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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    Second Impressions of A&E - Mind The Medic

    I’m half-way through the placement now and I feel more settled, I wrote about my first impressions of A&E here. It just takes time for me to get used to a new place and I remember it being the same for GP as well. In some ways I’ve found GP and A&E quite similar: both general based specialties with loads of opportunity to work independently.

    I’ve found A&E more difficult because the level of risk is higher and there’s so much I don’t know. I felt with GP, I regularly managed coughs and colds, UTIs, musculoskeletal pain and other times I could rely on my intuition/common sense. Whereas A&E, I’m suddenly presented with a foot x-ray and I’m supposed to work out whether there’s a fracture or not. It’s a huge learning curve.

    As part of the department we have a paediatrics area. And though I love kids, I do get a tremor every time I’m sent around to that side. Fortunately, it always turns out better than I expect and I’m able to get through them quite quickly. It’s usually more pleasant; the parents are more often than not able to give clear histories, the kids are happier, funnier and smell nicer. I’m learning to be more confident on paeds but I still find it difficult. I’m often wondering how I would treat an adult in a similar situation which I know is not an ideal approach, but again there’s always someone around to ask.

    There are always seniors around, always. The trick is knowing who to ask. I’ve got a good idea of who to go to and who to avoid. Most are really helpful and will listen and give advice. Some will do it reluctantly and others will snap just having looked in their direction. I do sometimes have an internal conflict I go through every time I want to ask a question. On one hand, I’m a foundation doctor and not an emergency medicine trainee and really I’m there to learn and gain the skills to be a better doctor, but on the other hand I need and want to be an independent clinician. Personally, I feel like my main priority (alongside amazing patient care) is learning and one of the ways to do that is by asking questions. It might just be me projecting my internal issues onto others.

    The shifts are long. And I know long shifts are part of the territory in medicine, my body just doesn’t agree. The upside of longer shifts is that we have more off days, but still, my body doesn’t care. In the first half of the shift I’m all ready to go, lots of energy, and towards the end I’m slower, yawning and repeatedly looking at the clock. And this is why a) I don’t book any locum shifts and b) I can’t see myself doing this long term. I’m not really fussed about the effect on my social life. I’m more concerned about not being able to put basic meals together. Or do laundry. Or write.

    Plus, there’s a whole lot of running around and being on the ball. It’s like you have to be at least 80% alert at all times, not like on a ward-round where you could twiddle your thumbs whilst you followed the consultant around.

    I have liked how social the department is. There are loads of junior doctors plus locum doctors as well. If ever there is a lull it’s really nice to have people around to talk to.

    I'm 2 months down, just 2 more to go.
    More blog posts here --> MindTheMedic.com
     
  2. The Medic Mind

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    Out Of Sync - Mind The Medic


    When my colleagues, complained about the A&E rota, I thought it wouldn’t bother me as much. They moaned about how tired they felt etc. I secretly thought I’d be able to weather all of this because of my gift. I can fall asleep anytime, any place.

    But now, I feel their pain. Not only am I tired all the time, I’m just out of sync. I was on nights last week, Monday to Thursday. Usually, I’m able to get myself back into day-mode relatively quickly. It’s a week later, and I’m still out of it. I haven’t had a full night’s sleep for 5 days. And I know I need to sort it out sooner rather than later, hold off sleeping too early and not succumb to a few random hours here and there, but I’m just too weak.

    And I’m just too tired to do any of the things on my to do list, so I nap, but then I’m up at the early hours of the morning and I can’t sleep. As if I wasn’t already falling behind on my emails. I’m awake when the rest of civilisation is asleep, I’m sat at my screen wondering if 2 o’clock in the morning is a weird time to respond to a work email.

    All I can say is, I don’t know how people do this long term. I certainly don't know how people are doing this and looking after children/household. Any tips on getting me back on track would be highly appreciated.

    Please send love to my new Facebook page. Thank you!
     
  3. The Medic Mind

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    Post Work Routine - Mind The Medic

    Sometimes I come back from work late, like early hours of the morning. Aside from having to sit in my car and literally wait for ice to defrost, journey time is around half an hour. I’ve realised that over the course of a few months, I’ve developed a routine for myself which goes like this:

    I arrive home, take off my jacket and eat in front of the TV. I watch Modern Family. It’s light enough and funny enough to make me temporarily forget about work. The storylines are easy to follow and I can just relax. Each episode is about 25 minutes and by the end, I’m in a better mood.

    Then I go upstairs and have a very hot shower to wash away everything that happened that day. I ignore my growing pile of laundry and settle on my bed, ready to watch a few YouTube videos.

    I read through my emails and mentally reply to each. I’ll save it to when I’m more awake and can make a sensible coherent response.

    I might try to write for a bit. I sometimes have a buttered tea cake with some dark chocolate (ideally salted caramel) and some tea.

    Then I close my laptop, snuggle down and read for a bit. Currently, I’m partway through 4 books. When I’m ready to sleep, I check my alarm has been set every 5 minutes until I actually do fall asleep which doesn’t take long because I’m so tired.

    I find this routine helps me wind down mentally, especially if it’s been a particularly difficult shift. Rocking back and forth in the shower also helps for really bad days.

    But in all honesty, by the time I get home, I've genuinely expended all my emotional and physical energy. I find running around the department incredibly tiring. I ran into someone recently who said that working in A&E must feel like being on-call all the time.

    That is exactly how it feels.
     
  4. The Medic Mind

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    Why I Write These Posts - Mind The Medic

    Recently, I was asked to do a procedure/examination for a patient in the department. All the senior doctors were tied up and there was no one else around. I’d been taught by the consultant how to do the examination and I'd recently read around the examination so I felt like I knew what to do.

    If I hadn’t, I would have said so. I felt competent, but I was still a bit nervous at having to carry it out for the first time on my own. The nurse was persistent, it needed to be done right away.

    I carried out the exam and the nurse was unhappy. ‘I’ve never seen it done like that’ she remarked. That’s not what I wanted to hear and all of a sudden I lost confidence. I respect the nurses’ opinion because they’ve seen this examination being done numerous times. So when she said that, I stopped.

    I looked for the registrar to let him know what happened. He wasn’t concerned about my technique which made me so relieved. I'd felt like I’d endangered the patient which upset me, because that’s the opposite of what I intended. 

In the end, I learnt from what happened. The registrar talked me through the examination again. He was able to answer my questions and now I know a lot more about how to carry it out.

    I really do believe in speaking up if you think something’s wrong, nurses have corrected my mistakes in the past. But in that space of time between me stopping the examination and the registrar debriefing me, I was crushed. I was worried I’d made a huge mistake.

    When I write these journal type entries about a specific event, it’s because I want to keep a specific memory documented to remember it. Moments like these, where my heart’s in my stomach, are moments I don’t want to forget a few years down the line. I want to remember what happened and how I felt. I want to be able to understand the situations that led me to make certain choices. It’s such a potent reminder for me that even with the best intentions things can go wrong, mistakes can be made. And in medicine, mistakes have higher stakes and the weight of that responsibility is starting to feel like a lot to bear.

    Facebook Page: https://www.facebook.com/MindTheMedic/
     
  5. The Medic Mind

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    So, What Do You Want To Do? - Mind The Medic

    Or any iteration of that question used to make me nervous. Granted, it’s a good conversation piece amongst medics but it used to rack up a lot of emotions for me. I wanted to choose my answer carefully, but I also didn’t really know what my answer was, but I also didn’t want to invite any more questions.

    It made me resent the question for making me feel that way, and probably the person asking. I felt like the asker was waiting to categorise me in their head. It was a simple enough question, but it was re-picking an old wound that had just started to close over.

    I’m not sure which specialty to choose because I’m not even sure if medicine is even the path for me anymore. But opening that can of worms with someone else is something I wasn’t ready for and to some extent still not ready for now. I don’t really want to face someone else’s judgement, especially when it’s uncalled for.

    So I used to give some vague response like: ‘I’m not really sure yet’. And for some that wouldn’t be enough.

    ‘You must know.’

    Must I?

    Now it’s a little easier to have that conversation. Especially in A&E, which relies heavily on locums. And even some of the long-term staff have been out of training for several years. They’re quite open minded and receptive to the idea that I’m taking time out to do whatever and actually, they’re quite encouraging.

    But I’m also more confident in the fact that I want to take a break. Feeling like I was keeping a secret was probably the worst part of having to answer that question. So now I just let people know that I’m taking a break and I’m unsure about my plans.
     
  6. The Medic Mind

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    Am I Discouraging People From Applying To Medicine? - Mind The Medic

    I was on nights with a nurse last week who told me she was applying to medicine. When she told me, I had to hold back a retort and instead say something like, ‘oh, that’s interesting. How come?’ I did get the sense that she was quite curious just by some of the questions she’d been asking me throughout the night. So it was clear she was more interested in the ‘why’ of everything, in the critical thinking and the decision making.

    I wished her best of luck because it’s amazing to see someone have a goal and work towards it. And even though nursing is not the usual route people take into medicine, I think it’ll only serve as a huge asset to her career in medicine. Plus, the fact that she works in the NHS already means she knows what she’s getting herself into.

    I feel like every time I hear that someone wants to apply to medicine my knee jerk response is to shout ‘DON’T DO IT’ in slow motion and I have to stop myself because 1) it’s an irrational response based on my own opinions and experiences and 2) it's probably a bit over the top.

    I’ve been asked a couple of times to either speak to students to encourage them to apply for medicine or to have some sort of sign on my blog aimed at medical students and my first thought is always: hell no. And it’s not because I hate medicine, or because I think it’s not a great career. One of my reasons for declining is that I don’t want to be a hypocrite. On the one hand, moaning about what I’ve had to deal with but on the other hand pushing UKCAT courses down people’s throats.

    When I was applying for medicine (many moons ago) there was an overwhelming amount of encouragement. I was constantly told ‘medicine is a great career’, ‘it’s a privilege’, ‘it’s a good career choice’ etc, etc. I had no one to tell me otherwise or to give me a different opinion. There weren’t any medics in my family to give me a realistic outlook on what being a doctor in the 21st century or in the NHS would look like.

    I never had a conversation about whether medicine was the right choice for me. I sort of accepted that medicine would be ‘great’ and I just went with it. And that speaks to the lack of critical thinking I had at that age. I went with what seemed like the best option based on the opinion of everyone around me. But I how else do you make decisions at age 16/17?

    So, I like being able to share my less than rosy experiences like here and show a different opinion. And my aim isn’t to discourage people from applying. I never want to turn people away from something they feel strongly about. That isn’t my goal. Rather, I want anyone who’s even thinking about medicine to think broadly about their decision. To look at the good as well as the bad.
     

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