Dear Nearly New FY1s,
I remember my shadowing as a blur of paperwork and an urgent sense that I needed to assimilate all the knowledge in the week I had before someone handed me a pager and left me with actual responsibility for actual patients. I kept thinking that eventually I’d be escorted from the building when someone realised that I’d graduated medical school by mistake. I felt a little bit as if Sputnik had landed on my head.
You can’t have missed what’s been going on in the the last fortnight: take that seriously, by all means, we’re being disrespected and disenfranchised and lied about, and, yes, be furious and be engaged and get involved, but don’t let that ruin this for you and don’t think for a minute that it means we love our jobs any less. The political bullshit: yes. The job, the being doctors, the looking after people: no. The thing about the #ImInWorkJeremy pictures wasn’t just that we were in work, it was that we mostly looked pretty happy to be there.
I love this job. Yes, it is hard and exhausting, and you’ll have days when you want to scream and days when you come home and sit in the dark and cry at the cats. I love it anyway. It has terrible days, but it also has days when I catch myself thinking, I can’t believe I get to do this for a job. I think it’s the best job in the world. I hope you will too.
There is a lot of advice that I could give, and I’ve tried to do that below. I’ve stolen a few of my #tipsfornewdocs from my Twitter colleagues and I’ve tried to credit them appropriately.
But there are only three things really: care for and about your patients, remember ABCDE, and don’t be scared to ask for help.
– Be early.
– Comfy shoes. Get some.
– At the beginning of the day, ask the nursing staff the following questions: is there anyone sick, is there anyone new, is there anyone going home?
– I thought until recently that this was self-evident, but you need to go on the ward round.
– Whatever you need, it is in the secret drawer at the nurses’ station: pens, markers, death certificates, chocolates. Ask. (@STIrwin)
– Cultivate relationships with the nurses, the pharmacists, the person carrying the on call microbiology bleep, and the radiologists.
– You will develop compulsive tendencies regarding lists and systems of half coloured in boxes. This is normal.
– Eat something.
– Drink something. Don’t succumb to on-call AKI.
– There are no routine investigations. If you don’t have a reason for doing it, don’t do it.
– For blood transfusions and contrast scans, you shouldn’t be using anything smaller than a pink venflon.
– Ask where the phlebotomist leaves the blood forms for the samples that they couldn’t do. There’s really nothing quite like getting to three o’clock, chasing all the bloods, and realising that half of them haven’t even been taken yet…
– If a patient has died or if a patient has a complicated discharge, phone their GP.
– Never ask a GP to chase an outstanding result. If a test has been done in secondary care, it is the responsibility of secondary care to follow it up.
– The bloods need chased and acted upon. It is important that you record a low potassium, but it is also important that you do something to replace it. It is important that you draw a circle around a rising CRP, but it is more important that you try to find out why and do something about it. If you get a weird result and don’t know what to do about it, ask.
– Do a fluid / insulin / warfarin / gentamicin / vancomycin round before you go home.
– Don’t take the on call bleep home. (@DrLatifaPatel)
– There are some things that it is bad manners to hand over to the on call team. PRs, for example.
– A routine for the day before going onto a run of night shifts is essential, and you have to figure out what works for you which will not be the same thing as what works for someone else. This advice from the Royal College of Physicians is a good place to start.
– Try thinking of your nights as something to be embraced rather than something to be endured. As an FY1, this is where you’ll get to practice some actual medicine.
– Eat something.
– On ward cover nights, try doing the following in this order: 1) if you are concerned about anyone you’ve been handed over, let your SHO know that you’re going to review someone sick and might be calling for help or advice sooner rather than later, 2) go and review them, 3) take a tour of the wards that you’re responsible for, to ask the nurses if they’ve got any routine jobs that need doing and to ask them to keep a list of routine jobs for when you come back round later in the night, and 4) actually go back round later in the night.
– At 5am on a busy night shift what you need is a piece of white toast with a lot of proper butter and a strong cup of tea. (@traumagasdoc)
– Give me the grace to accept with serenity the things which cannot be fixed overnight, the courage and skills to fix the things which should, and the wisdom to distinguish one from another. (@drewseybaby)
– If you are asking switchboard to put you through to the haematology lab or the biochemistry lab at 3am, take the extra ten seconds to make sure they know you really do mean the lab and not the consultant. I mean, they’ll still get it wrong sometimes but at least you tried.
– If you are covering an area that doesn’t have a formal handover in the morning, do make sure to either ring round or visit wards where there were overnight issues.
– Your bed is the best place in the universe. Seriously. You will never look at it in the same way again.
On Your Fellow FY1s
– Be kind to each other.
– If you’re ever tempted to burn bridges, remember that medicine is a really small world and you’re probably going to be referring patients to each other for the next thirty years.
– Do some.
– Don’t listen too much to the horror stories. It is one of my favourite things in the world and if you approach it with a little bit of enthusiasm you’ll learn more here than anywhere else in FY1.
– In surgical receiving, don’t forget to do a coag and a group and save.
– Try to corner someone who has done receiving before and interrogate them about how the post-take works. If you’re starting on receiving and haven’t spent your shadowing week there, this might mean cornering the outgoing FY1 or SHO who has just come off night shift. They will almost certainly not mind. It is a system unique to each individual department, and consultants who have worked in their department for twenty years often have a tendency to think that that system is something we pass on to each other through divine inspiration. I worked in a surgical department once where they were very particular about how and in what colour things were written on a paper handover and two different whiteboards.
On Bad Days
– People make bad choices when they’re mad or scared or stressed. Breathe.
– There is no shame in tears.
– If you make a mistake, admit to it.
– Your first failed arrest call will be awful. Your second one will be awful, too. Eventually, you won’t always (but you will sometimes) need to cry in the sluice afterwards but it will never not be awful. That’s okay. There are some things we aren’t meant to get used to.
– The first time you have to confirm death, take someone in with you.
– Some days you have to come home, eat a banana, and go to bed at 7.30. Tomorrow is another day. (@medicalaxioms)
– Eat when you can, sleep when you can, read when you can, learn something new every day. (@TraumaAnnie)
– Reflection is valuable. Reflection all in a rush at the end of May because you haven’t done any yet for ePortfolio is not.
– There is no getting away from exams, but nor is there any obligation to take them at the very first available opportunity. The fact that everyone else is sitting an exam not an actual reason to sit an exam.
On Getting Help
– No one expects an FY1 in August to be functioning at the same level as an FY1 in July.
– If you aren’t sure, ask. (@PenfoldDr)
– If your patient is sick and you’re out of your depth and your immediate senior can’t or won’t come, your next step is to go to their senior.
– If your patient is sick sick sick and you’re assessing them, I absolutely do not expect you to wait for all their investigation results to come back before you come to get me.
– SHOs don’t bite.
– The med reg is your best friend.
– Your patients are people. Don’t ever refer to them as diagnoses or bed numbers.
– Always remember that a patient, usually unwell, is at the centre of all that you do. (@DrMarkMcInerny)
– For your patients, a hospital is almost never going to be something as benign as the place where they go to work. It isn’t a big deal for you to go into hospital in the morning. It is a huge deal and usually a really scary thing for them, and that shouldn’t be minimised.
– A patient with a chronic condition will usually know more about their disease than you will.
– The importance of ideas, concerns, and expectations isn’t just a medical school thing. It’s a real thing.
– Don’t make assumptions.