Chapter 2

Keeping track of patients and their details is extremely important as a doctor. This can quickly become an arduous task if you are not organized. Filling in forms after work is a waste of precious evenings and should be avoided at all costs if possible. Fortunately, you can greatly reduce the time you spend chasing paper, patients and results with the core weapon in a junior doctor’s arsenal: a folder.

Personal folder and the lists

A well-organized ring binder or slot-in folder can save days of time. Unlike a Filofax or tablet/iPad, a folder doubles up as a clipboard, providing a decent writing surface at the bedside and an immediate supply of forms during ward rounds, so that you can do all the paperwork during rounds. As well as saving time, a folder means you are less likely to forget things because you can do many tasks as soon as they are requested. Although they look great and are very useful as a reference source, tablets and iPads unfortunately don’t synchronize (yet) with hospital electronic medical record systems. There are also multiple issues with patient confidentiality that still exist with personal computer devices.

How to make a personal folder

You need one A4 ring-binder folder and multiple brightly coloured dividers. Sheets of pre-punched transparent plastic pockets for each section are also very useful. Fill the folder with all the different forms you use regularly during the day, stacking each type of form behind different dividers. Label the dividers. You can keep spare blank forms (e.g. blood forms) in the plastic pockets. Useful contents include spare continuation/history sheets, blood forms (biochemistry, haematology, microbiology/virology and group and save/cross match), radiology and nuclear medicine request cards, ECHO and cardiology request forms, endoscopy request forms, drug charts, discharge forms (if these are still paper in your hospital) and commonly used telephone numbers:

  1. You can almost always find a hole puncher at the ward clerk’s desk to use.
  2. Consider keeping common drug regimens in the front of the folder for easy reference. These might include heparin dosing, insulin sliding scales, glyceryl trinitrate and morphine infusions and gentamicin dosing. Common antibiotic regimens and doses specific to your hospital are also really helpful.
  3. Hospitals have their own days for doing specialty procedures (such as isotope scans and endoscopy). Colleagues and relevant departments will know when these are. Find out from your colleagues what you need to bring for team activities such as radiology conferences, academic events and mortality/morbidity meetings. Find out if there is a pro forma that you can use for these events, and if so make sure you have plenty of copies.
  4. Phone numbers are essential. Making a list early saves a lot of time. You can shrink the list and stick it on the front of your ward folder for easy reference. Another option is to include it in a small font on the bottom of your patient list so it is reprinted each day. Get out-of-hours contact numbers as well. It is important to have senior colleagues’ bleeps, the critical care outreach team’s numbers and medical/surgical registrar’s numbers close to hand. From experience, it is easier to find names if the list is strictly alphabetical. Copy or modify Figure 2.1 if you like.
  5. Your folder should also contain relevant patient information such as up-to-date blood test results or scan results.

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