July 2017. I graduated from Manchester University. My family were so proud. I had an influx of messages of congratulations. There was an air of achievement amongst me and my colleagues. Finally, I had achieved that which many said I could not. I had that precious piece of paper that confirmed that I now was, Dr McIntosh. I celebrated, deservingly with my family and loved ones in a bliss air of ignorance of the reality that in a few weeks’ time, I was THE Doctor. The one responsible for the health of many individuals. The person that other medical professionals would look towards for guidance. The first point of call when someone was ill. Everything I had worked for had emerged in one overawing day of reflection. I am now nearing the end of F1, and I am going to share with you my reflections on becoming a doctor and my personal tips to try and help you transition as smoothly as possible.
First and foremost, when you do graduate or confirm that you’ve passed all your exams, be sure to celebrate! It has been your main goal and you have dedicated a significant proportion of your valuable time, focus and energy towards it. Enjoy those months where you are not working but you are no longer a student. Whilst it is brief, I believe it serves a significant purpose; to recharge, reflect and to enjoy all you have achieved. Spend time with your family, travel, read (something non-medical!), do something you have never done before. Make good habits! This is the time as all those things become much more difficult once you are working!
The weeks leading up to your first day involve the compulsory shadowing and the orientations, meeting your supervisors, induction days, IT support days, important local protocols, presentations on key things to be a safe doctor, prescribing advice, microbiology and biochemistry talks; basically, it is a whistle stop tour of everything you need to know to be a successful F1. I remember clearly my first day. I remember not remembering most of what I had been told in the weeks prior, and anything I did remember I did not trust I had remembered it correctly! I spent the day like a young baby; struggling to stand on my own feet whilst attempting to absorb as much knowledge as I could from those around me to survive this hectic environment. Sick patients clearly took no notice of the fact this was my first day on the job and selfishly expected me to act like a competent doctor. Solve all their problems. Stop their pain, their sickness and make decisions on whether they were well enough to go home. The nurses expected the same. They never broke stride. As far as they were concerned you have done 6 years at university, you have your piece of paper, you are the same as the doctor working here yesterday aren’t you?
If you knew me personally, you would know that I am a confident, loud, some would say eccentric type of character who rides boastfully into the face of adversity. Or so I thought. This was a stretch even for me. I looked around confused and with what probably came across as sheer panic the first time I was asked to prescribe medication for a patient. That signature now came with authority and instruction. It is terrifying when you give your advice and ‘make a decision’ and the nurse turns to you and says, “what’s your name sorry”? To my dismay she followed that with “It’s just for my documentation”! How naïve of me to think she was just being friendly!
If I could return to my old self I would remind myself of two key things:
You are not the primary decision maker for any patient
Every other F1 no matter how smart, relaxed they may seem, is just as wide eyed and nervous as you are
This process repeats at each stage of advancement in medicine. A new level of responsibility comes with a new fear of failure or inadequacy. So here is my advice for getting through and coping with that new title of Doctor:
Be aware of your own character
Do not compare yourself to anyone else. Everyone has their strengths and weaknesses including yourself. Be aware of your own rather than other peoples and you will achieve far better results
ABCDE and SBAR
Learn it, practise it. Get good at it. In any situation this is your bread and butter. A patient with a simple fall, to a patient with an unrecordable BP. Structure keeps your mind focused in these stressful times. Go through each section and correct what you can.
Escalate – once you have screened a patient and you have done the urgent things, whether these interventions are successful or not. Escalate. Get support. If you cannot leave the patient, ask a nurse or another member of staff to get it for you.
You are part of a team!
It is not your job to make decisions for patients. Where you are confident, exercise your knowledge and experience but do not be afraid to ask for help or just to check you are doing the right thing.
Get your seniors mobile numbers (consultant as well) to discuss your patients regularly!
Utilise specialist support – dieticians, physios, occupational therapy, mental health teams. They are all there for support. Use them!
Make a jobs list everyday and manage your time effectively. Scrutinize the urgent against the non-urgent and work accordingly.
Take as long as you need
The fast and furious nature of a ward round can be daunting. Make sure to document correctly and make a note of jobs you need to do. Even if the consultant is bothering you to hurry up. It is better to be safe than sorry. Being shouted at for being slow is better than missing something of vital importance.
Ask and ask again
The only silly question is the one never asked! Swallow your pride and ask a question. The more you ask the more you learn. Do not be afraid to say you don’t know. Seniors love to teach and take people under their wing! Even if they get upset, at least you now know the answer!
Secondly, if your unsure something is being done in the right way question your colleagues, even senior ones and remind them of important facts. They are also human and rely on you for key parts of information. It is a good learning opportunity too!
Put Yourself first
After finish time, if no-one is acutely ill – GO HOME! Handover jobs that need to be handed over and go home. Your rest is important. Your life away from hospital is more important than that in it. Without that being maintained, your hospital life will suffer!
If there are concerns raise them early with your supervisors. They get paid to help you so use them! In every aspect of life, there are different kinds of people including the kind that rub you the wrong way. The hospital is no different. Do not take things to heart. When people are horrible, it’s usually a reflection of themselves. There are ways to give feedback. Do not be afraid to speak to someone if you are being unfairly treated.
Exception report – report the missed breaks, the late hours as that’s what the contract states. You will be liable if you work unsafe hours and do not report them!
Whatever your passions/interests are get involved. Take on new roles. Volunteer to have difficult discussions. Do procedures. In the end you will have to do them so get an early start. Watch first then try!
Medicine despite its negatives is a fun and rewarding profession! Make friends, smile and arrive at work with a positive attitude!!
Medicine is an art. Its not a science as we were taught it. We make decisions based on best evidence, weighing the odds, and most importantly the patient before you, their wishes, their life now and what it could be like after any intervention. See the patient and not the numbers or results. As such, everyone will make mistakes. When that time comes, and you ask yourself could you have done more? Was it your fault? Remember you are part of a team and you make decisions together. There is support there. We do all we can based on the information we have. Inevitably we all must be wrong sometimes. You are human. There will be emotional moments both happy and sad. Honesty and emotion are key parts to a patient’s happiness. Be genuine. Your title does not change these things. Even a Doctor can be human.
Written By Dr Jerome McIntosh