Advice for new doctors

It’s been 6 years since I qualified from medical school, and 6 days since my final shift as an SHO. Between those points I learnt a thing or two about being a junior doctor. Before I ascend to the heady heights of registardom and forget it all, I want to pass along a few bits of advice to the new crop of F1s. I hope it will be of use.

Firstly, get ready for a surprise. All that studying you did, all those placements and modules you went through, all the exams you sat and OSCEs you survived…are poor preparation for being a doctor. Real life on the wards is very different to textbook land, and the problems you have to deal with are entirely unrelated to your finals. Instead of being asked for 4 differential diagnoses for a third cranial nerve palsy you’ll be faced with questions like ‘does this wound look a bit funny?’ and ‘do I need to do anything about a bilirubin of 32?’

It’s normal not to have the foggiest idea about these things – you’ll simply learn to sound more confident in your totally un-evidence based answers over time – but if you aren’t sure, just ask. You never know if it might actually be important. You don’t know what you don’t know, and having a junior doctor who asks questions all the time is far better than having one who doesn’t (we wonder if they aren’t interested or are a bit full of themselves).

Thankfully though, in another strange twist of events, situations in which you’ll have to make a decision won’t be as common as you think. The vast majority of your time will be spent writing in the notes, ordering scans, taking bloods and chasing the results, and writing discharge summaries. For some new doctors this can be a let-down, but these are actually all deceptively important jobs that require practice and effort. Don’t knock them. A clear discharge summary which explains the details of the admission and the plan can be priceless for a patient who would otherwise have no idea what was going to happen next. An efficiently ordered and chased scan can save someone days in hospital (near all those resistant bacteria). Making sure follow-up appointments are booked ensures that your patients don’t just deteriorate unchecked at home and get readmitted. Be proud of running a tight ship.

All that said, there will be times when you’re the one in charge of an emergency situation, usually when you’re on call or managing the ward when everyone else is away. In these spots, trust your instincts and training (A, B, C, D, E…), listen to the nurses and call for help really quickly if you think you need it. You probably will, and this is fine – medical school basically only prepares you to be good enough to do the basics and call for help. It’s your job to ask for help, watch and learn, which is actually pretty cool. Your seniors shouldn’t mind and if they do, it’s their problem. Again, we much prefer junior doctors who call us every 20 minutes to ones who manage things they aren’t sure about, by themselves, in a quiet corner of the ward.

On the subject of colleagues, value them. Especially the nurses. They’ve been doing their jobs for years, they’ve seen tens if not hundreds of new doctors so they know when you don’t know something, and they can get you out of really sticky situations. If you mess up, which you will at some point, they’ll be there to back you up, but only if you’ve been nice. And despite the fact that they lack a bright, shiny new medical degree, they do actually know a lot about acute management of sick people. When I was half-asleep at 4am on one of my first night shifts as a surgical F1, the high-dependency bay nurse basically talked me through an acute assessment of abdominal pain, while somehow making me feel like I was doing it myself. I remember it to this day and I still owe her a G+T.

There will be times when it all gets too much. You will be stuck in a high-pressure environment for over 50 hours a week, seeing one gravely ill human being after another, some of whom will be very nice, and then die. There will be nothing you can do to help many of them, which is another nasty shock. Some of your colleagues may be cold, demanding and uninterested. It is normal to feel upset and overwhelmed. Crying is okay, but talk it over with your friends and colleagues and make sure it doesn’t turn into anything more serious like depression. Look out for your colleagues too. Try to keep your hobbies going, stay in contact with your family and take all your annual leave. And alcohol might be a fun way to de-stress at medical school, but it’s a dangerous way to cope as a doctor.

Bearing that in mind, there will also be amazingly fun times. Being a junior doctor is still a bit like medical school, in that you get taught a lot and have a close-knit group of peers, but better in some ways as you also get paid and get some respect. This is cool. Patients are incredible people, the things you will see, hear and do will be revelations to you, and you might even help someone in a critical way. And mess parties are fun. Savour this time, because no matter how hard your rota is, you’ll look back on it a few years later and slightly wish you had that time back again.

Finally, more about patients. Medical school may have taught you that patients come into hospital to have one or more well-circumscribed medical problems fixed, at which point their lives will resume normal service. This is rubbish. Patients end up in hospital for many reasons, a lot of which aren’t things like ‘crushing central chest pain’ or ‘right-sided weakness’. They come in because they get a bit dizzy and their carer – the fifth new one in 2 weeks – panics. They come in because their sodium is low due to diuretics and they weren’t confident to get to the GP for monitoring. They come in due to falls in cluttered houses and UTIs from dehydration. The important message is, fixing the acute problem is only half the job. To wholly help someone, ask yourself what the real reasons are for their admission, and tackle those. Furthermore, don’t just treat symptoms but ask the patient what they want from life – it might not be relief from pain but the physical strength and freedom to visit their grandchildren. Facilitating these desires is what being a good doctor is really about.

Good luck, best wishes, and remember – if you’re not sure, just ask. There are generations of former new doctors there to help. We just look a bit older and grumpier than we used to.

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About Alex Langford
I am a psychiatrist (now an SpR) based in Oxford after 3 years working in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

6 Responses to Advice for new doctors

  1. This is brilliant. As someone just about to become an F1 in acute surgery, excited and terrified, this was just what I needed. Reassurance and inspiration!

    • I’m really pleased you think so. Good luck for the job, and share the blog post if you like.

  2. Alex what a brilliant blog. I particularly like the excellent advice about a work life balance where enjoying your hobbies is so important as is controlling alcohol intake . These are two things that will really help young doctor cope with the strains of the new life. The other bit of advice I would give is don’t assume that patience don’t know anything about the condition they have. Check out what they do know is that important to ensure they have the right information.
    Good luck!

  3. good practical advice….people dont generally realise the practice of medicine, especially in the early years, is exactly like this.

  4. @hand_ties says:

    Hello Alex,

    Firstly. excellent blog.

    There is very little information on true Core Psychiatric Trainee/Higher Trainee experiences online, and this is exactly what I was looking for.

    I am a new CT1 Core Surgical Trainee, ever since I was a child I loved the idea of being a Surgeon. Since medical school I have breathed surgery, during every single rotation regardless of speciality you would find me in theatre as soon as everything had settled on the ward. My CV is just a pdf of type seven surgery as you would expect. Audit, presentations, teaching, thousands of pounds on courses, fees etc etc

    I have had the honour of completed my last post in FY2 in Psychiatry. DGH, with an inpatient unit, good community/htt/liason support. I loved it.

    During the first few weeks of transition into CT1, I seem to keep on asking myself a question I thought I would never ask myself and to be honest many of my surgical peers/seniors would be (lets be kind) surprised about.

    ‘What would my life be like as a Psychiatrist?’

    I miss it. Why? Is a question I am unable to really answer. Is it the comeradeire of being the only/first point of call in an acute mental health unit? Is it the fact all the staff and patient know you as well as see you develop? Is it actually talking to patients, not looking at the numbers?

    Maybe I miss the interaction. Today we had a 25 minute WR of 12 patients, the surgeon leading is excellent. Everything surgical was covered and all surgical needs were noted. Will I ever know what each of these patient actually want/need apart from what the scans/bloods say? Probably not. ‘Plan: Dietician, Physio, Social & DTOC’

    Or maybe its the patient centric meetings/ward rounds? Based on patient needs not on doctors time restraints? (Teas and cakes are always a plus).

    Will I ever know anything about the 70 year old gentleman who I have just spent 6 hours ‘assisting’ doing a Lap Pancreatectomy + Splenectomy? Probably not. Holistically would I know how this patient would be post op from a 10 minute review 6 weeks later? The OPD might be with another SHO/Reg who has never seen this patient before.

    As a doctor primarily it is difficult to manage your ideals of practice and the realistic needs of patients in an already stretched service.

    I would be intrigued to know what your experinces with training and fulfilment were? As a new SPr are you as ‘disgruntled’ as everyone in the NHS seems to be? Or do you go home at night with a good sense of vocation?

    On the other hand do you miss the world of clinical medicine and the acute life most traditional junior doctors find themselves in?

    Would you reccommend Psychiatry in the NHS as a career?

    @Hand_ties

    • Hi, and thanks for the comment.

      It sounds like you’re being really honest with yourself, which is important. A lot of doctors (including myself) seem to start their medical lives assuming that they want to do a particular specialty, and when they enjoy something else, not notice straight away…but it seems you’ve avoided that.

      Psychiatry is a good career. I do often leave work feeling satisfied that I’ve helped people, and I do get to know my patients really well. You have to do that as part of the job. And psychiatry has a lot of hidden benefits too. We’re a broad church, so as well as offering opportunities in neurobiology and imaging, you can get stuck into some phenomenology, sociology, spiritual psychiatry or hell, even anti-psychiatry. The fact that we get a day a week to spend on special interests helps. As does a relatively family-orientated on call pattern.

      Almost all the purported flaws in psychiatry as a career aren’t true. Our patients get better (lots), they’re often very unwell, our treatments work and we can be very scientific if we want to.

      That said, it can be a real challenge. Poor funding makes it a nightmare for patients and often for us. Waiting lists for psychotherapy for non-mild problems usually top a year, we never have any beds and we’re usually understaffed. Some psychiatrists are not well trained and their poor practice poisons the well for everyone. But these are challenges too. It gives another dimension to caring for people and makes it all the more rewarding.

      My advice would be to follow your gut and not to be afraid to try a bit more psychiatry. Maybe take a year out, or 6 months. We see loads of ex-surgical, medical and GP recruits who have made the same switch, so you wouldn’t be alone. Perhaps sneak off to a psych conference or two – the Royal College do a great selection.

      Failing that, stay literate in mental health and advocate for your surgical patients who have mental health problems, in what can sadly still be a very stigmatising environment for them.

      I would be more than happy to help or make suggestions if you do decide to pursue this further.

      Best wishes.

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