Thursday, 17 October 2019

Remembering who you are outside of medicine

When anyone starts a new job there is the inevitable adjustment period: getting used to the role, the team, the inner workings of the company. Of course, I didn’t expect my first job as a doctor to be easy. However, the problem I’m having is remembering who I was before I started that job. In truth, it feels as if I haven’t done much else than work. 

It’s quite strange that I even became a doctor, when I was more suited to the humanities and languages. I have no special ability in science, definitely not in physics. Medical school applicants are usually students with a wide array of hobbies: sports, musical instruments, public speaking, charity work. It attracts someone who is used to spinning 10 plates at once. Now that I’ve started my job, I am really struggling to remember what I like to do in my own time. That being said, there isn’t exactly a lot of your own time anyway. 

I am short on time, I work hard and am still behind on my tasks. I feel guilty about the audit that isn’t complete, the portfolio sign offs I’ve yet to chase, the teaching session I haven’t written, the cremation forms that the cash office still hasn’t paid me for, the study leave form I haven’t given to my supervisor yet. The weekend I was due to do my first half marathon I am now going on a career taster weekend. Not that I actually committed to the necessary running training programme to begin with. 

In truth, the thought of doing some of my hobbies feels nothing more than a chore. Running isn’t really fun and effortless unless I’m training regularly, playing the piano is frustrating when I haven’t practised enough to play the pieces to the standard I want them at. 

Many people would read this and think, “you don’t find time, you make time for things you find important”. This is the realisation I am at now. We had a lecture on resilience at work and it was surprisingly good. All of this struggle is subjective. I have to remind myself that every day I choose to do this job, I can accept what comes with it or leave. No one is forcing me to turn up every day. I cannot complain when it is my choice. Sadly a boy I went to school with has died recently, he was the same age as me. Each day is a reminder that I have an opportunity that he will never have. 

I love being a doctor, but I also want to be a separate person other than my job. To have the time to be all the other facets of myself. Navigating how I will do this isn’t a chore, but a privilege to have.

Sunday, 15 September 2019

My first month as a doctor

On Wednesday 7th August 2019 I began working as a doctor. I work in a small district general hospital on an acute medical ward. This is a summary of how the first month has been! 

Baptism of fire would be an understatement. My first day I was working a normal 8-4 shift on the ward, except the consultant was on annual leave, so we had a locum who like myself was entirely naïve to the software and general running of the hospital. It was myself, two consultants and two other FY1 doctors. The ward has no permanent middle grade or registrar doctors, and given the acute nature of the ward it means that the rounds are meant to always be consultant led. This has definitely been a huge help on my first few weeks knowing that although there are few people to delegate jobs to, there's always a senior to speak to. Except when one day we had no consultant cover and nobody knew, including the ward sister. 

After that first day I was quite shaken up. I felt so wired with adrenaline and couldn't really sleep. The second day was pretty awful. I was so relieved when Friday came and I knew I had a weekend to recover. I felt guilty for feeling so wrecked when I had only worked 3 days - how could it be that bad? On that Sunday night I had such dread about going in the next day. Slowly things started to click and make sense. I am becoming quicker at doing the jobs.

My first patient death was a slap in the face. Although it was expected, I was shocked and extremely upset. I had to leave the ward to cry, and not just a little cry. It really struck me how little some people seemed to care about patients having a 'good' death. Why didn't everyone care about having those conversations about resuscitation, just in case medicines and preferred place of care?

I then had a week of being on take clerking patients in A&E majors, and a few night shifts as the FY1 doctor covering all of 'back of house' - all the medical wards. My biggest challenge in those first few weeks was my panic and anxiousness, which made it really hard to think systematically. It was easy to catastrophise problems that weren't really that significant. I found it so hard to do a proper SBAR hand over when I was feeling so anxious, heart racing and mouth dry. I would crave a coffee but knew it would make the anxiousness worse. 

Nights were good and bad. I had quite a spectacular end to my first ever night shift: a patient who had a pericardial effusion rapidly deteriorated. I called the med reg, then the anaesthetist came, the call went out and a cardiologist drained the effusion on the ward and took the patient to ITU. All at 5 minutes before handover. Again, it was so hard to sleep whilst feeling so wired from everything that had happened. I cried to my SHO before starting the next night shift, I felt so out of my depth. They had a quiet word with the med reg and they both supported me so well for the next two shifts. 

It can be quite hard to stay on top of admin work and also have time to look after yourself. I have not been exercising enough because I mostly seem to come home, eat dinner and crash into a heap on the sofa. I've been able to eat regularly, but not always the healthiest choices. I have struggled to be present when I'm with my loved ones; wondering if I remembered to do XYZ or what will work be like tomorrow. I am trying my best to remember to be grateful, use the Calm app and still practise my hobbies. 

I am not saying all this because I resent my job - I love being a doctor. Overall, I am really enjoying the experience! I know there are many juniors who have it worse off than I do, but I think it's important that we can be publicly honest about the reality of the job. I am slowly embracing, even enjoying the madness and frenetic nature of the ward. I really like my team. I laugh and smile every day. I am so grateful to have this job. 

Wednesday, 26 June 2019

My medical school experience

Somehow I have now completed my medical degree, and am graduating in a month's time. I thought it would be interesting to describe my preconceptions versus the reality of medical school.

I really had no idea what to expect. I didn't have any close friends who were medical students, and I was under the impression that training had changed a lot over the past 30 years. My only two preconceptions were: everyone is posh and it's going to be bloody hard work. 

The reality of my medical degree, 2014-2019, was this:

It was very clique-y
I had the impression most applicants were from private school. Surely everyone would have a double-barrelled surname and be a member of the conservative party? Apparently not. There's no denying most people would be considered middle class, but there was much more diversity compared to my sixth form. Everyone formed their friendship groups very quickly and there was not a lot of movement after that. You all had your set part of the lecture theatre you sat in, where you ate at lunch, what study area of the library you used. 

Healthcare professionals are sometimes horrible 
This was the biggest shock to me. I was a very naïve 18 year old who wanted to help people  (I know) and hated confrontation. I was floored by how people spoke to each other and how obvious the hierarchy was. Some doctors had a real God complex. There was so much slagging off of other health care professionals and patients. I couldn't believe people actually treated each other in that way. 

It's not all hard work...  but it is relentless hoop jumping
I vividly remember my first anatomy lectures and feeling like it was in a different language. I never learnt Latin or Greek at school. I would write down every word I hadn't heard before and by the end of the lecture I had pages of completely incomprehensible scribbles of words I would Google later. What was everyone saying? Then when you began clinical placements it was non-stop acronyms. What was BIBA? MOFT/TOFT? Having said that, most of the concepts weren't much more complex than what we did at A level. The overwhelming quantity of information seemed ridiculous. You would memorise the circle of Willis and be able to apply it clinically, only to completely forget it 3 months later when revisiting your notes. Some essays seemed completely pointless. It was very demoralising when I spent so long on a research project I was passionate about for my supervisor to go AWOL and never mark it. No explanation, definitely no apology. It was a constant hoop jumping exercise and I don't think that will ever go away as you progress into postgraduate medical training. 

Not everyone wants to practice medicine
I could not believe people would put themselves through so much hard work whilst feeling that medicine was not the career for them. I loved the subject and that motivated me to persevere through the exams. I could not have done it without that fascination, yet many people did not enjoy it at all and still put themselves through the relentless exams and did much better than me. 

People start asking you for advice
I try not to tell people I am a medical student, but when you do it often follows with lots of medical-related questions. Questions they must think we are equipped to answer but we are really not! Doctors know that it is wrong and unethical to treat close friends and family, but you are guaranteed to be asked by most people you know for advice and answers to their medical queries. 

Formaldehyde makes you hungry
Going back to learning anatomy, it is quite unnerving to spend 2-3 hours looking at deceased bodies preserved in formaldehyde and then start feeling really hungry. People  often said formaldehyde was previously used to induce hunger in patients with anorexia nervosa but I haven't been able to find any evidence of this. 

You have to accept a far away placement, or several
I think every medical school has their equivalent of the hospital placement that is very far away and possibly very rural, and you cross everything hoping you won't be sent there. I never knew you had this obligatory process of changing hospitals so often throughout training, with very little say. You have to cover most if not all the transportation costs yourself. It was a shock to realise all of medical training has this element of uncertainty where you will be forced to work. 

The training pathway is longer than you expected
Minimum 5 years of medical school, 2 years foundation training, then 3 years specialist training if you want to be a GP. Some specialities provide run through training (4+ years training immediately after foundation training), others require an intermediate stage ie Core Surgical Training (2 years) or Internal Medicine Training (now 3 years), then followed by 4+ years of specialist training. And that doesn't take into account a possible year out after foundation training ('F3' year), sick leave, maternity leave, less than full time training, fellowships or PhDs. Oh, and the assumption you will get a sought-after training number on your first application, or pass your postgraduate exams first time (many don't). This realisation was enough to put many students off the speciality they thought they were going into medical school for.  

You feel very average, if not wholly inferior to everyone else
I had a huge confidence crisis at medical school. I would work as hard as I could to be just plain average. I have been slowly building that confidence back, but I have struggled to accept that I'm not very good at the academic side of medicine and do much better in the clinical and communication side of it. This is kind of a relief because the human interaction was what made me want to be a doctor, but it's fair to say medical school 'put me in my place'. It has adversely affected me, because now I shy away from academic projects. The irony of this is it potentially weakens my future job applications. Over the last few months I've said no to two poster presentations that my supervisors suggested I should do, because I didn't think I was clever enough.

Doctors work a million more hours than the ones they're paid for
I have so much respect for doctors now I understand the training pathway better. It really is relentless. At each stage those hoops become more challenging and there are more and more to jump through. They are the humans we expect to be superheroes, who we criticise in the media for not being so; the people that have to pay to work, and work hours they will never be paid for. 


Tuesday, 18 June 2019

An honest account of medicine

I have spent the last year trying to understand what is and is not appropriate to share online regarding my medical training. This blog came to existence because of the paucity of information I found whilst at school about what it was really like to be a medical student. I hoped I could fill the gap, and felt it would be important to do so. 

Over five years I have talked about my workload, my mental health and the many challenges along the way. Sometimes I felt I had so much to say but feared it would be unprofessional to share. There are things I do not like about the NHS and the way medical students are treated, but was this the appropriate place to share those views? What would my colleagues think?

I reread the GMC’s guidance of ‘Doctors use of social media’. I remember at the start of medical school being told to read over this, but I had not looked at it since. In all honesty I got very little from reading it again. The key points I took from it were: “always maintain patient confidentiality… information you publish must be factual and can be checked”, you should not communicate with patients via your private social media profile, “If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name … When you post material online, you should be open about any conflict of interest and declare any financial or commercial interests”. To my knowledge there is no guidance specifically on blogging.

My ultimate, uncomfortable question was: can I really talk about how hard it is sometimes? Whilst I know I can describe my working hours, my training requirements, the city hopping from hospital to hospital, this isn’t really the right place to put my feelings. I find this frustrating because prospective medical students deserve to know what they are signing up for, and part of that is the emotional toll it can take. The elephant in the room is the bullying and poor treatment of healthcare professionals that still continues today. I have been the victim of that and I have observed it happen to others. Sadly we are not always in a safe environment to raise those concerns without worrying about potential personal repercussions. It’s a bitter pill to swallow, but I don’t think I should share these experiences publicly. 

With this in mind, I wondered what the point of this blog would be. I think there is still a lot I can contribute to explaining how medical training works by sharing my own journey, but safe to say it will be an edited and less emotional version of events. 
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