Read this

http://bit.ly/VpAHqI

At what point do we say no?

My patients are, and will always be my first priority.

As a junior based solely on the shop floor (i.e. the wards) I'm often better suited to tell the consultant or registrar how the management plans have been panning out.

The problem comes when the seniors expect you to go above and beyond the line of duty.

I work hard - very hard. I often don't take proper breaks and almost never leave on time. However this is being taken for granted. At 1700 I'm officially 'not here / a figment of your imagination / don't ask me unless it's life threatening' however it seems to be expected that I will stay practically forever to ensure things are to my consultants liking.

I get that medicine used to be like that, however with greater workload, paperwork and responsibility comes a higher likelihood of burnout. In my current job I feel I'm heading that way.

I'm finally learning so say 'no' but it doesn't seem to be going down well.

Ive tried explaining that I'm happy to hand things on to the on-call team but it seems this isn't good enough.

What would you do?

Attachment

Sometimes knowing when to stop is one of the hardest things in medicine.

I find looking after a patient list so hard because I have lots of sick patients who sometimes die. It's difficult to know how far to go before you hold your hands up and admit defeat.

The debate at the moment with the Liverpool Care Pathway makes me very frustrated. The LCP is not a morphine pump to kill people (as a patient told me this week), but a (hopefully) more comfortable and less agitated way for dying people to pass away.

As part of a multi disciplinary team I have completed the paperwork for the LCP several times and it's never been something I've regretted. In fact on one occasion I felt horrific as I'd missed the opportunity to start the LCP and a patient died very distressed.

Making a decision about when to stop medical treatment for a patient is one of the hardest to make and is even harder given the appalling press coverage recently.

So much for supporting the NHS

Oh dear

As I mentioned in my last post I'm having teething problems.

After today I'm not so sure they're just going to be a short term issue. The problem comes down to the usual shortage of resources and division of labour, i.e. there are only so many things I can do within a finite time period.

I manage my time well, barely get breaks and have a strong work ethic appropriate to my grade. If I can't get everything done when you ask me to then you either need more staff or a more senior/experienced doctor.

I'm not superhuman. I can't wave a magic wand and get everything done instantly, some things have to take clinical priority. Doing discharge paperwork when I have a patient with a very low blood pressure is not sensible. The bed manager might prefer it that way as they could end up getting 2 empty beds for the price of one, but I don't think the GMC would view it favourably.

Give me the opportunity to do my job and leave me to prioritise my tasks according to need. If you can't do that then feel free to muck in and help me.

Rant over

Teething problems

The reason things have been so quiet lately is mainly due to work problems.

The job switch went fairly smoothly initially but is now not working out so well with regards to logistical issues and job role.

It's all a work-in-progress and will hopefully sort itself out shortly, but if not, well, it's only 2 months until job change again.

The joy of nights

As an F1 some hospitals won't let you do nights. I wasn't that unlucky.

Nights help you feel like a real doctor - the kind that actually has to make decisions off their own backs.

As you can probably gather, I love nights. There are less relatives, less hospital management and generally less people to annoy everyone.

I'm also very lucky that I can switch from days to nights (and back) very easily. I know some of my colleagues struggle with nights, but I love them.

But then I guess nights are like Marmite - you either love them or hate them!

Locum

AKA being a mercenary. Is it wrong to pick up extra shifts for 2.5x your normal working rate? (or should I be requesting more!)



Sent from my iPhone

The fallout from the killing season

It's suggested (hopefully mythically) that August in the NHS has the highest death rate for the whole year. Strangely this correlates with the period where new junior doctors start their career.

It's very strange to think that 12 months ago that was me, and I was a terrified FY1.

I'm sure that everyone says this, but I'm pretty sure I didn't have an attitude like a couple of people I work with have. Humility is a great tool when you start a new job, especially one where you don't have a lot of experience.

It is also very weird to be called an SHO (senior house officer) as this suggests greater responsibility. It also covers doctors from FY2 right the way to CT/ST2 or 3 (the doctors that are just about to become registrars) and as such the experience gap is massive.

So while I'm not aware of massive mess ups yet within my job I'm sure there are plenty of learning opportunities to be had by everyone.

Back to school

It's especially strange to think that tomorrow is my last day in my current job and as of Wednesday I'm an FY2 doctor who is fully registered on the GMC website.

Since I'm changing hospital trusts again it has an odd feeling of starting a new school year.

I've bought my new pens, selected and ironed my clothes, scheduled my bed time, polished my shoes and filled the car up with fuel.

This extra preparation won't make a difference though as I will still be bricking it tomorrow evening for a new job. I'll also be back to my usual self next week and forgetting to make myself some lunch and prepare clothes the night before.

As much as I've really hated my current job, I really love the people I've worked with. I think we shared a mutual dislike of the particular speciality and made the best of it. Possibly one of the best bunch of people I've ever worked with and the patient care has been genuinely excellent.

I'm going to miss having the time to chat to patients, make sure they get a drink while we're there (yes we really do do this as we know the nurses are manically busy) and explaining things to family without massive time pressures. I won't have this luxury in my next job.

So all in all I've learnt a hell of a lot in the last year - probably more than I ever realised. I think I've kept most of my personality and humanity despite working in a couple of tough specialities and as much as I've had some really stressful times, I wouldn't change it for the world.

So here's to medicine and making hopefully the correct decision for me when I was choosing between being a doctor and a paramedic.

Don't get ill in August...

365 days in the blink of an eye

From August 1st I will have a full GMC registration (F1 doctors in the UK hold provisional registration until they have been signed off as competent after 12 months). This means I'm technically an SHO (senior house office), albeit at the bottom of the pile.

The plus side of being hellishly terrified is that I get a payrise for having been through hell for the last year.

I think the reason I'm so scared is that now there are people more junior than me that aren't medical students! This means I have to pretend to actually know some stuff and not just stand quietly behind the SHO.

The good news is that I rotate jobs and I'm hoping it will be more interesting than my current one. If I find something I don't particularly enjoy then I don't learn a great deal - my current job falls into this category.

So for everyone new as an F1 on Wednesday welcome to the working world of the NHS and prepare to have your eyes opened.