A Year In Review

Hey.

All of July, I’ve been doing weekly posts on things I wish I knew before starting F1 or at least advise I could give to someone else starting their F1 post in August. And for the final post of July I had something else in mind. Unfortunately, I’ve been unwell and that particular post would have required a lot of research. Therefore, I’ve opted for something else: a year in review. Taking a step back and reviewing my first year as a doctor as I step into a new one.

It has been without a doubt, the hardest year of my life. Challenging beyond belief. There were so many moments where I felt lost and unsure. I’ve had times where I’ve been incredibly unhappy and more so recently where I’ve been so close to resigning. The hardest situations have been where I’ve felt personally scrutinised, where someone else’s perceptions of me contradicts how I see myself. These have left me feeling hurt and confused and wondering whether I know myself as much as I thought did. It’s often led to a lot of over analysing on my part to the point where I have often questioned something I knew to be true. It’s difficult to explain but I think my confidence in my own convictions has wavered under pressure. I’ve been blamed for issues that haven’t been my fault, I’ve had difficulties with senior colleagues and I’ve found it hard to know who to turn to.

I guess it’s an indication of how much I need to work on.

I know I could have been better. Much better. I could have taken care of myself more. There were times I could have been more honest, where I could have communicated more. I could have spoken up more, I could have taken myself less seriously. I could have stepped out of my comfort zone more. There’s comfort in knowing I’ve become a better doctor, but I question whether all of this has made me a better person.

And at this very moment, looking back through everything I’ve experienced, more than anything, I’m grateful that I’ve made it through. It wasn’t supposed to be easy.  I just never imagined it would be so hard.

Have I enjoyed F1? No. There’s no circling around the answer, I haven’t. I’m glad I’ll soon be able to close the door on those experiences and move on. And part of me wonders whether F2 will change the way I think about medicine. Will being a more senior member of the team shift my views so drastically that I finally realise that medicine is everything I wanted? I doubt it. I think my placements in F2 are more in line with what I want to do. But again, I doubt that will make a huge difference to the way I feel. I think the fundamental issues I have won’t change with a different placement or being at a different stage in my career.

Which makes me think that there is another side to this issue. Me. Medicine isn’t serving me the way I would have hoped. And it comes across in what I write. I would have liked this blog to show a lighter side of medicine, but I’ve tried to honestly depict how I’ve felt in my experiences. There are parts I enjoy but there’s so much that I don’t and it’s this realisation that makes me think that I’ve made the wrong choice.

Medicine was always the career I thought of the most, even though I wasn’t entirely sure what I wanted to do. Out of everything else, it was the one thing I could see myself doing. I’m happy I’ve been able to experience this journey and make a better judgement on what it is I want in a career.

Heading into F2, I pray that I can take all the lessons I’ve learnt and make this year better. I want to focus more on my physical and mental health, my hobbies and a career out of medicine. I think F2 should give me a more definitive answer about whether medicine is for me. Either way, I’m ready to make some changes.

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How To Survive A Night Shift As A F1

How To Survive A Night Shift

I started my set of nights very early, within a few weeks of F1. And though I wasn’t particularly happy about it, I reconciled with the fact that it could have been worse. If this is you and you’ve looked at the rota with horror, I hope you’ll find this post useful. I’ve written two other posts here and here about surviving F1. Take what you think is relevant and throw the rest away. I’ve split it up into before, during and after so it makes more sense.

Before:

  • People have different ways they like to handle the day/night before a night shift. Some people try not to sleep the night before so that they can sleep during the day and feel more awake during their night shift. Some people just go to bed as normal, the night before, and have a small pre-night shift nap. Others wake up in the morning, stay awake all day, work the night shift and then go home and sleep, meaning they’ve stayed awake for 24 hours plus. It might take a while to find a routine that works for you but eventually, you’ll find a routine what works for you.
  • Prepare meals. The last thing I want to do after a night shift is to hit the kitchen and start making food. So, before a week of nights, I usually make a big pot of something that will last me several days.
  • So that your whole routine isn’t completely thrown out of the window, plan when you will run, go to post office, whatever errands that you might need to do, because there’s not a lot of time left over for you to do the things you want to.

During

  • Drink plenty of water.
  • Healthy snacks: dried mangos and nuts for me. It’d be easy to hit the vending machine and buy lots of junk. I’m partial to the odd cookie, but having some good options makes me feel like I’m not completely falling off the wagon. And it’s also cheaper. I can get into this mentality sometimes where I play victim: ‘I’m on nights, I deserve a biscuit’.
  • Take it easy. You’ll be covering a lot of wards and patients. Some nights can be quiet, but on those busy ones, pace yourself. Take breaks. I found when I didn’t, I could be reading the same line in a patient’s notes over and over again and not take anything in.
  • If there’s ten jobs waiting to be done, you can’t do them all at once. You’re going to have to prioritise. Sometimes the messages can be so cryptic it can be hard to make a decision. So call ahead and find out what the issue is.
  • Group the tasks by location. If you’re going to one ward, you might as well branch across the ward opposite if they need fluids prescribing. It’ll save you walking all the way back.
  • Know all the codes to the doors and short cuts. Make your life easy. Keep codes in the notes app in your phone so that you can come back to it. And important bleeps and numbers you need to know, like the medical registrar.
  • Try not to cut corners. It might be your fifth falls assessment of the night and doing a neuro exam on a sleepy elderly lady at 2:30 am isn’t the easiest thing to do. Chances are if someone has fallen in hospital, it could complicate their admission. You could be asked later down the line to explain what happened and how you responded.
  • If a nurse calls to let you know someone is unwell, give them some instructions of what to do before you get there: bloods, cannula etc.
  • Some issues will self-resolve. It’s surprising to me how many people I would be called to see because they weren’t sleeping and would arrive to find said person sleeping.
  • Know trust policy or at least know where to find them on the following: electrolyte imbalance (you’ll be prescribing loads of fluids), agitated patients (which benzodiazepine to prescribe), loose stools, fall management plan etc.

After

  • I’ve found that I feel so alert when I’m walking towards my car at the end of the night shift but 15 minutes later I’m starting to dip. I’ve written about it here. But when I get tired, I stop. It’s tempting to just try to power through and get home sooner. People have died from being tired at the wheel. You’ll still get home, just a little later.
  • Don’t get distracted by anything else. Just sleep. I don’t have an issue with sleeping in bright sunlight, but if you think you might do, get a sleeping mask.

 

Good luck. And enjoy the free time you have left, don’t spend it worrying. Comment below if you have any questions or other suggestions. Thanks for reading.

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10 Survival Tips for F1 (Part 2)

Here is another list of 10 tips for surviving F1

  1. Don’t do things just because you feel pressured. You’re new, you don’t know all the rules yet. If something feels wrong, then there’s probably a legitimate reason why. Don’t be pushed into signing something or giving a medication you’re not comfortable with. I was asked to prescribe an anti-emetic that I didn’t know. The nurse told me the route and the dose and gave me the prescription chart. I respect that the nurse knows her stuff, but I wasn’t comfortable just signing off on a drug I’d never heard of before. It might be hard but take a moment to step back and pause. Say something like ‘OK, let me look into it’ and move away from whoever it is that’s piling on the pressure.
  2. Don’t be afraid to say no. No doesn’t come easy to me. I feel like I’m being rude or inconvenient but sometimes you have to be clear. It’s hard and it gets even more difficult depending on who you’re saying it to. I talked about one experience here where I had to say no to a consultant. Hard. Something like ‘sorry, I’m not comfortable doing that.’ I’ve learnt to say no more and more on my current placement. I’m often left working on my own on the ward and the nurses will often bleep me as the first point of call for every query and I’ve had to apologise and redirect them to someone else.
  3. Book annual leave and plan things ahead of time. If you need to have a certain weekend off for a prearranged event that is non-negotiable, make sure you’ve looked at the rota way ahead of time and made swaps where necessary. A lot of people miss annual leave days. Don’t let it be you. Don’t just rely on emailing the coordinator to warn them, a lot of the time that doesn’t work.
  4. You’ll be under a lot of stress. The things you’ll have to do and experience won’t be easy. They’ll come home with you. Exercising, meditating, drawing anything that makes you feel good and takes your mind off work is non-negotiable. Whatever it is that you do, don’t let it slip. You’ll need it now more than ever.
  5. You don’t know everything. Be comfortable saying ‘I don’t know’. You’ll be working with other health professionals who’ll be able to help. You’ll get that one job from the ward-round which will take ages to sort out. I’ve been there, going round and round in circles. Sometimes, it’s just easier speaking to someone directly who might know the answer. If the query is about a drug, ask a pharmacist. They might be able to help you in seconds, if not, they’ll know how to get the information. Use the team around you, it will save you a lot of time.
  6. Just as above, nurses can be super useful especially in the beginning. They can help fill the gaps left behind from the long induction you’ll be made to sit through. They’ve been working longer than you have and know how the hospital works: how to request scans, where the family service office is etc. In the beginning it’ll be overwhelming and unless you’ve worked in that hospital before it can take a while to learn ‘the system’.
  7. Be cautious. Not only are you a new colleague, you’re also a new doctor. In my experience, I think it’s meant that some members of staff feel they can take advantage or treat me differently than they would a more senior doctor. I’ve not had too much trouble and this is just my opinion. But be respectful (particularly with nurses) and be patient. They outnumber you.
  8. There will be a lot of pressure on you to do 5 things at once. Some things can wait, some things can’t. There would be times nurses would hound me for discharge letters and act like it was the most important thing, taking precedent over everything else and that’s rarely the reality. But in the beginning when I didn’t know any better, it made me feel so overwhelmed. I would get it from all sides: cannula, discharge letter, pharmacist. Everyone wants something and now. You get used to it. You prioritise.
  9. There might be a time when you need to rely on your documentation and at the very least, you want to be able to read what you’ve wrote. You’re going to be seeing so many patients, you won’t be able to remember what happened with every single one of them.
  10. Finally, ASK. Ask. Ask. Especially in the first few months, everyone expects you to know nothing. This is the best time to play that part. I used to ask the medical registrar the simplest of things but she made me feel comfortable enough to approach her. You’re not working at a desk making a PowerPoint presentation, you are caring after real people with real conditions. Don’t fall into the trap of being silent.

Bonus

  • Question everything. If someone asks you to do something, ask why. I’ve been in so many situations where I’m asked to do something, I go on my merry way until I’m questioned and I realise I’m not really sure what the rationale was. Trust me it makes it that much easier to convince someone to do a scan or to review a patient if you know the questions you want answered. Apparently ‘because my consultant wants it’ isn’t a good enough reason.

These are all based on my experiences as a F1. My colleagues could relate to some of them but maybe not all of them. But I hope this goes some way to make this year a tiny bit easier. Good luck to everyone starting a new F1 post. You’ve done amazingly well to get this point. If you found this useful, please share. And comment below if you have any questions.

 

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10 Survival Tips for F1

survival tips

It’s July 2016 and the realisation that there’s only a few weeks before I walk the hospital corridors as a doctor for the first time. I’m filled with terror and excitement, but mostly terror.  A year later, and here I am, older and hopefully a little wiser. A year has gone by very quickly but not without some lessons learnt. Here is some of the things I wished I knew before I started F1.

  1. Lower your expectations. This is so crucial. You’ll save a lot of pain and heartache knowing now that the idea you may have in your head is so different from reality. I struggled with this, and to some respect I still do. I hoped I’d be learning more, building on all the things I’d learnt for finals. Realistically, you learn how to document faster, recite blood results without looking and pre-empt what the consultants want even before they know they want it. All the things you revised for at med school go out the window.
  2. Think it through. There were times, especially in the beginning where I’d be in a situation and I just didn’t know what to do. A patient was unwell and I didn’t know why or what to do next or who to tell. My mind would start racing and I would feel myself start to panic. Don’t do that. Don’t panic. Unless it’s a crash call where you have to act really quickly, then you can take a few seconds to order your thoughts. The time you spend running around not really doing anything is time wasted. Take it back to basics if you don’t know what to do: ABCDE.
  3. There were so many times in the first month I would be paralysed by indecision. Some situations I just didn’t know what to do, even if it was a relatively simple query. But with time I got quicker at making those smaller decisions. It’s the same for everyone else. What helped me was looking up trust guidelines, having a quick Google, asking one of the F2s.
  4. Don’t take everything to heart. Consultant’s might question you, registrar’s might tell you off unfairly, other colleagues might seem unreasonable and then take it out on you. It might not even be about you, so don’t let it get to you.
  5. Take care of yourself. You’re working in a system that is under a lot of strain and pressure and some of that will filter down onto you. It’s not your burden to bear all of it. Working 24 hours a day for 7 days a week, won’t save the situation. Just be mindful and do what you can.
  6. Prepare to work hard. You’ll miss lunch, you’ll work when you’re sick and you have to give some stuff up. It’s a hard balance to strike but I always make sure I’ve eaten or I’ve at least had a break. Missing the odd one might not count. But doing this repeatedly will start to affect you and you deserve more than that. I don’t believe being a doctor means you provide a service all the while breaking yourself down. You can’t work in a team, be a good colleague or a good doctor if you don’t look after yourself. You are you first, before you’re a doctor.
  7. There are so many embarrassing moments and mistakes. I’ve had too many cringe-worthy moments, but I learnt from them to make sure they didn’t happen again. (They did, just less frequently)
  8. Don’t expect a lot of praise. When you do get some, it will feel amazing. To actually have someone else applaud your hard work is a great feeling. But don’t hang your hopes on waiting for it, that’s an easy way to be disappointed.
  9. There’ll probably be a not so great placement. I’ve had my share. Don’t let it get to you, not all rotations can’t be the same. You’ll love some more than others. In the ones that you love, enjoy those moments. In the ones you don’t, just focus on working through. They’re four months long, they will always come to an end. Take what you need from them in order to grow and brush the rest off.
  10. Be prepared to laugh and cry. You’ll be working with so many clever, insightful people. You’ll bond over hard shifts and difficult patients. Some of the stuff I’ve gone through I’ve been able to vent to colleagues about, and they get it. It’s important to have a support system that understands. A lot of the times I come home and vent even more, to my mum and on here. You’ll be dealing with a lot, don’t keep it all to yourself.

That’s 10 things I’ve learnt. The next piece will be out next week. Let me know what you think, whether you agree or disagree and share with anyone you think this might help!

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