Money On My Mind

My last placement was unbanded. No long days, no weekends and no nights meant more free time but less money. I started F1 on a rotation where I was on the on call rota and so moving from my first placement to my second placement meant I saw a huge drop in my income. As a result, I spent less. I shopped less and I kept my canteen lunches to a minimum. I didn’t cut back completely though because I started some art classes (I wanted to put all my free time to good use). But even with all the cutting back I realised by the time the next pay day arrived, I’d spent nearly all of the month’s salary.

I could have stopped the standing order I had to my savings account which was roughly 15% off my monthly income. The thought didn’t occur to me at the time, but I doubt I would have done it. I love saving. It makes me feel like I’m in control. At this point I don’t know whether it’s my rainy-day fund or whether it’s for a crazy gap year, I haven’t made up my mind. Whatever it is, it gives me options.

I don’t think I’d have been able to save as much if I’d moved out. Though, when people learn that I live at home, they’re always quick to assume that I’m saving loads more money. I imagine they must think I’m sitting on a growing pile of cash on the basis that I must not have to pay for anything. The truth is yes, I am saving money, but I’ve also got responsibilities that take a huge chunk of my salary. Initially it made me, not resentful but slightly envious of others who could actually live at home and didn’t have to pay for anything. But now I’m grateful that I can afford to help. I don’t try to explain my situation when people ask, I don’t feel like I really want to.

Not to mention the F1 salary isn’t great. The £500 drop from my first job to my second one was a little saddening. I don’t know how the other F1s managed with the drop. When people say don’t do medicine for the money, those four months were a great example of cutting back to pay for the necessary.

Continue Reading

Consent

consent

Recently, we had a patient under our care who spoke very little English. We could manage on very basic instructions but because the patient needed an operation, they needed to be consented for it.   Not one of us could speak anything other than fluent English, so we needed an interpreter.

I asked the ward clerk to book one in the patient’s preferred language. When interpreters are booked, they usually come the next day so I was beyond surprised when the ward clerk told me she’d arranged one for midday, little more than an hour away. I let my consultant know the good news.

Here’s where it turned sideways. He wanted me to do it. He wanted me to consent the patient for this operation. That caught me off guard. Consenting isn’t any old task. It’s a multi-layered subject that the GMC* takes very seriously because there’s so much to it. There’s so many aspects that needs to be taken into account: ethics, medical legal issues, capacity etc.

Then there’s the whole issue of F1s taking consent. It’s a grey area. We’re essentially baby doctors running around with a provisional registration. We can take consent for some procedures provided it’s something we’ve seen before. An example would be a colonoscopy (a camera that looks into your bowels). I can do that. I’ve seen several. But this operation I was being asked to consent for, I’d never seen it. I could hardly even pronounce it.

Obviously, all of this didn’t come to me at the time. I just held the phone to my ear for several seconds, trying to comprehend exactly what I was being asked to do. I started off with ‘O…..kay….’ Followed by ‘I don’t think I can’. Note the conviction in my wording. The consultant was urging me, saying I wasn’t really taking consent, I was just reading the form out to the patient and then the interpreter could sign the consent form. Still, it didn’t sit right. I was stuttering, falling over my words until eventually, I agreed.

But I was uneasy.

I walked back onto the ward heavy footed, wondering: why me? I kept going over it in my head.

Luckily, I bumped into another F1 and quickly ran over what happened. She gave me a definitive no, it wasn’t a good idea.

And really, it’s what I needed to hear. Intuitively, I knew it wasn’t a good idea. I wouldn’t be able to explain it to someone succinctly. Yes, I could read off a piece of paper, but that isn’t what consenting is about. I always find it difficult to say no, but I called the consultant back to let him know.

I managed to find someone else more versed in this procedure than me to explain it. He drew a diagram, he explained it clearly, he answered questions. Only a person with actual experience with the operation, could go into the amount of detail he did.

It made me realise how unfair it was for the consultant to put me in that position. Chances are, the operation would have gone smoothly. Yet even so, what if something bad did happen. It’s hard not to think of worse case scenario when there’s that constant reminder that you need to watch your back; we’re living in an increasingly litigious society.

Most importantly, it wasn’t fair on the patient. That patient needed to know exactly what was going to happen with their body. If they had questions, I definitely wouldn’t have been able to answer them. I knew what the aim of the procedure was, but how they were going to approach it, where they would make an incision or what exactly would happen would have been guess work. The patient deserves way more than that.

I’m really glad I made the right decision in the end. But I was so so close to making the wrong one. If I hadn’t talked it through with someone else, I genuinely think I might have done it. And it would have been a mistake. But in that moment, I felt pressure beyond belief. The consultant questioning why I couldn’t do it, telling me how busy the team were just made me feel more guilty.

It reminds me of the SJT**, the exam where you have to rank how you’d behave in different situations from the most appropriate to the least appropriate. It’s really easy to read a scenario on paper and say what you would do, but in reality, the situation can be very different. Rational thinking fails you, and your left to make quick judgement calls under a lot of pressure.

Let me know what you think. Has anyone else been in something similar? What happened? It would be good to know how I could have handled it differently.

 

*General Medical Council
**Situational Judgement Test

Continue Reading

Some Good Things

Some Good Things

Even when I feel down, there is always something to be grateful for. I try to make it a habit to look for the smallest things, just to keep me going and keep me motivated. Here are some examples of a few silver linings that have happened recently:

  1. When another F1 sent me a stinging message on a group WhatsApp, it left me confused. I couldn’t decipher the tone. Was it a question, covered in humour, or was I being told off? I’m not particularly close to this person so it was hard to tell. I replied as diplomatic as I could because I wanted to get the balance right so that 1) I addressed the issue, 2) I didn’t go overkill and have the other person tell me later they were joking and 3) have an all out argument on a group WhatsApp. No one wants to be told off by a colleague and I didn’t like that they felt they could embarrass/shame me in that way. If there was an issue, a private message would have been way more appropriate. I was really surprised and touched when the other F1s messaged me in private to support me. They were probably more ruffled than I was. It warmed me up a bit that other people took the time to try make me feel better.
  2. Even though I’m mid placement, I’ve already had my end of placement feedback for my ARCP. (Don’t ask why, the powers that be have decreed that it needs to be done two months before the actual end of the placement). My supervisor put the nicest things down, which took me aback a bit. It’s unusual to get really positive feedback in this game, it really is. You sort of just plod along and do the job. Maybe it’s because everyone expects you to be hardworking, that’s how we all got here. But as a newbie all you want to know, at least all I want to know, is that I’m doing OK. So imagine my heartache when it gets to the point we submit the form and the system decides to malfunction, deleting every nice thing that had been written. Luckily, my supervisor rewrote it all. I really needed to hear something positive, because my last placement had knocked my confidence, read here and here.
  3. My current placement has another F1 who is awesome. What’s annoying is that we don’t get to work together often because of our on call schedules. We’ve probably overlapped by four days so far. BUT, it looks like we’ll probably be working together more in June/July. We get on really well and we have a laugh, which makes the job much more bearable.

Just some of the good things that have taken me aback recently. I’m trying to remind myself of the good things and not allow myself to be weighed so heavily by the bad. Reading through comments is another thing that I look forward to. Even when I’m ranting, it’s really interesting to see your opinions and your take on a situation, so a big thank you for anyone who has left me a comment.

Continue Reading

Dear Paediatric Registrar

letter

Sorry that I don’t know your name. I’m writing this letter knowing that you won’t ever read it. I’m hoping by the virtue of me describing what happened this Saturday afternoon, it’ll serve to at least bring me closure and stop the angry rewinding and replaying in my mind.

At 3:30, I was bleeped by a nurse to do a discharge letter and discharge medication for a child. I let her know that I would do the letter as soon as I could.

Then you called a moment later.

I’m not sure what kind of day you had or what the situation was on your end, but equally you could say the same to me. So, when you said I needed to make this child a priority, I thought that was unfair and unnecessary. Every discharge letter that gets thrown my way is pushed on me because it’s urgent. It’s a Saturday and pharmacy closes before 4 (essentially giving me less than a half an hour window). When I’m waist deep in tasks, it’s unhelpful to tell me to leave what I’m doing, to do what you deem a priority. You had no idea what my workload was like, you failed to see beyond what needed to be ticked off your list.

You were unkind for telling me off for asking the nurse to look in the BNF for the antibiotic dose. I didn’t ask her to. She offered. And when she offered, I said she could. I don’t see where I went wrong. I didn’t ask her to prescribe it or to give a prescription. A nurse is more than capable to look in a book. But I didn’t argue with you. I got the sense that there would be no point. You clearly had a bone to pick.

I came up to the ward, leaving behind a stack of unfinished tasks and finished the letter. You bleeped me again: I had prescribed the formulation that the ward didn’t stock. And you wanted me to come back and prescribe on the bottle.

You were relentless.

Part of me wants to think it’s because you cared so much for the child at the end of all this. But I don’t think that explains everything. Because if it was truly that, if you really wanted to get that little girl home you could have prescribed the right antibiotic formulation, something you’d have done a thousand times. You could have written the prescription on the bottle, it would have taken you less than a minute. If that child was your priority you wouldn’t have instead dialled my bleep, countless times, to try to get me to leave everything, again, to come back up to your ward to jot a few words down. If you just did it yourself, you would have saved you and me a lot of time. I’m not sure why you needed to pick on every single thing.

I would understand more if it had come from a nurse. They get their own pressure from bed managers. But from a doctor who has been in the position I was in, who has been a junior doctor carrying the load several doctors normally would, I would have expected you to get it. To get that I’m one person and I can’t do everything at once.

At a time when everyone’s feeling the stress, you rely on your colleagues more to motivate and encourage you. But you gave me a metaphorical kick in the teeth. You were demanding and unfair. Again, I don’t know what type of day you had and I probably couldn’t imagine the stress that comes with being a paediatric registrar. But I hope that when those stress inducing situations arise, that you’re treated with more compassion and respect than you showed me.

Sincerely,
Zed

Continue Reading

Halfway

halfway

I’m halfway through my last placement as an F1 and I’m literally counting down the days to the end of July when I go away for a family holiday. It’s also really close to when we swap over, so coincidentally I’m also counting down the days till I never have to do surgery again.

I know surgery isn’t for me. I knew it halfway through medical school after a brief stint on the general surgical ward. I’m not keen to go to theatre. I’m not keen to stitch. I don’t really like seeing organs spilling out of the cavities they belong in. It just doesn’t stir any interest in me whatsoever.

The 2 year foundation programme should have a good balance of the different specialties which means there definitely should be a surgical rotation in there somewhere. Lucky for me, I got two. I’ve already completed one rotation so this is my last one. (!). I’m not very keen on my current surgical rotation. It’s a whole host of issues. Plus, the way F1s are treated on surgery is far from fun. Imagine a garbage truck at a landfill. We’re the landfill.

Surgery is very top heavy, so all the decisions come from up top. Daily consultant led ward rounds (which is good). In comparison to my first placement when it was a team of 4 junior doctors, we often had to lead our own rounds. I resented this in the beginning but now I’ve come to appreciate it. It meant I knew each patient, I knew their history and I knew where we were heading. I felt comfortable having discussions with patients and their relatives. It felt cohesive. The patients felt like my patients. I was making decisions and acting on them. Whilst on surgery, I don’t feel that same familiarity. The ward rounds happen so fast, it’s a bonus if I can catch a glimpse of the patient in front of me because I’m rigorously trying to scribble down as fast as I can.

I don’t ever fully know what’s going on with each individual patient. And the turnover is so fast, people become bed numbers because it’s so hard to keep up with who’s coming and going. I can’t confidently tell you what the plan is for everyone because honestly I can’t remember. The ward round is a blur. I pray that I’ve made a good list on my sheet or else it’s anyone’s guess what’s happening.

The moment the round is finished everyone disappears. It’s just me and my flimsy sheet of paper trying to figure out what the jobs are for each patient. There is another F1, but the rota is so choc block full of on calls that we hardly see each other. Honestly, I think the CT (core trainee) should be helping with the jobs, but surgeons don’t want to be on the ward, they want to be in theatre. So, all the menial tasks get dumped on the F1 (hence landfill). This is my experience anyway. Some of the other teams have more conscientious CTs who help. I can understand that they need to put the hours in and fulfil their requirements for their ARCP like we do. I get that. But they’re still junior members of the team and should be helping out on the ward. When the rota gap happened and left the team with no F1s, I was surprised the telling off I got. (Even though it wasn’t my fault). I had foolishly believed the CT would be able to do his bit and hold down the ward jobs. Obviously not. It seems the team can cope without a CT (and a registrar at the same time) but not without a F1. If all the F1s decided not to come in, surgery would crumble and just cease to move. You would think that would make us valued members of the team.

This isn’t to say that I can’t work on my own because I can. But so often I’m being spread thin across several wards. The bleeps go off constantly (guaranteed twice during lunch). Nurse A is calling from ward 1 and needs a discharge summary done (urgently), Nurse B is calling from Ward 2 because a patient’s blood pressure is 100/70 (yes, they feel fine), Nurse C is calling from Ward 3 because some fluids need prescribing (urgently). Nurse A wants to know how long for the discharge letter.

It gets to the point sometimes when I look forward to being on call just so I can escape that shrill call of my bleep and the person on the end who needs something done. And of course, it needs to be done A.S.A.P.

*core surgical trainees (CT): have completed the two year foundation programme (F1, F2) and are on a 2 year surgical training programme.

Continue Reading