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they came about. So sorry about this study. Frustrating. Okay, so they're speaking about. We spoke about the history of presenting complaint and guiding reader to make them understand why you made the decision to you. Did I think that's really important on. Then we spoke about, you know, treatments, that environment D and how this could be a useful diagnostic tool. Now if we included in our car it really dying someone reading freedom later about the series of events and provides a usual diagnostic tool so it gets something important to include on then this bit the background in past medical history. I think there's a huge standard deviation what's done well and what's not done well. So in my opinion, what's done poorly is we just include a list of eight is ed of all of the things that a patient has, and that could be what they told us they had. Or we can just drop it off the GP record that really provided very little information that's going to help the impatient even related to the history presents, complaint or otherwise. Because I'm not going happen to a patient for out there admission. So to provide one example. If you have an asthmatic that's coming in, is a huge difference between someone that you know occasionally has called steroid because they're poorly comport concordant on. There really used to be tracking this when someone's been admitted twice you for three time three times intubated and actually they've got peak flows of 100. And if we're aiming for peak flows of 3 to 400 is an impatient. We're never gonna get that because that's just not their baseline function. But it's no included in the platform, and the patient doesn't know when. It's gonna take the inpatient teenagers to find out by going through the notes. And really, that could have just been done front door and say nothing on the road. A note of effort. I used the example earlier. Something really advanced COPD, and they're one and only via home. If you don't document, you know who that patients under where they're assessed for their own IV and then around Northeast things. Then if you don't do that work, who's going to do that work well, it's gonna be rushed F one in three days after the patients had another, the setting It's been quite poor a year because they really, really looked it up and then not be meeting their settings. And it's hard to restrict. Your friend is getting worse. You see where I'm going. I'm so all of this really important information that we don't necessarily do that medical school very well. We did read 40 front Door Um, probably because we're very Russian. We have lots of agents to see, and we don't think it necessarily related to bit. But it makes a huge difference later on the line, particularly for our colleagues when were prepping teachers and destruction, Reese medication history and allergies. I'm going to speak about this quite a lot later because there's been loaded feedback that I got from social media consultants that have some. It's strong opinions on this, but essentially what we should not only doing, including documenting what patients are currently taking, that any recent changes doses he's prescribed, it has changed it cetera. I'll go on social history and baseline functional status. We'll talk about later for the same reason. This is something that I think is a huge. You see a huge difference between F ones F to use registrars and etcetera, and it's completely understandable that you're started. It started F one. You're terrified about hurting anyone. In fact, at the end of your stream, terrible, terrified, hurting anyone. And you haven't seen that many patients for our medical certain, not undifferentiated. So you may not be sure about what you think, causing the president presenting complaint. You may not have any ideas about the plan. If you don't know what differentials there are just writing it problems this and creating a problem of safe. It's eventually, or investigations by and large, from responses and Twitter and speaking consultants far outweigh the F one just for senior of you. And actually, if you think about the time it takes between you seeing a patient take and when your post a consultant sees a patient, maybe four or five hours and a lot of things could have happened that are absolutely safe for you to do in the interim. That would save a lot of time later on and would be beneficial for the patient, not only about as we mentioned earlier. You will always be seen by a senior writer, straw or two or three, so there's really no reason why you can't find your ideas off someone else and get senior approval before action is important before before being seen by. Okay, Is there any questions about what I've said before? We go on to what people, that smart fasting water than me? Think about doing a good job of medical parking, and I'll give it a second because I know this community. It's like, hopefully, the video doesn't drop in the interim. If there's no questions, concerns put a nice feeling. A dropped again. No thanks. A no good. That even means I'm speaking a lot of rubbish or we're covering all our bases, which is good. Um, I have people. What are the foundations of an excellent Clark? It it's for It is flu and concise. And once I speak about the detail of an important clocking, ultimately the consultants gonna spend a minute or two reading it, so it needs to be really clear. And that's why we're speaking about guiding the readers, the readers, you and understanding how you came to your decisions, including relevant negatives. Obviously, it's medical profession. We go about saying that summarizes one of the key information on it. provides clear justification for the decisions that mistaking, I think we just have somebody doing okay, provide evidence, referral discussion. I'm going to speak back. So I think we we discussed that. And if you think about all of the information, that's a huge amount of information. We have to gather for one single patient over our two hours about with that patient on Where can we get this information? So what medical school we really do is we clamp a patient, we speak to them, and if they got, if they've got a family member by the bedside or maxalt, which may be speaking about that, but that's really neglecting a huge, huge amount of information that we can get out there. That's really important, and all of this is going to be available to you for your take shifts. So obviously you've got the patient. Obviously, you've got the next kid, which you could bring up. Also, there's there's the care agencies. They'll be happy to speak you. Paramedic documentation will be uploaded whenever they get there, and that's such rich information that they're gathering when they see the patient immediately on kind of gets over one of the issues of patient memory and confusion, etcetera. You have a D documentation, and it's a bit controversial if you should look at that before you see the patient has been discussed later, they're not. They said there's outpatient letters, discharge summaries. We all have access to GP record nowadays. Got Isn't it so great with were know if one's 20 years ago on me, just that's actually speak to a patient and rely on our clinical judgment. We don't have to do that anymore. So I'd encourage you, actually, for every patient to look up all of this. Well, we just said disconnected. Have you lost a We still he, uh oh, yes, we're still missing girls. Good. Okay, get so what I've done. That's that's probably enough of enough of me talking rubbish about me. What I've done before, it's device make two loads It later, Junior Doctor, even my institution are out out outside of my institution and also a couple of patient section media. And the response is quite get. It seemed like other people. And this is what people think. So to start off with the verbal feedback I got with this, that despite the fact that we have all of this variety of information available to us. The most useful and safe thing to do is and then soon as your affinity patient going on with them, look at their observations. And this is for obvious reasons, because if we look at the time at states to do all of the task that the doc, it might be an hour before we see a patient. That's a long time for a friend and well patient not to be seen. We spoke about pressures, and when you go on your take shift, you will see the less the patient's building up that being referred. But as we remember earlier, this is one of the most that there's a very few amount really dangerous. I take dangerous, dangerous faces for an F one to be a Z in the places where there is the greatest risk and that is undifferentiated. Patients are relatively undifferentiated. It's patients that front door and also things like active hours. And why is that? Well, because you have or will be supervised. It's one of a and also you're seeing patients when they might be sick. It's the sickest they're going to be from the whole hospital stay, so there's a great potential for risk and the only way to do with that is to be strong and and not being rushed and say I'm going to go very slow and you got to remember that you would be the most junior member of this take team, so it's not your responsibility to keep up with the next. That's the job of the register on your on your more seniors. Your job is just to get a job with patients, you see, and if you feel you can go sit, go quicker what you will be because you do more more of these shifts than then that's great, but that's not your primary objective. We've spoken about saving your inpatient team time. So as you do your medical jobs, you find that the war's become very busy and it becomes very frustrating if you're dicking free. Previous notes or or ringing alternative hospitals are trying to get in touch with results, etcetera to find out information that could have quite easily in been gathered up front door and documents it. So you think about how you can say you're inpatient team time, even if it doesn't give you immediate gratification of making a difference right there and then we spoken about the fifth one down. This's kind of an interesting one. That's a shit. This is although your partner team doing huge about independently. But actually you need to remember the apartment team and your seems expecting to ask lots of questions. It could be it could be a really useful learning experience. If you do is well just for your decision making. We've spoken about that. Decisions on this is another really important thing we've got. Question. How do you know what installations relevant? Rather and documenting everything? The patient says What? Unfortunately, I think that's down to your clinical judgment. But if you're not sure, then we can sit around and ask later. Sometimes it will be. It will be really obvious because it'll be a clear presenting complaint. Other times it'll be on undifferentiated, complex patient and I think that's quite useful where we where we get our assistant review down rewrite If a few key issues in a lot of the feedback getting was that before these complex patients where we don't necessarily know why they come in that might be your only patient that's falling at home, for example, has found a little bit confused. This is where a system of you know, problems list with investigations, actions for each of the problems really going away. And if you work with a geriatrician, looks generally just totally work anyways, that so that would be my lancets of that, but unfortunately, down to clinical judgement. But don't worry. You're concerned we'll see a patient on for and hopefully we'll see questions, Uh, when we said that. So the safety eval your decisions and again again another another high risk point in a patient's admission. This is when you're prescribing all of their outpatient medications, so it's important you do it right. Often it sounds of hours, so it won't be checked by a pharmacist, and often it's complicated. By presenting complaint, I mean