Your first week as a house officer
Week one isn't about impressing anyone with medicine. It's about learning where things are, who decides what, and how to keep your patient list under control.
On this page
Before day one
- Get your PMDC provisional registration sorted and keep copies of all documents: degree, transcript, registration, CNIC and joining letter.
- Buy a good stethoscope if you haven't, a pocket notebook, a pen torch and two pens.
- Download this site to your phone so the guides work without signal in the basement wards.
- Find out your unit, your reporting time and who to report to. Ask a current house officer from that unit if you can.
- Sleep well the night before. You won't sleep well for a while after.
What to carry every day
| Item | Why |
|---|---|
| Stethoscope and pen torch | Every examination, every call |
| Pocket notebook or printed patient list | Tasks, results, plans |
| Three pens, one in a different colour | For forms, notes and marking done tasks |
| Phone with offline guides and a power bank | Calls, calculators, references |
| Water bottle and a snack | Rounds run long; hunger ruins judgement |
| Gloves and a few alcohol swabs | Not every ward has them stocked when you need them |
Day 1: learn the ward
Arrive early. Introduce yourself to the head nurse, the ward boys and your fellow house officers. These people will make your life easy or very hard.
Walk the ward and find:
- The crash cart, oxygen cylinders and suction, and check that you know how to switch the suction on.
- The drug cupboard and the emergency tray.
- Where files, investigation forms and consent forms live.
- The phone numbers for the lab, radiology, blood bank and your seniors. Save them in your phone on day one.
- The duty roster: who is on call tonight and who covers you.
Write the bed numbers of every patient in your notebook with their name, diagnosis and the senior responsible.
Day 2: learn the round
Watch how the PG presents patients and what the consultant asks about. Notice the format, then copy it.
Write every task down as soon as it's said. At the end of the round, ask a PG to check your list.
A simple task list format:
| Bed | Patient | Task | Done |
|---|---|---|---|
| 7 | Diabetic foot | Send pus culture; HbA1c | Tick when done |
| 12 | Pneumonia | Repeat CBC; chase blood culture | Tick when done |
Before the next round, have every result ready: the latest haemoglobin, creatinine, sodium, potassium, sugar profile and culture reports. How to present on ward rounds shows a format seniors like.
Day 3: learn the jobs
Practise the jobs you'll do every day:
- Writing investigation forms correctly so samples aren't rejected: full name, bed, MR number, test, clinical details, date and your signature.
- Sending samples and tracking results.
- Writing a clear progress note: date, time, subjective, findings, plan, your name.
- Writing a discharge slip with diagnosis, treatment, follow-up and red flags in Urdu.
Practical skills to get signed off or supervised early: IV cannulation, venepuncture and blood cultures, ECG recording, urinary catheterisation and NG tube insertion. Ask a senior or experienced nurse to watch your first few.
Day 4: learn the system
- How to get a CT or ultrasound done, and which forms need a consultant's signature.
- How referrals work: written call, phone, or walking down. Find out what the other unit expects to see written.
- What the blood bank needs for a cross-match and how donors are arranged. See blood transfusion.
- How medico-legal cases are handled in your hospital. Read MLCs for house officers before you meet one.
- Where the clerking templates are, or print your own from clerking templates.
Day 5: your first on call
Get the handover in writing. Ask which patients are sick, who is for resuscitation, and what jobs are pending.
When you're called:
- Ask the nurse for the observations.
- Decide how fast you need to go.
- See the patient, assess A to E.
- Do what's needed, write it down and escalate early.
How fast to go
| Call | Go |
|---|---|
| Patient not breathing, no pulse, fitting, unresponsive | Immediately; call for help on the way |
| Low saturation, low blood pressure, chest pain, new confusion, very high or low sugar | Within minutes |
| Fever in a stable patient, pain, a result to review | Within the hour, after the urgent ones |
| Fluids to rewrite, routine prescriptions | When the urgent work is done |
Our deteriorating patient guide is the one to read before your first night. Then read the common ward calls: low blood pressure, low oxygen saturations, chest pain on the ward, low blood sugar, temperature spike and low urine output. First independent on-call covers the night in more detail.
Days 6 and 7: review and settle
- Look back at your task list. Which jobs took longest, and why?
- Learn the fluid prescriptions your unit uses most. See prescribing IV fluids.
- Clarify anything you are still unsure about with a PG, not on the next busy round.
- Rest on your day off. The first week is tiring in a way that surprises most people.
Safe prescribing from day one
Most early errors are prescribing errors. Before writing any drug:
- Check allergies and write them on the chart.
- Check kidney function before antibiotics, NSAIDs, metformin, enoxaparin and other renally cleared drugs. Use the kidney function calculator if unsure.
- Write the generic name, dose, route, frequency and start date clearly, and sign.
- Never copy a dose from memory for a drug you have not prescribed before. Check the drug page or ask.
- Be extra careful with insulin, potassium, heparin, opioids and paediatric doses.
Concentrated potassium must never be given as an IV push. If you are asked to give potassium, check the strength, dilution and rate first, and see electrolytes on the ward.
Working with attendants
In Pakistani wards, attendants are part of the daily picture. Introduce yourself, explain plans simply, and tell them who to ask for updates. Do not give prognosis or bad news you are not authorised to give; involve your senior. Dealing with attendants has scripts for difficult conversations.
Mistakes everyone makes in week one
- Trying to remember tasks instead of writing them down.
- Being too scared to call a senior.
- Prescribing without checking allergies or kidney function.
- Forgetting to document, then not being able to prove what was done.
- Leaving the ward without handing over pending jobs.
- Skipping meals.
Looking after yourself
The house job is a long year. Eat on duty, drink water, especially in summer, and sleep after nights. Keep in touch with friends outside medicine. If you are struggling, tell someone early. See burnout in the house job and the house job survival guide.
Frequently asked questions
What should I carry on my first day of house job?
A stethoscope, pen torch, notebook, several pens, your phone with offline guides, a snack and a water bottle.
Is it okay to ask seniors questions in the first week?
Yes. Asking is expected in week one. Not asking and getting something wrong is worse.
What should I do if I am called to a sick patient and do not know what to do?
Assess A to E, start basic measures such as oxygen and IV access, and call your senior immediately with the observations. You are not expected to manage it alone.
How do I keep track of all the jobs on a busy ward?
Use one written list with bed number, patient, task and a tick box. Update it after every round and hand it over before you leave.
Can I refuse to do a procedure I have never done?
You should ask for supervision until you are competent. Say so honestly; it is safer for the patient and for you.