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.