An excerpt from Road Warrior Physician: Locum Tenens a How-to Guide.

There are few things that are more frustrating than to be delayed while en route to your assignment. It happens, so be prepared for it. Keep all travel emergency contact numbers handy. This is one of my prime Evernote uses. Note any additional flights in and around yours in case of delay or cancelation. Have the main phone number of the hospital or practice. Your delay may come after hours, but you can always leave a message in the event you won’t be showing up at the appointed time.

If you arrive early enough, take a test drive to the hospital or office the night before just to develop a little comfort with the route. When doing this, you can usually find where to park at least on that first day. Many hospitals will use your ID badge for parking; some require you to get a separate tag. Almost all will allow you to use visitor parking for the first day. All of this will save you time and anxiety on that first morning.

First day

“Learn your lines and don’t bump into the furniture.”
– Noel Coward

Your first day will give you a glimpse into the general milieu of your hospital. Orientation on that day varies greatly. Perhaps no other feature has such a range as the way hospitals or groups orient you. To illustrate this, I offer two extreme examples.

Hospital 1

I arrive, prepared with everything to start my first day. “Who are you?” the person at the OR desk asked.

“I am your locums anesthesiologist,” I reply politely.

“Another one?” she queries suspiciously.

“I am looking for the anesthesiologist in charge today, if possible.”

“Who’s in charge today for anesthesia?” she barks to those around.

Puzzled faces stare back at me. “Can I, at least, go to the locker room and change?” I ask.

Fingers point in the general direction of the locker room. Once in the locker room, I find my scrubs and am changing when another physician walks in. As luck would have it, she is one of the other locums anesthesiologists. We introduce ourselves, and she fills me in on the details about the practice there.

When we arrive at the OR desk, I am informed which OR I will be covering with no further information given. When I get to my room, I learn that I am doing a thoracotomy, a rather involved case, especially for someone who is still trying to figure out where everything is. Next I learn that the anesthesia tech that always helps with this is on vacation. None of the permanent staff step up to help me get started, but the other locums does.

Hospital 2

Prior to my arrival, I get an email from one of the permanent staff, introducing himself and giving me details about the hospital and the usual cases covered. When I arrive at the hospital, I am greeted by name by the charge nurse. Then the anesthesiologist in charge that day gives me a sheet with all of the phone numbers and access codes that I will need to get around the hospital. He then accompanies me to the pharmacy to make sure that my Pyxis access is in order and then introduces me to the rest of the staff.

I am given details and information about my first case and my surgeon. The anesthesia tech assists me with my first case to make sure I know where everything is. Later on in the day, when he is busy with another room, the anesthesiologist in charge checks on me to make sure that I have everything I need. Later that week, he and his wife have me over to their house for dinner to find out how things are going.

While these two examples are extreme, they illustrate how much preparedness counts when you encounter Hospital 1. Chances are, that even there, you can find an ally who is willing to assist you, some empathetic soul who already knows the drill and is willing to share it with you.

Back in the day when I first started doing locums, I would carry a blank sheet of paper and on it write names and various bits of information that I would need. I would even write descriptions of people to help me remember their names! Of course, I would also draw maps, codes I would need to remember, etc.

Say cheese!

I now use my phone camera to take pictures of people (after asking, of course) and send them to Evernote where I store all salient information needed for my assignment. This becomes invaluable if you return to a facility and helps avoid those embarrassing “I’m sorry, but I cannot recall your name” moments; in fact, you’ll look like the megastar you are when you can recall someone’s name and how they helped you previously.

Your cell phone camera can also capture snapshots of forms that you may need for orders, etc. Much of this has been replaced by the electronic medical record (EMR), but I never fail to be amazed by how much paperwork still exists in today’s hospitals.

All those tags and badges

At the very least, take a Ziploc bag with you to contain all of the tags, badges, etc. Your own bag can quickly become swamped with papers and items that you will acquire on your first day. I started using one of those zipper pouches that are in the school supply section of many stores.

It is useful because the mesh will allow you to see what badges you have, and the zipper will hold any pertinent items you want to keep safer, like a locker key or a pager. This is also useful for any return trips to the facility because I keep all of the items in their own folder at home. When I am heading out, I just put the folder in my bag, and I am ready to go!

Elizabeth Lumpkin is a physician and the author of Road Warrior Physician: Locum Tenens a How-to Guide.  She can be reached at Get Out of Your Rut and Onto the Road.

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