This is when you will see physicians (consultants) and budding physicians (registrars) with their thinking caps on. Be prepared to show them everything about the patient on the computer. They will want to see Observations, the Medication List and read any notes about overnight events. It always helps to include an issues list at the beginning of every ward round note. This ensures that all members of the team are on the same page. Make sure you don’t just copy and paste this part of the ward round note everyday as it can result in new issues not being added to the list or resolved issues remaining on the list. The most important part of the ward round note is the Impression and Plan. In your first few days, it can be difficult to come up with an impression yourself. Ask the registrar what they think. Document a clear and concise plan so that you aren’t called by the nursing staff 10 minutes after leaving the bedside.

Some medical ward rounds take a few hours and some take half a day. This is very dependent on your consultant and the number (and complexity) of patients you are seeing. When ward rounds are extra prolonged, it is wise to try and get some of the more urgent jobs done on the round as this can save time later.

Ward Jobs:

At the end of the ward round, sit down with your registrar and do a paper round. A paper round is where you sit down (+/- coffee) and talk through all the patients and their plans. You determine what ward jobs need to be done and divide them up amongst the team.

Common jobs generated from a medical ward round include:

• Requesting Radiology scans: Depending on your hospitals workflow, these usually require an electronic order on iEMR followed by a call to your friendly Radiology registrar with a summary of the patient’s story and why you need a scan. When quoting reasons you need a scan urgently, ‘because my Consultant wants it’, does not fare to well. Try and avoid this one. If you are unsure about why your patient needs this scan (when they have previously had ten other similar scans), ask your registrar. They might be 10 steps ahead or you might have missed something on the ward round.
• Requesting blood tests: There are these amazing people who roam the wards and take blood from people – they’re called phlebotomists and they are a junior doctor’s best friend! If you need urgent blood tests, it helps if you call the phlebotomist and explain the situation. Before you go home everyday, make sure you order blood tests for the next morning.
• Requesting medical consults: A kind registrar will make this phone call for you (especially in the first few days). However, if you are asked to get a consult from a medical specialty (e.g. cardiology, respiratory), ensure you have the patient’s full story with you and a specific question in mind. Read the section on ‘Referring’ in the Intern Survival Guide for further information.
• Referring for outpatient follow up: Some patients will need to be seen again in an outpatient setting once they are discharged from hospital. This may be a General Medical Clinic or it may a Specialty Clinic. Ensure you refer to the relevant specialty and put as much information on the referral as possible. State when you would like the follow up to take place – 2 weeks?, 6 months? 
• Complete Discharge Paperwork: This includes discharge prescriptions and medical certificates. I always like to let the pharmacist know which patient’s will be discharging. The pharmacists are great at flagging potential medication issues as well as talking to the patient about changes to their medications.
• Discharge Summaries: These are an intern’s best friend (NOT!). No junior doctor worth their salt enjoys discharge summaries. But they have to be done. Put yourself in the GP’s shoes and think what they would want to know when they see the patient in their clinic. A management plan on discharge will be at the top of their list. GP’s don’t really care what fluids a patient received in hospital so feel free to leave that out. I’ll be writing an article on the best way to write a concise and helpful discharge summary shortly.
• Follow up arrangements: Always discuss follow up arrangements with the patient on discharge. Ask them to see the GP for outstanding pathology or reviews. any removal of sutures or repeat pathology. Always give representation advice.