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Author: Dr Rhiannon Jones

Why Reflection Is Important For Your Medical Journey

What is it like to be a junior doctor?

When I think back to my first couple of weeks as a doctor, it literally chills me to the bone. I am not going to sugar-coat it. It was, without doubt, the most stressful, challenging and soul-destroying time of my life!

However, despite all this, I am still here today, and I love medicine. It is time every doctor has to go through, but we all muddle through it and get to the other side with a lot of help along the way.

During my first few weeks as an FY1, I wrote a diary to help deal with all the struggles I faced. These diary entries may help future students know what to expect and will hopefully reassure you that when you do start work, every doctor will feel the same way, to some extent, no matter how competent and resilient you think you are!

Support from other doctors

Talking to colleagues about how I felt during those first weeks offered me immeasurable help and support. If there is one thing to take away from this article, know that even in the darkest of days, somebody will be there for you and give you the support you need.

Disclaimer: These were my direct diary entries, so were my opinions, and mine alone. Please forgive the occasional swear word! 

Diary entries

Monday 24th July 2017

I start work next Wednesday, but the hospital induction starts on Thursday this week. I am apprehensive, to say the least. Having had months off, I’m worried I’ll struggle with the very basics.

What if I can’t even get in the easiest cannulas? I keep telling myself I’ll be fine… I will be fine. I have to be fine. There is no other option. Here’s hoping I can use the different IT systems, learn how to use a bleep, whilst not killing anyone in the meantime. Why did I choose this life again?

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Monday 31st July 2017 – 48 hours till D-day

Wow. Last Monday seems like weeks ago. Where to begin? I was really hoping Thursday (induction day one) would clear up many questions I have… but it was honestly one of the most stressful, anxiety-provoking days I’ve ever had.

Because of a 7:30 am-start, I was bleary-eyed having just cycled for 40min at (quite literally) the crack of dawn. Induction started with a half-hour lecture, from the dean of the hospital, basically saying ‘don’t kill anyone and you’ll be fine’ then an hour on fire safety and then nothing – basically, ‘Go fend for yourself!’

We met the anaesthetic consultant who’ll be in charge of us. She informed us that the whole system is changing, they are cutting the FY1’s on general surgery by at least half, and she doesn’t know what our on-call jobs will be… I mean, needless to say, we were all a bit shell-shocked! Especially as I am starting ‘on-call’ on Wednesday – why lord oh why.

Friday was equally a mind-f*** with no doctor to shadow. We had some induction training where they tested us on cannulas – wow. Aseptic cannulas?! What. Nothingggg like the ANTT approach we used at my last hospital! Everything is aseptic here! Crazy. It seems to complicate everything! How can you palpate a vein aseptically? Bizarre. Needless to say, I really needed the weekend.

I woke up very very bleary-eyed this morning despite going to bed at like 9:30/10 pm. Thankfully, some things on the ward have been a touch clearer today. We were finally able to shadow the urology FY1 – and found out we will be covering urology for on-calls. The FY1 was lovely and properly helped us out.

We saw some lovely people on the ward round. It reminded me of why I do actually like medicine. Especially when I’ve heard my housemates constantly saying how their jobs are just jobs, and they don’t get anything from them. At least I know I’ll be doing some good. However, horrifically hard that may be.

Thankfully, our general surgery group is fab – we just went out for dinner, which was nice. We seem to have a brilliant team. Chat always comes back to work, but it is nice to know we are all there for each other.

Friday 4th August 2017 – Days 1 and 2 of FY1

WOW. Such hell!

Wednesday (day one)

I had SOOO many jobs to do. I had to deal with an unwell patient first – a gentleman passing frank fresh blood 700mls over-night, and his blood pressure had dropped. I went to review him but didn’t have a clue what to do. Apparently, the urology registrar was ‘on his way…’ so I prescribed the patient 500mls NACL stat and hoped his blood pressure would come up with this in the meantime. I asked the nurses to bleep me if it didn’t, and told them the registrar was on his way.

After, I tried to get all the bloods out for the day and ultrasound scans booked. The ANP’s helped me order some of the bloods before induction because, despite us having had four induction days already, they thought it was necessary to do further inducting on our first official day! This was 1-3.30pm and meant I was behind on all jobs for the day. (I later raised this issue with the deanery)

After the induction, I went to see a patient who was in significant pain but was already on five different pain medications, including morphine. I tried to contact the pain team, but they finished at 5. I informed a senior who came downstairs and gave him an IV injection of morphine which settled him.

One patient didn’t have capacity for a blood transfusion. I had been given the job on the ward round to consent him for this. I rang his wife, spoke to his son and gave them a leaflet about this. I prescribed the blood and got the nurses to ring haematology about his group and save.

Finally, 1 hour after my shift was meant to finish, I tried to do one of the ANP’s jobs she had asked me to do. The ANP was, quite frankly, mean about it and said I had to do this today, even though it was literally an eye exam that wasn’t going to change immediate management but I didn’t want to get on the wrong side of her this early on. I couldn’t find the patient and started crying in front of the urology registrar (the nice one) who was very supportive and kind. She took me to one side and told me everyone feels like this, that I had done my best and I had prioritised correctly so all remaining jobs could wait till the next day.

Thursday (day two)

I dreaded it. Thankfully the consultant wasn’t angry and gave the registrar some of the day’s jobs to do.

After the ward round, I discharged some patients on the day unit. I was bleeped a gazillion times by an ANP saying I needed to get there ASAP if I wanted any bloods doing and that there were 2 patients who had come down with no regular medications prescribed (how?). I prescribed regular medications for one man – it literally took me like 45 minutes to do. He said he was allergic to something he couldn’t remember so I couldn’t prescribe anything extra until his wife arrived to tell me it was tramadol. Gahhh.

I then swapped a couple of patients antibiotics following the guidelines.
I was bleeped so many times to do little things that took so long to do because I’m not used to the systems like prescribing lactulose etc. GAH.
I assisted the urology registrar with a weird caude tip(?!) catheter, which was quite interesting. However, I was aware there were lots of other jobs that were outstanding.

Towards the end of my shift, I was bleeped to see a sick patient. I didn’t know the patient – all I knew is that she’d been very unwell overnight.
The nurse was concerned about her body swelling, but just in one arm. I didn’t have a clue what was going on. I queried ?? cannula issues or ?? overload.

I spoke to another FY1 who knew the patient from the night before and rang the night urology registrar after reviewing the patient – He was like ‘You need a better hand over..…’ Which was fair but I was on the hour 11, and this was my second day.

I realised she was hyperkalemic, followed guidelines, slowed fluids down and changed the cannula site and then went home.

So, in summary, I felt like nothing got done. And the nurses were angry at me. One (who seemed very good at her job) was like ‘why don’t you just stay here on this ward after the ward round…. ‘It realllllly annoyed me. I told her I have patients on other wards – I can’t do discharges and other jobs for all the patients from here because I don’t have their notes. She seemed to understand after that. But still, it all just feels like hell!

Things I’ve done well over the first 2 days:

  • Deeming the transfusion man not to have capacity and filling in the correct forms accordingly
  • Speaking to wife and then the son about this
  • Prescribing the man’s regular medications and antibiotics, but only after I knew he didn’t have any allergies
  • Discharging the patients on the day unit
  • Gentamicin prescribing
  • Prioritising the ill patients first

Not well

  • Warfarin prescribing – need to do this better in future
  • Pain management – really need to look up guidelines this week, conversion charts etc
  • Listen to ANP’s but prioritise their jobs against other jobs – e.g. getting routine bloods is a less important job than prescribing a blood transfusion for someone who’s got a low Hb!
  • Improve my A-E assessment and SBAR handover when seeing sick patients.

Tuesday 7th August 2017

Yesterday was dreamy. I was in theatre, on anaesthetics, with Dr J (what a honey). We didn’t have a patient till 11 am! There was an appendectomy and then some abscesses on the list. I left work on time!! Huzzah! I managed to cannulate, bag-mask and pass an I-gel. (with some help)

Wednesday 8th August 2017

I was meant to be in theatres again today. However, the anaesthetist I was meant to be with told me it was a complex case, and she wouldn’t have time to teach so I would be more useful on the wards. I went downstairs, slightly deflated, and did some discharges for the FY1 on-call.

I’m still fretting about the on-call shifts. There’s a famous quote by Bridget Jones (lol, ok, maybe not famous) but she says ‘it’s an inevitable fact of life that when one area of your life is going wonderfully, other areas are bound to go terribly’. I’d like ‘work’ to be the one area going wonderfully though if poss. Thanks very much!

Thoughts on these entries, 2 and a half years on…

As you can see, I really struggled in those first few days as a junior doctor. In hindsight, I think it was a particularly hard job to start on. There were no FY2 doctors to give us a helping hand when needed, and the seniors were contactable, but normally by phone only.

Having said this, I felt significantly more competent and happier as the weeks went by….

Wednesday 16th August 2017

Can’t stop thinking about a boy I fancy… Which I guess means work is going ok! Well, slightly better. Except for the manic patient on Sunday. Who blessed me and told me he was Jesus!’

I started to remember all the reasons why I had wanted to be a doctor in the first place. Weeks later, I actually preferred the on-call urology days to the anaesthetic day shifts. The urology on-call shifts went by quicker, and I started to enjoy the responsibility of the role. I improved my assessment skills of sick patients and handed over patients more effectively.

Ultimately, every medical student wants to be ‘the best’ foundation doctor. Unfortunately, we are all humans and ‘the perfect’ or ‘the best’ foundation doctor doesn’t exist. Everybody has different strengths and weaknesses. It is important to recognise these, and ask for help when needed.

To prospective medical students, be aware that this is the reality of the first week of starting work. It is horrible, but you get through it and come out a much better doctor, and person, at the end. Like any job, there are many pros and cons to a career in medicine. It is important you don’t just focus on the positives when applying to medicine and really consider how you would cope or who you could turn to when challenges arise.

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