Second Impressions of A&E

second impressions

Joseph Greve

I’m half-way through the placement now and I feel more settled, I wrote about my first impressions of A&E here. It just takes time for me to get used to a new place and I remember it being the same for GP as well. In some ways I’ve found GP and A&E quite similar: both general based specialties with loads of opportunity to work independently.

I’ve found A&E more difficult because the level of risk is higher and there’s so much I don’t know. I felt with GP, I regularly managed coughs and colds, UTIs, musculoskeletal pain and other times I could rely on my intuition/common sense. Whereas A&E, I’m suddenly presented with a foot x-ray and I’m supposed to work out whether there’s a fracture or not. It’s a huge learning curve.

As part of the department we have a paediatrics area. And though I love kids, I do get a tremor every time I’m sent around to that side. Fortunately, it always turns out better than I expect and I’m able to get through them quite quickly. It’s usually more pleasant; the parents are more often than not able to give clear histories, the kids are happier, funnier and smell nicer. I’m learning to be more confident on paeds but I still find it difficult. I’m often wondering how I would treat an adult in a similar situation which I know is not an ideal approach, but again there’s always someone around to ask.

There are always seniors around, always. The trick is knowing who to ask. I’ve got a good idea of who to go to and who to avoid. Most are really helpful and will listen and give advice. Some will do it reluctantly and others will snap just having looked in their direction. I do sometimes have an internal conflict I go through every time I want to ask a question. On one hand, I’m a foundation doctor and not an emergency medicine trainee and really I’m there to learn and gain the skills to be a better doctor, but on the other hand I need and want to be an independent clinician. Personally, I feel like my main priority (alongside amazing patient care) is learning and one of the ways to do that is by asking questions. It might just be me projecting my internal issues onto others.

The shifts are long. And I know long shifts are part of the territory in medicine, my body just doesn’t agree. The upside of longer shifts is that we have more off days, but still, my body doesn’t care. In the first half of the shift I’m all ready to go, lots of energy, and towards the end I’m slower, yawning and repeatedly looking at the clock. And this is why a) I don’t book any locum shifts and b) I can’t see myself doing this long term. I’m not really fussed about the effect on my social life. I’m more concerned about not being able to put basic meals together. Or do laundry. Or write.

Plus, there’s a whole lot of running around and being on the ball. It’s like you have to be at least 80% alert at all times, not like on a ward-round where you could twiddle your thumbs whilst you followed the consultant around.

I have liked how social the department is. There are loads of junior doctors plus locum doctors as well. If ever there is a lull it’s really nice to have people around to talk to.

I’m 2 months down, just 2 more to go.

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