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Diary of an FY1 – Tips for New Docs

July 12, 2015

“Is anyone else absolutely petrified about being an SHO next month?” Another FY1 asked. We were gathered together in the mess for lunch. The situation seems so perverse – for nearly a year, I have been an FY1 doctor and now it’s time to move on. I have adopted this role, physician with training-wheels, grown into it, until now I finally feel comfortable under that stethoscope. And now I’m bloody moving on! If I’m honest, I feel ready to be an FY1.5.

Call the SHO! Wait...That's me!

Call the SHO! Wait…That’s me!

At the risk of cliché, it is incredible just how quickly this year has passed me by. And yet, far from standing still, I feel I have grown so much in my continuing approximation of a good doctor. On my first day, I nervously asked my registrar’s permission to prescribe lactulose – and then I had to compulsively check the BNF that I wasn’t giving a lethal dose. Of lactulose.

I realise that next month, there will be a cohort of brand new doctors starting at their own incarnation of St Elsewhere’s including some of you. I think it is only fair that I take this opportunity to impart my wisdom (dubious as it may be) to spare you from floundering in front of your consultant on your first day. For the Twitter-literate among you, the #TipsForNewDocs hashtag is a goldmine of good advice.

Know your place. You are not Dr House or even Dr Cox. You are a fresh-faced baby-doctor who has spent the last five years in university. Cynicism that you haven’t earned is cringeworthy, and don’t you dare look down on anyone; not the nurses, not the HCAs, not the porters. That stethoscope around your neck lets you listen to chests; it does not mean you own the ward. I telling you this now from a place of love before the ward sister smacks the shit out of you. Nurses have honed over generations the skills necessary to bring down the cocky young doc by a peg or two – They are very good at it.

You are Not These Guys...

You are Not These Guys…

Equally, you may be junior but you are no one’s inferior. You are never “just the FY1” and pay no heed to anyone who tries to convince you otherwise. You survived medical school and joined this fraternity to care for people and do amazing things. Be awesome!

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If you are going to emulate a TV doctor, I would aim for JD (God, I love Scrubs). Wacky though he may be, he cares for his patients and tried to get along with most of the staff around him – That is what makes him a good doctor. It was my firm belief that medical school was a team sport and it remains an even firmer belief that hospital medicine is even more so. You will spend the first few weeks tearing your hair out in the clinical room, looking for cannulas and catheters – never be too proud to ask where to find something. Likewise, asking the nurses to do something for your patients works better than telling them and you’ll be more successful requesting X-Rays and CT scans than you will be ordering them. You will reap the full benefits of this later on – at the end of a ward cover weekend shift, when you are running on flagging willpower alone and you haven’t passed urine all day, the nurses will find you a chair and put the kettle on. By God, that tea is glorious!

That brings me to my next point. At some point this year, you will be overwhelmed. It might be a patient crashing in front of you and the medical registrar is on the other side of the hospital. You might be left on a ward alone with a host of jobs and no way of humanly finishing them all. It might be a weekend shift spent alone, being dumped on and harassed by bleep and telephone. It doesn’t matter what form your breaking point comes in – you will want to quit medicine there and then. What matters is how you respond to it. Stop. Pause. Breathe. Make a cup of tea. Have a cry in the clinical room. This too shall pass. Later, find your way back to being human. Meet up with friends. Walk along the Southbank. Play videogames. And read lots of books. I prophylactically book time off after I’m rostered for weekend ward cover.

screams-internally

Yep, Lookin’ Forward to that Weekend Ward Cover

So you had your heart set on working with Lord Darzi in Man’s Best Hospital in North West Thames but capricious fate has thrown you to St Elsewhere’s in some deserted wilderness? So what? Griping about FPAS and the SJT are fine (Believe me, I’ve done enough of it) but you can still do good medicine wherever you are and, with the right friends, you can enjoy yourself too. Medicine is a long career – There’s still plenty of time and opportunity to do everything you want. See my earlier point about being awesome. Make sure you’re awesome.

If you’re lucky, you will be gifted with some fledgling medical students. By God, you must look after them! Failing to care for your medical students is a sin on a level with killing mockingbirds. You will be busy, over-worked and under-appreciated but please find time for your medical students. Teach them with what time you have – not only does it help them but it helps you brush up on bits of medicine that might have grown cobwebby since finals. On the ward rounds, keep an eye out for patients that they can clerk and examine – and check this with the patients first. Final year med students asking for bloods and cannulas to do are worth their weight in gold – but just make they know what they’re doing before they exsanguinate Mrs. Jones.

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These are Your Medical Students. Take Care of Them.

Time is friend to no man. Use yours wisely. I prioritise TTOs, scan requests and referrals because I can then get on with ward jobs while they’re in progress. Also, the weekend is a regular event – it is two days at the end of every week. If you don’t ensure that drugs charts will last until Monday and that patients leaving on the weekend have discharge summaries, I will come for you. Promise. Staying a half hour late on Friday is far better than me coming for you to personally put you in the sea. When you do weekend ward cover, you’ll understand.

Odds are, you will not like ePortfolio. You might find it clunky and prescriptive. You might find linking DOPS and e-learning modules to the curriculum tedious to the point of tears. You might rail against the outrage and injustice that this is the stick against which your doctorhood will be measured. However, for all its faults, it is the medium by which you will be assessed – whether you like it or not (I did not). So do yourself a favour and “engage” with ePortfolio. It’s not going anywhere soon.

This advice also applies to fax machines.

Fax Machines

Realistic Depiction of My Struggle with Fax Machines

Lastly a word on the future. You may have your five year forward view all figured out or you may still be struggling to define what kind of doctor you want to be. That’s alright. I didn’t know last year what I wanted to be when I grow up – Now, a year later, I’m beginning to see the outline of who I’m going to be. Some of your peers may rush to grasp MRCP or MRCS Part I this year. They are overachievers and they deserve everything they get. Don’t get scared into playing their game. Do your medicine your way. There is only one thing you must do: you must be awesome.

Returning to that lunchtime conversation filled with dread and awe. A wise and calm SHO who had been sitting with us and until now had kept quiet. To quell our anxiety, he spoke up, “You guys are going to be more senior but you’ll still be house officers. There will still be things such as registrars and consultants.” He ended a succinct piece of advice, which will be as useful to you as it will be to me:

“You will be fine.”

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4 Comments leave one →
  1. Denise permalink
    July 13, 2015 7:35 pm

    Great stuff – well done !

  2. Leia permalink
    July 15, 2015 6:03 pm

    This is really very good advice

  3. Squitten permalink
    September 18, 2015 11:44 pm

    My worldview has improved significantly now that I turn into a cat every time a medical student quacks at me :).

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  1. Diary of an FY2 – Second First Day | Quinnfeld

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