The First Day

First day on A&E was intense, which I expected. Starting any placement was always going to be uncomfortable, and I’d been to the department enough times to know what I was getting myself into.

I was on an early shift, which meant I started work 4 hours before any proper induction to the department. Luckily, I had a mini introduction by one of the consultants, given a small tour and then started seeing patients straight away.

Switching placements so often is genuinely like leaving one job and starting another a few streets away. You need to quickly immerse yourself into the team and learn a whole new way of doing things, all the while trying not to step on anyone’s toes.

My first patient was a simple case of back pain (flank pain). I saw so much of this in the community I was happy to send him home. I’d taken a history and examined him thoroughly. To me, it was an open and shut case. Is there such a thing in A&E? The department seems to run on paranoia, the chance that something could be missed. I was told to start some investigations, which came back normal and then I was able to discharge him. Whilst I was waiting for this patient’s results to come back, I started seeing the next one. It got to a point where I was just juggling it all.

Another patient I saw had vomiting and diarrhoea for several months. I tried to take bloods and put a line in to give some intravenous fluids. And I failed to do either. 4 months of not laying an eye on a needle has made me soft. And my skills were not great to begin with in the first place. Plenty of time to practice though.

I managed to get to the end of my shift having consumed 200 ml of water. Luckily, I’m used to being in a state of sublevel dehydration so I wasn’t affected too badly. I know that it’s unhealthy and I’ll try to drink more water.

So overall an average start. It was never going to be a case of flying into A&E and clerking patients with my eyes shut. It’s going to take time before I become a bit more comfortable. It’s going to take a lot of asking too many questions, being embarrassed, learning form mistakes but most of all being kind to myself and not piling on unwarranted amounts of pressure. It would be too easy to become overwhelmed and overworked.

But we’ll try to avoid all that.

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GP Completed

Now that I’ve nearly completed four months of GP, the thought that keeps coming to my mind is: could I see myself doing this?

It’s always been easy for me to visualise myself as a GP. I’ve had numerous opportunities to be in consultation rooms as a student or even just personal experience as a patient. So, imagining it isn’t difficult. Plus, it’s always been in the back of my mind that if I did A&E and trained up to registrar level, I could jump-ship and become a GP later down the line. That way I could have the best of both worlds.

But do I want to, is the question. And the truth is I don’t. And there’s a number of reasons why, some that I’ve spoken about before. One of the biggest things I’ve found with this placement is how isolating it’s been. Being shut in a room for hours at a time has not been enjoyable for me. But I guess that’s just a matter of my experience. In comparison to the partners who own the practice, they’ve known each other for years and get on really well. They’re genuinely friends. How nice would it be to work with friends.

I’ve often wondered how GPs do the 10 minute slots. Being pushed from 30 minutes to 20 minutes had me ramping up the speed of my consultations considerably. A general run down of each consultation: I have a couple of minutes to read through the patients notes so that I’ve got some sense of their history, I call them in then wait for them to make their way down the corridor. I take a history, which takes time, I examine, which takes time. Patient has to get undressed then redressed and then sit back down to discuss a plan. I often have to look through guidelines for what to do next or what to prescribe, which takes time. Then I write it all up, some need further investigations, some need referral letters. It gets slightly more complicated with kids and people who don’t speak English well. Some patients come with a whole list of things they expect you to sort out as well. I dread the ‘…and also’ before the next onslaught of symptoms. I’m having to be a lot firmer and apologise and explain that time is not on our side. And there’s the consultations that you know that need that extra time. There’s the patient who is developing depression, there’s the lady who’s having to put her husband in a home because she can’t cope. Mental health issues shouldn’t be rushed or squeezed into a short time frame. I’d want to be the GP who did more than prescribe pills. I’ve enjoyed the times I’ve been able to have frank discussions, which has either shifted a perception or brought about a better understanding. But that time is a luxury. How could I do it with less than 10 minute slots?

It’s just down to the fundamental truth of whether I enjoyed the day to day experience. I’ve not enjoyed it enough to validate a lifelong career in it. It is what it is. So, for now, I know that GP isn’t the one. This is nothing against the staff or the GPs, they’ve all been amazing. This practice has been incredibly kind and patient with me. I feel like if there was ever a place that would have converted me, it would have been this one.

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A&E

I’ve mentioned in a previous post that I’d narrowed down my options to a very select few, A&E being the frontrunner. Essentially the only runner, because when it comes to the two other options my feelings to them are at best lukewarm.

And for a while now, I’ve felt like my path in medicine rests on whether or not I’ll enjoy A&E. So much so, that since the fourth year of medicine, I’d been trying to arrange a placement in the emergency department. Unfortunately, it didn’t happen.

When the time came around to apply for foundation jobs, I made it a priority to have a placement in A&E. How it works is that I had an option of 10 ‘tracks’ to choose from. Each track was made up of 6 different placements: a mix of surgical, medical placements with the odd psychiatry, paediatrics and other specialties thrown in. 3 placements for F1 and 3 for F2. Not all the training tracks had A&E but I sought out the ones that did and ranked them highly. I still had to rank all the other tracks in order of preference which was a game in itself. I had a list of ones I wanted to avoid. Vascular surgery, for example, dropped to the bottom of the list like a dead weight.

I did this with the hope that A&E would be for me, and I would live happily ever after. Or at least till the point I became too exhausted with it and then became a GP who occasionally dipped their toe in the ED department whenever the mood struck. That was my plan.

So now that it’s drawing closer, it’s starting to feel really real. I’ve built up a level of expectation over the years and now it’s nearly here, all of a sudden I don’t feel ready. It’s like I’m edging towards a big realisation which might be hard to swallow. I flip between excitement and fear. No in-between. Just a light switch, from one to the other.

It doesn’t help that my friends that have been on A&E for the past 4 months never fail to tell me how fed up they are of the random shift patterns or how tired they always seem to be. Or when other colleagues retell how horrific an experience it was for them when they did it. Or the fact that I’ll be heading in at the worst time of the year: winter.

Whatever happens, it’ll definitely give me a lot to write about.

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A Message To F1s

Suddenly, somehow we’re in the run down to the end of the first placement.

And at this point you’ve come accustomed to how your ward works, you’ve formed bonds with your teams and maybe even your consultants. But now it’s time to move on and remember a whole new set of names and door codes.

If you’re anything like I was, you’ve gotten used to the 9 to 5 grind mixed in with the night shifts and weekends. You’re still feeling tired all the time, but at this point it’s your new norm. You just get on with it.

Now, you don’t shake as visibly when you get called to see a sick patient, and if all else fails, you know taking bloods and giving fluids is nearly always OK.

Maybe you’ve started to have some niggling doubts crop up in those moments when you feel out of your depth. Your thrust head first into a bad situation but somehow you always muddle through.

You can’t remember exactly when in the past few months, your ideas of what it would be like to be a doctor were shattered. The rose tinted glasses have come off and you can see it all a bit more clearly. The disorganisation, the strain, none of it pretty.

Sometimes, you wish someone would tell you how you’re doing. Just a little word of encouragement or recognition, just so you know you’re doing OK. It’s nice to hear. But it can be few and far between. You’ve made it to four months, so well done.

I wrote this for anyone who’s finding the reality a little difficult, who feels constantly overwhelmed by the expectations being placed on them. If you’ve enjoyed your first placement, that’s great. If you haven’t that’s OK too. Either way it’s coming to an end. If you’ve found the last few months difficult, it’s because being a doctor is difficult. Plain and simple.

But it’ll start to feel a little easier.

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The Irony

As part of the two-year foundation programme, I’m based at one hospital site which serves a small town. Anyone who lives in this town and needs hospital care would come to this hospital. However, for the time being, I’m stationed at a GP practice not too far from the hospital.

During one of my morning appointments, I finished typing up the notes of the patient I’d just seen and clicked onto the next patient. How it works is that I have a list of appointments for the day along with the appointment time. When I need to access the patient’s notes, I double-click their name and occasionally a small grey notification box will pop up with some extra information or reminder or some warning. So, when I clicked on the next patient on the list, the helpful grey box popped up letting me know that this was a consultant, who worked at the same hospital I was based at.

To any other normal individual, they would take this information on board and amend their communication style accordingly. I, on the other hand, start to overthink the situation, making it 10 times more complicated than it needs to be.

Two things immediately spring to my mind about why this will be uncomfortable. The first: speaking to another medic. I’ve mentioned a similar situation here. I just find the whole situation weird, whether it’s me that needs to see my GP or when it’s this type of scenario and the dynamic is shifted to me being the one with the responsibility. I can’t help but think of the irony when I’m sat across from someone who has 20 more years of medical experience. It’s like having your head teacher come to you with a math equation they need help with. It’s a different dynamic.

The second conclusion my mind jumps to is the possibility that I might run into this person again, when I eventually get back to the hospital. Very frequently people share deeply personal issues which I try to deal with as sensitively as possible. That comes with the territory but I can compartmentalise it to an extent and leave it at work with the understanding that I’m unlikely to come across that patient outside of GP. However, the stakes are higher when you see someone who works where you work.

Thankfully, it was blood pressure related. I’ve never been so glad for someone to come in with hypertension. I don’t think I had the emotional bandwidth to handle anything more complicated than that.

How did I handle it? I decided to just treat him like a normal patient and not let on that I knew he was a consultant. Might not have been my brightest idea but I went along with it up until the point where he sort of started using medical terms and I just shifted it slightly to accommodate that. I just never asked what he did for work.

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Applications

It’s around this time of year that F2s start to really consider what they plan to do after F2. This is also the time in the year when specialty applications are submitted. Those that are lucky enough to have known exactly what they wanted to do since they were 12 don’t have any difficulties with choosing and applying for their specialties. For me, it’s never been that clear.

There were specialties that were a No from the get-go. There were specialties that I felt more drawn to like paediatrics but upon completing a placement I’d realise that they weren’t for me. So, by a process of elimination, I subconsciously and consciously  whittled it down to a few options. A&E being one of the few, which is fortunate as I have this placement coming up.

To be honest, it’s beginning to feel like I’ve been holding out for A&E, like a sort of saving grace. I’m hoping for that eureka moment, the dawning realisation that I’ve found what I want from life, that missing puzzle piece that will sustain me until retirement. Obviously, the clouds will part, allowing a beam of sunshine to hit me like a spotlight. Unfortunately, I don’t think that’s going to happen. I think I’ll do the placement, I may even enjoy certain aspects of it, but eventually the mounting exhaustion of irregular shift patterns, manoeuvring the complicated bureaucracy of the four hour wait plus the incoming strain that winter always seems to surprise us with, will eventually tire me. I might be wrong. I’m just sceptical that any joy will be enough to squash the growing level of doubt and cynicism.

But now I’m at a crossroad and a decision needs to be made. Do I put an application forward or do I sit on my hands, allow the deadline to pass and ultimately choose to not go onto a training programme?  A few people have suggested another option, option C, to put in an application, experience the process and then back out. I’m not keen on that idea.

I doubt I’ll be applying for specialty training as it stands, A&E or otherwise. And though initially that made me feel slightly nervous, attending the ACW 2017 event this past weekend has put me in a different headspace. Speaking to a whole range of medics who were experiencing varying levels of frustration was intense but it was also refreshing to listen to doctors who had created new careers for themselves.

Which makes me feel really hopeful for life after F2. The realisation that if I choose to not apply then I can pretty much do what I want. It sounds a lot like Freedom.

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Angry Patients

Photo by PAUL SMITH on Unsplash

A lot of GPs say that one of the attractions of general practice is that they don’t what’s going to come through the door. And it’s true. Every time I buzz someone through, I have a brief read through their records and wonder what symptoms or issues they’ll need help with. More importantly, I always wonder about the type of person who’s going to come through the door. The GPs might recognise the name and immediately recall who the patient is, who they’re related to, what they’re usually like. They have more background knowledge. I, on the other hand, have no clue what to expect.

For the most part, the consultations go well. There’ve been occasions where I would have liked a do-over. And once in a while, I’ll have a difficult consultation.

When it happens and I have an angry patient, usually male, sitting across from me (and on one occasion standing over me), I think immediately how vulnerable the situation is. I’m alone in a room, my back towards a closed door and only a corner of a desk separating me from an agitated person. On the plus side, I think to myself, the walls are thin, surely someone would come running if there was a scuffle. There’s also a safety alarm in each room. A rectangular red button encased in white plastic, is placed against the wall just underneath my computer screen. If the situation arose, I’d have to reach across to push it in full view of whoever I was afraid off. There’s nothing subtle about pressing a big red button.

Then I wonder, when would be the ideal time to press the button. I don’t want to blow a situation out of proportion, and have everyone come running from all corners of the building and descend onto my room. Embarrassing. Thankfully I haven’t needed to so far and the individual in question has eventually left. But in those situations, it’s like all my internal organs begin writhing around nervously. I feel uncomfortable and maybe, sort of threatened.

I sometimes get a twinge of discomfort when I’m supposed to go on a house visit. I might just have an active imagination. No, I know I have an active imagination which really helps me think up loads of ridiculous scenarios. For example, I don’t know if old Fred, who’s complaining of back pain, spent a part of his youth beating people up for money and has finally retired to his armchair but still has a mean left hook. At least in the practice I’m surrounded by colleagues but on a home visit, who knows what I’ll be walking into.

Like I said, active imagination.

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Another Meeting

Several weeks ago I told my supervisor I was feeling a little worn down. I wrote about it here. I was still feeling pretty disillusioned by the last 8 months in 2 bad placements. My supervisor wrapped up the meeting by asking to meet with me for another review.

Fast forward a few weeks and I sat down with her again. This time, I was in a much better head space and I was adjusting to GP. I remembered from our last meeting, she’d briefly mentioned the option of going less than full time. I already went into this meeting knowing in my head that I wanted to finish F2. But I thought it’d also be good to hear some options.

I let her know that I was feeling differently about medicine and she told me if I quit, it would all be a waste. It was the kind of encouragement I was expecting. I’ve learnt to keep my expectations low. I might have been a bit more disheartened if I genuinely thought that she may have answers for me. But from all my Googling I didn’t come up with any encouraging solution.  So again I wasn’t surprised.

I mentioned this on a different forum and someone mentioned that my educational supervisor was unlikely to be impartial. That makes sense, especially considering that I’ll also be working in her department for my last placement. Finding a locum to replace me would be hard, expensive and inconvenient.

But it just makes me wonder then, who’s looking out for me? It would be nice to discuss this with a senior colleague who genuinely cared about my best interests. I’ve found it difficult to form those types of relationships in medicine, what with the constant moving around. Even my current supervisor is new.

I’ve found a lot of comfort reading blogs online. The internal validation I get when I come across something that expresses what I feel or gives practical advice is helpful beyond belief. Which is part of the reason why I write: 1) because I enjoy it and 2) I hope someone else finds it even a little bit useful.

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Miserable Budgeting

Money is a constant source of worry for me. I’ve always seen it as a form of security and so I make a conscious effort to save and put some aside. I just think it’s a good habit to have. I wrote a post about it here.

I’m not sure what’s in store for me in the next few years; I don’t have any concrete plans in terms of what I’ll do at the end of F2. But I do know that one way I can prepare is having money saved up so that whatever I decide, I will have more control over my options. I don’t want to know how much of my salary in F1 went on carbohyrdrate-loaded canteen lunches. Avoiding things like that in F2 should make it a bit easier for me to save money.

Since the end of July, I’ve made myself a target goal of how much I want to save by the end of January 2018. And another goal for August 2018 (I love goals). It’s an ambitious amount, but I’m determined. I feel if I aim high and fall short of it, there’ll still be a good sum of money saved up.

The difficult part of budgeting, is the odd bill that pops up that you don’t expect. Like my exhaust pipe breaking off as I come off the motorway. Inconvenient, expensive and annoying as hell. I actually had to take an Uber to work to avoid being late.

Another thing I’ve found difficult is saying no to meals out and cinema etc. I love food. And most of my socialising revolves around food. It’s hard for me to think of fun things to do with friends that a) don’t involve eating out or b) that are inexpensive. So, it meant for a while, I ended up turning down a few invitations to do things, which was making me miserable. I was missing out on all the fun.

It felt like it was a cycle of work, home, work, home and then work again. All the while being starved off all of life’s joys. Confining myself to back-to-back Youtube videos of other people enjoying themselves instead. I was reading Solitary Diner‘s post on the same issue.

I realise I need a balance. I’m not prepared to make myself miserable, I have enough stresses without adding some more. I just need to figure out a way to be a bit more tactical with what  and how I spend. But so far so good.

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Outside The Box

From recent posts, it’s clear I’ve become more unsure about my path in medicine. But as of yet, I have no plan, or really any solid direction. What I do know is that the idea of taking a break has become more and more appealing to me.

The journey to where I am now has been linear. I went from high school, to sixth form (college), to university, to working without taking any gaps. I’m really grateful I didn’t have to reapply to medical school and that I got the grades I needed. It’s been a steady trajectory to where I am now. And there’s the opportunity to just keep going. I could potentially apply for another training programme after F2, become a trainee, become a registrar and then become a consultant or a GP. Do the necessary exams along the way, jump through the necessary hoops. Knowing at each point what my next step is going to be. And there’s safety in that, having a plan for the next 10 years. But right now, it doesn’t appeal to me.

Medicine can be rigid, particularly in a training programme. There’s not much control over where you go and what you do. Do you want to move to Bristol? Tough, you have to work somewhere else instead. It’s a constant juggling process: work, family, life in general with medicine always coming up as a top priority. You need to make sure accreditations are up to date, keep up with exams, portfolio all the while bouncing between night shifts and day shifts.

Ultimately, what is the rush? Do I want to be a young consultant? Not particularly. I want to have experiences that go beyond the allocated days I have for annual leave.  I wonder what it’ll be like to be in control of my own schedule, choosing what I want to do and when I want to do it. Taking risks, going out of my comfort zone. Taking the time to learn new skills, or live in new places

And it honestly feels like it’s not possible to do all those things alongside medicine.  At least right now. So, at the moment I’m taking tentative steps and looking outside the proverbial box. Just a peak to see what the world outside has to offer.

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