The Psychiatry SHO*

Advice for new doctors

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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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