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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

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    10 Survival Tips For F1 (Part 2)- Mind The Medic
    Here is another list of 10 tips for surviving F1

    1. Don’t do things just because you feel pressured. You’re new, you don’t know all the rules yet. If something feels wrong, then there’s probably a legitimate reason why. Don’t be pushed into signing something or giving a medication you’re not comfortable with. I was asked to prescribe an anti-emetic that I didn't know. The nurse told me the route and the dose and gave me the prescription chart. I respect that the nurse knows her stuff, but I wasn’t comfortable just signing off on a drug I’d never heard of before. It might be hard but take a moment to step back and pause. Say something like ‘OK, let me look into it’ and move away from whoever it is that’s piling on the pressure.
    2. Don’t be afraid to say no. No doesn’t come easy to me. I feel like I’m being rude or inconvenient but sometimes you have to be clear. It’s hard and it gets even more difficult depending on who you’re saying it to. I talked about one experience here where I had to say no to a consultant. Hard. Something like ‘sorry, I’m not comfortable doing that.’ I’ve learnt to say no more and more on my current placement. I’m often left working on my own on the ward and the nurses will often bleep me as the first point of call for every query and I’ve had to apologise and redirect them to someone else.
    3. Book annual leave and plan things ahead of time. If you need to have a certain weekend off for a prearranged event that is non-negotiable, make sure you’ve looked at the rota way ahead of time and made swaps where necessary. A lot of people miss annual leave days. Don’t let it be you. Don’t just rely on emailing the coordinator to warn them, a lot of the time that doesn’t work.
    4. You’ll be under a lot of stress. The things you’ll have to do and experience won’t be easy. They’ll come home with you. Exercising, meditating, drawing anything that makes you feel good and takes your mind off work is non-negotiable. Whatever it is that you do, don’t let it slip. You’ll need it now more than ever.
    5. You don’t know everything. Be comfortable saying ‘I don’t know’. You’ll be working with other health professionals who’ll be able to help. You’ll get that one job from the ward-round which will take ages to sort out. I’ve been there, going round and round in circles. Sometimes, it’s just easier speaking to someone directly who might know the answer. If the query is about a drug, ask a pharmacist. They might be able to help you in seconds, if not, they’ll know how to get the information. Use the team around you, it will save you a lot of time.
    6. Just as above, nurses can be super useful especially in the beginning. They can help fill the gaps left behind from the long induction you’ll be made to sit through. They’ve been working longer than you have and know how the hospital works: how to request scans, where the family service office is etc. In the beginning it’ll be overwhelming and unless you’ve worked in that hospital before it can take a while to learn ‘the system’.
    7. Be cautious. Not only are you a new colleague, you’re also a new doctor. In my experience, I think it’s meant that some members of staff feel they can take advantage or treat me differently than they would a more senior doctor. I’ve not had too much trouble and this is just my opinion. But be respectful (particularly with nurses) and be patient. They outnumber you.
    8. There will be a lot of pressure on you to do 5 things at once. Some things can wait, some things can’t. There would be times nurses would hound me for discharge letters and act like it was the most important thing, taking precedent over everything else and that’s rarely the reality. But in the beginning when I didn’t know any better, it made me feel so overwhelmed. I would get it from all sides: cannula, discharge letter, pharmacist. Everyone wants something and now. You get used to it. You prioritise.
    9. There might be a time when you need to rely on your documentation and at the very least, you want to be able to read what you’ve wrote. You’re going to be seeing so many patients, you won’t be able to remember what happened with every single one of them.
    10. Finally, ASK. Ask. Ask. Especially in the first few months, everyone expects you to know nothing. This is the best time to play that part. I used to ask the medical registrar the simplest of things but she made me feel comfortable enough to approach her. You’re not working at a desk making a PowerPoint presentation, you are caring after real people with real conditions. Don’t fall into the trap of being silent.
    Bonus

    • Question everything. If someone asks you to do something, ask why. I’ve been in so many situations where I’m asked to do something, I go on my merry way until I’m questioned and I realise I’m not really sure what the rationale was. Trust me it makes it that much easier to convince someone to do a scan or to review a patient if you know the questions you want answered. Apparently ‘because my consultant wants it’ isn’t a good enough reason.
    These are all based on my experiences as a F1. My colleagues could relate to some of them but maybe not all of them. But I hope this goes some way to make this year a tiny bit easier. Good luck to everyone starting a new F1 post. You’ve done amazingly well to get this point.
     
  2. The Medic Mind

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    The Last Day of F1 - Mind The Medic

    The last day was a mix of emotions. Overwhelming gratitude and relief that I’d finished a difficult placement but also a slight melancholy that I was leaving. I was happy, don’t get me wrong, I’d started a countdown midway through the four months. But while I was working through the final jobs, I kept thinking of how everything was coming to an end. Not only was this the end of a placement but it was also the end of the academic year, the majority of doctors would be moving on to new hospitals. The people I’d worked with over the last months, the relationships I’d built, the comradery, it all felt like it was coming to an end.

    We had a small get together at lunch with cakes and drinks and it felt like the end of an era.

    The hospital can be really sociable. Just walking down the corridor, I’m bound to run into someone I used to work with. I enjoy that aspect of working in hospital.

    My next placement is in GP which will be a massive change of environment. It’s always been the one thing that’s bugged me about general practice: the fact that there isn’t that community of peers around you. But I’m still looking forward to the change of scenery. I’m hoping GP will give me some of the learning experiences I’ve felt like I’ve been missing. Plus, surrendering my bleep for the next four months feels like a huge bonus. Not having the constant paranoia/palpitations every time I hear that beep anywhere around me and immediately look to see if it’s me that’s being summoned to some unknown problem. I just want to actually learn and do some medicine. Listen to a problem, take my time, explore the issues and be guided and taught as well. All whilst being sat down. I’m really hopeful.

    I had the new foundation doctors shadow me on Tuesday and I honestly tried to be as positive as possible. I tried to give them all the necessary information they needed but I know they’ll learn it all as they go along. Luckily, the consultants are lovely so they should be fine.
     
    #22 The Medic Mind, Aug 3, 2017
    Last edited: Sep 24, 2017
  3. The Medic Mind

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    Locum Shift - Mind The Medic

    I worked a locum shift during the weekend. Nothing stressful, just an admin shift. I pretty much sat around all day, flicking through paper and typing entries onto a computer. I expected it to be a chilled shift, so I didn’t even bother wearing my stethoscope. I was sort of spread across different wards, but I didn’t have any clinical duties, so I wasn’t seeing patients anything like that.

    That all changed one minute to the end of my shift. I was called over by a nurse to review an unresponsive lady. I felt so unprepared. Like I said, I wasn’t expecting to do anything clinical, I’d left my stethoscope in my bag. And I know the training that we get gives us what we need to do when a person becomes acutely unwell. I don’t know why, but in that moment I felt really unprepared. I went over and kind of went through the steps of assessing this elderly lady. To me, she wasn’t unresponsive but it’s hard for me to know how well she’d been an hour before. I don’t know how she’s like normally. I try to examine her, whilst giving some instructions to the nurses and dodge around 3 family members. It all felt very haphazard.

    The medical registrar came and took over, and he must have thought I was slow or something because he just did everything himself.

    Driving out an hour later then I should have been, I just felt deflated. I felt like I could have done so much better. And I use the excuse that I’ve feel like I’m out of the loop after having done surgery for so long but really, is that a reason?

    I was thinking about it all the way home. Just picking over the situation again and again.

    It’s hard to remember exactly what happened because my mind was somewhere else. So this is was what I think happened: I’m trying to join a dual carriageway with three lanes. I can see two cars, one blue car in the middle lane and another in the furthest lane (right lane). I look right, then left and then start to pull out. Then I break suddenly, to stop myself crashing into the blue car speeding past in front of me. I’m sure it wasn’t there before so I wonder whether it swapped lanes when I looked away.

    And I mention this because, it made me think. I was so concerned about how stupid I looked and how I did a bad job. I took that issue which was self contained (the patient was ok, the registrar had reviewed her) and I made it affect my driving to the point where I could have been in an accident. That would have been a much bigger problem and I’m really glad I narrowly avoided that.

    So, this really is a lesson for me, more than anything else. Be more careful and don’t make a bigger mess of things.
     
  4. The Medic Mind

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    General Practice - Mind The Medic

    We had a lot of exposure to general practice (GP) during medical school. Usually, I'd have one day a week based at a practice and sometimes a couple of four week blocks would be allocated for general practice alone. So I’ve seen a fair share of different practices, some were better than others. But overall, I felt like I had a better appreciation of what it would be like to be a GP.

    Throughout medical school we were told that at least half of us would be GPs. On its own, the statement doesn’t sound bad, but in context, a lot of the time it felt like we didn't have much choice in the matter. 50% of us would be GPs regardless of whether or not we wanted to. Some people took offense, I didn’t particularly, even though at the time I thought wanted to be a paediatrician.

    A few years later, now a F2 on my GP placement, I can see the appeal. 9 to 5 every day plus one afternoon off every week. I don’t have any night shifts or weekend shifts. There's 30 minutes to see each patient, all the while sat down in a room with plenty of opportunities for tea/coffee breaks. I know this isn't fully representative of an actual GP but it's generally a much better working environment than what I’ve experienced so far working in hospital.

    So part of me wants this to be it for me. Do GP, have a great work life balance and be financially stable. I really wish I could fall in love with it. At the moment, it just doesn’t excite me. Some of it does. I hear a lot about GPs who have more unusual working patterns, that go beyond seeing patients in a clinic. But if I go for general practice, I want to be really for it, not just the good bits. It's like buying a cake with icing but only being excited for the icing. And then throwing the cake away when all the icing has been eaten.
     
    #24 The Medic Mind, Aug 19, 2017
    Last edited: Sep 24, 2017
  5. The Medic Mind

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    A Bad Week - Mind The Medic

    Last week was a series of lows.

    I can't even describe it. It was a case of the proverbial faeces hitting the proverbial fan. Multiple times.

    I started the week feeling incredibly tired from the weekend. Nothing unusual, just a tad more Monday blues than normal. But I didn't think anything of it.

    I ran a few errands on Monday and Tuesday. I was slowly beginning to feel a bit overwhelmed with all the things I was juggling. And to top it all off, it felt like I was coming down with something. And instead of really tackling those issues, I found solace in lying in bed watching Youtube videos, just something to take my mind off everything.

    Then came Wednesday. I had my morning clinic and then went on a home visit to review an elderly man with back pain. The symptoms had resolved by the time I got there so I made my way to the hospital for the weekly afternoon teaching. I grabbed a Subway on the way, even though I'd been avoiding buying lunches because I am trying to save. But I'd been so tired, I hadn't prepared anything to bring in to work and eat, I must.

    My supervisor grabbed me as soon as I arrived, so that we could have our mandatory introductory session (which we have for the start of each placement). She asked me how I was and all of a sudden I just offload a tsunami of emotions, mostly about how deflated I felt etc, etc. She gave me a funny look: concern/surprise/worry and told me she wanted to see me again in two weeks. I caught her off guard but to be honest, she caught me off guard as well. Saying it out loud made it all seem a bit more real. I’m not sure why it all came spilling out like that and I kept thinking about it, all the way through teaching. I had some idea in my head that the medical postgraduate team were going to put me on red alert or something and start watching my every move.

    By 8, I was fast asleep, I was just too tired and achy to fight it any longer.

    I got to work Thursday morning. Settled into my clinic. First patient didn't arrive and I'd left my GP bag in the car (the one I use on house visits and that I had taken home with me the day before). I quickly went out to get it before the next patient arrived. I couldn't find it. Weird. I called home and asked if someone had taken it out of the car. No one had.

    I looked all around the car, panic rising. Where could it have gone? Eventually, I ran out of places to look and I had to walk back to my supervisor and let her know. I felt so responsible and stupid. I'd only been there (at the GP practice) for 2 weeks, and this really wasn't the way I wanted to form an impression. I felt like I let them all down.

    I went to the police station later on that day. My expectations were low; I knew it'd be unlikely they would find an unmarked generic black bag, but I needed to report it. The policewoman I met made me feel 10 times worse. She had a really accusing tone. One of the questions she asked me: “how do you know the bag was stolen” left me dumbfounded. I stared at her confused, I looked at my mum, and then back at her. I didn’t understand what she wanted me to say. There were other things she said that again made me feel like she was judging me or making assumptions about me. The whole experience was uncomfortable and unnecessarily so.

    So, all in all, not a great week.
     
    #25 The Medic Mind, Aug 24, 2017
    Last edited: Sep 24, 2017
  6. The Medic Mind

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    Medicine - An Art? Mind The Medic

    I recently had a long consultation with a patient. He was struggling with a variety of symptoms which he’d been investigated for and despite multiple scans he hadn’t received the answers he’d hoped for. This had started to affect his mood.

    He talked about his career briefly and how much he enjoyed his work as a mathematician. He felt it suited his personality as he found comfort in knowing that there were set outcomes for every question. A complex equation could be brought to a definitive answer. Unlike medicine, where often symptoms were left unexplained and the only option was to learn how to cope. All the while wondering: will it worsen? Will it ever improve? Will it become something else?

    He said something else that caught my attention, ‘I guess that’s why they say medicine is more an art than a science’. I’ve come across that phrase a few times and I’ve never stopped to actually think what it meant. But after he said it, I felt this dawning realisation. Like the feeling of suddenly working out the answer to an exam question the day after. Just talking to the patient in front of me, and watching him almost crumble under the weight of several uncertainties, it reminded me yet again how important it is to have these open conversations.

    Treating a condition goes beyond just treating a part of the body. Every time we try to help, and we dive in with good intentions sometimes we cause more issues. Some therapies don’t work and sometimes there are side effects. So, we trial different treatments and hope for the best. But there has to be a balance, an awareness of the impact that this might have on an individual. I think good doctors are the ones who truly put their patients at the centre of decision making and try to maintain that balance whilst juggling the multiple other issues each patient brings (family, job, finances). That is the art.
     
    #26 The Medic Mind, Sep 7, 2017
    Last edited: Sep 24, 2017
  7. The Medic Mind

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    The Phone Interview - Mind The Medic

    I recently applied to be a volunteer at an upcoming ACW event. I had the interview and I got the role. I’m not sure exactly what I’ll be doing, but I’m just excited that I’m going to be a part of it.

    Lately, I’ve been thinking about my options which means spending my time Googling. I’ve found myself on the Medic Footprints site quite a bit, especially their blog section. Sometimes, in between patients, I take a quick break and just read through some of the articles. I like reading about doctors who’ve forged new careers for themselves or who’ve adapted their careers in some way to suit their lifestyle.

    I find it difficult to openly talk about the possibility of leaving medicine behind. For some reason, it feels like a taboo subject. I know medics are a dedicated bunch with a strong sense of duty, but I sometimes wonder when this starts to become our weakness as well as our strength. It’s still a bit unusual to hear about doctors leaving. I can’t really speak for everyone else, but I do feel obligated to not tread the beaten path, to find a lifestyle that suits me. I'm looking forward to being around other like-minded people who share some of the same internal struggles that I’ve been facing.

    I’ll probably be limited to how much I can see and do because I’ll be helping out. But it’s better than nothing. The event takes place in London, over the course of two days. I’ll have to get there a day before, to help prepare.

    It’s weird, I knew this was a yearly event so I’d been waiting a while for the event details to be released and then when they were, I was initially hesitant: a) it was in London which meant I’d have to travel down and stay overnight, which is costly b) the ticket prices were more than I was expecting. On its own, I could probably have bit the bullet and paid for them but adding accommodation and travel and no doubt all the other costs along the way meant that I was going way over what I was prepared to spend. Just as I'd made up my mind not to go, I came across a small ‘volunteers’ sign.

    I had to do a quick interview over the phone, which I tried to fit into my lunch break. And halfway through morning clinic my phone just turned itself off. Cue: mini frantic crisis. Literally, no warning. Just turned itself off and wouldn’t come back on again. The battery wasn’t low either. I wouldn’t have minded if this had happened on any other day, but seriously, a couple of hours before I’m waiting for a call. Sacré bleu! Long story short, after a lot of troubleshooting, panicking and Googling, I was able to have the interview, wow them and start afternoon clinic on time.

    The idea of networking makes me nervous, but I guess that’s not necessarily a bad thing. It’s a skill I don’t have, might be useful to get out of my comfort zone and learn it. If anyone is interested in the event have a look at the Medic Footprints site and I’m also helping to sell some tickets as well here. I'll probably write about it afterwards as well to let you all know how it went.
     
    #27 The Medic Mind, Sep 15, 2017
    Last edited: Sep 24, 2017
  8. The Medic Mind

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    Stop - Mind The Medic

    Sometimes, I see patients and for whatever reason I get flustered. There might be a few complicating issues, the symptoms aren't clear, my mind is thinking of possibilities A, B, F, K, and Z, the clock is ticking and the floor is on fire. I feel under pressure and I can’t think straight. And when this happens and I don't know what to do, I realise that I need to just stop, take a breath and start from the top.

    Last Thursday, I had a difficult morning. I started the day with a complicated patient which set the tone for the rest of that morning clinic. My first appointment was a lady with known mental health issues. Midway through, she suddenly flipped and demanded I stop asking questions. She'd been getting more and more agitated and I think she'd just had enough. It put me in a bit of a bind. I examined her but I felt the safest thing I could do was refer her to be seen to rule out a blood clot. This was another mission. By the time I saw the next patient I was just all over the place. Add that with a complicated, slow computer program, that knows exactly when to act up and I started to jet steam from my ears.

    Stop, breathe and start from the top.

    I get like that occasionally, more than I’d care to admit. More often than not, I know what to do if I just slow down and take a minute to process everything. I know I add on a lot of pressure on myself and I get frustrated. I worry I might be judged by others. Judged by my colleagues or judged by patients for taking too long. I can't control what other people think of me, but it seems like my own self esteem relies heavily on it. It's a work in progress.

    I was recently listening to an interview by the author of The Subtle Art Of Not Giving A F*ck. I've not read it yet, but that book sounds like it was made for me.

    But until then:

    Stop.

    Breathe.

    Start from the top.

    More posts at Mind The Medic
     
  9. The Medic Mind

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    Outside The Box - Mind The Medic

    From recent posts, it’s clear I’ve become more unsure about my path in medicine. But as of yet, I have no plan, or really any solid direction. What I do know is that the idea of taking a break has become more and more appealing to me.

    The journey to where I am now has been linear. I went from high school, to sixth form (college), to university, to working without taking any gaps. I’m really grateful I didn’t have to reapply to medical school and that I got the grades I needed. It's been a steady trajectory to where I am now. And there’s the opportunity to just keep going. I could potentially apply for another training programme after F2, become a trainee, become a registrar and then become a consultant or a GP. Do the necessary exams along the way, jump through the necessary hoops. Knowing at each point what my next step is going to be. And there’s safety in that, having a plan for the next 10 years. But right now, it just doesn’t appeal to me...

    Read the rest here Mind The Medic
     
  10. The Medic Mind

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    A message to F1s - Mind The Medic

    Suddenly, somehow we're in the run down to the end of the first placement.

    And at this point you've come accustomed to how your ward works, you've formed bonds with your teams and maybe even your consultants. But now it’s time to move on and remember a whole new set of names and door codes.

    If you're anything like I was, you’ve gotten used to the 9 to 5 grind mixed in with the night shifts and weekends. You're still feeling tired all the time, but at this point it's your new norm. You just get on with it.

    Now, you don't shake as visibly when you get called to see a sick patient, and if all else fails, you know taking bloods and giving fluids is nearly always OK.

    Maybe you’ve started to have some niggling doubts crop up in those moments when you feel out of your depth. Your thrust head first into a bad situation but somehow you always muddle through.

    You can't remember exactly when in the past few months, your ideas of what it would be like to be a doctor were shattered. The rose tinted glasses have come off and you can see it all a bit more clearly. The disorganisation, the strain, none of it pretty.

    Sometimes, you wish someone would tell you how you’re doing. Just a little word of encouragement or recognition, just so you know you’re doing OK. It’s nice to hear. But it can be few and far between. You’ve made it to four months, so well done.

    I wrote this for anyone who’s finding the reality a little difficult, who feels constantly overwhelmed by the expectations being placed on them. If you've enjoyed your first placement, that's great. If you haven't that's OK too. Either way it's coming to an end. If you’ve found the last few months difficult, it’s because being a doctor is difficult. Plain and simple.

    But it’ll start to feel a little easier.
     

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