to taking jobs is its own thing. But we'll, uh, we'll touch on it a little bit. So why we've already covered that this is an important place to to show to shine. Um, and you know, the seniors think that the juniors run the war Ground is your domain, but we should probably be discussing actually why the war grounds are important to medicine in general. Um, you're on. Do you want to put you on the spot here? But do you Can you think of any ideas of why? Of why Award round is important in for medicine in general. Oh, you there, buddy. Yeah, there we go. So can you. Can you think of any possible. Um, any possible reasons why ward rounds are important in medicine. Yeah, I guess it's just really good to get kind of a whole teams perspective on the care of the patients. So it's all about team's working together rather than just having one clinician. You know, just doing everything obviously means that you can work with a multitude of professional as well. So physios, pharmacist, nurses, etcetera, very much so. And that's when it's a good MDT ward. And then also, um, I understand you're a med student, which means wardrobe where you're going to be so but I'm bringing it back in. But it's where you get a lot of teaching done there as well. Hopefully, the consultants are meant to be teaching. You know, the teaching experience as well as an F one. Make sure you're getting that. All right, but you can go back again. Thank you. So, Yeah. So that's a good point there near Oh, thank you. But the main points I want to impress are this one. These are legal documents. So, as a personal anecdote, I've been involved in a case in the anywhere There was a senior lady that came in. She had been seen before for this issue. Um, and, uh, we ended up admitting her, and she was found to have an injury later on that maybe when she got worse, but because I was able to say, Look, I looked for that injury. She we didn't have this guy concerned when she initially presented. And what have you? I was able to kind of protect myself, and that's basically from from an entry. So these entries, you're you're going to want to make sure that they're good quality because you you might be coming back to these entries months down the line, sometimes years, um so you're going to want to make sure that it's legible. I remember one of my medical oncology consultant said that he got pulled into, uh, discussion on a patient that that passed away, and he's only seen the patient wanted a referral, and you had no further input in them. And he wondered, Why Why have I been pulled in and, uh, to talk to you guys? And they said, Actually, it's because you're the only one that had a legible, uh, contact details at the bottom for us to get in touch with you. So it's important to keep all this stuff, and sadly, and it just doesn't happen that much. We really should be improving that, um, there's another thing. It tells the rest of the team the plan. So everyone, including the nurses, knows what they're meant to do. And the good part about that is that nurses can then disseminate that information to the family, right? The family have a loved one in the hospital there, unwell, the family feel quite powerless, so they just want as much information as they can all the time. And so they'll say, I want to talk to the doctor or I want to know what's going on. If the nurses know what's going on, they can give that information, which kind of takes the pressure away from you as the doctor and you can get, get, get on with all the other jobs that you have to deal with that day. Um, letting the team know what's going on is also really important when you need to get like the med Reg coming in, uh, met call to help your patients because they get a quick rundown of the stuff you've done a good entry, they get a quick rundown of the situation, and they can make decisions more quickly and be more effective for your patient rather than having to muddle through barely eligible or or very sparse notes. Um, it's also legal looking to protect your seniors a lot because you're describing for them a lot. So for them, it's really important that they're good quality as well. Um, for Ortho. Specifically, I had issues. I didn't know some of the tests they were doing and I weren't writing in the tests they were doing and they were like, We're not We know what the results are gonna be for these tests that we're going to be doing them and we don't want them written down so that we can show that we've assessed for these injuries. So it's important for the seniors as well. And lastly, there are those Weekend award ground and they're super important surgical. Generally they get seen by a consultant for the weekend as well. So they're they're they're pretty good medical. They don't have the capacity for that. So generally the F one and S H o s can be called in to see unwell patients by the nurses. And if you have a weekend war drowned, note that, um, explains the plan. What's going on Really well, for them, it just increases the chances that when you come back on Monday, your patients going to be there to greet you rather than if you have an empty bed there instead. Uh, so it's important for patient safety, too, the types of work around. So there are three that I can think of the fast one where it's, uh, where it's generally senior lead. Um, like surgical, the slow one and the self run one. And the cell phone was one that was terrified when I when I was starting, but the fast one generally surgical going to be consulted on a Reg lead every day. Um, maybe with multiple juniors running at once for one for one senior, the boss man, either consultant, the Red is gonna want either knows what's going on because they they've done it day on day that week, or they're gonna need a quick rundown and then they'll give the plan for the day, examine the patient and move on, and they want to be moving on quickly, especially if they have a large volume. Then there are the slow ones. These are fabled. I only ever had this with the medical oncology ward round. Um, where the consultants leave the war drowned and they really care about every facet of the patients. Care specifically, Look at them very holistically. Um, I think I might use a bit similar to this because I like it goes like a two h in terms of they care about every different system of the patient, and they go through them daily and I'll put down daily. But the different things that from my personal experience, I've seen that whilst the juniors are reeling off their information, the anti consultants just poking the ventilator in the corner. Um, whereas with the medicine guys, they really were interested in more of the holistic and the the patients' feelings and their expectations. But that's more slower. Um, slower wardrobe. Finally, this is what I dreaded. It was a self reward round where there isn't a senior that you're facilitating. You're not describing for someone, but you see a batch of patients yourself. Maybe a day or two. This generally happens more in Jerry's and in medical wards, like I had somebody that did it on the end of the world. I did on the end of award as well myself. Uh, and generally you'll have a senior. You can actually run complex issues by. So you're not being so Don't sweat it too much. You're not, um, you're not being left high and dry. You just have a system, and you'll get through it. Okay? Prewar drowned. So I'm not going to pull your arms back in. But there is, uh I'm sure that I I remember. And I'm sure that you guys may have noticed I remembered as well. When you're a medical student and you feel out of place at the handover, you have these doctors, some of them quite tired, sling information backwards and forwards get to the end of this. Everyone still stands up and walks off, walks off and gets their job done. And you're just wandering around, uh, feeling neglected. Well, as you start becoming as you become an F one, you're gonna have to pay attention to those around more and more because they're going to be your patients. Um, and before you start before you start your job. Normally you might have a little bit of shadow period. Or you can, uh, if from rotation one rotation to you can contact the team that's doing your job already, Uh, the team that's that's that's leaving normally is nice to tell you how the mornings run. Generally, a list will need to be updated in the morning. You'll probably be continuing. Whatever set up has been done before. Um, I had some places where they had a pa come in before we came along, and they updated the list. Uh, other places. We had one person come in, uh, just a tad smidge early earlier than everyone else, at least to get the get this done or people go to hand over. One person will update the list instead. Um, and the whole point of that is you don't want to make you want to make sure that people are in the right slot. So, like the right patient in the right bed, and you don't have to jump around the list that you can just go down the list, and also no one has missed. That's really an important part of this. As an FYI, nurses do their hand over half an hour before you guys, so they have an updated list of all the patients on the ward before you. So if you're gonna be using, if you're using on electronic ways of tracking patients, use them. Um, the 100 guys probably get a handle of the patients that the local team took care of, or maybe their own patients, that they were on well overnight. And they disseminate that information to the war drowned guys. Um, and then the war drowned. Guys, it's their turn to shine. Uh, and the aim of the game in the pre war around Stage two. Just ensure no one gets missed. Uh, if you need to grab a senior, um, like a consultant out of an operating list, like four or five PM he's going to generate jobs for you for this patient, and he's kind of got to expect you to do it. And you really don't want to be staying over time. You shouldn't be either, um, but it's going to reflect badly on you that that you know, you missed this patient and he's made these jobs and they're not going to be until tomorrow. Um so So make sure that you try and get them all seen in the in the morning. Yeah, those those take home message is there, right? The war down itself. So there's 33 parts. I want to go through the repairing of the notes, what's in the entry and how to do it efficiently. Just some benefits to give it the end, Uh, prepping the notes, I can give you for four bits of information on this one. So when you do it, the timing wise, you don't You should be coming in early to do that. Uh, as soon as the list gets done, you should be starting to prep notes. Um, no one should be coming in early, and, uh, more likely you'll maybe prep a couple of the notes, but then during the war and you have to prep and go at the same time, um is here in August anymore, because it's not really an agreement. Um, but if you're being forced into coming early to meet the expectations of the team like prepping notes before hand or what have you, you need to exception report it, especially if it's happening regularly how often you accept a report on what cutoffs you have are totally up to you. Like when I started, that was when exception important was starting, I think. And we were saying, Hey, you know what if I say half an hour an hour over there except the report, but it's it's changed, it's completely up to you. It's your decision how you report it. The NHS is an entity. Doesn't care that you come in 15 minutes early every day to make sure the ward run ward round run smoothly. Your bosses are going to give you a gold star and you can't even put on your CV. So all you're doing is normalizing it for seniors to have untenable expectations of they're juniors. Uh, so updates. So you want to read the updates from the last entry on word you want to read the last entry? See what they thought was going on, what the plan is for them, uh, see if there's any issues overnight and when you enter obey, you can also ask the nurse Hey, do you have any patients who are concerned about in this bay or any concerns that you have, and then you can bring, like, maybe prescription concerns. We'll have you. And they can bring that up for the, uh, for the senior in the water so you can get advice there and then rather than having to research it yourself and it takes a long time 0.3. Leave yourself space. So take a whole page two if you need to. Whenever I see an entry from Specialty Regiment pills two pages, you know what I'm thinking? I'm thinking that they have given proper consideration for the whole situation. When they gave me their advice. I really I really like that. We're not, sadly, in the business of saving trees in the chest or more about saving patients. But places are going more towards electronic notes, which is always a good thing. You'll get the hang of how much each job requires in terms of space eventually as you keep doing it, Uh, and lastly on the go. So if your prepping during the war down, especially in surgery, the tendency is to do less and less right and less and less like the stereotypes. That's very sparse entries, and you try and come back and fill me in later. It's not reliable. I wouldn't recommend it. Um, sometimes it's an eventuality, but it's you just forget. Um, you do forget things, and it's it's a problem. Uh, I'd say I I do have to say you run the world around, Uh, so it's It's your name at the bottom of the page. So you can always ask your seniors if you can have a second to catch up from my experience, I have this graphic. So I always let the seniors know, Hey, I have problems with writing, especially as quickly, so just give me so I might need to ask you to slow down now and again. And the ones that are worth a damn will will facilitate that because they know that they're covering their own. But it's too, and they're making sure the whole team does it. So definitely important thing. All right, so the next two pages, let me just show you these, uh, this is like, uh, made. This one is like a it's on the website, and it's a run through, sort of the stuff you'd be looking at. So if you can see my, uh, date and time there, some sort of Democratic patient problems. It's like 1234 medics of doing that, uh, some status of the patient, a free text, um, and then an examination, uh, impression and plan. And you sign at the bottom. This is the components just going more into detail, as is the next page. So there's any jobs specific stuff there examinations. Like I said, with Ortho, if you don't know them or just run them initially past, uh, past your seniors, make sure you're getting the right information. Always put your bleep down to the team. Knows who. Uh, the nurses know who to contact if they have any issues, especially with your handwriting. Um, so on the subject of war grounds, three things I can talk about is basically the same system is when your senior does it, except you have. It's under your own time. It's under your own steam. So take the time to go through all the information that you need to to get a handle on feel of this patient. What's going on? Um, and yeah, just do the same thing. They, uh so they might do a very in surgery, specifically a very specific examination just for the abdomen. But, hey, you're an F one or an F To give them a rundown examination, feel listen to their chest. Feel their abdomen. Uh, medical, uh, awards. It's really important to touch the toes, you know, feel for people and, um, and stuff like that. So just give the patient a good overall look and talk to the patients because you don't have that rush of Oh God, My senior wants me to get this done because they have to go to a clinic So you do get a bit more chance to communicate with your patients, find out what their concerns are and treat them more holistically. So it is a good opportunity there, as we can always jump back to the senior if you have. If you have any concerns, you can always help that efficiency tips. Three that I can think of one scans and referrals when you're doing the water and have a couple of copies of referral forms for regular use, more paper copies of like imaging forms. That's when you're when the boss says ct, abdomen, pelvis, your you whip it out and you start writing. All right, boss, What are you looking for? Uh, and this is important so that then you don't write the wrong thing down. You don't take it to the to the radiology, uh, on call, and then they shoot down your referral. You have to go back to the boss saying you got rejected, and then they have to take time to get it discussed again. So you look like a bit of a mug. Don't do it. Uh, often there and then. And also, um, uh, it helps with referrals as well, because you're on the phone with the guys, and they're going to be giving up their time for it as well. So you want to make sure you know why you're doing the referral? What they're meant to be looking for what the clinical question is to leapfrogging. So if you have enough juniors to two senior, so you have one senior for juniors. First Guy looks the first patient second guy, perhaps the second patient. Third, One third, fourth and forth. First guy goes fifth, and it keeps on going like that. Leapfrog it. It's not good for learning, I will admit, but on the ones where you have one senior in multiple juniors. Generally, you have a really high volume, and efficiency is key, so you need to get through it. So you finished performing today. And what have you, um, and then the guys off to prep it? You can after you finish writing that you can do your imaging form there and then as well before you start prepping the next one 3rd 3rd thing keeping jobs list, and then it helps amalgamate and one master list after the war drowned tract. Important details. Like who's gonna be discharged? Uh, that day. What's going to happen later on that, uh, that week? Um, so yeah. Jobless. Really important to do. Right? Let's take a little breather. I'm just gonna have a little drink. I I invite you to do anything while you have. You have a sip of water. As I should have said at the beginning, keep the questions coming through. The Facebook chat lab is very friendly. I'm sure he'd be happy to answer. Answer them. I'm going to put them to you at the end of that's all right, AB. Does that mean we've already We've already got questions. We do have questions. We do have questions, so keep them coming. Guys, I'm looking forward. I'm looking forward to it. We'll go through the questions just like one or two more slides, I believe. And then we're done. Right? Um, so three rules for Post Ward around, Uh, that that question Things got me hooked. Number one, if the boss man wants to buy you coffee, you get that damn coffee before cove ID, They were practically no freebees for doctors, all right. And the NHS like, Hey, it's a great passion, but there there weren't many other better. But you also need, So if they're going to give you coffee, take all right. Also, it's really important the social aspect of medicine. And I only learned this after I started the job. How you need to how you grease the wheels of the N h s. And it's it's full of people. So it's all people interaction. It's strangely so much. Makes your life so much easier when you're friends with that s t six. Um, gastro Reg, the dozen IBD and your bosses wanted a Doggy Dogg, and you feel a little bit embarrassed asking and you know that if you put on the paper form is going to get rejected flat out. So you have a chat with the ST Sticks in the corridor and they're like, Don't worry, send them over. I'll see what I can do. Maybe they can work in a different way to get the get the investigation done. Uh, so the social aspects of medicine is still very important number to compile a master job list. I have slides of that in a bit. Allocate who's doing what group things together. The whole team doesn't have to go down to the imaging department and the sacrificial lamb that you are going to send over to the radiologist. Explain to them about the request. Give them a bit of a back story so you don't literally just send them into their, uh, to get their head bit off. As a rule, discharge summaries need to be done a couple of hours before discharge, hopefully ASAP. If they're going the same day, imaging should be done. Same day expert. Expedite all the jobs for the patients are unwell. Referrals need to be requested at some point, but it's understood that sometimes even if you do the referral, they're not gonna be able to see them the same day. That's understood, and everything needs to get done in preparation for that patient that's going to be going into theaters the next day there. For surgeons, that's very important. I say that because I I work a lot more with surgical teams and I do with medical. That's where my experience comes from. Lastly, keep communicating as you do jobs. So if you're leaving the war to go for an executive period, maybe chase down specific person, go to the back end of the hospital to have some forms and let the other guys know you can take some of their forms to They don't need to go down. You're you're building the camera, agree with your other team. Also, it means that they know that you're actually going and doing something important rather than just banking off. There's a stereotype about the F one that goes into theaters and neglect all these jobs. Do not be that guy because go to theaters. Hell, yeah, but make sure you're supporting your the rest of your team because that information gets disseminated between between your other juniors and eventually it goes up to the seniors. And when they hear that, maybe they don't want to be as helpful to they don't give you those development opportunities. The the the audits and stuff that are easy that are good marks the presentations, So keep that in mind. Okay, Um, also let us know when you go for your protective teaching time, you protect it, but let them know so they can plan around that, you know, right. So on the screen you should be seeing this is like a It's a fake one. But it's a copy of a job's list of one person that you go to bed one day, one bed, one baby, one bed for So you're missing patients. And if you've done, if they had no jobs. You're saying that and you just keep a list of the jobs there, right? And that was your one. And then this is like a copy of the master list version. So with a big team, we had something like this. We put all the imaging on one side and who gets allocated, what jobs there and then these boxes you cross out when when they're finished the referrals. There you know, discharge summaries and other for anything else. We need to review a patient or what have you, uh, do other jobs as well? Um, that's a copy of a mass left, but they're very flexible. You just do them as you want them. Um, and this is some further reading. Uh, this is the website. I'm sure you already know about in mind the sleep. Uh, the wardrobe one is where I got a couple of this stuff a couple of resources from, So check that out is very helpful. And that's the end of the first talk. I'm just going to grab some water. That's okay. Uh, should we do the Should we do you answer those questions now? Maybe the guys while they're the other guys that have questions or filling out feedback. How does that sound? Yeah, that sounds good to you. Just grab your 30 seconds 30. We'll pick up. Okay. So thanks for all of your questions, guys. And we're going to put them to put them to have to answer, keep them coming. He's happy to answer, um, pretty much anything to do with the topic or F one in general. And in the meantime, we're really appreciate it. If you could start filling out our feedback form so you can scan the QR code or visit the link that we put up there, it's really, really important for us to get good quality feedback. Were really keen to improve our sessions. So instead of just saying things were good or bad, if you can give detailed feedback, would really appreciate that. And it's also essential, as you probably will know for the portfolios of the doctors who have given up their time to teach. So please don't leave without filling in a few minutes of feedback and we'll be back shortly. With the second half of the presentation, I'm back and he's back. Yeah, I said 30 seconds. Uh, that was that was very quick. Drink of water. I have it next to me. I will be continuing to sip as the teacher goes on, and I recommend that the guys do the same as well. Can I Can I close this one down and open the other one? Yes, sure you can. While you do that, I'm just going to put the questions to you. Okay. Oh, please do Go ahead. all right. So actually, the two main questions that we've got our about about the first stage. So I think you you alluded to prepping notes. So people are wondering what exactly is involved in the process of prepping notes and a follow up question to that. Do you need to see patients and examine them to prep the notes? So what actually is prepping notes and do you know to see the patients and examine them to do that? Okay, so let's let's go with the, uh, I'm going to answer the second part first, If that's okay, the the do you need to see patients? Um, it depends, too. What level you want to prep the notes. So generally, let's say you're busy you're running. I would not recommend you go round and you see, see patients, Um, for that, Unless for like, I know in some medical teams there ward rounds happen at like one PM or the senior wardrobe happens like one PM, but what? But you're not really prepping notes for that. What you're doing is you're doing your own many war drowned beforehand to make sure your patients are safe until the senior wardrobe Okay, um, so you would be running off of the paperwork. That's already there. Um, noting down their observations, like the components. And I said, the observations, the the outputs of their drains. Uh, their day this POSTOP, the findings of CT scans, um, that were done, like two days ago. We just want to write it there. So it's in the entry. So that the So when they look at your entry later on, they know that you saw you know of that that CT scan and what have you so I wouldn't recommend you Go and see patients if you have the time. Hell, yeah. You can ask them how you especially your day your your day. One post office, right? You can just ask them how you're feeling if you open your bowels and what have you. And that means that when because they don't like record. If patients have been passing flatus not all nurse's record that right, they don't write it in the in the in the Bristol score, uh, all up in your chart. So if you ask the patient and they give you that information and then when you're giving that mini hand over to the senior. Um, it seems like, Well, you know more. Um, you know, quite a bit. You're on top of your game. You seem competent. I like it. Um, so that's if you need to see them. What was what was the first? The first part? What? What? What are your prepping? Yes. So what's actually involved in the process? Everything you can write in without seeing the patient. So the imaging that's on the computer, the bloods that are on the computer, Um, the consultants gonna be taking over their observations. Um, getting saving room and stuff? Um, yeah. Just everything that you don't need to see the patient for. So leave space for examination. Little bit of space for free text so they can add more information to you when they're seeing the patient. Um, and if you can guess that part of the plan, go ahead and start writing that input. Obviously, you can just wait until the boss man says the plan there. All right. Is that okay? Yeah. All right. Fantastic. I think that clears that up. We've also got a sort of just trying to simultaneously write a comment on Facebook at the same time, we've got another question. Um, so do you have any tips on how to keep your seniors happy? And like on surgical versus medical world around? So there's certain things that you should know about the patient in advance, depending on what kind of work around it is. That is such an interesting question, and it's going to take a little bit. Okay, You know, if the new F one C is the surgical S H o U tab on the ground, how would they make you happy? I mean, number one, um, I am going to be leading it for surgical. Do not lead. It's either lead, but Okay, so this is how Okay. And when I was on my medical job, this is how I made my seniors happy when it was my reg. So number one, these are there are people who would be working with daily, so have a good rapport with them when they're happy to come into work to see you, especially on difficult awards. Um, it's a treat. You don't want to go and work with spend time and work with people that you don't like, or they seem to think they don't like you, so make them feel appreciated. You know, um, other things that they like. So if you if they can give you information like they're they're free. How much free time they have, Like in in some surgical attachments? Uh, surgical attachment. I had the registrar that runs the war down in the morning. Said, Look, we're starting at eight. I need to be in clinic at nine. And we looked at the list like, we're not going to get to see all these patients. So what we did was we highlighted the ones that were important for him to see. We made We saw those ones with him, and then we made sure a senior S h o went through the rest of them, um, to make sure there was no worries. And then we just relay that information back to the boss until he could see it himself later on. So facilitating around their needs is very important, making things as efficient as possible. Um give communicating with them, giving, giving feedback on the jobs they've generated, but not overloading them with it. So more specifically would be like findings of CTS really important. Um, if things get rejected, let them know early. Um, outcomes of referrals. Uh, you need to go to the nitty gritty because just like my surgical right, Just don't want to know the nitty gritty of cardiology, but they'll be, But you can be like they've changed the meds. It's sorted. Anesthetics is happy. They're they're good to go for their, uh, surgery tomorrow. Um, what else? Uh, and yeah, I think, actually, that's generally going to be in terms of how to make them happy. As long as you're efficient, you're not making them wait too much. Um, and then it's just going to be being efficient throughout the day, getting enacting their wishes. Basically, they'll they'll love that, too. Great. Thanks. Yeah, I think that was a loaded question. And as you say, it's quite team specific. You've given us some really good tips there and a very quick one before we move on to discharge summaries. Because this is one that I'm also interesting. So if you're using kind of Well, even if you're not using a computer based system, even if you've got sort of paper notes, how would you write out kind of the normal blood results and the abnormal blood results. Would you write out a long list or would you you know, would you put an asterisks by the abnormal blood results? How would you highlight what kind of what results are are important for whoever's reading the notes to see a good idea? So, um, if you have time, that's that's really the biggest thing. Uh, most lists that I've looked at, at least on the surgical side. They'll have, uh, an area where all the daily bloods are. The trends are there. Um, you can just note down the you can either note down on the important ones and say the other ones are like F B C equals nad or what have you like? Let's say, um, it's a It's a CD. You patient they've been They've been clocked into being on on on on award, and you're just seeing them as part of a post take. You might. Instead of writing down all of this stuff, you might say Fbc nad LFTs nad. So you're you're showing groups of them and you're saying they were normal. However, most ward rounds the way that it would run would be You write down all the bloods and what you do is it will be, let's say H B equals 93. And then in brackets it would be 92 where 92 was yesterday's. So you're showing the trend as well? That's really important. Um, and if there are important abnormality, all right, so thanks for answering all the questions, So Oh, sorry. I just cut you off there. I was just going to say, just to point out one last thing. Um, the stuff that's abnormal, that's important. Like, let's say, a race bilirubin obstructive joined us, underline it just it just brings their ice truck. That's some really sound advice. Thank you very much. And thanks for all your questions, guys. So we're now going to move on to discharge summary. So again you know something that will be doing day in day out. So I was going to tell us how to write a good good discharge. The perfect discharge summary. Let's not Let's not raise their expectations. I've put in the comments the link to the mind, the bleeding article for this topic. So feel free to read through it while you're listening and keep the questions coming over to, um All right, Um, and you can see the slides. Yeah. Perfecto. So, um, before, let's just take a little quick, breathe and garage. Don't Don't start running away, because I will be needing. Um well, I mean, you kind of you kind of figure it out yourself, but, um, let's say you're in a ward with a large turnover of patients right there. Loads and loads coming in. You have to assess them, get diagnosis, and then treat them and check them out. And you have to do it in, like, three or four days. Um, as an f one. What do you think Your time's May filled up the most pain discharge summary. You knew the answer. Because I yourself get out of here. I'm done with you. But yes, it's not assessing patients. It shouldn't be. Well, it might be attending theaters if it is your lucky. But I bet my money that after time on ward rounds, the thing I spent most time on was doing discharge. Some reason that one. It's a quintessential skill. It's one that you don't get taught. Well, a lot of medical. At least I didn't back in back in imperial, but a shoutout to Imperial. You taught me a lot of other stuff and stuff. Uh, it's one where you're expected to be better than your seniors. That in a room full of more senior doctors, you're the one that, sadly expected to do the discharge summary you're not expected to. Generally be asking them for help in the discharge summary is into asking them to do one for you. Um, uh, obviously, in the first couple of weeks of your job, sure, you can ask them to look over his discharge summary to give you advice and or or point out how to do things. But after that initial phase, it's not something you then keep asking about. Uh and I've heard about that. One is being safety because they couldn't do this for some reason, they said where they gave them to seniors that I can't do. You do it for me, and they just didn't want to learn out of it. So once again, you don't want to seem seem, uh, the thought of it negatively by your seniors. It's also the main communication between secondary primary care. It tells the GP. All they need to know about Doris, the 90 year old and her three months in the hospital, and why all of Doris Meds are now changed and what jobs are still outstanding for the GP to do. It's an important document, and it's also what the patient one of the few documents the patient takes home with them after they leave your care. So it's a record of them, too, And this one, we're gonna disregard the war down in the in the corner. I apologize, but it's, uh what they This is, uh, we're just going to introduction. Why we do it. The components. And, uh, any additional point is I can add to so name wise discharge summaries. Sometimes called T T e s t t o. That's basically more of the medications. Um, so, actually, Niraj, are you Are you around again? If not, don't worry. You are, uh good. Well, you can't. You can't. You can't put your names on the call. Um, have you seen a discharge summary before? Okay, um, and would you say that if you're a layman, would you say it was easy to go through that discharge summary Easy to understand easily formatted? Or was it more complex? Well, I guess it really depends on whose written it and kind of what hospital you were at. I know that some hospitals have sort of like specific instructions to the patient and then go into medical bit. But generally speaking, I think they can be quite difficult to patients, you know, for patients to understand. And you said an interesting bit and then they go into the medical bit. So are you assuming that the patient shouldn't be understanding that part? No, not at all. But they kind of go into They use more medical terminology, which exactly? It's weird. Yeah. I mean, you know, there are things that slip through GPS, unfortunately, and it helps with both patients. And GP are aware of what needs to be done on discharge from the hospital. Obviously, if one party doesn't understand what's going on, you're getting all the points. That's exactly where, Okay, you don't meet yourself. You're doing my slides for me to get out of here. But I do want to touch on the fact that you said that it's weird that it's it's how there's a medical bit that they're not expected. Know, like you're being trained for years not to communicate with patients in jargon. Uh, and here you are, giving them the only record that they will take home with them of their stay with you. And it's gonna be full of jargon would be so tough for them to go through that, um, not talking about my patients and stuff, but, like, I I don't expect them to be able to, uh, read the full discharge, Uh, the way that I I write them and my colleagues write them. And probably the reason for that is because discharge summaries fulfill lots of different roles. Two different people and I actually go through those first before before I actually go into how to write one. Because I need to impress upon you how vital you guys are gonna be for the NHS and how vital this job is for the NHS before then. Basically, spend around 20 minutes teaching guys how to go through a form. So it's it's pretty, pretty simple, pretty mundane, but it's important. It really is. Now. You touched on some point, you gave some point that I wasn't prepared for, uh, It's way further down the sides, but we've got four. I. I put four categories of of uses for, um, for discharge summaries. Number one. It's communication with primary care. So let them know what the heck's going on with Doris what scan she's had, what they found. That she may have a new cancer, and they're waiting on the results. MG t results on it that you discharged with a high ish potassium that was getting kind of better, but you kind of want it to be checked in the next couple of days to maybe a week so that you don't end up finding Doris passed out on her on her sofa in a month's time. Uh, so it's communicating with primary care Uh, number two, uh, facilitating the discharge so that kind of goes into a couple different branches. But nurses in some hospitals can send some patients to discharge summaries. Discharge lounge is where they sit and wait for transport, but it frees up a bed, but they can only do that if there's a complete discharge summary there, the beds freed up and you can ship someone up to the to the ward. Patient can start their treatment and you can see another person. The colleagues keep turning When the nurses tell the bed managers in the morning these patients are going home. Bed managers take that to mean This bed is now free. Please fill it and they will. And then they'll pressure the nurse is Why is my bed not free? Nurses will pressure you. Everyone on the ward gets dour. Everyone gets unhappy, so keep the wheels turning. Do your destruction. Recently, second part to facilitating discharge. Pharmacy uses it to get medications ready, for patients are going home, and they need to be getting those patients those meds ready before they go. So, uh, so they use that form as well, uh, record keeping for future teams When your POSTOP patients and obviously comes back the next day with complications, the ambulance team would have seen your discharge summary, and they understand what's going on. The any doctor that looks at them will be using your discharge summary to get some information from them as well. Uh, for people that hospital that haven't gone to fully electronic notes. Discharge summaries are probably one of the few things that most hospitals ubiquitously have electronically, so you may be using them quite regularly for your audits and research. So you want good quality ones Because you're gonna You're gonna be helping yourself when you go back to it in a couple of months to do that. Audit number four, uh, informing the patient. It's the take away the patient takes with them. It's not where you're meant to inform them of things. It's where you're meant to remind them the information you've previously been giving them. Now, I think I remember a statistic when I was back in med school like it was 30% of, um uh What a patient of what you tell a patient actually goes in because alien surroundings and they're unwell and stressful. And you give them once they hear the big C word, they don't hear anything else stuff like that. So it's where you can give them that information again. They can refer back to it later. Stuff like POSTOP surgical instructions, driving advice, what their scans showed, um, and that new medication you put them on that you want the GP to check in the next couple days because the GP is not going to get the district summary for, like, maybe a week or two. So if you give a physical copy to the patient and say, Go to your GP to get a blood test in the next couple of days, they can take that to the GP. GP knows what's going on. They can sort of the blood test Patient's goes home safe and happy components. Um, broken four categories. Basically their presentation. What brought them in the hospital? What happened in the hospital? What's the plan after hospital medications? That's it, Um, so prep. We like to prepare before we start things. So things to consider when you need to do it generally give it 3 to 4 hours before they actually had to physically to the hospital, Um, the ones being discharged the next day, they immediately go to the bottom of my jobs list because the thing I'm taking care of my patients that day, that's more important. But if they're going home in the afternoon, I'm getting it done in the morning. I'm giving pharmacy 3 to 4 hours to do it. Uh, I'd say that in terms of list of jobs, TTS take a lower priority than imaging requests or anything for sick patients. And why three hours? Because pharmacy needs that time for Dossett boxes there. Complicated, and a lot of elderly people are on them because they're really helpful. But they take time and they need to redo them. If you have to change the prescription, so don't so make sure the prescriptions all right, uh, point to some say it's better to better practice to start and then update the discharge summary as a patient goes along their journey. I'm not that kind of doctor. I haven't worked with many people that were that kind of doctor. It's more common in like geriatrics. Um, so I would, uh, recommend that, uh, if your colleagues are doing the same thing. But if they're not, if you're too busy, If the workload is too heavy, then maybe you just don't get the chance that you're too busy caring for your patients that day. And I think that's okay. Just make sure that if your colleagues are doing it, you're doing it for them to write. Don't Don't be the old one. Number three get paper notes and a drug chart together, and then go to a secluded area to be able to type up your stuff. Um, most doctors' offices. They're just off of your award sometimes, Uh, and that's okay, um, because you're not really allowed to take notes off award. It's like a safety issue. But as long as you let the nurses know where you're taking them, then they can grab like a drug chart if they need it or what have you? Um, and it's important. So you get off the water a little bit to do this, because nurses are really busy and they're very efficient, which includes handing over stuff so they'll notice an issue. And while they're doing doing two other jobs and and juggling to other other things along with those jobs, uh, they'll let you know, by the way, there's this issue and they think for you like fluids. I think for you Boom, just prescribe it and you're done. But it might take you five or so minutes. You might need to get up off the computer and you lose the computer. So if you get somewhere where you can get your stuff done safely and quickly, and then get back on the war and helping out the team. Better for everyone involved, right? And if it's important, they'll bleep you. Don't worry about it. They'll know where you hide. Um, number four. You want to look at wards rounds that summarize the stuff that happened previously? Um, so that's where your award round entries come in. You're helping yourself in the long term. You want to look at what what they actually came in with. So you want to look at their admission paperwork by E. D. Generally or so I know care a lot about PT and OT for their patients. But as a doctor, I generally haven't written that in myself. Some trust the PT and ot put them, put the information in themselves, or nurses just find a way of making sure the PT ot care is done for the patients. I've had a great deal of input in um, generally it's happened in the background, which is which is why I haven't had to get involved because they do it so well. Uh, and then also bring up your scans and their blood on the system. So you just check them just before you go. Uh, and you can copy and paste stuff as you need to into the, uh, into the note. So, in terms of components, patient demographics date, uh, in time and GP details, all that stuff generally gets water populated normally, um, problems with the patient. Basically, you're telling a story. So see how they came in What investigations you did, How they what you treated them with how they responded. Any complications, how you treat their complications, keep on doing that until they try and keep a concise You're not writing a long, long story. Um, also like to do a bullet points and what have you, But, you know, there are different ways of doing it, but that's the general gist, right? You're trying to give the patient journey, uh, next part of an extensive past medical history. The next doctor Clarkson in will love you for it. Because in e d, patient comes in there on Well, they don't really want to give me all of their possible history. They have 20 issues wrong with them. If you have a good version of a past medical history there, it helps the GI guys right, Because at least know what they're meant to be getting out of the patient. Uh, I know in daycare surgery, sometimes the edges that do discharges don't write that down. But you're the F one. You should be doing it to a higher level, right? It's your job, right? Your special your your specialization, I guess, uh, investigations. I have never copied and pasted blood into a disruption in my life. It is a mark of a lazy doctor that does, uh, summarize fbc using these LFTs crp nad done. Which basically means all these blood tests normal. Uh, and the abnormalities. Let's say they have a high potassium. You want to write the, uh They're one on discharge in brackets one just before it. Um, but you don't copy and paste the whole page imaging. Um, copy and paste the part of the conclusion if you want to, uh, if you're even more on it, you can be like, uh, you know, the CT head. That was done. Nothing abnormal there, but they wrote, like, two lines. You just a CT head nad Fine. Um and, uh, no one I'm going to say here I might say a couple of times. Well, no one should ever find out. They have cancer from the discharge summary. So be careful with your wording. Make sure that patients know of things before you put it on the discharge summary. So I don't find it when they go home. Also, if at the bottom of the conclusion the radiologist had urgent orthopedic referral, um advised, uh, maybe don't add that just because it adds, uh, if they don't remember seeing an orthopod, they will be wondering, Why didn't I get this? And that might be a reason that happened behind the scenes. So be careful about what you put in next, the GP to do and and, uh, the hospital to do. Uh, there are three big rules here. I'm not a GI personally, but I can give some input in terms of, uh, what's the one you can't tell the GP to do Any imaging, right? They're basically a consultant level themselves. The first thing they'll say is, when you say that is, you do it, which they're right to do. It's tougher for GPS to get imaging. There's, uh they have strict criteria if their imaging rates are very different from the ones in the hospitals around them. Uh, or in the other surgeries around them. They get penalized, last looked into, So it's not so. They don't want to do it if they don't have to. And if you're saying this is indicated, it's easier for you for you to do it. You can get it faster. You do it. Um, the work around is in the surgery. I've seen a patient may say near the end of their, uh, admission. I've got this issue and it might be a very mild issue. Something in the medical team doesn't even need to look at this point in Time. GP can look at it a little bit later. You can say, Look, if it goes on for a couple more days, go and have a chat with the GP and they'll investigate it further. Um, stuff like query cancer stuff doesn't fall into that. You can't. You can't just kick the bucket down the line. Um, it still seems a bit dodgy to me to to do that, but for efficiency sake, some places do it. I don't condone, Have, um, next one is GPS shouldn't be following up on your scans, either. If they happen in the hospital and the report back yet or they happen outside the hospital. Uh, if you're doing it, you're the one that's responsible for for following up on it. That's because the GPS are know a lot about a lot of different subjects, but they might not know the very nuances of the imaging that that you've requested, and then they're stuck. Okay, I have this information. Do I need to send them into a and immediately Is this an emergency or something to be seen in six weeks? So you don't know exactly how to respond to in every case. So you follow up on your bone scans. It's the right thing to do. Thirdly, for your own follow up state, specifically, when it will be happening, where it will be happening and who are like, what team is going to follow up on it. This means this important, the patient, so they know in a month's time where they're meant to be what they meant to do. It means that if they miss it or we don't give an appointment for it that it prompts. This is the time frame it should have happened in, and they can start chasing Where the hell did my follow up? So they're not lost to follow up. Keep people safe. Uh, next section. So medications don't get allergies. Pharmacy needs something signed to give outpatient meds. Normally, it's, uh, the hospitals have some sort of contract with GPS to give out, like two weeks of regular patient medications. CVS need to be written words and figures signed specifically in different ways. Different types of different rules. If you cook it up, don't worry. You can always talk to the friendly award pharmacist, or even better, wait for them to hunt you down because they can and will do that. So maybe just get it right. First time I talked to them initially when you start, the job will help. You don't worry. Make their life easier to. Lastly, there will be a section for advice for patients specifically useful after surgery. Um, when to start driving again when lifting most places allowed to, uh, like copping places. So you have a whole list of inguinal hernia stuff done that day being discharge, copy and paste advice. It's fine. You've already given it to them. Maybe getting in, giving them writing two and then Finally, you have to sign your handiwork. Obviously, right. Tips the any our status medics of putting it in their, uh, in their districts is very important. Post, uh, post when it was done, uh, who the conversation was with to get it done. Uh, specific. Specific. They're sealing of care. That was decided. Um, appointments. Check with the war clock. If they book those specific appointments. If they don't, then that might mean that no one will book that appointment and your patients lost. Pardon me. Excuse me. Um, so in the first couple of weeks, you'll find out the relevant emails are ways of setting up your appointments at the work. Looks won't do third warfarin rules. They are very important. And they change every trust you go to warfarin kills, so make sure that you're there's a proper follow up in place. If you're changing it a couple days before they discharge, get some sort of follow up sorted out. Tell them you need to be checking it out in the next couple of days. Otherwise, if they wait a week and they have a major bleed, it does happen. It's a terrible event, and it's easily avoidable. So So make sure that they're important about how important as well to get that checked out. And two at night and in the population. General. Very important. Uh, I think I got 18 minutes on that one, so thanks very much, guys. Uh, for your time, I wanna thank you guys behind the scenes neurology, for helping me out, Vinny as well in the background, I stole the template of these slides of a cash. And I did it, uh, well, and I want to thank him for, for for letting me borrow the template for the for these slides. And I want to thank the guys as well for for their attention, uh, for these long talks. And I hope you guys have the greatest experience. I love that one. It's the tough words. You get good experiences. You build camaraderie with other doctors. So, yeah, it's good stuff. Mirage back to you. Thanks very much. And I think you I think you deserve that glass of water. Now I let you, I'll let you grab some water. We've got some really interesting questions which you come in. So, guys, if you're watching, if you hang around and we'll we'll address as many questions as possible. We're also going to get lasagne on shortly from the M D U to give you some top tips from their side of things. Um, just a quick note on feedback. So again, the feedback link and QR code is up there. Thank you so much for attending. Please make sure that you complete this feedback and give us some really, really detailed kind of feedback on what we could do better or what didn't go so well. Um, it's really useful for us because we'll be running these every week for a couple of months and obviously for the doctor's, like, who have given up their time, it's really important for them to get some evidence for their portfolios as well. So, um right, ab, are you happy to take some questions down? Hit me Cool. There are quite a few. So I'm going to pick them out, and if you could just answer them relatively quickly. Um so really interesting question, actually. So would you say that adapting your style of discharge summary too like the style of writing to each patient would be a good thing to do if you had the time to Yes. Hell, yeah. Um, specifically, if they have a medical background as well, they appreciate that. Um, to be honest, I think most adaptation comes in the part you give to the patient itself. Um, the information you give us the GP generally going to be the same no matter what. Because you're not talking to the patient. You're talking the GP. Fantastic. Thank you. Another one. If you request a scan or test in hospital after discharge, how do you make sure that you're notified of the results? Obviously, is the requesting clinician you're responsible for following up on the results? So how do you How do you kind of make that happen? That's the weird caveat, right? So two things number one you need to so generally, like in my case is it was going to be the ridges that said, uh, we should do this as well as an outpatient, because I would be saying, Hey, it's a test we need to do. Let's do it as an inpatient. What? You a couple of ways you can do it. One If you clarify that it needs to be, Let's say, an ultrasound in two weeks' time. You can then also request a clinic follow up in four weeks' time. Uh, some places have specific pathways, So feeling hospital I know, for example, has, uh, has a pathway in their ambulatory care where you request both the ambulatory care clinic and the ultrasound on the for the same day. Uh, they go to the ultrasound, sit in ambulatory care until your on call team reviews them with the results and give them their findings. Um, and lastly, uh, if the red says, yeah, we need to get get this ct for them and say, Okay, who's going to follow up? And generally it will be I'll put it on my list Or when you are the requesting clinician, it's not actually under you per se. It's under the consultant that the person was under the care of, so they'll be informed of it as well. So they have a They have an obligation to make sure that those things are followed up, too. So if you ever asked to do that, you should just make sure that you know, you just you just ask that question. Who's going to follow it up? exactly come back to clinic. And if they if they if the ridges say GP, we'll follow up then either. Say they don't love doing that like awesome. If they should be doing something else or in the discharge summary, cover your own but and say Registrar said that, uh, my GP to follow it up. Cool. And the last question before we hand over to san would we be expected to write discharge summaries that patients we might not know very well. What if we don't know the full patient journey? And I'm assuming you sometimes do get asked to write discharge summaries of patients like that? Oh yeah, all the time. Um, it's not. It's not great, but let's say like in terms of job job allocation, you get just allocated that job of doing all the discharge summary that day. Um, the sometimes patients we haven't seen you haven't seen on war drowned, Um, or maybe they were discharged over the weekend and someone was naughty and didn't do the discharge summary. Yes, you do have to do it, but then there's paper copies, paper notes there that you can use. It may mean that there is a decrease in the quality of your, um, of your discharge summary, which is regrettable. But if a patient comes, uh, into the hospital through a and so you leave a and they need to go home with some form of discharge summary there needs to be a paper copy there, so you need to do the best you can do. Um, even if that's, uh, that's a patient you don't know. Was there any other new answer that question? Or did I answer? That was pretty much it. Thank you. And I think that's what a lot of people are nervous about because I think it's more often than not. You do have to, unfortunately, right, a discharge summary for a patient. You don't know too well, but it helps helps to have your kind of your view on that, too. So thank you very much. You've done it. I'm sorry. One thing I want to say, Don't put anything out your your but in terms of thinking about stuff, if you can't read any writing on there like once I missed, I missed the emphysema with empyema. Um, and the lung guys called me a couple days after saying, What on earth have you done? So don't miss right stuff. Uh, put the follow up that they have said they've requested in there. Don't Don't go out of your comfort zone. That's what I'm saying. Great. Yeah. We don't want to anger. We don't want to anger the the lung guys. And as much as we do need the m d u. And we're about to hand over to listen, we always hope that we don't need their services. A couple of questions coming in in the chat. We will answer them after the end of this, if that's okay, guys, keep the questions coming. We're happy to keep answering after we end the live video. So Luzon, over to you. Do you want to share your slides? I Hi, everyone. Um I actually like with the discharge summaries as well. Where you're saying you can in the discharge summary make it clear that you are doing it after the fact. And you can also make it clear that you are writing the summary based on records and not seeing the patient. If that makes you feel better as well. Okay. Let me quickly share my screen. You know. Like I said, I don't have that, uh, option anymore. It seems I've lost my showing. Are those? Sorry. It's been weird. Okay, Dex, Right. So, yeah, I just thought I'd give you our top tips from a medical legal point of view. So these are the type of stuff that we see, uh, doctors sometimes getting into trouble with. Very simply, write legibly, and please make sure your daytime and sign records. Okay. Uh, and when we talk about signing records, we definitely don't mean a little scribbled signature. Okay, You print your name, you make it clear who has done these records so that they can come to you if they have questions. And it also shows that your professional and that you're open and honest. Always make sure, and you'll be so surprised how often this kind of happens. Make sure that you specify the anatomical side very clearly. So we're not a big fan of putting a l or or are in a circle. Don't know how, but those two can sometimes look the same. So write out the word clearly in capitals even better, obviously, always be professional and always always avoid personal comments. now it's one of those things that all doctors when you ask them, they know this. But whenever every now and then we'll get records and it will have just things on there that you just really don't want the patient to see full details and request forms as well. So you know, I always kind of remember that in the hospital, where you have lots of pieces of paper, those pieces of paper can sometimes go missing. So if it's found, it's really important that it's put back in its rightful place. You know, write the full details on yeah. Clear comments on test results and actions is a big, honest file. Also record relative positive and negative findings. Um, now it's very important. We do get this sometimes where it's important to kind of put that in context with your patient. So if you have a patient who has come to see you because they are, they say that they have trouble breathing or that they try to go to sleep at night and their chest is whistling. If you go and they listen to their chest and you don't hear anything like what they describe, it's important that you say you don't hear those things rather than just saying chest sounds normal because it shows that you you listened and you listen to what your patient, uh, was asking you If unfortunately, somewhere down the line, there's a complaint, you know, and the patient read these records and they can see you know, a much better explanation of what you listen for. It will also jog their memory. Oh, yeah? Yeah. The doctor did do that. Okay, so it's just very important. Um, again, you know, with discharge as well. Just ensure treatment changes. Monitoring requirements are very clearly communicated. It's, uh, handovers and discharge summaries is one of those places things can sometimes be missed and go quite wrong. And chaperones very, very important to make sure that you note in your records the fact that you've offered a chaperone the fact that there was one available the fact that there wasn't one available the fact that the patient has said that they don't need a chaperone or they're happy for, you know, the family member to kind of just go in with them and all of those kind of things that are really, really important just make it very, very clear. And lastly, consent. Most important thing. Remember that consent state and times specific. So it's very, very important that you kind of you can't just get a blanket concerned at the start of a hospital. Stay and then do what you like. You have to get consent all the way through at every step, and it's important to just continuously talk to your patient. Check that they're still happy. Give them plenty of opportunity to tell you if they're not rather than kind of them being worried or complaining about it afterwards. Okay, that's it. Great. Thank you so much for that. Lausanne. Thank you for coming. Thank you for supporting us. And, um, I know that we've got some really exciting stuff coming up with you in the next few weeks, So we're looking forward to that as well. Listen, there aren't really many questions about the medical legal side of things here, but just a quick one. So we spoke to We spoke earlier about kind of writing about patients that you don't know. You know, you don't know too well, and obviously we said that if you have a if you've got a discharge summary or something that you need to write somebody else, that you should make it clear. And I guess you should just make it clear, you know, whatever it is, if you if you're on call and you are asked to see another team's patients. So the exact question here is Are you able to basically write discharge summaries for other teams patients? So would you just say it's always a good safety net to make it clear in your documentation that you don't? The patient isn't necessarily under your your parent team? Yeah, I think it's It's a It's an important fact, and it can sometimes helps with kind of telling the story as well. Um, you know, if there's anything that's kind of a contentious, anything like that, the fact that whoever looked at the nose can see Oh, it wasn't written by the person who saw the patient that can help them, Kind of maybe, you know, figure out, you know, there might be something more to it. I might have to look further. It's just, you know, well rounded information that gives a clear picture, um, like a virus that you're not going to necessarily get away with not doing it because somebody has to do it. But you know, it doesn't mean that you can't protect yourself. And you know you are protecting your patients in the things by making sure you give clear and accurate information. The last thing we want you to ever do as well is like if you can imagine if you're on like a post a quarter ground and, um, you get called a way to quickly go and do something where you're supposed to be taking the notes and stuff, you know, you can't note what you don't see, really. So it's very important if you can hand over the responsibility to a colleague who's staying behind. Do that. If you can't then come back and do the notes and check with a consultant. Does this say everything you wanted it to say? Thank you very much, And I think that's really interesting what you just said about painting a clear picture, and this comes back to something you said earlier about handwriting and stuff. A question that's had a few lights on the on the comments is how acceptable is it? And I think we'll make this the last question to answer life. How acceptable is it to use acronyms in world around notes? Have you ever come across sort of, um, issues with with nonstandard acronyms being used maybe specialty, specific ones that other people might not be able to decipher? Me? Yeah, both of you. Why don't you go first lasagna and then and then I'll jump in. Yeah. So we're very much advocated that you stick to the approved list of abbreviations. Um, mostly because you can get into bad habits. You know, you work in one hospital, and maybe it's the same hospital. We've done rotations before as a student, and they use is one thing, and then you move across the country and they have no idea what you're talking about. So stick to the approved abbreviations. But I also think it is very important that the discharge summary if you start using all sorts of jargon, all sorts of variations in that you're asking your patient to go and google those things. And, you know, like any normal person, if you google something, you get 10 explanations, and you might unfortunately, you have the one that's not relevant to you stick in your head and make you worried. So you know, we don't want that. I I will echo that. Uh, they will see, they will see cancer, and they will assume that they're a little bit of cellulitis. Cancer and boom. You now have a worried patient on your hands. Um, I would agree, Um, in terms of in practice, you noticed specifically, uh, special will have their own set of abbreviations. They aren't the same between trust, like PRB for PR bleeding. Um, my first surgical job. They didn't The consultant know what that was? And over time as well, Like, consultants won't know the abbreviations the juniors are using. So, um, when you But does that have a quick question to add on to that? The when you say, approved abbreviations? What sourcing do we say that this is an approved one? When When When does it become approved? That's a tough one to say. Yeah, well, the best list really is from the Royal College of Physicians. Okay, so they have a list is basically I think it's like an excel sheet, but you can get and we've got it. I can I can send it on if you want it. Even I'm learning stuff today. Good stick. Stick to the actual list. Because that is the list of people are going to use when they look things up. You know, um, they won't be like any kind of the abbreviation is that Is that in your you know, your pocket prescriber and stuff like that? They're usually approved abbreviations and, you know, in your be an f and stuff like that, so that should be absolutely fine. It is just, you know, if anybody ever asks you what does this mean? I have a little red flag. Go and check out that you're using something that's real great. Well, thank you so much, guys. Thanks again. Uh, listen for giving up your evenings to to teach, um, it's been it's been great. We had I didn't want to say this at the beginning of to make you to not make you nervous, but we had over 350 people watching live