‘I can't wait to be a cardiologist/paediatrician/neurosurgeon/*insert a medical speciality here*'.
You spend hours researching your future life as a consultant, imagining yourself diagnosing patients with complex diseases and performing ground-breaking operations.
“Do I want to be living the fast-paced life of emergency medicine, performing roadside thoracotomies or do I want to treat premature babies with multiple congenital defects?
Whilst it is important (and inevitable) to think about the end goal, it’s also good to find out a little bit more about the journey. After medical school, you’ll be spending at least 5 years being a junior doctor if you want to become a GP (General Practitioner) and even longer if you want to become a hospital Consultant. Instead of McDreamy and McSteamy, think more JD from Scrubs as a reference.
What exactly does a Junior Doctor do? Since a Junior Doctor can be anyone from a foundation year 1 (FY1) to a Registrar training in a particular speciality, the experience can be quite varied. I'm nearing towards the end of my time as an FY1 doctor, so in this blog post, I'll be telling you a little bit of what it is like to step out from the safety of medical school into the clutches of a busy hospital ward for the first time.
The night is dark and full of terrors
The dreaded on-call: what everyone worries about when starting out as a doctor.
“What will I get bleeped about?”
“What if I don’t know what to do?”
“What if I do something wrong?”
Just a few quotes from every Junior Doctor. You are classed as on-call if you are working weekends and nights – pretty much whenever everyone else has gone home. That’s right, the usual ward’s team has left the building and you are covering multiple wards in their place. Your bleep dictated the whole of your on-call shift. If it rang, I answered it. Wherever it told me to go, I went.
During an average on-call shift covering the wards, I would be called to:
Review patients who have become unwell by:
- Becoming short of breath
- Developing chest pain
- Developing a fever
- Becoming more confused or unresponsive
- Review patients who may have had a fall
- Review someone’s blood results
- Prescribe intravenous fluids or pain relief
Oh and also just about anything else you can think of – the hospital likes to give you a surprise every now and again. Got to mix things up. Keep it fresh and exciting.
On-call shifts were a true test of prioritisation and time management, as bleeps, much like the London buses, tend to arrive in bursts. You may be waiting for hours without hearing a single thing (ah, the bliss), being lulled into a false sense of security that everything is under control when suddenly you may be asked to review multiple patients at different ends of the hospital (snap back to reality). After getting over the initial panic and dread (important first step – not to be underestimated), I found that the most important thing was to find out as much about your patients so that you could to prioritise and to get help early on! Medicine is a team sport after all.
….ONE, TWO, THREE AND CLEAR!
Every now and again, a crackly robot voice came from my bleep saying ‘ADULT CARDIAC ARREST! ADULT CARDIAC ARREST!’. Next thing you know, you’re making a beeline for the nearest corridor, hoping that you know where on earth you’re going.
You see it on TV and movies (spoiler alert: it’s nothing like the movies). You learn about it and practice what to do during medical school, simulation after simulation. You even go on refresher courses throughout your time as a doctor, with more simulations so you are prepared as to what to do during a cardiac arrest.
There’s a crowd of people running on adrenaline working together to bring the patient back. Everyone has a role.
- There’s the anaesthetist who is in charge of the patient’s airway, who may place a tube down the patient’s throat so they can control their breathing.
- Others will be carrying out chest compressions – trying to get the heart to start again.
- Someone will be trying to get a drip into the patient, in order to give them adrenaline and other medications that will help the heart.
- There’ll be blood tests, heart tracings and pieces of paper everywhere as people piece together the cause of the arrest.
Like a well-oiled machine, everyone works together for a common goal. Sometimes it’s successful, sometimes it’s not.
Ward rounds are a marathon, not a sprint
Maybe you’ll be glad to hear that my day job wasn’t as adrenaline-packed as on-calls (or not). I spend most of my weekdays on an acute elderly unit which assesses patients before either discharging them or admitting them onto a base ward elsewhere in the hospital. Each day begins with a ward round with the Consultant where each patient is reviewed and a plan for the day is made. As the Junior Doctor, I do a lot of writing in the notes and navigating through the ever-confusing computer systems to pull up the most recent blood test results, scans and letters that help to demystify the patient. Dashing from one patient to the next, you try your best to keep a list of all the jobs that need to be done for the day.
Typical tasks during the day include:
- Completing discharge letters for patients going home
- Referring to other specialities – for example, if a patient has a new murmur, you may want cardiology to come to see them
- Requesting scans and blood tests
- Discussing further scans or treatment with specialities such as microbiology and radiology
The rest of the day is then spent trying to complete all of your jobs for the day with a satisfying tick in each box as you complete them.
Elementary, Dear Watson
Fun fact: the author of Sherlock Holmes, Sir Arthur Conan Doyle, was a doctor.
Like I said, my ward was an assessment unit so at times I would be ‘clerking’ patients in. This essentially means seeing new patients and finding out why they have come in by taking a history and then examining them. They come to you with bits of paper from the emergency department, the ambulance or the GP (or all three) with a version of the events, blood results, observation charts, bags of medications that they are taking and heart tracings. It’s then up to you to find out what’s been happening, come up with a diagnosis and start them on treatment. At least until they get a ‘senior review’ by a Consultant later on in the day. So much like Sherlock, you take all the little details that you see and put it together with (hopefully) a terrifyingly accurate and precise diagnosis of the events.
So between reviewing sick patients in the middle of the night, powering through long ward rounds, clerking new patients and responding to a crash call, life as a foundation year one doctor can be pretty varied. And like this blog post, it's just a start! Keep your eyes peeled for our future blog posts from other members of the MSAG team about what life is like as a Junior Doctor in a different speciality.