On a medical on-call, you will never finish every job.

Never.

If you try, you will:

feel overwhelmed
rush decisions
miss sick patients
burn out

Your goal is not to complete everything.

Your goal is simple:

See the sick patients first and keep everyone safe.

Everything else is secondary.

The reality of on-call

Within the first hour you might have:

10+ bleeps
5 ward reviews
discharge letters
rewriting drug charts
blood requests
family updates
one actually sick patient

All of them will sound “urgent”.

They are not.

If you treat everything as urgent → you prioritise nothing.

The golden rule

Always remember:

Unwell patient > time-critical task > routine job

In that order.

Every time.

No exceptions.

Use the traffic light system (simple and safe)

This is the easiest way to think clearly under pressure.

🔴 RED — see immediately

Drop everything and go now.

These patients can deteriorate within minutes.

Examples:

NEWS ≥5–7
hypotension
hypoxia
chest pain
reduced GCS
active bleeding
seizures
septic patient
“nurse is very worried”
“doesn’t look right”

If you hear these words → don’t negotiate → go.

Even if you’re halfway through paperwork.

🟠 ORANGE — urgent but stable

Needs review soon (within 30–60 min), but not crashing.

Examples:

rising NEWS but stable
AKI review
new confusion
abnormal blood results
hyperkalaemia without ECG changes
new oxygen requirement
fluid review
pain issues
IV access problems

These come after all RED jobs.

🟢 GREEN — routine / can wait

These are important but not safety-critical.

Examples:

discharge summaries
rewriting drug charts
routine bloods
paperwork
TTOs
referral letters
“just check something”
family updates
chasing results

These can wait hours.

And that’s okay.

Night shifts are for safety, not admin perfection.

How to triage a bleep properly

Never walk to a ward without information.

Ask focused questions first.

When a nurse bleeps, ask:

What are the observations?
What is the NEWS score?
What exactly is the problem?
When did it start?
Are they stable right now?

This takes 20 seconds and saves 20 minutes.

You can usually decide RED / ORANGE / GREEN just from this.

Batch your jobs (huge time saver)

Don’t walk back and forth unnecessarily.

Example:

❌ Bad:

Ward A → Ward B → Ward A → Ward C

✔ Better:

Finish all tasks in Ward A
Then move to Ward B
Then Ward C

Reduces walking and mental fatigue.

Small efficiency → massive difference overnight.

Never start with paperwork

Classic junior mistake:

Starting shift → opening discharge summaries → getting interrupted constantly → falling behind → missing sick patient.

Admin should be:

last job of the night, not first.

Always ask:

“Is anyone sick before I sit down?”

Protect your time

It’s okay to say:

“I’m with an unwell patient, I’ll come after.”

This is safe practice, not laziness.

If you try to please everyone immediately, you’ll end up helping nobody properly.

Re-prioritise every hour

Priorities change quickly.

Every 60–90 minutes:

Pause for 1 minute and ask yourself:

Who is sick now?
Any new red flags?
What actually matters next?

This resets your focus and prevents drifting into low-value tasks.

Common mistakes juniors make

❌ Treating every job as urgent
❌ Walking to wards without triaging
❌ Starting paperwork first
❌ Saying yes to everything immediately
❌ Not reassessing priorities
❌ Getting stuck on one patient too long

These create stress and unsafe care.

Not lack of knowledge.

A simple mental checklist

Before doing any task, quickly ask:

Is someone sicker than this?
Will delaying this harm the patient?
Is this admin that can wait?

If yes → delay it.

Real NHS mindset shift

Night on-call is not about:

❌ finishing all jobs

It is about:

✔ keeping patients alive
✔ spotting deterioration early
✔ escalating appropriately

Everything else is bonus.

Once you accept this, on-calls become much calmer.

Take-home concept

Good doctors don’t work faster.

They work smarter.

If you consistently:

see sick first
delay routine work
triage bleeps properly

Your shifts will feel organised instead of chaotic.

Prioritisation is the real on-call skill.

Medicine comes second.