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Mind The Medic: A Junior Doctor's Blog

Discussion in 'Weblogs' started by The Medic Mind, Jun 27, 2016.

  1. The Medic Mind

    The Medic Mind New Member

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    I'm currently a fifth year medic, nearly about to graduate. I'll be starting work as a junior doctor this August and I'll be writing all about it on my blog: Mind The Medic
     
    #1 The Medic Mind, Jun 27, 2016
    Last edited: May 27, 2017
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  2. The Medic Mind

    The Medic Mind New Member

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    To be frank, I wasn't looking forward to it. I had failed to haggle a day off before the night shift unfortunately, which in hindsight is probably fair enough. But I did manage to get a day off after. Thank goodness for small mercies. Anyway, I wasn't looking forward to Thursday night at all. By Tuesday, I could already feel a cold coming on. That tickly feeling in my throat, which was only slightly uncomfortable, was a warning of a greater doom impending. 'Please, not now', I prayed. In actual fact I could have postponed the night shift. I had just needed to do one, it was not specified exactly when. I still had one more week of the placement left to choose a night from. But I had planned it specifically for this Thursday, so that I could take the Friday off and have the weekend to recover. And I couldn't miss next Friday. So, I decided to stick to the plan.

    Now, the preparation. I had to be in on Wednesday as normal. I did the ward round, which was excruciatingly long. 4 hours of standing and trailing behind the consultant as we weaved in and out of rooms and curtains. And as it stretched out I knew I was definitely coming down with something. My body was feeling a bit achy and heavy, but not a great deal.

    Finally ward round ended. And I'd decided by then, to go home. Thinking it through, I was doing a 12 hour night shift the next day and I was getting ill. If I tired myself out now, I wouldn't be able to survive it. So I left.

    I got home and just slept, which was weird. I must have been really tired. Fast forward to 2 hours later, I woke up blurry eyed and feeling very much refreshed, ready to begin my preparation. My plan was to stay awake all Wednesday night, so that I could fall asleep Thursday morning and wake up refreshed to take on Thursday night. For this task I needed help; snacks, remote control, cups of tea/coffee, blanket, laptop. It was a long night

    The next day I woke up and got ready for my night shift.

    The beginning of the night was ok. Just a bunch of routine jobs that needed doing. I was tagging along with one of the FY doctors. He was really chilled out and funny, so we had a laugh.

    Then things went downhill pretty quickly. We were called to see someone who supposedly had post ictal confusion. I wasn't expecting anything major, I thought we would go down help out a little and be back on our merry way. When we arrived the patient was pacing around the room, rambling and shouting about someone being swapped for someone else and then repeatedly pulling at the emergency buzzer on the wall. Every time she did the whole ward would pulse with this red glow and the alarm would go off. She was definitely agitated. It was now three in the morning and we'd been there for an hour and a half at this point. Eventually the F1 prescribed some sedation. We ummed and arhed about which one would be the best, but in the back of our minds we're wandering how we will persuade her to take it. Thankfully, she required minimal restraining. We came back an hour later, to check up on her. She was fast asleep.

    'We need to take her bloods'. What? The patient was asleep, the nurses were finally getting back to their jobs, the ward was quiet and peaceful and now we were going to wake up the acutely psychotic patient and stick a needle in her arm. I was slightly apprehensive. But it went better than expected.

    The next call was to see an elderly patient who had fallen and nursing staff was querying a seizure. It was a small elderly lady who was very frail. We couldn’t feel a pulse or take a blood pressure reading so we had to put a crash call out. They were trying to take blood but they couldn't get a radial pulse, or a brachial pulse and just barely managed a femoral pulse.

    It was difficult to get a cannula in. Once they did, we all set about squeezing 500 ml saline bags as hard as we could to propel some fluids into her system. Gradually, all her observations started picking up and thankfully she improved. Her husband came to see her. We left them to it.

    By that time. The sun had risen, and was shining in all its glory.

    We did a few other menial tasks. And finished off the shift.
     
    #2 The Medic Mind, Jun 27, 2016
    Last edited: Jun 27, 2016
  3. The Medic Mind

    The Medic Mind New Member

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    How to prepare for an OSCE

    OSCEs aren't easy exams. It's a high pressured, anxiety inducing couple of hours. The best way to approach the OSCE is to have prepared for it. My OSCEs are generally made up of 16 stations/scenarios. They're 6 minutes long with 2 minutes for questions. When I practised for my finals, I used this format as well.

    I like to work in groups. Group work is more realistic. One person can be the simulated patient, one can be an examiner and another has to be the student. The 'station', which means scenario, is then timed.

    By doing this, you give yourself the chance to hear yourself in a safe setting. 6 minutes is a small amount of time and if you're not careful, the pressure of the situation might make you spurt out drivel. You need to get used to being in that mindset. Also, by practising certain words and phrases, you'll have them ready for the day of the exam. You'll also know what words actually don't sound right and you can avoid those. Say you've practised how to explain Crohn's disease. You've practised and you know what phrases sound better and what types of jargon to avoid. On the day, if you're so lucky to have a scenario like that, you'll be able to go into semi-automatic mode and perform as you've practised. You want to get into a rhythm so that it feels natural and easy.

    After the 6 minutes is over, the examiner and pretend patient will try to give honest feedback. The feedback needs to be honest or else there is no point. You don't need people to applaud and tell you how great you are. You need the truth. You need to know where you might lose marks and what you can do to gain them. Criticism should be given in a way that is helpful. You don't want to put people down unnecessarily. I adopt my medical school's approach: describe what the person did well and what they could improve on and how. Give them a few options: try say it like this or avoid this word. You don't always have to change everything, take what's been said on board, think over it and decide whether to keep it or not. If you're comfortable with the way you do something then don't change it. At the end of the day, it's someone else's opinion.

    Get the basics first and then build on it. I think it's best to know a little about a lot than a lot about a little. If you don't know how to do a certain skill, look it up. Try to find a video that closely resembles your school's method. If this is an examination, try it on a friend then on an actual patient (with consent) and have someone watch you and analyse your method. Having a doctor watch you would be the next step up. This isn't always feasible. However, if you're in a teaching session around the bedside and the consultant asks for someone to step forward and do a respiratory exam. Put yourself forward. I didn't enjoy doing it, but that sweaty and awkward feeling you get when you're being watched by people is basically what it feels like in an exam. This helped me to get used that feeling and have someone superior tell me what I need to change. Again, each consultant has their way of doing things and their way is not necessarily the right way. Just nod and smile.

    Practice when you can. Some OSCEs require you to perform skills like taking blood. Try practice these throughout the year and not just in the run up to exams. Like I mentioned before. You want to get into a rhythm of performing the skill so that it becomes automatic and you're not thinking through each step.

    Find out what's been tested in the past and make sure you've practised. Also, find out from people in the year above what examiners look for. I know that we automatically lose a mark if we forget to use alcogel on our hands in the beginning of the station. That's useful to know because I don’t want to keep losing marks at every station.

    These are some of the things that helped me get through and pass my OSCEs. They're not nice exams but I guess they're a necessary evil.

    Read more on my blog themedicmind.blogspot.com
     
  4. The Medic Mind

    The Medic Mind New Member

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    I recently published a blog post about all the things I'll miss about medical school. It's easier to think of them all now that I've finished. The last five years seem to have flown by so quickly and I'm waiting expectantly to start my new job as an F1.

    Read more here: themedicmind.blogspot.com/2016/07/becoming-a-doctor.html
     
    #4 The Medic Mind, Jul 13, 2016
    Last edited: Jul 16, 2016
  5. The Medic Mind

    The Medic Mind New Member

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    So a few weeks ago, I published a post about what I'd miss about med school and in the interest of balance I thought I'd write a few things that I won't miss about med school.

    I won't miss ward rounds. All that standing around and walking solemnly from patient to patient whilst the consultant mumbles to the other doctors, flicks through the observation charts and makes minimal changes to the drug chart gets very boring very quickly. It's hard to stay focused when they've actually forgotten I'm there. Some ward rounds can be up to 4 hours long, with no hope of rest or salvation

    I always felt like I was taking up space. Technically, I'm there to learn so there's not a great deal I add. So if I'm with the nurse whilst she's counselling a patient before a procedure and I'm just casually hovering over her left shoulder I do feel a little but useless.

    After 5 years of med school, I am so poor. Med school is not cheap. The debt I'm accumulating makes me want to cry and I'm so far in into my overdraft it's worrying. But I think I've managed to keep it together as best as I could. My car has been the biggest drain on my finances, but with some of the far off places the medical school has flung us off to, it has been my saviour.

    Bringing me swiftly to my next point: travelling. My med school loves to send us to the furthest, hardest to get to places in the name of medical experience. Some of these places can take up to a couple of hours to get to if you don't have a car. I quickly got one.

    I won't miss swapping wards every few weeks. Just about being able to remember the names of everyone on the ward and knowing where everything is, before moving on to a brand new ward and starting all over again.

    I've graduated and now I'm officially a doctor. I'll let you know how I get on.

    themedicmind.blogspot.com
     
  6. The Medic Mind

    The Medic Mind New Member

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    4 weeks in and I'm exhausted.

    My body went from 8+ hours sleep a day to lucky-to-get-6 hours sleep a day. I come back from work tired, I wake up tired, I'm yawning whilst eating lunch. I'm just generally tired.

    I think it's taking a while for my body to adjust to being a full time doctor. Or just being a full time anything. Before I started work I had a few months of taking it easy. Waking up when I wanted, sleeping when I wanted and not doing much in between. Now, most of my day is spent on my feet. I'm standing at the computer, at the bedside, running after consultants, the list goes on. The drive home is probably my first chance to actually sit down.

    I'm hoping my body will get used to this and realise that this is the new normal. The good times are over. I need to be in bed by 11 and awake at 6. And if I'm not in bed by 11, tough, I still need to be up by 6.

    I've started to depend on coffee now. I'm not a big coffee drinker but I've been hitting them pretty often nowadays. In the morning or at lunch time. Just something to stop me yawning whilst the nurse is trying to talk to me.

    It's not just that the work is physically demanding; it's also mentally draining. Especially, when patients need to vent their frustration and you get the full brunt of it all. You have to answer for someone else's decisions or the NHS's shortcomings. It's not easy to shake that off when you get home. I know for me it spins round and round in my mind for hours, weighing me down and then I feel even more exhausted.

    Social life is hovering at 0. If I'm lucky to get home at 6, I'm wiped out. Those few hours after work, I feel like a zombie. Barely any energy to actually feed myself. Anything that requires a good level of concentration I can't do. It's probably why I end up just laying on my bed scrolling through Facebook. Swiping down with my thumb requires very little brain power and I'm getting some social interaction from the comfort of my bed. It honestly feels like I step in at 6 and time starts to fast forward. Before I know it, it's 10 pm and I can't understand where the last 4 hours have gone. I blink, it's quarter to 11. I go to brush my teeth, I come back and it's 11:30. Sleep, wake up and it starts all over again.

    It gets worse when there are long days and nights. Then there's only a couple days to recover and then back to the 9 to 5 grind.

    Which reminds me, I have a set of nights coming up. Fantastic.


    themedicmind.blogspot.com
     
  7. The Medic Mind

    The Medic Mind New Member

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    I like change (to a degree). I don't like monotony, doing the same things over and over again with little or no difference in results. So for me, I'm looking forward to the new placement: a new team, a different workload, a different set of skills to learn. It keeps work interesting and keeps me on my toes.

    I don't think I've mentioned properly that I've been on a cardiology ward all this time. We treat the same things MI's (heart attacks) and heart failures. All. The. Time. It was interesting and new to me in the first couple of months but now it's becoming tiresome.

    Read more at: http://themedicmind.blogspot.com/2016/11/change-over.html
     
  8. The Medic Mind

    The Medic Mind New Member

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    So, I've moved my blog to a new space. Find me at Mind The Medic!!
     
  9. The Medic Mind

    The Medic Mind New Member

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    I planned to post something different but reading on from my last piece, I thought an update would be more appropriate. I sort of left it on a cliff-hanger and I haven’t yet talked about my current placement (which is funny because I’m a few weeks away from my next placement).

    It’s been a tough placement for me. Not tough in the way the previous one was. In comparison, my current workload is way more manageable and easier, plus I don’t have as much responsibilities. It’s just been really hard to adjust to. 3 months in and I still don’t feel like I’ve become a part of the team. The other day, I was asking for study leave from one of my consultants and he offhandedly replied that it didn’t really matter because I was a ‘supernumerary’. It struck me that that is how I’ve been feeling through the whole time I’ve been here.

    The last three months have taken a hit on my confidence. By the end of my first placement I’d built myself to the idea that I was a good F1, or I had the potential to be. The feedback I’d received had all been positive and I felt more empowered to get better. And now, it’s been different. I’ve been told off, constantly criticised and questioned to the point where it’s left me feeling quite vulnerable and ostracised from the team. I hate that I feel like the odd one out and I don’t feel included. It sucks that I’ve not felt as close to this team as I was with my last one. I am a people pleaser and to realise that people aren’t happy with me, it honestly puts me down. I understand people not liking me for my personality but it’s unusual for me to have a lot of criticism in a work place environment. I can only describe it as having a ‘type A personality’, someone who’s always aiming for As and A*s on homework and test papers. All of that contributes to a pleasing mentality, so all of a sudden I’m getting Ds and Fs (figuratively speaking) and I’m panicking because I’m not used to it.

    When anyone asks me how my placement is going. I want to smile and put a positive spin on it, but that part of me that always likes to blurt out the truth, gives a pained smile instead and I don’t have the energy to lie.

    In short, the placement has been painful for me but the end is so near. At least the experience has highlighted some of my shortcomings and to be honest, I couldn’t expect every placement to be plain sailing. There’s a lesson to every experience. I’m ready to take the lessons and move on as quickly as possible and hopefully make the next placement 100x better.

    Mind The Medic
     
  10. The Medic Mind

    The Medic Mind New Member

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    Like the final moments before the end of a marathon, I’m just trying to sprint*. I’m running, I’m keeping my head down and getting on with the job. Yep, I can do that. Yes, that’s fine, I’ll do it. The finish line is in sight and I’m so nearly there. If I can just make it through this placement on a good note, that’ll be a success. Anything potentially annoying, I just smile and move on. I’m so, so close. Just a few days left. I’m just praying I can sail through the last few shifts hassle free.

    I’ve been telling myself to ‘grin and bear it’ for the last several weeks, but the penultimate days have been the hardest. Only because I’m yearning to dive into the sweet release of annual leave. I can almost picture it which makes me even more desperate for it to arrive sooner. Like now. Alas, patience is required.

    Towards the end of this placement, I’d already decided to cut my losses and just get on with the job. The idea that this rotation would live up to the last one in terms of the relationships I’d built with my team was unrealistic. I’m just happy to survive it all with a fewer scars as possible.

    * (At least, that’s what I assume happens.)

    www.mindthemedic.com
     
  11. The Medic Mind

    The Medic Mind New Member

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    Three main reasons why I decided to book a trip on my own:-

    Why?
    1. I have travel envy. Seeing other people visiting new places, it makes me want to travel. Swiping through Instagram makes me feel inspired to look up cheap flights and dream.
    2. It’s hard to work around schedules and people are busy. After a few attempts, things just never panned out which is ok. Plus, with our kind of schedule (nights, on calls and the like) finding time takes a lot of forward planning and effort.
    3. I want some time away. Lately I’ve been feeling overwhelmed and unmotivated. I just want to take it easy and not think about the wards or hospital or the last few months.
     
  12. The Medic Mind

    The Medic Mind New Member

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    ARCP - Mind The Medic
    I have approximately 6-7 weeks before ARCP (annual review of competence progression) and I’m nervous. By the deadline, I should have completed all the competences before I’m found good enough to progress on to F2. These include: procedures, evidence of teaching sessions, case discussions etc. Essentially, there are hoops to jump. I have a few left to jump, but they’re not the easy ones. If it were a computer game, these hoops would be the golden coins you have to travel up a mountain and lose several lives in the process. They’re difficult, because the opportunities to actually get them done are hard to come by.

    What worries me isn’t the amount of time, it’s that I’ll be too busy doing ward jobs to make time. And annoyingly, I had time on my last placement to get through these, but for some reason I just didn’t get as much done as I would have liked. This is completely on me.

    I don’t have a lot left to do, and I know I shouldn’t panic but I’m automatically visualising worst case scenario. So, I’m working on a plan to get everything done before doomsday.

    Read more here
     
    #12 The Medic Mind, Apr 23, 2017
    Last edited: May 30, 2017
  13. The Medic Mind

    The Medic Mind New Member

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    New Placement - Mind The Medic
    Things have picked up a bit in my new placement, which I appreciate. (I might soon regret this). But for now, I’m just relieved to be in a new team, doing a new job.

    The first few days were hectic. Nothing major, just a moderate amount of jobs that kept me busy enough. I cover around 4+ wards, so there’s a lot of to-ing and fro-ing. The first day was an immense amount of to-ing and fro-ing, which meant I got tired really quickly. Over the next few days, I tried completing jobs by working my way through one ward, then moving onto the next one. It made things a bit easier but the nurses and patients didn’t play to my masterful plan, but nonetheless I was running around a whole lot less.

    Even though it hasn’t been super busy, it’s enough of a pace that I’m constantly on my feet. And I need to be quite conscious of time so that I don’t stay too late. I’m trying to be organised and get things done as quickly as possible. This is why I try to delegate jobs if I can. If there’s something that I need to do, I’ll have to do it. If it’s something that potentially a nurse could do, then it’s super super helpful if they do it. The most tedious of jobs are cannulating and bloods, the bane of my existence.

    The setup, the cleaning, the procedure itself, the clean down, then putting all the extra bits back in the right places. It’s all just too time consuming. You can imagine the immense gratitude I feel when I come across a nurse that can put cannulas in. My eyes roll to the back of my head with a silent prayer of thanks. I appreciate the nurses trying and having a go.

    On Thursday, one of the nurses bleeped me on the ward to say her patient needed a cannula for his antibiotics. She’d tried and couldn’t get it. Fair enough. But I was still a bit annoyed, not at her, but at the cannulation situation. I get there, put one in and leave, I’ve still got quite a lot to do. Discharge summaries to write, other people to bleed (I think phlebotomists were on strike that day), scans to request etc. I get called an hour later, to put a cannula into the same patient I’d just put a cannula in because he pulled it out. Irritated, doesn’t begin to explain…

    At that point, I still had a backlog of uncompleted tasks and I was annoyed at the idea that I had to go redo something I’d just done. It wasn’t the nurses or the patient’s fault. These things happen. I explained I wouldn’t be able to get there as I was swamped, and that if she could or anyone else could try but I wouldn’t be able to get there quickly.

    When I got there, there was a tiny plastic cannula, nicely bandaged on the patient’s arm. I’m not sure who put it in, but it was like seeing a rainbow on a rainy day.
     
    #13 The Medic Mind, Apr 30, 2017
    Last edited: May 30, 2017
  14. The Medic Mind

    The Medic Mind New Member

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    Mistakes - Mind The Medic
    I had a really sick patient over the weekend. Everything I gave him seemed to have a temporary effect. The surgical registrar reviewed him, then asked me to get a medical opinion.

    The way the bleeping system works is you press a single number, the bleep you're trying to reach and the number of the extension you're calling from. (The handheld phone didn’t have the sticker which tells you what the extension number is, but I knew the number off by heart anyway). I bleeped the med reg (medical registrar). No answer. I bleeped the assisting med reg. No answer. I waited. They're probably really busy. I should just be a little patient. So I waited a little more. I might have bleeped a couple more times. Then I bleeped the critical care team because I was really worried about the patient. No answer. (In hindsight, I can see why this should have been a clue)

    A little later I finally got the med reg to see my patient.

    I left the med reg to it and tried to get on with the growing list of jobs. It was fast becoming a sea of green, amber and red requests. I was on a different surgical ward when I picked up the phone. I can’t remember who I was going to call or bleep but I flipped the phone over to check the extension number and I froze. Like actually stopped in my tracks and didn’t move. These were the four same numbers I'd dialled in earlier when I was trying to get the med reg. I cover these wards so often I’d mixed up extension numbers in my head. So every time I'd bleeped, they had probably been ringing this phone on this ward, whilst I waited on a different phone on a different ward.

    What a stupid, embarrassing mistake to make. Obviously, I didn't own up to it. This particular med reg wasn't the kind you would have even a slightly humorous conversation with. I imagine he would first stare me down until I disintegrated, then later make me the butt of every joke, till the end of time.

    *embarrassed face emoji*

    Read more here
     
    #14 The Medic Mind, May 21, 2017
    Last edited: May 30, 2017
  15. The Medic Mind

    The Medic Mind New Member

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    Saying NO - Mind The Medic
    I feel uncomfortable saying no to people. Blame it on the people pleasing child in me. The one that wants to keep other people happy whatever the cost. The one who hasn’t grown enough self-esteem to just say no, simply and plainly.

    My consultant wants me to do an audit. She mentioned it and in a roundabout way, I let her know that I didn't think I would be able to. I hadn't even completed the audit from my previous placement. She mentioned it again 5 minutes later and explained the project a bit more. At this point I could feel the pressure. Now my consultant is super nice and it’s the niceness that makes it even harder to say no.

    Who am I kidding? I just don’t like saying no, particularly to someone above me, like my supervisor. I feel like by saying no, I might rile them and turn them against me.

    I’ve been learning a few tough lessons over the course of the last few months. I thought I was a smart individual, but it seems like I have to go through the same type of situation over and over again before I learn my lesson. And each time I fail to learn, the lessons become harder and the consequences harsher.

    I can see it now: I’ll take on this project, I’ll end up staying late multiple times after my shift to complete it, it’ll end up being subpar, I’ll be grumpy and unhappy and subconsciously take it out on everyone else.

    I just need to be honest with myself and clearly let her know that I cannot. Already, I feel like I've got a lot on my plate, I honestly don’t think I could cope with the additional pressure of something else. Any spare energy I have, I want to spend it on me. I already give a lot of my energy to this job. And I don’t even like doing audits. GP audits are easier to do because everything is computerised, there won’t be any wading through pages and pages of notes trying to decipher handwriting. I just don't want to.

    Obviously, she doesn’t need to know all of that. But I should just be honest.
     
    #15 The Medic Mind, May 27, 2017
    Last edited: May 30, 2017
  16. The Medic Mind

    The Medic Mind New Member

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    Halfway - Mind The Medic

    I'm halfway through my last placement as an F1 and I’m literally counting down the days to the end of July when I go away for a family holiday. It’s also really close to when we swap over, so coincidentally I’m also counting down the days till I never have to do surgery again.

    I know surgery isn’t for me. I knew it halfway through medical school after a brief stint on the general surgical ward. I’m not keen to go to theatre. I’m not keen to stitch. I don’t really like seeing organs spilling out of the cavities they belong in. It just doesn’t stir any interest in me whatsoever.

    The 2 year foundation programme should have a good balance of the different specialties which means there definitely should be a surgical rotation in there somewhere. Lucky for me, I got two. I've already completed one rotation so this is my last one. (!) I'm not very keen on my current surgical rotation. It’s a whole host of issues. Plus, the way F1s are treated on surgery isn’t fun. Imagine a garbage truck at a landfill. We’re the landfill.

    Surgery is very top heavy, so all the decisions come from up top. Daily consultant led ward rounds (which is good). In comparison to my first placement when it was a team of 4 junior doctors, we often had to lead our own rounds. I resented this in the beginning but now I’ve come to appreciate it. It meant I knew each patient, I knew their history and I knew where we were heading. I felt comfortable having discussions with patients and their relatives. It felt cohesive. Patients felt like they were my patients. I was making decisions and acting on them. Whilst on surgery, I don’t feel that same familiarity. The ward rounds happen so fast, it’s a bonus if I can catch a glimpse of the patient in front of me because I’m rigorously trying to scribble down as fast as I can.

    I don’t ever fully know what’s going on with each individual patient. And the turnover of patients is so fast, people become bed numbers because it’s so hard to keep up with who’s coming and going. I can’t confidently tell you what the plan is for everyone because honestly I can’t remember. The ward round is a blur. I pray that I’ve made a good list on my sheet or else it’s anyone’s guess what’s happening.

    The moment the round is finished everyone disappears. It’s just me and my flimsy sheet of paper trying to figure out what the jobs are for each patient. There is another F1, but the rota is so choc block full of on calls that we hardly see each other. Honestly, I think the CT should be helping with the jobs, but surgeons don’t want to be on the ward, they want to be in theatre. So, all the menial tasks get dumped on the F1 (hence landfill). This is my experience anyway. Some of the other teams do have more conscientious CTs who help. I can understand that they need to put the hours in and fulfil their requirements for their ARCP like we do. I get that. But they’re still junior members of the team and should be helping out on the ward. When the rota gap happened and left the team with no F1s, I was surprised the telling off I got. (Even though it wasn’t my fault). I had foolishly believed the CT would be able to do his bit and hold down the ward jobs. Obviously not. It seems the team can cope without a CT but not without a F1. If all the F1s decided not to come in, surgery would crumble and just cease to move. You would think that would make us valued members of the team.

    This isn’t to say that I can’t work on my own because I can. But so often I’m being spread thin across several wards. The bleeps go off constantly (guaranteed twice during lunch). Nurse A is calling from ward 1 and needs a discharge summary done (urgently), Nurse B is calling from Ward 2 because a patient’s blood pressure is 100/70 (yes, they feel fine), Nurse C is calling from Ward 3 because some fluids need prescribing (urgently). Nurse A wants to know how long for the discharge letter.

    It gets to the point sometimes when I look forward to being on call just so I can escape that shrill call of my bleep and the person on the end who needs something done. And of course, it needs to be done A.S.A.P.
     
  17. The Medic Mind

    The Medic Mind New Member

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    Dear Paediatric Registrar - Mind The Medic
    Sorry that I don’t know your name. I’m writing this letter knowing that you won’t ever read it. I’m hoping by the virtue of me describing what happened this Saturday afternoon, it’ll serve to at least bring me closure and stop the angry rewinding and replaying in my mind.

    At 3:30, I was bleeped by a nurse to do a discharge letter and discharge medication for a child. I let her know that I would do the letter as soon as I could.

    Then you called a moment later.

    I’m not sure what kind of day you had or what the situation was on your end, but equally you could say the same to me. So, when you said I needed to make this child a priority, I thought that was unfair and unnecessary. Every discharge letter that gets thrown my way is pushed on me because it’s urgent. It’s a Saturday and pharmacy closes before 4 (essentially giving me less than a half an hour window). When I’m waist deep in tasks, it’s unhelpful to tell me to leave what I’m doing, to do what you deem a priority. You had no idea what my workload was like, you failed to see beyond what needed to be ticked off your list.

    You were unkind for telling me off for asking the nurse to look in the BNF for the antibiotic dose. I didn’t ask her to. She offered. And when she offered, I said she could. I don’t see where I went wrong. I didn’t ask her to prescribe it or to give a prescription. A nurse is more than capable to look in a book. But I didn’t argue with you. I got the sense that there would be no point. You clearly had a bone to pick.

    I came up to the ward, leaving behind a stack of unfinished tasks and finished the letter. You bleeped me again: I had prescribed the formulation that the ward didn’t stock. And you wanted me to come back and prescribe on the bottle.

    You were relentless.

    Part of me wants to think it’s because you cared so much for the child at the end of all this. But I don’t think that explains everything. Because if it was truly that, if you really wanted to get that little girl home you could have prescribed the right antibiotic formulation, something you’d have done a thousand times. You could have written the prescription on the bottle, it would have taken you less than a minute. If that child was your priority you wouldn’t have instead dialled my bleep, countless times, to try to get me to leave everything, again, to come back up to your ward to jot a few words down. If you just did it yourself, you would have saved you and me a lot of time. I’m not sure why you needed to pick on every single thing.

    I would understand more if it had come from a nurse. They get their own pressure from bed managers. But from a doctor who has been in the position I was in, who has been a junior doctor carrying the load several doctors normally would, I would have expected you to get it. To get that I’m one person and I can’t do everything at once.

    At a time when everyone’s feeling the stress, you rely on your colleagues more to motivate and encourage you. But you gave me a metaphorical kick in the teeth. You were demanding and unfair. Again, I don’t know what type of day you had and I probably couldn’t imagine the stress that comes with being a paediatric registrar. But I hope that when those stress inducing situations arise, that you’re treated with more compassion and respect than you showed me.

    Sincerely,
    Zed
     
  18. The Medic Mind

    The Medic Mind New Member

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    Some Good Things - Mind the Medic
    Even when I feel down, there is always something to be grateful for. I try to make it a habit to look for the smallest things, just to keep me going and keep me motivated. Here are some examples of a few silver linings that have happened recently:

    1. When another F1 sent me a stinging message on a group WhatsApp, it left me confused. I couldn’t decipher the tone. Was it a question, covered in humour, or was I being told off? I’m not particularly close to this person so it was hard to tell. I replied as diplomatic as I could because I wanted to get the balance right so that 1) I addressed the issue, 2) I didn’t go overkill and have the other person tell me later they were joking and 3) have an all out argument on a group WhatsApp. No one wants to be told off by a colleague and I didn't like that they felt they could embarrass/shame me in that way. If there was an issue, a private message would have been way more appropriate. I was really surprised and touched when the other F1s messaged me in private to support me. They were probably more ruffled than I was. It warmed me up a bit that other people took the time to try make me feel better.
    2. Even though I’m mid placement, I've already had my end of placement feedback for my ARCP. (Don’t ask why, the powers that be have decreed that it needs to be done two months before the actual end of the placement). My supervisor put the nicest things down, which took me aback a bit. It’s unusual to get really positive feedback in this game, it really is. You sort of just plod along and do the job. Maybe it's because everyone expects you to be hardworking, that’s how we all got here. But as a newbie all you want to know, at least all I want to know, is that I’m doing OK. So imagine my heartache when it gets to the point we submit the form and the system decides to malfunction, deleting every nice thing that had been written. Luckily, my supervisor rewrote it all. I really needed to hear something positive, because my last placement had knocked my confidence.
    3. My current placement has another F1 who is awesome. What’s annoying is that we don’t get to work together often because of our on call schedules. We’ve probably overlapped by four days so far. BUT, it looks like we’ll probably be working together more in June/July. We get on really well and we have a laugh, which makes the job much more bearable.
    Just some of the good things that have taken me aback recently. I’m trying to remind myself of the good things and not allow myself to be weighed so heavily by the bad.
     
  19. The Medic Mind

    The Medic Mind New Member

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    Consent - Mind The Medic

    Recently, we had a patient under our care who spoke very little English. We could manage on very basic instructions but because the patient needed an operation, they needed to be consented for it. Not one of us could speak anything other than fluent English, so we needed an interpreter.

    I asked the ward clerk to book one in the patient’s preferred language. When interpreters are booked, they usually come the next day so I was beyond surprised when the ward clerk told me she’d arranged one for midday, little more than an hour away. I let my consultant know the good news.

    Here’s where it turned sideways. He wanted me to do it. He wanted me to consent the patient for this operation. That caught me off guard. Consenting isn’t any old task. The GMC* takes consent very seriously because there’s so much to it. There’s so many aspects that needs to be taken into account: ethics, medical legal issues, capacity etc.

    Then there’s the whole issue of F1s taking consent. It’s a grey area. We can take consent for some procedures provided it’s something we’ve seen before. An example would be a colonoscopy (a camera that looks into your bowels). I can do that. I’ve seen several. But this operation I was being asked to consent for, I’d never seen it. I could hardly even pronounce it.

    Obviously, all of this didn’t come to me at the time. I just held the phone to my ear for several seconds, trying to comprehend exactly what I was being asked to do. I started off with ‘O…..kay….’ Followed by ‘I don’t think I can’. Note the conviction in my wording. The consultant was urging me, saying I wasn’t really taking consent, I was just reading the form out to the patient and then the interpreter could sign the consent form. Still, it didn’t sit right. I was stuttering, falling over my words until eventually, I agreed.

    But I was uneasy.

    I walked back onto the ward heavy footed, wondering: why me? I kept going over it in my head.

    Luckily, I bumped into another F1 and quickly ran over what happened. She gave me a definitive no, it wasn’t a good idea.

    And really, it’s what I needed to hear. Intuitively, I knew it wasn’t a good idea. I wouldn’t be able to explain it to someone succinctly. Yes, I could read off a piece of paper, but that isn’t what consenting is about. I always find it difficult to say no, but I called the consultant back to let him know.

    I managed to find someone else more versed in this procedure than me to explain it. He drew a diagram, he explained it clearly, he answered questions. Only a person with actual experience with the operation, could go into the amount of detail he did.

    It made me realise how unfair it was for the consultant to put me in that position. Chances are, the operation would have gone smoothly. Yet even so, what if something bad did happen. It’s hard not to think of worse case scenario when there’s that constant reminder that you need to watch your back; we’re living in an increasingly litigious society.

    Most importantly, it wasn’t fair on the patient. That patient needed to know exactly what was going to happen with their body. If they had questions, I definitely wouldn't have been able to answer them. I knew what the aim of the procedure was, but how they were going to approach it, where they would make an incision or what exactly would happen would have been guess work. The patient deserves way more than that.

    I’m really glad I made the right decision in the end. But I was so so close to making the wrong one. If I hadn’t talked it through with someone else, I genuinely think I might have done it. And it would have been a mistake. But in that moment, I felt pressure beyond belief. The consultant questioning why I couldn’t do it, telling me how busy the team were just made me feel more guilty.

    It reminds me of the SJT, the exam where you have to rank how you’d behave in different situations from the most appropriate to the least appropriate. It’s really easy to read a scenario on paper and say what you would do, but in reality, the situation can be very different. Rational thinking fails you, and your left to make quick judgement calls under a lot of pressure.
     
  20. The Medic Mind

    The Medic Mind New Member

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    10 Survival Tips For F1 - Mind The Medic
    It’s July 2016 and the realisation that there’s only a few weeks before I walk the hospital corridors as a doctor for the first time. I’m filled with terror and excitement, but mostly terror. A year later, and here I am, older and hopefully a little wiser. A year has gone by very quickly but not without some lessons learnt. Here is some of the things I wished I knew before I started F1.

    1. Lower your expectations. This is so crucial. You’ll save a lot of pain and heartache knowing now that the idea you may have in your head is so different from reality. I struggled with this, and to some respect I still do. I hoped I’d be learning more, building on all the things I’d learnt for finals. Realistically, you learn how to document faster, recite blood results without looking and pre-empt what the consultants want even before they know they want it. All the things you revised for at med school go out the window.
    2. Think it through. There were times, especially in the beginning where I’d be in a situation and I just didn’t know what to do. A patient was unwell and I didn’t know why or what to do next or who to tell. My mind would start racing and I would feel myself start to panic. Don’t do that. Don’t panic. Unless it’s a crash call where you have to act really quickly, then you can take a few seconds to order your thoughts. The time you spend running around not really doing anything is time wasted. Take it back to basics if you don’t know what to do: ABCDE.
    3. There were so many times in the first month I would be paralysed by indecision. Some situations I just didn’t know what to do, even if it was a relatively simple query. But with time I got quicker at making those smaller decisions. It’s the same for everyone else. What helped me was looking up trust guidelines, having a quick Google, asking one of the F2s.
    4. Don’t take everything to heart. Consultant’s might question you, registrar’s might tell you off unfairly, other colleagues might seem unreasonable and then take it out on you. It might not even be about you, so don’t let it get to you.
    5. Take care of yourself. You’re working in a system that is under a lot of strain and pressure and some of that will filter down onto you. It’s not your burden to bear all of it. Working 24 hours a day for 7 days a week, won’t save the situation. Just be mindful and do what you can.
    6. Prepare to work hard. You’ll miss lunch, you’ll work when you’re sick and you have to give some stuff up. It’s a hard balance to strike but I always make sure I’ve eaten or I’ve at least had a break. Missing the odd one might not count. But doing this repeatedly will start to affect you and you deserve more than that. I don’t believe being a doctor means you provide a service all the while breaking yourself down. You can’t work in a team, be a good colleague or a good doctor if you don’t look after yourself. You are you first, before you’re a doctor.
    7. There are so many embarrassing moments and mistakes. I’ve had too many cringe-worthy moments, but I learnt from them to make sure they didn’t happen again. (They did, just less frequently)
    8. Don’t expect a lot of praise. When you do get some, it will feel amazing. To actually have someone else applaud your hard work is a great feeling. But don’t hang your hopes on waiting for it, that’s an easy way to be disappointed.
    9. There’ll probably be a not so great placement. I’ve had my share. Don’t let it get to you, not all rotations can’t be the same. You’ll love some more than others. In the ones that you love, enjoy those moments. In the ones you don’t, just focus on working through. They’re four months long, they will always come to an end. Take what you need from them in order to grow and brush the rest off.
    10. Be prepared to laugh and cry. You’ll be working with so many clever, insightful people. You’ll bond over hard shifts and difficult patients. Some of the stuff I’ve gone through I’ve been able to vent to colleagues about, and they get it. It’s important to have a support system that understands. A lot of the times I come home and vent even more, to my mum and on here. You’ll be dealing with a lot, don’t keep it all to yourself.
    That’s 10 things I’ve learnt. The next piece will be on my blog next week. Let me know what you think, whether you agree or disagree and share with anyone you think this might help!
     

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