General Practice

Photo by Brigitte Tohm on Unsplash

We had a lot of exposure to general practice (GP) during medical school. Usually, I’d have one day a week based at a practice and sometimes a couple of four week blocks would be allocated for general practice alone. So I’ve seen a fair share of different practices, some were better than others. But overall, I felt like I had a better appreciation of what it would be like to be a GP.

Throughout medical school we were told that at least half of us would be GPs. On its own, the statement doesn’t sound bad, but in context, a lot of the time it felt like we didn’t have much choice in the matter. 50% of us would be GPs regardless of whether or not we wanted to. Some people took offense, I didn’t particularly, even though at the time I thought wanted to be a paediatrician.

A few years later, now a F2 on my GP placement, I can see the appeal. 9 to 5 every day plus one afternoon off every week. I don’t have any night shifts or weekend shifts. There’s 30 minutes to see each patient, all the while sat down in a room with plenty of opportunities for tea/coffee breaks. I know this isn’t fully representative of an actual GP but it’s generally a much better working environment than what I’ve experienced so far working in hospital.

So part of me wants this to be it for me. Do GP, have a great work life balance and be financially stable. I really wish I could fall in love with it. At the moment, it just doesn’t excite me. Some of it does. I hear a lot about GPs who have more unusual working patterns, that go beyond seeing patients in a clinic. But if I go for general practice, I want to be really for it, not just the good bits. It’s like buying a cake with icing but only being excited for the icing. And then throwing the cake away when all the icing has been eaten.

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The Last Day of F1

The last day was a mix of emotions. Overwhelming gratitude and relief that I’d finished a difficult placement but also a slight melancholy that I was leaving. I was happy, don’t get me wrong, I’d started a countdown midway through the four months. But while I was working through the final jobs, I kept thinking of how everything was coming to an end. Not only was this the end of a placement but it was also the end of the academic year, the majority of doctors would be moving on to new hospitals. The people I’d worked with over the last months, the relationships I’d built, the comradery, it all felt like it was coming to an end.

We had a small get together at lunch with cakes and drinks and it felt like the end of an era.
The hospital can be really sociable. Just walking down the corridor, I’m bound to run into someone I used to work with. I enjoy that aspect of working in hospital.

My next placement is in GP which will be a massive change of environment. It’s always been the one thing that’s bugged me about general practice: the fact that there isn’t that community of peers around you. But I’m still looking forward to the change of scenery. I’m hoping GP will give me some of the learning experiences I’ve felt like I’ve been missing. Plus, surrendering my bleep for the next four months feels like a huge bonus. Not having the constant paranoia/palpitations every time I hear that beep anywhere around me. Immediately looking down at my bleep to see if it’s me that’s being summoned to some unknown problem. I just want to actually learn and do some medicine. Listen to a problem, take my time, explore the issues and be guided and taught as well. All whilst being sat down. I’m really hopeful.

I had the new foundation doctors shadow me on Tuesday and I honestly tried to be as positive as possible. I tried to give them all the necessary information they needed but I know they’ll learn it all as they go along. Luckily, the consultants are lovely so they should be fine.

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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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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

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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.

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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

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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.

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