Surgical on call

There is little that can be learnt here through reading - it is mostly practical experience which makes a difference. Listed below are a few points of advice which may be helpful:

• learn rapidly to trust what you feel about a patient, especially where it makes you want to act more rapidly. If your feelings are negative, you should try to analyse why, and should probably be mostly ignored where you are in danger of neglecting a patient. Examples include situations where you assess a patient and you feel they are in more pain than they are telling you. Here you are probably working by pattern recognition of factors you may not be able to quantify; under identical circumstances one of the authors correctly diagnosed a ruptured abdominal aortic aneurysm. However it must also be remembered that hypochondriacs can get serious illnesses.
• be polite to your working colleagues no matter how upset, annoyed or tired you feel. People have an extremely good memory for poor manners.
• finish one job before going on to the next, even when being harassed to move on. There are obvious exceptions to this rule, but you will never return to the unfinished job if you don't try to stick to it.
• your own food and hydration are very important, so don't skip meals. Even when extremely busy it makes sense to take ten minutes for a meal; it improves your ability to function.
• when tired, do exactly as you would normally, only more slowly and performing more checks to prevent mistakes.