Medical students spend years at university preparing to work as doctors. But there’s a difference between being a doctor theoretically and practically in real life. Is anyone ever ready? The answer is – No. A big fat NO. And that’s okay!
During this series, I will take you through some of the familiar experiences that myself and fellow medic friends of mine have gone through as FY1s. But don’t worry, I also drop a few handy tips that I learnt on the job from trial and error, mistakes and advice from senior colleagues.
PART ONE: THE WARDS
Ward life is vastly different from placement and OSCE life, so much so that many new – and even older – doctors struggle with the new role in the first few months. But in what ways?
The high demand: This is one thing that shocks a lot of new FY1 doctors: Getting multiple bleeps, ordering investigations or barely having a lunch break, the nurses coming into the office every 5 minutes asking you questions, relatives requesting updates about patients on your ward, seniors adding more jobs to your already-long list of jobs – I could go on and on and on! And I feel like we can all relate that this is a common feeling regarding our daily work.
The high demand to multitask: Did I mention that it’s a usual occurrence for all of the above to come all at the same time? Sometimes it can feel as if your brain is about to split 5 ways, or that you’re being stretched in all directions like a toy being fought over by kids!
Selling and negotiating: If you don’t like talking to people all the time or are introverted, well, I have some news for you. You will be doing just that, multiple times a day, every day. This job will either make you become a negotiator and salesman or at least make you better at it.
Each day involves some form of negotiation; trying to sell your request to the radiologist, as to why your CT scan is urgent and can’t be done next week. Or, you could be trying to convince the cardiology registrar to come review your patient who you suspect has new, worsening or ongoing cardiac issues.
The advantage is that a lot of doctors turn out to be great business people and entrepreneurs (So, I guess the MBBS is worth it).
Being the patient’s private counsellor: We doctors get into the habit of reducing patients to their bed numbers and clinical diagnoses as this makes it easier to remember and identify patients in discussions.
However, we are often reminded that they are also real people when somehow, you find yourself at their bed space 1 hour later listening to their life stories and concerns around their health problem(s). You become their means of expressing their anxieties, low mood, anger and frustrations. This is understandable, as many patients don’t have relatives or friends to speak to or visit them.
As you can imagine, this can be counterproductive as you still have a long list of jobs to do, your bleep keeps going off and you definitely do need to take a break and most patients are completely oblivious to all of this!
Cleaning up the “mess” of others: A bit of hyperbole, but colleagues, seniors and bosses can make mistakes. This shouldn’t be surprising, the hospital is a very fast-moving, high-pressure, high-demand work environment and even the best doctors can forget to complete tasks.
Luckily, most mistakes are not critical and do not harm the patient in any form. Issues that juniors often have to clean up are ones due to the lack of or unclear communication.
There are also admin errors such as incorrect information in the discharge letter or TTO/ TTH, outstanding jobs from the previous day (or even week), requests that leave the recipient fuming or confused or failure to document clinical information or discussions.
To remain professional, the NHS encourages a non-blame culture and to take collective responsibility in line with the duty of candour. Blaming an individual will most likely ruin that work relationship and is definitely not the best thing to do when that individual is your senior!
Hospital protocols and guidelines: These can be very helpful but also quite confusing and difficult to find. Hospitals often have their own systems for treating, managing and diagnosing patients which can make what you have memorised in medical school seem obsolete. Nevertheless, when in emergencies or treatment they serve as quick references to refresh your memory.
"The way it’s done around here" AKA Hospital politics: Politics is ubiquitous to the employment field. The best way I can explain this is “the things you want to get done can’t be done because people higher up don’t see the need for it, the request won’t generate money or may create more work for others”. Even if this request can be done, it may involve a very convoluted process that may discourage you from pursuing it.
The most common political issue is “patient ping-pong” (a self-made nomenclature).
Normally, in patient care there is a parent speciality team whose consultant leads the care with or without adjuvant input from other specialities. Sometimes there is joint-care where the care is shared between the specialties.
So-called “PPP” occurs when specialties bounce a patient between themselves, as the consultants are not keen to take the lead responsibility for the patient. It commonly occurs when a patient has multiple clinical needs that involve more than one specialty and it is not clear which clinical problem is the dominant one. It can also occur when the main clinical problem has been resolved but then another arises.
This can become inconvenient and disruptive, as you’re left as the middleman and negotiator making endless futile phone calls with doses of passive aggression between each of the teams.
Patients are themselves here – sprinkled with doses of relatives: Ward patients are generally like the patient you encounter in OSCEs and structured patient teaching. However, there are times whereby the patients can be unreasonably demanding, inappropriate if you’re female, hard to reason with and unfortunately, racist or misogynistic.
Other ward-related items that can add to stress include old IT systems that mean frequent crashes and slow processing, and unfamiliar hospital systems.
Your real-life emotions and thought processes: Doctors are expected to be composed, have level-headed thinking, be very effective with their time and efficient with their jobs. But, reading the above, did your fight or flight response get stimulated? Mine did.
All of the above is a lot to deal with, especially at the same time. You will experience a plethora of emotions – panic when you realise your patient is very sick; low confidence and frustration when you can’t insert the cannula after your 5th attempt; anger when you realise your colleague from days ago didn’t do some jobs and now the consultant is taking it out on you; annoyance when nurses or relatives are poking for your attention; mental and physical exhaustion from the continuous mental processing and late breaks; sadness for your sick or lonely patients, etc.
It doesn’t help if you’re going through your own ordeal of personal issues in your life, if you feel unsupported by your team, not familiar with the various systems or just moved 200 miles away from home.
This a cocktail for burnout, mental health issues and even quitting medicine all together which many juniors feel they are ever creeping towards.
If this article has made you feel hopeless, don’t worry. There’s hope. It’s possible to not just survive, but to thrive in the wards and in my next article, I will show you how you can too.
Article written by Dr Victoria Onyeka, junior doctor in West Norfolk