A Day in the life of an F1

By Zana Martin

As a newly qualified FY1, typically each day has something new to offer. I’m currently based in care of the elderly, spending my time with a fantastic team of people and facing new challenges daily…

Each day starts with a full board round of every patient, where we discuss recent results and more importantly discuss discharge plans. As the FY1 my role usually entails shouting out the significant blood results and chipping in with and titbits of information I have managed to glean from family members. From there, we divide and conquer, each taking a handful of patients, for which we are responsible that day (being on a well-staffed ward makes all the difference!). 

As the clinician responsible for those patients, it is our job to ensure jobs are done and discharged letters prepared in advance, with TTO’s written early to avoid delays. Often this means you have 4 or 5 letters to prep in a day, which seems a lot but makes your life easier in the future! We are also responsible for updating families and the nearest and dearest, and asking the difficult questions when there is no clear plan surrounding resuscitation. While it was daunting initially, being able to have these conversations early on does allow for a good rapport to be formed between patients and staff and makes the journey a lot more pleasant for everyone involved. Believe me, the difference it makes when you remember a relatives name is amazing. 

One of the biggest challenges I’m sure every FY1 faces is learning to trust your clinical judgement and having the courage to implement a plan for a patient. Things like prescribing laxatives will induce panic, as will the thought of being around a patient with a EWS of anything more than one. Despite feeling like you will never be able to do it, the confidence and competence will grow exponentially in those first few weeks and suddenly you will find yourself wondering why you worried in the first place. For example being called to an unwell patient on the ward with an increasing oxygen demand and tachycardia (that was just me, not the patient) and feeling like a fish out of water, I managed to call on the 5 years of training and issue some basic management until senior help arrived. Thankfully the patient survived. That is certainly a personal highlight. 

But the most enjoyable part of FY1 so far? (And no it’s not the wage, though that is glorious) Is being part of a team and being able to make a difference to real lives, even if it’s something as minor as holding a patient’s hand while you speak to them, or helping to make a bed when there’s a lull in the day. Those small interventions that we don’t consider to be of value are often the most valuable to patients and their families, and are what make the job special. 

Life as a locum doctor

There’s a lot of pressure on young doctors to go straight into specialty training and tick certain boxes for fear of damaging their career chances.

I never planned on having a conventional career in medicine. I always wanted to do relief work and work in the international healthcare setting.

Earlier this year I travelled to Iraq to be part of a medical mission with a small NGO called Global Kindness Foundation. 

They set up dental clinics and optometrists in schools in Najaf and Karbala. These schools are mainly attended by orphans and disadvantaged children.  We set up a rudimentary clinic and as the only female doctor on the trip I provided primary care and health check ups to girls from between the ages of 6-18 years of age. 

 I’ve also visited Northern Greece with another NGO called Health Point Foundation as their co-ordinator on ground for 3 months. We were the main providers of dental care to over 15 camps within that region. Everyday we’d pack our clinic equipment into a car and set up in a new camp. I was involved with inducting, supervising and assisting the dental volunteers. I was also the main liaison for regional government and other NGOs in the health sector and worked hard to expand our efforts to the refugees in other camps or squats. 

After that I went onto study for a diploma in tropical medicine and hygiene. I’ve since been out to Lebanon to assist in the set up of medical clinics for refugees close to the Syrian border. 

Why did I get involved in these projects? It’s what I’ve always wanted to do. 

I worked as a locum doctor in between trips, which meant I had the choice of working or the freedom to leave the country for months at a time – something I couldn’t have done in specialty training. I was also fortunate enough to visit Sri Lanka, Turkey, Switzerland and Germany in this time. 

I know the experiences I have had are beyond value and have given me skills that will be an asset in the future.

To sign up with Holt Doctors and receive your bonus go to the locum page on our website https://www.whatthebleep.co.uk/holtdoctorsbonus

The Home Visit

By Catriona McNicol, June 2018

There are certain situations that can test even the most experienced of GPs in a home visit; the clammy cardiopath clutching his chest as you enter the flat, the elderly lady with lips so blue from hypoxia that you genuinely try to wipe her funky lipstick off before you realise her sats are 76%, the young distressed psychotic patient who is a real risk to himself and his ever faithful mother or the angry, aggressive relative who just needs to vent at a doctor and you happen to be the one doing the home visit.

It’s just you, your bag, your clinical skills, your best chat and a big dose of, “you’ve got this”.

But nothing prepares you for that single terrifying moment which you know is going to happen at some point. That point of no return. That awful experience which ultimately makes you fear every other home visit you’ll ever do. 

That time when a parrot lands on your head. 

No words. None. I am a broken woman.

The Truman Show

By Catriona McNicol 

Please, please tell me that I’m not the only person that this kind of stuff happens to, because I’m beginning to think that I’m on some sort of Truman Show. 

The day started well. Unbeknown to me, it turns out that the very pleasant, but possibly mildly stoned youth who takes your orders at the drive-thru McDonald’s has come to recognise me.

“Hey, good to see you. You’re early today, one white coffee, the usual price!” he offered as he held out the contactless card machine. 

Wow, I spend a lot of time and money in here. Mental note to self, “Stop this”.

I threw back some friendly comment and he said, “You’re always so happy, that’s a nice thing”. I was quite taken aback, but flattered nonetheless. 

“What’s not to be happy about? I’m getting a take-away coffee! It’s my favourite part of the day”, I said, a little too jolly for pre-caffeine interactions. 

His eyes narrowed and he offered a half smile, “you’re favourite part of the day is getting a drive-thru McDonald’s large white coffee? That’s not a good place to be in, dude. You gotta start living a little! On to the next window! See you tomorrow”, he said as he closed the glass divide before my eyes. 

Oh. My. God. The marijuana-smoking, slack lining dude who works in McDonald’s just gave me lifestyle advice. 

I chugged on in my little red car playing an old cassette that I recently found in my neighbour’s bin (this is a true story…she’s a neonatal consultant and well aware that I’ve pilfered it). Turns out it was the Beautiful South, Carry On Up The Charts, and with the sun shining down it felt like a good choice. 

I rocked up at work and reversed my car in to the ‘doctor’ space outside my surgery, painfully aware of the worried looks of the patients who eyeballed my 18 year old car that sounds like a foghorn in light of the detached exhaust. I stepped from the car and dropped my doctor’s bag, the contents spilling everywhere. Why hadn’t I zipped it up? I looked like an incompetent numbnut, but I gathered it all up, scooped up my coffee and headed into battle for the morning. 

The morning surgery went well. I felt in control, I did some good doctoring and I left enough time to scrape together the relevant paperwork to dash over to the other side of the city to meet with my Educational Supervisor for the much needed ES Report. 

Right, got to go. I have 18 minutes to travel the 17 minutes it takes to get there. Just need my keys. My keys. Just need them. 

I looked EVERYWHERE. I almost recalled my patients to look in their shoes, pants etc on the off chance that they’d been waylaid during examination. I looked upstairs, in the toilet, in the staffroom, on the stairs. 

Eventually after 15 minutes of sweating I figured I should check outside around my car so I headed into the blazing sunshine to look around my vehicle. Nope. Nowhere. 

What the flock was I going to do? I leant against the car wondering how I could transport myself to the other side of the city and low and behold, the wee buggers were sitting on the driver’s seat with the front door open about an inch. 

Now, thankfully the good folk of the affluent North Leeds suburb in which I work must have recognised that any form of jail time for this old beat up car wasn’t worth it, and the vehicle and its contents were untouched. 

I hopped in and wound down the window, pressed play on the cassette player and drove the 200 metres to Sainsbury’s. It was short but satisfying journey. I knew I was going to be late for my ES meeting but I had to eat. I just had to. 

I parked up outside a pedestrian entrance to the precinct, keeping an eagle eye for any dead equine (see earlier post), wound up the window and then ran into the shop. I did a supermarket sweep (RIP Dale) and was out in no time at all. 

I ran towards the small path where my car was parked just beyond and as I approached the zebra crossing, just on the corner, my life flashed before my eyes. Round the corner, at speeds way beyond those that should be acceptable for pavement based vehicles, came an elderly lady with a glint in her eye and the wildest hair I’ve ever seen. 

We briefly made eye contact before she, yes true story, ran me over. I repeat, today I was run over by an old lady on a mobility scooter. As in hit by the scooter, knocked to the ground, and she ran over the end of my shoe, narrowly missing my toes. 

What the actual Chuffing Nora? 

I was slightly dazed for a second before I stood back up, and yes I could feel everything and nothing hurt too much. I was about to open up a can of Whoop Ass when she looked at me and said in a proper wonderful West Yorkshire accent, “oooo luv, are you ok? Ooooo, I’m so sorry. I think I was going too fast, I’m on my way to get some cat food for Neville, he’s got poorly kidneys and needs one of them reduced protein meat sachets”. 

And this is my life. 

Run over by a mobility scooter because Neville The Cat has got freaking CKD. 

I brushed myself off, calmed the lady down and made sure she was ok before strolling back to the car thinking, “I’m totes telling the McDonald’s dude about this tomorrow. I’ll show him living life!”.

All change again

By F1doc

I can't quite believe it, but apparently it is time to switch rotations again. On Wednesday I will have completed 2/3 of FY1 which means that in just 4 months I will be an FY2. Fresh faced graduates will be shadowing me for a week and expecting me to have all the answers. All seems so strange.

I have to be honest about my second rotation, I was dreading surgery and for the first few weeks that dread was a reality. I didn't like my job much and I got anxious about the day ahead. Mainly because it was such a shift from medicine which I had come to know and love. 

4 months on and I am actually sad to leave surgery. Now don't get me wrong- I ain't no surgeon. I actually laughed out loud a few weeks ago when a patient invited me to sit on her bed and chat with her. " You don't want to do surgery, do you dear?" 

"No, I said" 

She smiled at me and replied " I thought as much".

But despite not wanting to be a surgeon there are many things I will miss about being a surgical FY1:

Ward rounds are quick which means you have time to do your jobs during the day and I mainly leave work on time.

I worked in an office with other FY1's which meant I got to make good friends and it was very social.

A lot of patients were young and relatively well, after their surgery they got better quickly and went home. 

It taught me to be less squeamish- after having bile thrown up onto my shoes, a stoma explode in my hands and seeing more pus filled abscesses than I though possible I can honestly say that there isn't a bodily fluid that will stop me eating my lunch any more. 

So it is with some sadness that I leave the past 4 months behind me, but only some, because my final FY1 rotation is psychiatry. The dream!

The Hadiza Bawa-Garba case is a watershed for patient safety

By Rachel Clarke for BMJ Blogs. 29th January 2018

Watershed moments, if genuine, are palpable. We can feel it when something tectonic is afoot. Who will forget how, last year, the blackened shell of Grenfell Tower fractured a country’s belief in itself as fundamentally humane? Or the fury unleashed by Harvey Weinstein’s victims, and the potency of #MeToo as it rips round the globe?

Medics have a habit of thinking nothing matters quite so much as medicine. But last week’s successful appeal by the General Medical Council to have paediatric trainee, Hadiza Bawa-Garba, permanently struck off the medical register is nothing if not an NHS watershed.

What is at stake here—as unsafe staffing continues to wreak havoc on our ability to provide patient care—is whether the profession’s regulator finally has the gumption to confront this reality. Or, will it continue to ignore the state of the health service, thus permitting individual practitioners whose abilities—it knows full well—are so crippled, so often, by skeleton staffing, to shoulder the blame for NHS-wide failings? If ever there was a moment to put patients first, this is it—as people continue to die on trolleys in hospital corridors, or at home while waiting for the ambulance that never arrives.

In 2015, Bawa-Garba was convicted of gross negligence manslaughter for the avoidable death, from sepsis, of a six year old boy, Jack Adcock, after a jury concluded her mismanagement of the child was “truly exceptionally bad.” The GMC then insisted that public confidence in the profession could not be maintained unless Bawa-Garba was permanently erased from the register.

Superficially, this may seem reasonable enough. A young child had died in unforgivable circumstances, a doctor criminally convicted. So why has her treatment so convulsed the profession? We are angered, in part, by the absence from the GMC’s narrative of the possibility that Bawa-Garba’s negligence arose because it was the working conditions into which she was thrust that day that were “truly exceptionally bad.” Rota gaps forced her to cover two other doctors’ jobs as well as her own work. Her consultant was off on a teaching day. The hospital IT had broken down, causing chaos.

So what, precisely, was Bawa-Garba meant to do? Down tools and say it was unsafe for her to work? Is that what we should all do now—simply walk out on our patients when rota gaps are dangerous? Or struggle on, sick with dread, knowing a patient may slip through the understaffed net, and that we too may face criminal conviction as a consequence?

When this question was put to him last week on BBC Radio 4, the GMC’s chief executive, Charlie Massey was evasive, refusing to answer. Small wonder doctors are afraid. Many of us battle daily with understaffed bedlam. Fancy a spot of corridor medicine, anyone? Picking the patient you think will die next in the corridor, to award them the one empty space in Resus? Yet the GMC’s only advice to those trainees now terrified of both treating and not treating their patients is platitudinous—essentially, to tell someone senior you think conditions are suboptimal.

That, frankly, is not helpful. What is the point of frontline doctors speaking out about understaffing when all those with actual clout—the GMC, the CQC, Jeremy Hunt, and the prime minister—know that in today’s overstretched NHS, patients are jeopardised by rota gaps daily. It is ironic that the profession’s regulator, so committed—ostensibly—to NHS candour, is itself refusing to be candid in public about the dangers to patients of endemic understaffing.

Last week, doctors took matters into their own hands, crowdfunding £160,000 in donations in less than 24 hours to provide expert legal opinion for Bawa-Garba. Those are sobering statistics for a regulatory body that purports to uphold public confidence in doctors—yet appears to have lost the trust of its rank and file.

Vague and hollow reassurance from the regulator no longer cuts it for doctors. We need action, not empty words. In the spirit of preserving patient safety, the GMC could set a powerful precedent by speaking bluntly about the dangers of rota gaps. It could insist we report every single one of them, and make it quick, easy, and—crucially—safe for us to do so. A simple, anonymised GMC form on which we can document every staff shortage without fear of employer retribution. It could collate these data nationally and publish them openly. Imagine the force of a GMC divulgence of the scale and repercussions of doctor understaffing.

Recently, I had a conversation with a senior figure in the NHS who, irked by doctors speaking out, asked me: “Don’t you think you have a corporate responsibility to maintain public confidence in the NHS?” I took a deep breath. The rot that passes for “candour” could not have been phrased more succinctly. “No,” I replied. “I think quite the opposite. Covering up risks, if they exist, is the exact opposite of candour. If I thought it was okay to spin away reality, I’d be a politician, not a doctor.”

It is time for the GMC to choose. Does it wants to be part of the problem or the solution? Because, right now, every one of us could state the same refrain: #IAmHadiza.

Rachel Clarke is a specialty doctor in palliative medicine. Follow her on Twitter @doctor_oxford

WhatsApp with the Bleeps?

by Dr Rhydian Harris,  25th January 2017

You’re about to insert a chest drain when your bleep fires. Hands tied up, you just about manage to see and memorise the number before a second bleep sounds and a request for yet another call appears.

Gloves off, you start the process of trying to answers the bleeps. Phone at the nurses station is out - pharmacist waiting on a call back from the F1 – so into the office you go.

First number - 3999; line engaged. Onto the second, 4752. “Anyone bleep intensive care?”  you hear yelled down the ward. “Sorry doctor, he’s with the patient, can you call back in 5 minutes?”

Off goes your bleep again – 3999 on the screen – turns out the line was engaged when you called back because they were bleeping you again.

Bleeping is just as frustrating for the caller. Sat by a landline, waiting for a call back, not knowing who is at the other end, or whether the bleep has been heard, unable to carry on with other tasks. It’s a maddeningly out-dated system.

Though reliable at transmitting the need for a discussion, bleeps lack any context, indication of priority, and fail to identify the caller. There is no feedback on whether the message has got through - the bleep could be switched off or have a dead battery, or the holder may not be able to reply due to being scrubbed or otherwise too busy. Sadly, this results in patients suffering adverse outcomes due to delays in contacting clinicians for review. 

Little wonder, then, that clinicians have started using their phones to co-ordinate patient care.^[1] The rapid dissemination of information, knowing who you will find at the other end, and the ability to know when your message has got through are key draws that bleeps do not offer.

The impact these workarounds can have on patient care are remarkable. WhattsApp groups have been used to control response to major incidents in London.^[2]Paramedics in Argentina send WhatsApp photos of ECGs to cardiologists for review to ensure the right patients get to primary coronary intervention (PCI) in a timely fashion. Similarly, we’ve heard anecdotal stories of UK clinicians sharing ECGs with their local PCI centre via WhatsApp because of fax machines being slow and unreliable.^[3] Further examples include sharing photos of x-rays, blood gas reports and CT videos with off site consultants; a picture is worth a thousand words, particularly when it’s your half asleep boss at 4am!

WhatsApp is not without major drawbacks, which place the clinician in a difficult position. It’s well-known end-to-end encryption does not prevent data being sent outside the UK. Data is also permanently kept on the handset and is not pin protected, leaving it open to being seen by the wrong eyes.^[4] As many will have experienced, it’s all too easy to send a message to the wrong person. Hospitals are tightening up their policies with new General Data Protection Rules coming in May 2018. Breaches of data governance are a huge problem legally, and doctors face disciplinary action if they are responsible.^[5]

The work around many use day to day is to anonymize patient data. This is cumbersome and leaves room for error – defeating the purpose of using the messaging platform. A further difficulty is that the clinician is limited to contacting those whose personal numbers they have, resulting in a default to bleeping.

The need for a solution is why we, as junior doctors, have built Forward. Forward is a secure messaging platform, built to feel like WhatsApp, but also allowing patient profiles and images to be shared.^[6] Forward provides a searchable “My Hospital” and UK wide directory of users,  QR code scanning to instantly populate a patient list, and simplified workflow with task lists shared and updated by your team in real time. We encourage clinicians to download Forward - to save them frustration, and free up the time to do the things that really matter. 

Forward Clinical Ltd is run by a team of NHS junior doctors. If you would like to discuss bringing Forward to your workplace, please email Rhydian@forwardapp.co.uk

Forward is free to download and use, and is available on the App and Play stores. It is NHS Information Governance Toolkit Level 2 certified. 

More info at http://forwardapp.co.uk/

---

^[1]http://innovations.bmj.com/content/early/2017/10/24/bmjinnov-2017-000239

^[2] https://traumagasdoc.wordpress.com/2017/07/23/whatsapp-doc/

^[3] http://blogs.bmj.com/technology/2017/11/16/whatsapp-in-the-nhs-framing-the-problem/

^[4] https://www.hsj.co.uk/technology-and-innovation/clinician-use-of-whatsapp-is-a-ticking-time-bomb/7020115.article? utm_source=t.co&utm_ medium=Social&utm_campaign=commentfeed

^[5] http://www.bmj.com/content/358/bmj.j4099

^[6]https://www.igt.hscic.gov.uk/AssessmentReportCriteria.aspx? tk=430647085572384&lnv=3& cb=3121afa9-23e7-4d6e-8b8c-dd90efef23f0& sViewOrgId=53443& sDesc=8JP98

Medicine V Surgery

By F1doc.

This time last year I was busily prepping for my med school finals and it seems like a lifetime ago. If there are any med students reading this, then please stick with it. Time will fly past and I can honestly say that I have LOVED the past 6 months as an FY1. It is a wonderful job.

Life as a surgical FY1 is drastically different from being a medical FY1.

Surgery is incredibly fast paced for short bursts of time and then it slows down. But you never know when that 'burst' is coming.

I'm learning that if a surgeon asks you for a scan, they mean they want the scan NOW! Ward rounds are faster than fast and I am much better at taking blood than I was on medicine.

The thing i'm enjoying most about surgery is that it is more social, there is an office where 7 of us surgical FY1's are based and although we aren't often there all together there is usually someone there you can chat with or ask for advice. 

Don't get me wrong though, i'm definitely NOT a surgeon. I miss medicine a lot. I miss having time to really delve into what is going on for a patient, to piece together all the pieces of the puzzle. The speed of the ward rounds mean that I often panic I've missed something and end up having to go back and check all the observations and previous note entries.

I still haven't actually scrubbed up and been in to theatre, which is something I need to make myself do before this rotation ends.

Outside of hospital life i'm finding it hard to exercise which is one thing about being an FY1 that really gets me down. It is probably more of a problem now because of the dark evenings, I don't like running in the dark and I cannot afford gym membership that I know I wont use. I'm really hoping that as the  daylight hours increase I will find the motivation to get my running shoes back on.

Being an FY1 is amazing, as I keep telling everyone but I do need to remember to look after myself too.

Positive Feedback

F1doc 6th November 2017

I have exactly 1 month left of my first FY1 rotation. The switch from medicine to surgery feels almost as daunting as the switch from med student to FY1. A whole new team of people to get used to, fast ward rounds as opposed to the lengthy medical rounds and 8am starts instead of a far more acceptable 9am.

Before I leave medicine I wanted to share a few of my experiences from the past few weeks.

A couple of weeks ago I was the FY1 on evening medical ward cover and I got bleeped about a patient who was becoming unresponsive and spiking temperatures. Immediately my heart started beating faster and my brain became a bit fuzzy, I asked for a few more details on the phone and immediately headed to the ward. 

My first thought was to bleep the SHO on call and ask them to come with me to assess the patient. But I decided to visit the patient first.

When I got there the nurse was trying to get an ECG and put a cannula in, the patient was writhing around on the bed in a confused state and it was clear that neither an ECG or cannulation were going to happen quickly.

My first few minutes there were chaotic, my head was spinning and I know that I must have seemed flustered but I eventually managed to remember basics and perform an A-E assessment.

The patient triggered QSOFA (new criteria for triggering sepsis bundle) and 02 sats dropped.

I managed to get an ABG, order a CXR and send an MSU and the lovely nurse got cultures and a cannula in. The next hour went by really quickly and before I knew it I was writing in the notes and the patient was happily sleeping having had the first dose of IV Abx.

I managed the whole thing without calling the SHO, but that doesn't mean I managed without help. The ward nurse was amazing and I called the critical care outreach nurse who was equally fab. Just having them there made me feel so much calmer and more supported.

It may seem like a small triumph, but I was thrilled to have managed a sepsis patient. The patient recovered well and went home later that week.

The next day I got an unexpected email from the sepsis lead telling me that she had reviewed the notes and that we had managed the case really well. Receiving that positive feedback gave me such a boost and made me feel valued. It is so important to provide positive feedback to colleagues and I hope that I remember to use opportunities to do the same in the future.

On the other side

Posted by F1doc 3rd October 2017

Cannot believe 2 months has passed by since I was shadowing the outgoing FY1’s and finding myself consumed by fear at the prospect of taking on that responsibility myself.

Turns out that all those people who said to me “you’ll be fine”, were actually right.

We’ve had medical students start this week and it is a really strange experience to be on the other side of what used to seem like such a massive divide.

I remember that horrible awkwardness I used to feel, always standing in the wrong place, wondering how many questions I can ask before I annoy someone. The nerves building before feeling able to ask someone to sign my logbook…

And I also remember how it made my day to have someone smile at me and make me feel welcome or try to include me as part of the team.  There were plenty of junior doctors who gave up their free time to teach me as a student and I promised myself at the time that I would make sure I did the same. So I taught a group of students this week and it was great fun but definitely surreal to be on that other side.

 

My ABG success percentage has increased to around 80% which I am extremely happy about, I finally feel confident enough to prescribe paracetamol without looking it up just in case the dose mysteriously changed overnight and I can write a discharge summary during board round. 

Just when I’m starting to feel settled in and comfortable everything is about to change, the registrars switch over next week and I am nervous in case my new reg. isn’t as nice as the current one. Then not long after that my SHO switches over and then there will only be a month before I move to my next rotation. I think that is one of the hardest things about being a junior doctor, you start to build good working relationships and then it all changes and you start over again.  On the upside it means there are always plenty of reasons to have farewell drinks!

Where did the last month go?

Posted by Thenewdoc August 30th 2017

I’ve been an FY1 doctor for a month now and safe to say it has been the most intense month I have ever lived through (and that includes the month of my medical school finals!). It has been a month of firsts: first on-call, first night shift, first bleep, first weekend, first sick patient and sadly, first patient to pass away. Life as we know it is all about these first experiences, they are after all how we learn, but by the time you reach your mid-twenties, these first experiences should be few and far between. As an F1 however, every day is a cacophony of first experiences and suddenly the excuse “I’ve just started” begins to sound very well worn.

The learning curve has been mind-blowing. I know that I went into my first day thinking “It’s ok, everyone knows I’m new, it shouldn’t be too bad” and by rights it wasn’t. All the staff were friendly and patient but it became very clear, very quickly that regardless of how terrified or nervous I was, the running of the hospital just went on. Patients don’t care that it’s your first day, if they are going to get sick, you need to see them. If they need drugs prescribing, you just have to do it. With every bleep that I got, I jumped out of my skin but I just had to push any nerves to the back of my mind and get on with the job at hand; patient care just had to continue. That first day was long and tiring but I went into every job with a “get stuck in” mentality and I think it really helped quash any nerves.

I’ve surprised myself with how easily I’ve been able to stick to that mentality but I must confess that it’s not been infallible. The first time that I really felt shaken was when the first patient under my care passed away. Death is part of this job but for me it’s still a relatively new experience and my first brush with it as an F1 came as a bit of a surprise. I suddenly found myself as the only doctor on the ward with all the nurses staring at me, the family on their way and my brain slowly coming to the painful realisation that not only did I need to confirm death but I also needed to inform the family. That was the first time I’d thought, “oh the doctor needs to do that… oh wait… that’s me.” In that moment, I really felt young, inexperienced and emotionally drained. But at 4 in the morning and with the only other doctors in the hospital busy, you just have to put any personal stuff to rest and think about the patient and their family; after all, that moment is about them, not you. I can only hope that I did the sobering task justice.

It’s only been 4 weeks since starting but even I can appreciate how much I’ve learned. I no longer get a sense of dread any time my bleep goes off. I no longer fear being asked to do cannulas or take blood or put in an NG tube. I (sort of!) no longer feel like I’m going to pass out from nerves whenever I get a call about a patient that’s scoring highly. I’ve learned that the seniors actually expect the F1s to ring them and that the nurses don’t intentionally bog you down with rubbish jobs. But most of all, I’ve learned that the ability to stay calm and patient and to flash a smile to all you come across can actually get you a hell of a lot further than an encyclopaedic knowledge of medicine.

It’s been a long hard month but with all the time that flies by I know that slowly, but surely, I’m getting the hang of this.

I survived

By F1doc August 2017

I’ve survived my first 2 weeks as an FY1 including a weekend on ward cover and a 13 hour on take day in A&E. I’ve been shouted at by relatives, humiliated by a radiologist and been on ward rounds that really do last an entire day. But I have also been treated with kindness and understanding, I’ve laughed with nurses and patients, i’ve had lunch at a reasonable time most days and managed to make it to all of my teaching sessions. 

 

Things I have learned in the past 2 weeks:

 

* there is a lot more admin and a lot less medicine than I had imagined.

* nurses are amazing, on my ward they do everything!

* the ward pharmacist is my best friend

* take every single bit of clinical information when speaking to a radiologist!

* if feeling overwhelmed, go for a 5 min walk around the hospital looking busy! (a tip from a previous FY1 which really works.)

* write detailed plans for weekend handovers, because when you are on at the weekend and called to a ward you don’t know to see a patient you have never met - that plan is crucial.

 

The hardest part for me has been working out which decisions I can make on my own and which decisions I have to check with a senior. Which treatments can I start on my own, which ones should I seek advice about?

If a nurse shows me an ECG is it enough for me to read it and say what I think or should I get a senior to double check?

On my ward these decisions aren’t so tough because there is always someone there so we discuss everything, but at the weekend when it is just me, an SHO and a ward reg (who are both equally busy with jobs) It is hard to work out the expectations and limitations of an FY1 role.

Week one

By F1blogger August 2017

I’ve been a “doctor” for about a week now. My first rotation is on Intensive Care and Anaesthetics so myself and another FY1 rotate weekly on each. Some would say starting on Intensive Care must feel like you are being thrown in at the deep end, but in reality it’s a very well supported job. I’m never on my own and thankfully have two registrars on the Unit all the time to help me out when I need it. Then there’s the highly-skilled ICU nurses who are so friendly and approachable and I am already learning a great deal about how to deal with sick patients just from working with them this past week. 

My shadowing period flew by and the junior doctor I was shadowing was running me through the jobs that we are expected to do daily. For example, how to request bloods and look through the patient’s recorded vital signs on a brand new (to my eyes anyway!) computer system, how to fill out requests for X-rays and various scans on paper and where to take them, as well as attempting to describe to me where certain departments were around the hospital (which I’m still getting used to!). 

It’s safe to say that I was overwhelmed with all of this new information and was extremely nervous for my first day without my old FY1 to hold my hand. But Wednesday came around and we started on the ward round. Then I was given patients to go and see myself and carried out the various jobs throughout the day. It’s always scary making that first phone call to a medical registrar, for example, to come and review your patient if they need to step down from ICU to a medical ward, but with time it becomes second nature. The day ran (to my surprise) quite smoothly. What was very alien to me was having nurses ask me to prescribe pain relief and anti-sickness medication for their patients. In my head I was thinking that they know more than me about what to prescribe, they’d been doing this job for years and suddenly it was up to me to make a decision, and that’s when your knowledge from medical school comes in to play (and the BNF!).

Last week, I saw a patient who’d had a nasty fall down an embankment and when she came to ICU she was very unwell, needing respiratory support. Her journey to getting better is still ongoing and at the end of last week I thought I had seen the last of her as she was being moved to another ward. I wished her well and was so pleased to see her looking better and privileged to be part of a team that helped to make that happen. Then today I was walking into theatre and saw her walking with the physiotherapist outside her ward. She looked like a new woman and had the biggest smile on her face. It was so heart-warming to see. I know that this job is not going to be easy; the FY1 I was shadowing warned me that she’d had a testing year full of ups and downs. But seeing that patient much improved and on the path to full recovery today was definitely one of my “up” days. 

Ready to Go

Posted by F1doc

It’s Saturday evening and I am finally sitting down to reflect on what was one of the most intense weeks of my life. Induction week is amazing and terrifying in equal measure.

The other FY1’s are great, the current FY1’s and everyone who has been to talk to us have been fab and so welcoming but the volume of new information is mind blowing.

Every minute of every day was accounted for, my head felt like it was going to explode! We had a prescribing assessment on our second day which was a shocking throwback to medical school exams and we also had some simulation training which was actually very useful.

It’s reassuring to know that everyone else seems to feel the same way and when we all piled into the pub (free bar- thanks to the Doctors mess!) on Friday evening the majority of the conversation was “how on earth will I be able to all this in a few days time?!”

I thinks it’s important to write all this stuff down because in a few weeks time when I’m still feeling terrified and out of my depth (as I undoubtedly will), I want to be able to also write a list of things I have achieved so that I can remind myself that I am making progress.

I will start as I mean to carry on and remind myself that although the past week felt as if I was a total fraud for claiming to be a doctor I did manage to make a referral, update a handover sheet, write a discharge letter and prescribe drugs in a syringe driver. I also managed to socialise with the other FY1’s and spend some time with my family.

Thinking about the week ahead, I have another 2 days of shadowing and although I have a list of questions as long as my arm it might be better just to go with it. Wednesday is the big day. First official day and I start on a 13 hour shift on take, carrying the crash call bleep! My only saving grace is that if there is any day I can get away with looking like a helpless idiot it will be my first day.

Wish me luck!!

Two weeks and counting.

Posted by F1doc 19th July 2017

Exactly 2 weeks until my first day as an FY1. It still feels very unreal, I just cannot begin to imagine what it will be like. My first day is 13 hours working in A&E, in other words  a massive belly flop into the deep end of a shark infested pool!

Things I am currently worrying about are practical procedures like ABG’s, catheters, cannulas etc. not looking like an idiot, getting to grips with the computer systems, making good referrals, not looking like an idiot! Basically, as the start date gets nearer I find more things to get anxious about.

I start my induction and shadowing on Monday, I’m planning to grill the current FY1’s to get all the information I need. There is so much to know just in terms of organisational stuff, for example - where is the hand-over room? What time is the phleb round? How do I print labels? And many, many more.

I’m looking forward to getting these early days over with, hoping that at some point I will feel a little less on edge and more comfortable in my role. I know it will happen, but getting there may be tough. 

Brexit, junior doctor contracts and the Tory-DUP deal - a perfect storm for junior doctor morale

By MedShr, 2017

 

With the latest political war over, the dust will now begin to settle, talk will turn back to celebrities and frivolity, and the NHS will continue on its current trajectory with Hunt at the helm. But what does the new government mean for the NHS - and in particular the current state of morale for junior doctors?

 

The morale of NHS doctors has been a concern for many years, and results from the latest NHS staff survey show that 39% of NHS staff admitted to experiencing work-related stress that made them feel unwell in the last 12 months (NHS Staff Survey, 2016).

 

Why are junior doctors suffering from low morale?

 

Let’s start with Brexit. In 2016, 10% of doctors were from elsewhere in the EU according to the English Health Service’s Electronic Staff Record. If Brexit negotiations turn sour, and EU citizens can’t be guaranteed their rights within the UK - or in fact just don’t feel welcome anymore - we would face an NHS staffing crisis amongst doctors. The BMA polled over 1,000 doctors from the EU working in the NHS after the Brexit vote, and found that 42% are thinking of leaving, and a further 23% were unsure (BMA, 2017).

 

And then there is the 1% pay cap that was introduced by the Conservative government, which means that with inflation, staff are actually getting paid less year-on-year. This is simply an insult to the people we are entrusting to save our lives, and was exacerbated by Theresa May’s unsympathetic comments during the election campaign that there is “no magic money tree.” Real term pay cuts for doctors and nurses are having a direct effect on recruitment and retention across the NHS.

 

Next is the workforce crisis that is hidden from public view. Already thinly stretched, junior doctors are reporting gaps in rotas and regularly working longer than their allocated hours to protect patient safety and complete essential clinical work. These excessive and often unrealistic workloads, coupled with falling pay, are pushing doctors to leave medicine. The Royal College of Physicians (RCP) even issued a warning at the end of last year that patient safety was seriously compromised by gaps in junior doctor rotas. For example, in paediatrics, the most recent workforce report shows hospitals are currently having to cope with an average junior doctor vacancy rate of 14% and 240 empty consultant posts (Politics, 2017).

 

And finally, the lack of recognition. Politicians talk about increased spending and promises about recruitment to the NHS, but what we must remember is that these pledges affect real people; people who are doing their best to keep us safe. Junior doctors are at the start of their careers, but face low morale and the risk of burnout from year one, so it’s no wonder they are leaving to work in sunnier climates with better working conditions (BMA, 2016).

 

What can we do about low morale?

 

We need to start focusing on the health and wellbeing, both mental and physical, of those who look after ours. Nearly all political parties promised an increase in NHS funding. More resources and increased staffing would mean that junior doctors will feel less stretched, causing less work-related stress and ultimately improving morale - but with an ever-increasing population, is the UK government willing to put up taxes to pay for it? Is the NHS as efficient as it can be, and if not, what streamlining and collaboration can be introduced to improve services and reduce the workload on junior doctors?

 

The NHS under the Conservative-DUP deal

 

During their 2017 election campaign, the Conservatives pledged to support GPs in delivering “innovative services that better meet patients’ needs, including phone and online consultations and the use of technology to triage people better and support integrated working.” However, they also want all newly qualified doctors to be forced to work for the NHS for at least four years - a form of indentured labour which is highly unlikely to make doctors feel valued and may exacerbate the antipathy.

 

Could the Conservatives’ health policies be the reason May failed to gain a majority? And will the DUP block or support the Conservatives in their healthcare plans? In 2016, the DUP released a document that states they believe that the NHS needs to evolve to fit 21st century patients and societal problems, an NHS that is “more efficient, more productive and embraces innovation. One that realises the full potential of our integrated health and social care systems” (DUP, 2016). This could mean that a Tory-DUP deal will attempt to streamline NHS pathways and improve efficiency between primary and secondary care. But is this even possible without a significant increase in funding and resolving the lack of morale that is currently rife amongst overworked junior doctors?

 

The literature and first-hand anecdotes are out there, and it’s a well-trodden mantra - the NHS is underfunded. Without increased funding, there simply will not be enough staff, and junior doctors will continue to feel overworked and undervalued. And without junior doctors staying to progress within the NHS, there may not be a free NHS forever. Aneurin Bevan – often credited as creating the NHS - said in parliament on February 8th 1948, “take pride…we are still able to do the most civilised thing in the world, put the welfare for the sick in front of every other consideration,” - but perhaps we no longer are.