Internship 101 - What You Need to Know 2019 - AMA WA
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Internship 101 –
What You Need to Know
2019
1
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 1
Contents
Welcome to the Medical Profession .................................................... 2
Welcome from AMA (WA) Doctors in Training (DiT) Committee........... 3
Welcome from AMA Council of Doctors in Training Chair.................... 5
WACHS Intern....................................................................................... 6
Intern – Top Tips to Surviving............................................................... 7
Intern-ship: Tips for Smooth Sailing..................................................... 8
The Power of One Voice.......................................................................10
Golden Rules for Interns – From Those Who Have Been There!.........11
Salary Packaging Explained................................................................12
AMA (WA): A One-Stop-Shop for Doctors in Training –
Professional and Industrial Services....................................................13
Key Entitlements – What You Need to Know.......................................14
Doctors in Training – Salary Rates Guide............................................16
Your Payslip..........................................................................................17
Prescribing 101....................................................................................20
Internship 101 – Junior Doctor Wellbeing........................................... 22
Looking after your Mental Health and Wellbeing.................................25
The Value of AMA (WA) Membership...................................................27
AMA (WA) Junior Doctor of the Year
(Dr Camille Michener Legacy Award)................................................. 29
Contacts.............................................................................................. 32
2
2 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
Welcome to the Medical Profession
Starting out in the medical profession will
be at once the most exciting and terrifying
moment of many of your lives.
Finally, after so many years There has been a lot of focus on You almost always get more out
of study, learning and exams, junior doctor wellbeing over the than you put in...
you get the opportunity to put last few years and for good reason.
AMA (WA) membership is really
your skills and knowledge into Our profession can be tough and
important for all doctors as
practice (whilst at last earning unrelenting at times and for some
AMA (WA) is the only body able
some money...). Thankfully, for the challenges can seem to great to
to look after you in almost any
you and your patients, that will bear. The workplace has changed
aspect of your professional life and
happen under the watchful eyes over the years and although you
provides many services that will
of more senior doctors who have will work less hours than interns in
help you navigate the years ahead.
years of experience on top of the the past, the pressures exist and
AMA (WA) also works hard to put
medical knowledge that you have the guaranteed career pathways of
the medical profession on the front
accumulated. the past are no longer so clear. You
foot in the media and on public
must look after yourself and your
On behalf of all doctors in WA, health issues and I hope that you
peers. Don’t be afraid to ask for help
I would like to welcome you to our will all be proud to continue your
as it may not be obvious to others
profession. The reality is that your AMA (WA) membership throughout
when you are struggling.
learning is only just beginning. your careers, as I have.
The quest for improving our skills If you don’t have your own GP
For most doctors I know, although
and knowledge is one of the its a great time to find one. You
they may grumble from time to time
defining aspects of Medicine and are probably very healthy, but it
about their lives and some aspects
for good doctors it never ends. is amazing how quickly that can
of their careers – they don’t regret
change once you get immersed in
Now is the time for you to learn their choice of profession. We have
work and the other challenges of
how to take responsibility for the a great job and we get to work in a
life and every doctor needs to have
wellbeing of your patients and for very good health system.
someone to look after them. If you
the continuation of your learning
don’t know who to see, AMA (WA) Welcome to Medicine and good luck!
journey – there is no longer anyone
maintains a list of GPs happy to look
looking over your shoulder telling
after other doctors.
you what you have to know or do. Omar Khorshid
I would also urge you to stay President
Some of you have already decided
engaged with your profession
on your path – that’s great! For the
– you can get involved with the
rest – there is no hurry. Get out
RMO societies, AMA (WA) DiT
there and try your hand in different
Committee, the JMO Forum and
areas. There is amazing breadth
many other groups as you progress
of opportunity in Medicine and a
through your training. For me,
special niche is available for all of us.
these interactions have been very
rewarding over my career and they
have provided me the foundations
to become a better doctor for my
patients and the leadership skills to
make a difference in our profession.
3
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 3
Welcome from AMA (WA) Doctors
en s
in Training (DiT) Committee Dr Jaso
n L au r D r R ebe
cca Woo
d
DR JASON LAURENS & DR REBECCA WOOD,
Co-Chairs DiT Committee
Congratulations on surviving medical school! Now starts a career that is both
challenging and extremely rewarding.
Internship is an amazing time – Seek out learning opportunities 5) Get involved!
you’re seeing patients, making on the wards and ask your AMA (WA) DiT Committee has
decisions and getting paid for it! seniors for feedback on how a proud reputation of being the
People know you’re on your ‘P’ you’re progressing. This will keep strongest local advocate for
plates so they give you lots of you in good stead for the years to hospital-based DiTs across the
support, plenty of guidance and a come. country. We represent DiTs from
gentler roster. Everyone will also 4) Join AMA (WA) internship through to trainee
want to give you tips on how to get As you hit the wards you’ll quickly registrars and tie in with the
through internship. We hate to miss realise there’s more to being a RMO Societies at each hospital
out, so here’s ours: doctor than the day-to-day care to ensure we have a good
of patients. Play your part in the understanding of ‘on the ground’
1) Be nice!
bigger picture by belonging to issues at all sites. The Committee
This is the year you create your
the peak medical group – the is open to any DiT member of the
reputation. Everyone will talk
Australian Medical Association. Association, so come and share
about you – you just won’t know
You’ll have seen AMA (WA) your opinion on the important
it. Learn names. Say hello,
advocate for patients, hospitals issues facing WA DiTs.
goodbye and thank you (even if
they’re telling you something you and doctors on a daily basis in Again, on behalf of the DiT
didn’t want to hear). the media, but what you haven’t Committee and AMA (WA) we’d like
experienced yet is the individual to congratulate you on completing
2) Be organised.
advocacy AMA (WA) provides for your studies and embarking on your
Internship is less about how great
its members. Should you have medical career. Being a doctor is
your medical knowledge is and
a problem with pay, leave or a privilege few get to experience.
more about your ability to get
anything else, you’ll always have No doubt there’ll be plenty of
things done. Know your patients
your Association in your corner. challenges ahead, but with those
and their pertinent results. Have a
system for keeping track of your In 2019 AMA (WA) will be re- challenges will come opportunities
jobs. Communicate the plan with negotiating all DiT and senior to both grow professionally and
others. Often this will also involve doctor contracts with the Dept to grow the profession, and we’d
practicing tip 1. of Health (WA) – the greater encourage you to take an active
saturation of members we part in your RMO Society, the PMC
3) Don’t forget your own learning.
have the more power we have JMO Forum and AMA (WA) DiT
As mentioned in tip 2, the focus
when negotiating your pay and Committee. With your help we can
in internship is different from
industrial rights. continue our tradition of strong DiT
your time spent learning as a
med student, but that doesn’t involvement in 2019.
mean you know it all. Remember;
it’s OK not to know – that’s why
we surround you with lots of
support. Make sure you get to
intern teaching/grand rounds/
departmental teaching.
AMA(WA)
Intern Sundowner
Tuesday 26th February 2019
6pm
4
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 5
Welcome from AMA Council of
Doctors in Training Chair
DR TESSA KENNEDY,
Chair, AMA Council of Doctors in Training
Congratulations on levelling up from student to intern,
and welcome to the medical profession!
A lot of things are about to change. I’ve worked with a consultant I’d strongly encourage you to get
First up, you get paid to be at for three months who never involved, either in the AMA, or any
hospital. Flip side – you actually have remembered my name. other avenue that allows you to help
to be at the hospital. You will be shape our professional world for
Any doctors can tell you there’s
given responsibility for patient care, the better.
nothing terribly remarkable about
perhaps the most satisfying part
these stories. I don’t share this Despite its many challenges and
of the job – but with it comes the
to scare or depress you, but to frustrations I love my job. I can’t
potential to do patients harm.
encourage you to take ownership imagine doing anything else and
You will be pushed to your limits:
of your experiences. I believe it to be a privilege to care
are you ready?
for my community. But doctors are
No doubt there are certain stressors
I truly believe it is the challenge of part of that community, and we are
inherent to the practice of medicine:
our work that makes it worthwhile, deserving of the same care and
dealing with death and suffering,
but to avoid burnout, it’s critical to compassion we afford our patients.
high stakes decision making,
balance work with life.
unpredictable workloads. However, As you enter internship with a hard
The Hippocratic Oath tells us to many others are not inevitable, earned ‘Dr’ before your name, here
first do no harm. But the practice more the result of health systems are 10 things that will help you thrive:
of medicine isn’t just capable of under strain, asked to do more 1. You are not alone.
inflicting harm on patients, doctors and more with less and less. 2. When and where to get help.
too can suffer in its pursuit. In the This is unhealthy not only for us, 3. Your rights (this is where AMA
last few years there has been a but for our patients, who are and ASMOF come in handy).
spotlight held up to the epidemic of placed at increased risk of harm.
4. Your limits.
psychological distress and mental
The various State AMA Doctors in 5. Your supports and safety nets.
ill-health which may be created,
Training Committees have quantified 6. It’s ok not to have a 10 year plan.
or perpetuated by the culture of
many of the concerns of doctors in 7. There is no wasted experience.
medicine and the way we work as
training through our Hospital Health
doctors. 8. Things can change – but you
Check surveys. This has allowed
need to drive it.
Personally, I’ve worked back to us to drive long overdue change to
9. Eat, sleep, and exercise before
back 16 hour shifts, 90 hour weeks common issues like unpaid overtime,
saving lives (and you’ll be better
and then gone home to study. I’ve difficulties accessing leave, unsafe
at it).
felt unable to call in sick because working hours, working when
there is no one to cover me. I’ve sick, service provision eclipsing 10. Our job is so amazing!
regularly stayed back only to be told training and more. The Federal The next few weeks and months will
I can’t claim overtime. I’ve caught AMA Council of Doctors in Training be full of challenges, but also rich
myself falling asleep driving home, of which I am Chair are working rewards.
90km from home. I’ve had a sleep- to address a number of broader
deprived panic attack before a high issues for DiTs, from gender inequity I wish you all the best, and can’t
stakes college exam. I’ve sat in my and discrimination to onerous wait to see what you do with your
car and cried inconsolably after a requirements for vocational training time in the profession.
near miss with a patient for which entry and completion.
I felt culpable.
5
6 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
WACHS Intern
DR HEIDI TUDEHOPE
Intern, Bunbury Regional Hospital
My first day as an intern A few things I learned on my It’s easy to doubt yourself, and can
I was rostered to work 7am first day, or wish I had known in be very useful to run ‘silly’ questions
to 11pm at my hospital, advance: past someone at your level.
Bunbury Regional. This shift Get by with a little help I would recommend going through
involved a full day with my from your friends! potential clinical scenarios
team, picking up a cordless The fact my new teammates were yourselves – think of what you might
phone before 4pm, and prepared to do what they could to be called for on the job. Patient
taking calls from any ward make my first day easier made me in pain? Have your options for
in the hospital that needed feel supported. Throughout the term analgesia – dosing and everything –
medical help after the teams we brought each other coffee, food readily at hand so you can write the
and water, took jobs off each other prescription. Patient nauseous and
finished for the day.
to even up the workload. We would vomiting? What are your options for
There were two other interns on the push someone out the door at 5pm anti emetics, and what do you need
team I was working with for term if they were driving up to Perth, or to know about the patient?
one who met me with “we saw the had family visiting. This is not a 9 to Often, well-meaning non-medical
roster, are you ok? Can we bring 5 job. Self care, taking breaks and colleagues suggest to you what they
you dinner?”. getting your off time is important, think is appropriate for the patient
I showed up at 6.30am, because but I think it’s just as important we – just never forget, your signature
I heard general surgery started realise the commitment to this job – your responsibility. Absolutely
earlier than the rostered 7am. is a big one, and you will survive. take advice and ALWAYS listen to
After fumbling with setting up lists, Keeping non-perishable snacks your non-medical colleagues. Just
chasing the team for rounds, I had such as muesli bars and bottled don’t forget you have the ultimate
to then go to hospital orientation. water have been essential to getting responsibility.
Already overloaded with information, through my day. Starting earlier
might also be necessary, even 15-20 In eight months on the job I have
I picked up the most terrifying thing:
minutes can be valuable to get your been through a lot. I’ve held hands
the on call phone. Then, it rang. The
team organised and on time for of people while they have taken their
caller started with “Doctor, come
the day, and it might even save you last breath. I am now allowed to
quickly!” – ah, I thought, there’s
staying back late. prescribe strong analgesia and stop
my glory moment! – followed with
someone writhing around in pain.
“there’s a patient bleeding from his On that first night, my bestie from I’ve worked as part of a team of
bottom”. My first patient consult uni was at the end of the phone with nurses and allied health staff using
as a doctor was a messy PR. After a stack of textbooks at the ready in all of our different skills to get the
a few more hours of responding case I had to phone a friend. In turn, I best outcome for our patients. What
to calls I was able to hand over offered to be that person for the intern we do is hard work, it is confronting,
the phone and drive a very short who took over on call after my run. but it’s an honour and a privilege
distance home (yay for country In the beginning few weeks, don’t be and I wouldn’t be anywhere else.
living!) and collapse into bed. afraid to pick a non-scary friend and
run decisions past each other. Good luck! If you’re doing a country
rotation in Bunbury (lucky you, it’s
awesome here!), say G’day!
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 7
Intern – Top Tips to Surviving
DR AMELIA LAMBERS
Intern, Fiona Stanley Hospital
1. Work/life balance Arrange for a team meeting to • If you made a mistake or said
• It does not have to be perfect. discuss issues. If there is still no something rude, then apologise.
Book one social event a week improvement then talk to your Patient safety is first if a clinical
in advance. Studies have amazing medical workforce team! mistake has occurred.
shown that if you catch up with • Everyone should be treated
colleagues you are less likely to equally and with respect! 7.Join a group that you feel
burn out as you both share your passionate about
stories together. 3. Continue your learning • I was able to join the AMA (WA)
• Exercise (this doesn’t have to • Set aside 1-2hrs a week for DiT Welfare Sub-committee
be a marathon!) just a 30min topics you have seen during the and, we are working on a Junior
walk daily (make it a habit – week, or look up one topic a day. Doctor Welfare Symposium
always before or after work). which is great fun!
4. A rrive on time and be • Possibly join a painting class or
Burn out is highest in interns,
prepared do a yoga course – there are so
please be proactive about looking
• Be early! This takes the stress many options! Have a think about
after yourself.
away from starting work late what gets your clock ticking.
• Have a support network –
and makes you a reliable team
join up to the mentor programs,
member who shows up on time!
keep in contact with your close
• Dress well, don’t look like you
university friends and family.
have just come out of a night
• Have your 8 hour sleep (healthy
club. Groom yourself, have a
bed time habits – put your phone
shower and brush your teeth!
in another room, read a book etc).
2. If you experience a 5. Food
colleague mistreating • Carry muesli bars and water Have a support
you or who is difficult with you. Leave these on your
to work with (not computer or in your pocket. Ward network – join up to
sharing jobs fairly or rounds can go into the afternoons the mentor programs,
being condescending/ and it’s important to maintain that
aggressive etc) energy. keep in contact with
• Have a chat to them first. Are your close university
they burnt out? Offer them 6. Be friendly to everyone
support in the form of contacting • Show respect to all staff including
friends and family.
medical workforce/GP. cleaners, patients, family of
• If this does not solve the issue, patients.
then talk to your senior such • Treat people the way you want to
as the registrar on your team. be treated!
Always have examples prepared • If you feel annoyed about a
and let them know how this is situation, then walk away, take a
affecting patient safety/your work. deep breath, have a cup of tea,
then return.
8 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
Intern-ship:
Tips for Smooth Sailing
DR SARAH NEWMAN
Assistant Director Doctors’ Health Advisory Service,
GP, Former Co-Chair Doctors’ Health Advisory Service
All aboard the Internship! –
for first time sailors, you are
still getting sea legs. Despite
studying all the maps, the
concept of sailing into the
great unknown can be
frightening. Sometimes you
will feel you are frantically
swimming just to stay afloat.
But here are a few tips from
seasoned sailors, often learnt
the hard way (apologies
for the excess nautical
references)
Pleasure Cruise
Firstly, don’t underestimate how
exciting and fulfilling this career
is. You worked long and hard to
attain this, with the bonus of a
disposable income. But life is about Apply your own Lifejacket
experiences – so enjoy the journey. first
Take pride in your work and be As a doctor the tendancy is to This means take your holidays (when
willing to learn. But take time to prioitise everyone else’s welfare, you can), make time to eat well
enjoy the space of not studying. but looking after yourself is critically (not just chips and gravy) and find
Have a joke, laugh with your important. Burnout leads to medical time to exercise (not just walking to
colleagues – it builds camaraderie error and poorer patient outcome, radiology).
and team spirit. It also helps let alone puts your mental and
Also, you are not ONLY a doctor
debrief – If we didn’t laugh we’d physical health at risk. Outside this
– you might be a mother, friend,
cry. Remember though sometimes nautical analogy, think of yourself
musician, amateur darts champion,
feeling emotional and overwhelmed like a Formula 1 vehicle – refined for
DIY handyman or all of these!
comes with the territory. Don’t bottle peak performance at the highest
Work-life balance improves
it away, talk with your friends and stakes. But you have to look after
professional performance, career
colleagues, chances are you are not the engine.
satisfaction, reduces burnout and
alone.
You cannot drive full throttle improves patient outcomes. Nurture
constantly, you need pit stops to that other part of you that sustains
maintain condition and prevent your passion for your job. Make time
faults before a problem. You also for outside interests and your non-
need the highest quality fuel, and a medical friends to get perspective
supportive pit crew. and help remind you what is really
important.INTERNSHIP 101 – WHAT YOU NEED TO KNOW 9
I know when you were studying you Still waters run deep Lifesaver
thought you were busy…it’s about to Something I have found very useful Related to mindfulness – kindfulness
get a whole lot worse! Your off time is the concept of mindfulness. is approaching life with a friendly
is precious – This means if people It relates to a non-judgemental and forgiving view. We doctors can
eat into your “you” time – you should attention to the present moment, be very uncivil, made worse by the
be compensated – so claim your and can involve meditative pressures of the job.
overtime and don’t feel pressured to techniques of breath and body
stay after hours – that’s what cover But we are all in this together – offer
awareness. It is increasingly being
is for. Schedule time for what’s to help others, lend a supportive
applied in the medical setting with
important in your life, including life shoulder, give praise freely.
encouraging results.
admin and sleep. Buy someone a coffee, or bring
The application is focusing on what
cake for your ward – baking will get
“
is happening now, and not worrying
you everywhere. I don’t quite believe
about the future, or ruminating on
in karma, but those who treat others
the past. I am terrible at this, but
Buy someone a coffee, with kindness tend to start receiving
leaving work worries at work allows
or bring cake for your space to recharge and make the
it back.
ward – baking will get most of my off time. Bon voyage sailors – remember
you everywhere. I don’t At work, it has taught me to avoid
to look after yourself to avoid sea
sickness, scurvy and falling over
quite believe in karma, the highly addictive urge to multi-
board!
but those who treat others task, something proven to be
with kindness tend to start associated by more errors and
inefficiency.
receiving it back.
So instead, try mono-tasking – that
means no more eating your lunch
and doing a discharge summary
while on the phone to the med reg
and recharting the PRNs.
Clinical Excellence Specialist Workforce Capacity
Office of the Chief Medical Officer
Medical Workforce Branch Program (SWCP) summary sheets
Email: medicalworkforce@health.wa.gov.au
The SWCP summary sheets have been developed to provide
an overview of the WA medical workforce based on the SWCP
2015.
Each SWCP summary sheet provides the following information:
The projected workforce 2015 to 2025
Projected consultant supply and demand 2015 to 2025
Workforce distribution 2015
Trainees and new fellows
Consultant age distribution 2015
Workforce planning and risk rating 2015 to 2025
The SWCP summary sheets should be read in conjunction with
the User information: Specialist Workforce Capacity Program summary sheets.
https://ww2.health.wa.gov.au/Articles/S_T/Specialist-Workforce-Capacity-Program-SWCP/Specialist-Workforce-
Capacity-Program-SWCP-2015-summary-sheets10 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
The Power of One Voice
DR KATHARINE NOONAN
Executive Officer – Policy and Research Lead Clinical
AMA (WA)
First, let me be the hundredth or Whether it’s chasing regular We often underestimate the
so person to congratulate you on medications or a recent discharge importance of our voice in public
joining the medical profession. It’s for an inpatient, treating the endless health debates. Doctors have
going to be a wild and bumpy ride. supply of patients scourged by credibility, meaning that what you
drugs and alcohol during the ED say matters to patients and the
The good news is that if you don’t
“disco shift”, or observing the community. And if you so desire,
want to think too hard from now
injustice of a mental health patient you can lend that voice to worthy
on, you don’t need to. That’s not to
waiting days for an acute bed – causes, speaking alongside groups
say that working as a doctor isn’t
doctors witness the issues firsthand. less able to make the noise. When
mentally and physically tough, or
we speak as a united front, with the
that any future exams won’t be Sometimes it all feels overwhelming
collective interests of patients and
gruelling – sorry! and insurmountable, and frustration
the community at the forefront, it is
can morph into apathy. I would
The hours can be long, your sleep much harder for those in power to
strongly recommend that you
patterns get out of whack and the ignore.
harness that frustration, coupled
realities of illness, life and death
with the sense that things can Leadership is critical to achieving
weigh heavy on the shoulders of
be done better and your fresh change in the health system and in
anyone with the slightest empathy.
perspective on the long-running public health more broadly. There
At the same time, the option is there issues, and channel it into a pursuit are also many different types of
to keep your head down, enjoy the outside of your day job. leaders that are needed, beyond
paycheck, and get through internship the traditional idea of a charismatic
One way to do this of course, is
and training as unscathed as (white) man at the head of an
to become a member of AMA
possible. Questioning the way things organisation.
(WA). As well as representing the
are done is a very optional extra.
interests and welfare of doctors, We still have a way to go in
However, I guarantee you that as AMA (WA) advocates on behalf of challenging our perceptions of who
interns and RMOs, at the frontline the community and our patients, fits the bill of a potential leader.
of providing care (read: bottom of aiming to improve the health of However, progress is being made.
the food chain), you will become all Western Australians. Whether And for progress to continue, put
acutely aware of the inefficiencies you’re contributing towards your hand up and demand a seat
and gaps in the system. It also policy submissions to Parliament, around the table.
becomes apparent to doctors that a engaging in a symposium on end-
As you embark on a new phase in
large proportion of health problems of-life choices, or completing a
your career, remember that your
could be avoided with sustained survey on weight management in
voice has immense value. I look
and coordinated efforts to improve the community, there are endless
forward to making some noise
prevention, health promotion and opportunities to have your voice
with you.
provision of primary care. heard and contribute to advocacy
on behalf of the medical profession.6
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 11
Golden Rules for Interns –
From Those Who Have Been There!
Join AMA (WA). AMA (WA) is the • Professional Services Review If you believe you have something
only organisation that effectively Committee investigations to say, then say it. Some Seniors
advocates for the profession as • Hospital inquiries don’t like being questioned, but often
a whole. Doctors in Training are they’re the ones who need it most.
Keep copies of documents such
particularly vulnerable because they
as your contracts of employment, No task is beneath you. Helping
don’t join organisations and are by
overtime and call back claims, tie a patient’s shoe laces, fetching
nature a fragmented workforce.
payslips and rosters and, of course, them a glass of water, holding
AMA (WA) is the only organisation
your leave application forms. their hand when they cry. You are
that will effectively advocate for
It will enable you to cross-check a fellow human being first and a
you on issues like Intern places,
issues and AMA (WA) will need this doctor second. Be kind, patient and
training places, changes to
information should it be necessary compassionate.
training programs and issues
to pursue matters on your behalf. It’s OK to be nervous – being
with your employer.
Check your payslips. Doctors nervous reminds you that you
Join an MDO. As a Doctor in
in Training have discovered many are taking care of people who are
Training, you are covered by the
errors in their fortnightly payslips sick, and you can’t be nonchalant
State Government’s Medical
and AMA (WA) has advocated about it.
Indemnity Policy in relation to
on behalf of members to rectify Step back from time to time and
medical negligence claims made
those errors. realise how amazing your job is.
against you that arise from the
provision of medical services to Help out your fellow Interns – You get to help people at the times
patients in the public health system. swap shifts with them if you are able they are most in need. Medicine is
However, there are a number of and you will be repaid with the same challenging, stimulating, complex,
exemptions that are not covered when you need it. and most of all, very rewarding.
by this indemnity arrangement,
Treat your patients like people, Take responsibility for your
such as:
not collections of diseases. actions. If you haven’t ordered a
• Coronial investigations test or performed an examination –
• Medical Board inquiries When you’re in your patient’s
admit it.
• Royal Commissions presence, don’t talk about them
– talk to them. Educate your Take the time to establish rapport
• Disciplinary proceedings
patients. This is part of helping them and trust with patients, their
medically. families and your colleagues
throughout the hospital system.
Don’t be afraid to ask for help.
Having your own top-up If you don’t find it with the first If you’re sick take sick leave.
person you ask, ask someone else. If you come to work, you will be
medical indemnity insurance expected to perform at 100%. If you
is essential and gives you Respect each other. Be sure to
can’t, you will only cause yourself
respect all your fellow doctors and
the security of knowing and your patients grief and you may
treat them all equally regardless of
that you will have your own gender, race or age.
also infect your colleagues.
independent representatives If you encounter problems in the
Care about your patients, but care
providing you with workplace, don’t let it fester.
about yourself too. Take time for
Talk to a trusted senior colleague,
assistance, support and lunch/coffee/a breath of fresh air!
your peers, hospital administration
legal advice. Lack of experience doesn’t mean or AMA (WA). Our Doctors in
lack of talent. Ignore those who Training Committee representatives
limit your abilities. Be the best and staff are there to assist
MDA National
doctor you can be. members with workplace issues.
www.mdanational.com.au12 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
7
What is Salary Packaging?
Salary packaging is a process where
you restructure the way you take
your salary in order to save tax.
This process can effectively convert
Salary Packaging Explained
Salary packaging can be a great way for doctors to get
ahead financially but many don’t get around to organising it,
or simply don’t realise how much they are missing out on.
HERE’S AN EXAMPLE:
An employee at a major hospital, earning approximately $70,000 per
year who chooses to sacrifice $10,000 out of their annual salary will get
a total yearly tax saving of $3,450! (Based on the individual income tax
your current cash salary into a
rates 2017/2018)
‘package’ which includes both cash
salary and payment of other benefits.
Salary packaging doesn’t change Details No Salary
Package Package
the amount you’re entitled to, just the
way in which you get paid. Salary 70,000 70,000
The first step involves giving up a Less: Amount Sacrificed – 10,000
portion of your regular cash wage
each pay period. Don’t panic! Taxable Income 70,000 60,000
It’s a sacrifice that reaps rewards. Tax Payable 15,697 12,247
By reducing your cash wage each
pay cycle you are entitled to a Net wages paid by hospital 54,303 47,753
reduction in the amount of income Add: Reimbursement of amount sacrificed – 10,000
tax you pay on your wage.
Total $54,303 $57,753
Next, you convert the amount of
cash salary that you have sacrificed
into other benefits such as rent In WA, there are two packaging providers who administer the arrangement on
payments, car lease, utility bills – behalf of your employer and yourself. Specific information about how to sign
this makes up the difference for the up and what can be packaged can be obtained from these providers.
amount of cash salary you sacrificed
out of your regular wage.
The result is that you still get the Need more information?
same total amount of salary, but pay HCN 6444 5000
less tax – leaving more money in hcn@health.wa.gov.au
your back pocket! Paywise 1300 132 532
info@paywise.com.au
What About Fringe www.paywise.com.au
Benefits Tax?
Fringe Benefits Tax is specifically Smart Salary 1300 476 278
designed to tax salary packaging www.smartsalary.com.au
arrangements.
If you’re considering salary
packaging, make sure you
seek advice to make sure your
arrangement is exempt from Fringe
Benefits Tax or the resulting tax
bill will most certainly wipe out any
potential savings.8
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 13
AMA (WA): A One-Stop-Shop for
Doctors in Training – Professional
and Industrial Services
Membership of AMA (WA) gives you Agreement Negotiation • Underpayment and overpayment
access to a comprehensive range of AMA (WA)’s proud history of salaries;
professional and industrial services of negotiating significant • Assistance and support with
including: improvements to salary rates, disciplinary processes.
• Industrial advice and allowances and employment
representation conditions has benefited junior Member Exclusive Events
• Access to Doctors in Training doctors over many years. You will and Seminars
(DiT) Committee meetings now be a beneficiary of the work of Confirmed dates for these events in
• Opportunity to contribute to the our dedicated staff. 2019 will be available on the AMA
profession’s political and public (WA) website www.amawa.com.au
As a result the 2016 Industrial
health advocacy Agreement negotiations WA • Intern Cocktail Function
• Agreement negotiation Interns were the first Intern cohort • Medico-legal Seminars
• Member-only communications in Australia to receive three year • Volunteering and Working Abroad
• Social and networking events appointments. As an Intern, having
• Intern/RMO Application
• Commercial benefits satisfactorily completed your
information evenings
internship and achieved general
• Clinical Topic Seminars
Political Advocacy registration you will progress
• Leadership and Management
AMA (WA) advocates on behalf directly to Resident Medical Officer,
Training
of Doctors in Training (Interns, resulting in greater job security
and guaranteed professional • CPR Training
Residents and Registrars) on a wide
range of public hospital issues. progression. Previously practitioners New events monthly. Keep an eye
Our priorities for 2019 include the would have been required to apply on your emails and the AMA (WA)
availability of training positions, for a RMO role. events page for notifications of
junior doctors’ access to leave In 2019 AMA (WA) will commence additional topics and events.
entitlements, improved rostering negotiations for replacement Member Only
practices and flexible work Agreements. Key issues for junior Communications
arrangements for trainees, including doctors include access to annual AMA members receive:
access to part time work. leave, rostering, overtime, on call
• Medical Journal of Australia
The DiT Committee Hospital Health and hours of work.
• Medicus
Check 2018 survey revealed a Part time work and flexible working • Australian Medicine
number of ongoing workplace arrangements are growing areas of • Industrial Updates
concerns affecting junior doctors. interest as junior doctors increasingly
The issues identified by the survey, • e-DiT (National e newsletter for
seek to establish a work life balance
coupled with AMA (WA)’s advocacy, Doctors in Training)
for themselves and their families.
has been a driving force in the
hospitals implementing change. Industrial Representation
Following the results of AMA (WA)’s AMA (WA) Industrial Officers can
survey on sexual harassment in the provide specialist advice and
workplace, a joint task force was assistance to junior doctors on a
established with the Department of range of issues including:
Health. This led to the launch of the • Contracts and offers of
‘SHOUT’ (Sexual Harassment OUT) employment;
Campaign and an ongoing campaign • Disputes which arise during the
by AMA (WA) to end unacceptable course of your employment;
behavior in the workplace. • Accessing your industrial
http://www.sh-out.com.au/ entitlements including leave;9
14 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
Key Entitlements – What You Need to Know
What are the ordinary • Hours worked on Saturday shall Sick leave in excess of two
hours of work under the attract a penalty of 50%. consecutive days requires a medical
Agreement? • Hours worked between midnight certificate or reasonable evidence of
A full-time practitioner’s ordinary Saturday & 8am Monday shall the illness or injury.
hours of work are an average of 40 attract a penalty of 75%.
hours per week. Rostered hours • Hours worked between What is a meal allowance
worked shall not exceed 75 hours 12 midnight at the and when does it apply?
in 7 consecutive days and not more commencement of a public A practitioner, who works more
than 140 hours in any 14 day period. holiday and 8am on the day after than 10 hours (exclusive of breaks)
a public holiday shall attract a or is required to work overtime
Practitioners shall be rostered for
penalty of 150%, or if agreed, a which means the practitioner takes
a minimum period of 3 hours and
penalty of 50% with time off in a meal away from the usual place
can be rostered for a maximum of
lieu of the public holiday worked. of residence, is entitled to a meal
15 hours for a day shift. However,
allowance of Breakfast $10.80,
practitioners starting work after
12 noon shall not be rostered for
How do I calculate the Lunch $13.30 and Dinner $15.95
more than 12 consecutive hours.
applicable penalty rate? and Supper $10.80.
Practitioners cannot be rostered to If a practitioner works hours which
would entitle that practitioner to What are the parental
work split shifts.
payment of more than one of the leave provisions under
monetary penalties payable (i.e. the Agreement?
How is overtime paid?
public holidays, overtime, on-call 52 weeks of unpaid parental leave
Paid hours in excess of 80 hours
and call back, shift and weekend which may include:
in any two week pay cycle shall be
work), only the highest of any such • 14 weeks paid leave for the
paid at the rate of 150%.
penalty shall be payable. primary care giver with at least
Paid hours in excess of 120 hours 12 months continuous service.
in any two week pay cycle shall be How much notice is the • 8 weeks concurrent leave (both
paid at the rate of 200%. hospital required to give parents allowed to be on leave at
for rosters? the same time).
What rest break Practitioners shall be given a
entitlements apply under A practitioner must provide 10 weeks
minimum of 14 days’ notice
the Agreement? notice if seeking to take leave.
and where possible 21 days’
A practitioner shall be entitled to a notice, of rosters prior to their Unpaid parental leave and
paid rest break of 30 minutes within commencement. Except in cases concurrent leave cannot be refused
each rostered period of duty. If a of emergency, or if the practitioner by your employer if you have met all
roster period exceeds 10 hours then agrees, rosters shall not be necessary notice and evidentiary
the practitioner shall be entitled amended during their currency. requirements.
to a second paid rest break of
30 minutes. How much sick leave am What are the long service
I entitled to? leave provisions under the
What penalty rates apply A full time practitioner shall be Agreement?
under the Agreement? entitled to 80 hours paid sick leave A practitioner is entitled to 13 weeks
• Hours worked between 6pm and for each year of service. Leave long service leave after 10 years
12 midnight on any weekday shall accrues pro rata on a weekly basis. continuous service.
attract a penalty of 20%.
A practitioner, in their first year
• Hours worked between 12
of service, may take sick leave in
midnight and 8am on any weekday
advance of the entitlement having
shall attract a penalty of 25%.
accrued.INTERNSHIP 101 – WHAT YOU NEED TO KNOW 15
• For any work between midnight Non-accruing leave is lost if not
and 6.00am at the rate of 200%. taken. However if you apply for the
• If the call back period exceeds leave and it is not granted by your
three hours, the practitioner shall employer it converts to accruing
be paid at the rate of 200% for leave. For this reason it is important
each additional hour. that you apply for your leave.
Please note that when you are How long is my contract
paid for a call back you will be of employment?
deducted the on call allowance
In WA Interns are offered a three
for the corresponding hours.
year contract extending into their
RMO terms, subject to successful
Payment for Public
completion of their internship.
Holidays
Hours worked on a public holiday What are the notice
How much annual leave
shall attract a penalty of 150%, provisions under the
am I entitled to?
or, if the practitioner and employer Agreement?
A full-time practitioner shall be
agree, at the rate of 50% and the
entitled to a minimum of 160 hours • For contracts of 12 months or
practitioner shall be entitled to a day
annual leave for each year of less – 4 weeks’ notice.
in lieu for the day worked.
service. Leave accrues pro rata on • For contracts of more than
a weekly basis. A practitioner may If a practitioner is rostered off duty 12 months but equal to or less
also accrue a maximum of 40 hours on a public holiday, the practitioner than 2 years – 6 weeks’ notice.
additional leave per year associated shall be paid as if it was an ordinary • For contracts of more than
with performance of on-call or working day, or if the employer 2 years but equal to or less than
working ordinary hours on Sundays/ agrees, be allowed to take a day off 3 years – 8 weeks’ notice.
Public holidays. in lieu at a mutually agreed time. • For contracts of more than
3 years – 12 weeks’ notice.
What are the on call How much Professional
entitlements under the Development Leave (PDL) Are there any differences if
Agreement? am I entitled to? I am employed by WACHS
Practitioners rostered on call A DiT is entitled to 3 weeks of PDL: or seconded to WACHS?
shall be paid an hourly allowance • 1 week is accruing Yes. We recommend that you
of $11.68 (from 1/10/2018). No • 2 weeks non-accruing contact AMA (WA) to discuss further.
practitioner shall be required to be
on call more frequently than one day Accruing leave carries over each
in three. year if not taken.
What are the call-back
entitlements under the
Agreement?
Practitioners who are recalled to The responses detailed above are provided as a general guide only
work shall be paid a minimum of and must NOT be taken to be a definitive statement of the Agreement.
three hours as follows: Whilst every attempt has been made to ensure the contents of this
• For any work between 6.00am summary are accurate, AMA (WA) and its Officers expressly disclaim
and midnight at the rate of 150%. liability for any act or omissions done in reliance on the information
provided or for any consequences whether direct or indirect of any such
• For work on Sunday between
act or omission. Please contact Sandra Thorp or Lauren Hillbrick on
6.00am and midnight at the rate
(08) 9273 3000 to discuss your specific queries.
of 175%.10
16 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
Doctors in Training –
Salary Rates Guide
Public
Base and PDA
Overtime Shift Loading Holidays
(1 Oct 18)
Worked
Hrs >80
Salary PDA PDA and Hrs Hrs
Pay per Hourly per fort- 120 in
Level annum rate annum nightly fortnight fortnight 20% 25% 50% 75% 250%
Intern 1 $78,479 $37.60 $5,742 $220.14 $56.41 $75.22 $7.52 $9.40 $18.80 $28.21 $94.02
RMOYr1 2 $86,328 $41.37 $5,742 $220.14 $62.06 $82.74 $8.27 $10.34 $20.69 $31.03 $103.43
RMOYr2 3 $94,960 $45.50 $5,742 $220.14 $68.26 $91.02 $9.10 $11.38 $22.75 $34.13 $113.77
RMOYr3 4 $104,456 $50.05 $5,742 $220.14 $75.09 $100.12 $10.01 $12.51 $25.02 $37.54 $125.15
Registrar Yr1 5 $109,678 $52.56 $10,048 $385.23 $78.84 $105.12 $10.51 $13.14 $26.28 $39.42 $131.40
Registrar Yr2 6 $115,163 $55.19 $10,048 $385.23 $82.78 $110.38 $11.03 $13.80 $27.59 $41.39 $137.98
Registrar Yr3 7 $123,800 $59.32 $10,048 $385.23 $88.99 $118.66 $11.86 $14.83 $29.66 $44.49 $148.32
Registrar Yr4 8 $129,990 $62.29 $10,048 $385.23 $93.44 $124.59 $12.45 $15.57 $31.14 $46.72 $155.74
Registrar Yr5 9 $136,489 $65.41 $10,048 $385.23 $98.11 $130.82 $13.08 $16.35 $32.70 $49.05 $163.53
Registrar Yr6 10 $143,314 $68.68 $10,048 $385.23 $103.02 $137.36 $13.73 $17.17 $34.34 $51.51 $171.70
Registrar Yr7 11 $150,479 $72.11 $10,048 $385.23 $108.17 $144.23 $14.42 $18.03 $36.05 $54.08 $180.29
Senior 12 $161,766 $77.52 $14,354 $550.31 $116.28 $155.05 $15.50 $19.38 $38.76 $58.14 $193.81
Registrar Yr1
Senior 13 $169,854 $81.39 $14,354 $550.31 $122.09 $162.80 $16.28 $20.35 $40.69 $61.04 $203.50
Registrar Yr2
Composite Salary
(Base + PDA) 1 Oct 18
Queries regarding
your pay slip,
Intern $84,221 including underpayments,
Resident Medical Officer $92,070–$110,198 should be directed to your
employer in the first instance.
Registrar $119,726–$160,527
Senior Registrar $176,120–$184,208 The Industrial Relations Team
at AMA (WA) are able to provide
* PDA – Professional Development Allowance support and advocacy on your
All figures used in the above example have been rounded and should be used as a guide only. behalf if the matter remains
unresolved.
Please contact either
Sandra Thorp or Lauren
Hillbrick on 9273 3000.11
INTERNSHIP 101 – WHAT YOU NEED TO KNOW 17
Your Payslip
As an Intern, deciphering your payslip may seem like the
least of your worries. However, AMA (WA) recommends that
you check your payslip each fortnight to ensure that you are
being paid correctly.
NORTH METRO AREA HEALTH SERVICE (GUIDE ONLY)
Employee Name Emp No: CGNM123456
Waldron, Mary Payroll Date Address
Send to
11/01/2019 4 STIRLING HIGHWAY
1
WALDRON, MARY
NEDLANDS WA 6009 The Intern base salary
14 Stirling Highway
NEDLANDS WA 6009 ABN No: 123456789101
is $78,479 as at
1 October 2018
Are your base hours correct? Check against your Period No: 536
roster. AMA (WA) advises that you keep copies of HR Contact:
your rosters in case of any pay dispute. HSS PAYROLL SERVICES Full-Time Salary
Telephone: 1300 553 927 $78,479.00
1. TAXED EARNINGS This Pay Year to Date 4. TAX This Pay Year to Date
Hours Rate Description Amount Description Amount
72 37.60 BASE HOURS 2,707.20 TAXATION 920.00
8 37.60 P/HOL OBSERV 300.80 Have you been paid appropriately
4 18.80 O/T 1.5 75.20 for public holidays?
10 11.68 O/CALL DIT 116.80
4 7.52 PENALTIES AT 20% 30.08
Have your shift 8 18.80 PENALTIES AT 50% 150.40
penalties been
8 28.21 PENALTIES AT 75% 225.68
calculated correctly?
2 9.40 PENALTIES AT 25% 18.80
Professional Development Allowance for
0 0 PROF DEV ALL 220.14
Interns is $220.14 as at 1 October2018
0 0 SMART SALARY –384.48
Total 3,460.62 3,460.62 Total 870.00 870.00
2. UNTAXED EARNINGS This Pay Year to Date 5. DEDUCTIONS This Pay Year to Date
Description Amount Description Amount
TOTAL 0.00 TOTAL 0.00
*Untaxed Earnings Total 0.00 0.00
3. TOTAL TAXABLE EARNINGS This Pay Year to Date 6. SUPERANNUATION This Pay Year to Date
3,460.62 3,460.62 Super Contributions Amount
NEW GESB SUPER WS6 328.76 328.76
7. NET PAY 2,590.62 2,590.62
GENERAL INFORMATION: LEAVE Balance Calculated Leave Type
DISBURSEMENTS (BANKED) ANNUAL LEAVE 0.15 W
Bank Account Amount LONG SERVICE LEAVE 0.00 W
CBA Mary Waldron 2,590.62 MED PRACT AL ADDIT LVE 3.00 H
PROF DEV LV ACCRUING 0.15 H
Are your leave balances
PROF DEV LV NON-ACCRUE 80.00 H
accruing each fortnight?
SICK LEAVE – FULL PAY 3.06 H
Are any deductions in leave correct?
TOIL PUBLIC HOLIDAY 0.00 H
Leave Balanced displayed are subject to audit
COMMENTS
* Tax on earnings is dependant on a number of variables.
The legend below explains the most commonly used codes you may find on your payslip.
BASE HOURS PENS 25% O/T 2.0
Base hours – as a full time employee this ought to be Penalty of 25% for hours worked 12 midnight and 8am Overtime for hours worked in excess of 120 per
80 hours per fortnight (including any observed/worked PENS 50% fortnight paid at 200%
public holidays) Penalty of 50% for hours worked on a Saturday ON CALL ALLCE – DIT
PROF DEV ALL PENS 75% On call allowance
Professional development allowance Penalty of 75% for hours worked between midnight P/HOL OBSERV
PENS 20% Saturday and 8am Monday Public holiday (observed) when rostered off duty on
Penalty of 20% for working between 6pm and O/T 1.5 public holiday, paid as if the day was an ordinary
12 midnight on any weekday Overtime for hours worked in excess of 80 hours per working day
fornight paid at 150%18 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
NORTH METRO AREA HEALTH SERVICE
Employee Name ABN No: 123456789101
Waldron, Mary Payroll Date Period
10/01/2019 522
Date From Date To Description Units Rate Amount
PRIOR PERIOD TAXED EARNINGS
TOTAL 0.00
CURRENT PERIOD TAXED EARNINGS
Check your hours for
28/12/2018 BASE HOURS 8 37.60 300.80
each shift are correct
28/12/2018 PENALTIES AT 20% 4 7.52 30.08
29/12/2018 BASE HOURS 8 37.60 300.80
29/12/2018 PENALTIES AT 50% 8 18.80 150.40
30/12/2018 BASE HOURS 8 37.60 300.80
30/12/2018 PENALTIES AT 75% 8 28.21 225.68
01/01/2019 P/HOL OBSERV 8 37.60 300.80
02/01/2019 BASE HOURS 8 37.60 300.80
02/01/2019 ON CALL ALLCE-DIT 10 11.68 116.80
04/01/2019 BASE HOURS 10 37.60 376.00
07/01/2019 BASE HOURS 10 37.60 376.00
08/01/2019 BASE HOURS 10 37.60 376.00
09/01/2019 BASE HOURS 10 37.60 376.00
09/01/2019 PENALTIES AT 25% 2 9.40 18.80
Did you receive all
10/01/2019 OVERTIME @1.5 4 18.80 75.20
overtime owing to you?
28/12/2018 10/01/2019 PROFESSIONAL DEVT ALLOW $220.14
28/12/2018 10/01/2019 SMART SALARY SP FIXED -$384.48
TOTAL $3,460.62
TOTAL TAXABLE EARNINGS (SECTION 1) $3,460.62
PRIOR PERIOD UNTAXED EARNINGS
TOTAL 0.00
CURRENT PERIOD UNTAXED EARNINGS
TOTAL 0.00
TOTAL UNTAXED EARNINGS (SECTION 2) 0.00
As an AMA (WA) member service, our Industrial Team can advocacy relating to identified salary and entitlement errors
(including underpayment and overpayment).
If you are experiencing problems in rectifying pay errors, you can have the issues dealt with by following these steps:
• Having established that there is an error, approach your hospital rostering team (Medical Administration/Workforce)
to verify the error and seek their assistance in correcting the error. In most cases the error can be fixed by updating
the roster information.
• After having verified the error with hospital rostering team, ensure they follow up with HSS. Your employer is
responsible for ensuring you receive your correct pay. Hospital Health Service (HSS) is the centralised payroll
service for the Department of Health.
• Keep records of all contacts made or attempted with your employer.
If you are not able to make any progress after having followed this process, please contact
the AMA (WA) Industrial Team on 9273 3000 to assist you or email mail@amawa.com.au.It’s here...an unsurpassed
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20 INTERNSHIP 101 – WHAT YOU NEED TO KNOW
Prescribing 101
Not much changes between your last day as a medical student and first day as an Intern –
apart from the title! There is no profound change in knowledge base or skill set.
But your most important accessory is your pen. Black or Blue is best. Avoid other colours unless you want to
battle it out with a pharmacist.
Now you prescribe because you have to, so here are some quick tips to help get you scribbling safely.
The Medication Chart A Legal Order Prescribing Checklist
• Front page – single dose For a medication to be given safely 1. Allergies – What are they?
medications (eg resus drugs) in a hospital it must have a legal Could it be a side effect? Will
• Front page – telephone orders. order – if done correctly this will other drugs in that class affect
Utilise this on your ward cover also save you precious time. the patient?
shift when you can’t get to a 2. Admission – Why have they
A legal order consists of:
patient straight away. Don’t been admitted? If they have
PATIENT – Check the label (and
forget to ask about allergies been admitted with syncope
if you start a new chart, place a from postural hypotension then
before prescribing.
sticker on it). withholding their antihypertensive
• Inside of medication chart
ROUTE – IV/PO/inh. This will may be necessary.
– Variable dose medications depend on whether the drug is
(most commonly gentamicin) 3. Bloods – Do they have any
bioavailable for the given route. renal or liver dysfunction? Is
• The patient’s regular medications For example, naloxone is not it iatrogenic? Eg Flucloxacillin
• Back page – PRN medications. bioavailable via oral route. Some causing liver dysfunction and
Do your colleagues a favour and drugs come in multiple oral worsening renal function due
put some pain relief, anti–emetics formulations i.e. Oxycodone TABS to Vancomycin. So you need to
and aperients for all your patients vs CAPS (S8 prescriptions need to adjust the dose due to impaired
on admission. When prescribing be very specific!). renal function?
PRN medications, you should DRUG – Use generic names 4. Check Obs – This may prompt
also include an indication in the (it helps everyone out). you to withhold or commence
space provided. DOSE – With correct unit of new medication.
measure. If you use (ii) then you 5. DVT – Do they need prophylaxis
The Anticoagulation Chart must write the strength of the tablet or do they need anti–coagulants
• DVT prophylaxis should next to the name. withheld? Most surgeons have
be considered in every their own preferred anti–coagulant
TIME/FREQUENCY – Date with
hospitalised patient. regime – ask the Registrar.
24 hour times. You must write the
• Common reasons NOT to give times in the boxes provided. 6. Drug Boffins – When stuck or
prophylaxis include; unsure ask the pharmacist. They
YOUR SIGNATURE AND PRINTED
– Bleeding SURNAME – The prescriber must are very approachable and know
– Anticoagulation for be identifiable for an order to more about medications than the
another cause be valid. doctors (unless pharmacy was
• The front of chart – single IMPORTANT TIP – All prescriptions your undergrad – if so everyone
dose drugs, prophylaxis will ask you instead).
should be written in a legible
orders and therapeutic manner. 7. Extra Tests – Some drugs will
anticoagulation orders. require that the patient have a
• The middle sheets – heparin drug level or blood test following
infusion including dosing administration. Eg gentamicin and
strategies for VTE and ACS. warfarin. Don’t forget to submit
the path forms in advance.
• The back sheet – LMWH
recommendations for dosing, 8. Oxygen charts are here to
Warfarin recommendations for stay and need to be renewed
dosing AND reversal. regularly. If your patient has
COPD do NOT give unrestricted
oxygen and aim for sats 88–92You can also read
