Panic?
Never panic. One of the main things that terrifies junior doctors is that they will be expected to act beyond their level of competency and to run a cardiac arrest on their own when they don’t even know where the patient is, let alone where the arrest trolley is.
At the start, the wards and the hospital can be unfamiliar, daunting places. The whole situation is enough to cause excessive sweating and palpitations, something that regularly occurs to junior doctors.
The most important thing to remember is that you are never alone. There is always someone that will be able to help you. Your seniors will not expect you to know much on your first day and will help you develop during your time with them. Everyone will show you what to do, and soon it will become second nature to you.
People to help you
You are surrounded by people who can help you. All you need to do is to ask them. They include:
- Nurses who often know a great deal about what needs to be done for each patient. Many are very experienced and have been doing their jobs for years. Their advice can often be invaluable. They often also know individual patients very well. They generally have fewer patients on their lists than the doctors and may have spent considerable time with both the individual patient and their relatives. Every time they take a patient’s observations or administer drugs they are exposed to the subtle signs of disease. This gives them a great ‘intuition’ for when patients are developing a problem. If you are unsure about the current issues or plan with a patient then their nurse will hopefully be able to help.
- Patients who want to be treated kindly and properly and with as little pain as possible. Developing an open and honest approach with patients will make your life infinitely easier. If there is an issue you do not know the answer to or cannot fix immediately it is usually best to acknowledge this. A partnership with patients empowers them and also reduces the stress that comes from pretending to be an omniscient doctor.
- Other doctors who love to demonstrate their skill at just about everything. Most people are secretly happy to be asked by a junior doctor for help; it makes them feel useful and gives them a chance to shine. If you ask for help you will almost certainly get it. There is no shame in it, and you will be helping others by developing a culture of honesty and cooperation. If you are unfortunate enough to initially meet with some degree of apparent resistance or negativity do not take it personally. Some doctors (usually the busy ones) won’t always be overjoyed by having another thing added to their list; however, this does not mean that you should not have asked or that they are critical of you. Try not to take any emotional outbursts personally.
- Other members of the multidisciplinary team. These allied healthcare professionals can be really helpful in providing you with useful information about your patient.
- Problems arise when junior doctors do NOT ask for help. This can be a disaster. If you feel panic rising in your throat, please just ask for help. This is counter-intuitive for self-reliant medics, but it saves lives (yours and the patient’s).
- Make sure you attend orientation day for junior doctors if the hospital has one. It is useful for finding out what the hospital can do for you. They can be painful and bureaucratic but they are often sources of important information. Most hospitals now have a mandatory shadowing week when you start your FY1. Use this to your advantage to get acquainted with the hospital.
- If possible contact your predecessors before their last day on the job. They can give you invaluable information about what to expect (the idea for this book originally came from a request for help from a new junior doctor). In particular, ask them for any nuggets of information, for example, what your new consultants do and do not like, how to access the computer systems, if there are any specific specialist investigations you may be required to request and how to do so.
- Most people find that they are physically exhausted during their first week of work. Such fatigue passes as you get used to the hospital and new routines. Plan to be kind to yourself during this time and try to avoid planning too many late nights. Hospital life is always much easier when you are well rested.
Three basic tips
- Take the initiative in hospitals. If things are not working, do something about it. If there is a problem, try to think of a solution for it, and contact the person in charge. You may need more firepower, and this can come from your senior sister on the ward, your consultant or even the general ward managers. Junior doctors can achieve amazing changes when they make the effort to do so.
- Similarly, take initiative in managing patients. Try to know why each patient came to hospital and what their current problem is. This may sound insultingly basic but it is not unusual to see a patient on a ward round when no one has this information to hand. Again, nurses are usually quite good at knowing what a patient’s current problems are. Present seniors with a plan for your patients rather than just asking them what to do. You will learn how to manage problems much more quickly if you think about them yourself first. Don’t be afraid to look beyond what is asked of you. If you feel that a patient has a problem that your team is not interested in then don’t just ignore it, take the initiative. The fact that a senior doctor has not addressed a problem does not necessarily mean that it is okay to ignore it. Thinking strategically actually makes work more fun and prepares you for more responsibility.
- Prioritize your work. When tasks are being fired at you from all directions, priority setting is really important. Try to learn early on which things are very urgent and which can wait. Despite the hype, in between moments of chaos, there is quite a lot of downtime in your junior doctor year (unless you are very unlucky or disorganized!). Keeping a list of written jobs is essential, especially when you are really busy. If it’s not written down clearly, you will at some point forget it no matter how important you know it is.
Other useful start-up information
Dress
It is worth bearing in mind that patients often dress up to the nines to ‘visit the doctor’. I once watched an elderly woman with deteriorating eyesight, high-heeled shoes and lopsided make-up hobble over the hospital lawn to visit the diabetes clinic. Having always dressed casually, I dressed my best from then on.
- Changing from student to doctor mode can put grave dents into your early pay cheques. If nothing else, buy good-quality shoes which will look good and will stay comfortable after a hard day on the wards.
You may get stained with all sorts of unmentionable substances as a junior doctor. Stain removers from supermarkets and household stores can fix most things. Soaking garments in cold water and lots of soap followed by a normal machine wash removes blood stains.
- Whilst wearing theatre scrubs (‘blues’) on the wards can be all the rage, doing so is a theoretical infection risk and frowned on by some hospitals. If you have to wear them outside theatre, remember to change regularly and return them to the hospital laundry to be washed! Wearing them outside hospital grounds is definitely not acceptable.
A general rule of thumb is to dress modestly and smartly. Avoid flashy jewellery as this poses an infection risk, and open toe shoes should be avoided. High heels can be cumbersome and in some specialities rather inappropriate, for example, intensive care unit (ICU).
Equipment
Always carry the following things:
