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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.