My First 6 Months as a Doctor

  I'm sorry I can't get through this video without feeling emotional but it really... This is probably the hardest video I've filmed so far. Right, let me kick off my sandals and let's get started. Sandals are out of the picture, let's go. So this is just going to be a fairly relaxed and chatty video where I just reflect on my first six months working as a doctor. A bit of background for those of you who don't know me, I graduated from Cambridge last June and I started work as a doctor in the NHS in London in August. And just at the start of February, which is when I'm filming this, is when I officially have actually worked for six months in the NHS. So in this video, I'll firstly talk about my experiences so far and what I've done, what rotations I've had, what kind of things really stuck out to me as really memorable. Secondly, I'll talk about the overall positives I've drawn from this. Next, I'll talk about the things that have actually been quite stressful or potentially negative. And then I'll wrap up my reflections with a little bit of a conclusion before moving on to answering all your questions that you asked me over on Instagram. Well, I say all your questions, as many as I can manage. So let's get started. So I started at the very beginning of August working as a Foundation Year One doctor in the Trauma and Orthopaedics department. Trauma and Orthopaedics is basically a specialty that focuses on fixing broken bones and putting pieces of metal in them and so essentially if someone's involved in a car crash or has a really nasty fall while skiing and then they're brought in and then the consultants in the orthopaedics department will look at all the scans of their bones and decide on how to fix them with various different bits of metals and plates and frames and things like that. In terms of the F1s working there, there was me and three other F1s and I was so grateful to have a group of F1s all working together on our first job because we could sort of learn from each other and feel like we weren't alone in that process. The role that we had in the orthopaedics department was mostly to run the ward, so essentially the ward is all the beds which have these orthopaedic patients in them either waiting for an operation or after having an operation and they're just recovering until they're safe to go home. This would generally involve doing things like blood tests, taking lots of x-rays, either pre or post op, and then also making sure all the medications were right, taking care of the patients medically, because often orthopaedic surgeons are not super interested in the medical management of patients, so that would basically be our responsibility and also some of the SHOs. And we'd also be in charge of patient flow and making sure their discharge summaries were written and doing all the next of kin discussions as appropriate to our level. This, I'm not gonna lie, was a busy first job to start on. There were always loads of bloods, loads of x-rays, loads of things that needed to be vetted and scans and CTs, MRIs, various discharge summaries, lots of patient families wanting discussions and updates on their family. And during my rotation, the department was super duper busy with sometimes over 70 patients on the list who we would be ideally seeing every day on the ward round. But obviously with 70 patients, it's hard to really spend any significant amount of time on them. And the NHS is just under so much pressure at the moment. And it's so difficult to get beds or get patients discharged or get them the appropriate care that they need just because there's so much strain on the moment and it's so difficult to get beds or get patients discharged or get them the appropriate care that they need just because there's so much strain on the system and not enough resources there. And so working in a department like that the team was fantastic they were so supportive everyone was super helpful and I just I kind of enjoyed the orthopedic banter. Stereotypically orthopedic surgeons are like rugby lads supposedly but I quite enjoyed the chat and there's just the team vibes that we had going on in orthopaedics. That was quite fun. And I really did miss that on my next job. But even so, working in that job was pretty busy and pretty stressful, especially as a first job. Some of my shifts would start at 7.30 in the morning and then finish at 8.30 in the evening. And sometimes I'd have four of those shifts in a row. And that doesn't sound too bad, but when you're completely brand new to something, there's always going to be a certain level of increased stress that you have while trying to do it. And I definitely felt really stressed at work all the time for my first, I'd say my first month or so. I would always feel stressed at work. And often there wouldn't be time to eat lunch, or I'd feel like there wasn't time to eat lunch, or I'd even feel guilty to take a break to eat lunch when we're actually meant to have a break. And I remember sometimes after spending four days in a row working 13 hours a day, I would just feel like a complete shell of a human being and I feel like I hadn't had any time to myself because my commute is around an hour. So if I'm working for 13 hours then two hours of taking up commuting, that leaves me with nine hours to myself at home. I need eight hours of sleep. So that means there's one hour for me to eat and do all my like morning and evening routines and do all my self-care, do everything else in my life. And that felt really really stressful and felt like I didn't have a life sometimes. I know I wasn't the only one that felt that way and again that's why I'm so grateful that there were other F1s working in that job because we could commiserate about it being difficult and then that made it almost easier to bear because then I could think like oh you know what I'm feeling stressed by this, not because I'm really bad or crap at my job but because actually this is hard and this is tiring and it's stressful. I remember very clearly after I messed up printing some patient list and it printed in the wrong format I had to do it again and all sorts of print issues. But then I ended up being around five minutes late to bring the list to the trauma meeting in the morning where they essentially discuss all the patients that are waiting for operations and discuss whether or not they should be for theatre that day or the next day. And then while in the trauma meeting, I realised that I hadn't sent off a certain blood test called Group and Save for a patient the night before because I'd been so stressed with so many other jobs and unwell patients who are having upper GI bleeds or other various things like that. So I went to the doctor's restroom and I just sat down and honestly had a little bit of a cry because the levels of stress had just boiled up to the point where actually I felt overwhelmed. And I don't think there's any shame in having to take a break to deal with your emotions or let them come to the surface in that way and experience them fully because suppressing emotions over and over again is actually, I've realised, not a sustainable way to deal with them. Mistakes are going to happen at work and you're going to get things wrong but it's just about taking responsibility for that, being accountable for it and making sure that you've done everything in your power to correct it. So for me what I did is I immediately went at that point to send off those bloods as soon as I could when I realized... I don't feel ready I feel like, I just feel so emotional when I think about all the times I went to like cry in being a medical student and not having any responsibility really and being able to just be there and learn to suddenly being the one who all of the bloods and x-rays rest upon and if you don't do it then no one else is going to be doing this stuff and having to take that professional responsibility and step up to it is a level of burden and stress that I hadn't experienced before and I feel like I've had to go through a lot of personal growth in order to be able to handle that and even just thinking about the way that I felt back then and how stressed I was and how hard I found it makes me feel emotional and I'm sorry I can't get through this video without feeling emotional but it really... this is probably the hardest video I've filmed so far which isn't saying a lot because I haven't filmed very many hard videos. I just very clearly remember a good handful of times when I would have to take a break from my day and go find somewhere quiet, either go to a toilet or go to the doctor's mess and just sort of cry a little bit and just like I'd feel some tears well up in my eyes and it wouldn't be a big sob session, it would just be a few silent tears, just feeling the pressure and feeling that it needs that outlet and needs to be released somewhere. Another time this happened to me was actually during a night shift. So my second rotation, which I'm currently on, is in like acute medicine and general medicine. So we do night shifts and often we'll have like three or four night shifts in a row, starting from 8.30pm until 9.30am the next morning. During one of my night shifts, there was a patient who was on non-invasive ventilation, which is essentially when they put a mask over your face, which helps you to breathe and kind of creates pressure to help you get air into your lungs. And they'd been on this non-invasive ventilation for around a day or so, a day or two. During this time, they had actually become unresponsive, and after an extended discussion with my senior, who was a registrar overnight, they decided to take the decision to turn off the ventilation and as the medical F1 covering essentially the whole hospital for the night, I was asked to go over and supervise the ventilation being taken off. The patient's family had all gathered around to visit and myself and one of the nurses switched off the ventilation and took off the mask and popped on just some normal oxygen instead. Within minutes the patient's breathing stopped and her heart stopped beating and I certified the death with a family there. Certifying a death essentially involves listening for any breath sounds or heart sounds, feeling for a pulse, checking for any pupil responses to light and checking for any response to painful stimuli. I told the family what happened and then I left them be just for a moment to have some privacy with their loved one after they had passed away. This was one of those moments where I felt like, wow, actually really the work that I'm doing is really genuinely dealing with matters of life and death. And in that moment, I genuinely felt like a doctor, able to certify someone's death and communicate that with delicacy to a family who are already grieving the loss of their loved one. But at the same time, it also affected me personally. And after that, I sort of went away and I actually went for a walk outside just at night. This was at like 2 a.m. Just to get some fresh air and just feel the emotions that that had stirred up in me. And that's the thing with medicine, it places you in this unique position where you've been trained with all of the skills that you need to communicate, to perform clinical examinations, and form initial diagnoses for investigations, management, etc. But when you're actually in the ring and actually doing it rather than just learning it in a simulated setting or on past medicine, it feels so different because it's real and that's actually a moment that those family members will probably never forget, that will always be in their memory. And it's genuinely an honour to be able to use skills and knowledge that you've gained in order to be there at that time for people who really need it. After that initial transition period where everything was initially like so stressful, so new, I had no idea what I was doing, I felt like I was always doing things wrong, always having to ask people how to do things, when I finally started to gain that feeling of confidence that goes along with actual competence, that was actually an incredible feeling, to be able to just turn up to my job and feel like I could actually do it and deliver a good job, job well done. That was a really good feeling because being able to have discussions with family members or being able to bang out a set of bloods or being able to whack out a few discharge summaries and get patients sent home and give them their prescriptions, it feels good, it felt really good. So to anyone who's watching this who might be starting work as a doctor soon or wondering what it might be like, that initial transition is hard, it is really hard, and it's going to be hard. Don't feel like you're the only one who's struggling because literally everybody else is finding it really difficult as well. I certainly did and I know so many others who have found it so difficult. So know that it's hard, but also know that it's worth it and that you will upskill really rapidly and you'll get so much better so quickly. And within like a month or two, you'll be feeling so much more confident, so much more competent, and that will just continue to increase over the whole of F1. When I finally switched rotations to my current rotation, which is general internal medicine slash acute medicine, I realised how busy my first job on orthopaedics actually was because it is still busy but there's actually much more time per patient, the lists are smaller, instead of having 70 patients on the list maybe there'll be 15 and this is so much more manageable. I know that sounds obvious but it actually is so much more manageable and I found that the pace in medicine has been much more measured and there's more time spent thinking about electrolytes like sodium potassium and worrying about those sort of medical aspects which makes a lot of sense because in terms of the orthopedic side of things they're mostly concerned about actually making sure that the bones are fixed and they're strong and that they're healing and all of that sort of things whereas in medicine you're actually trying to balance all of these different physiological processes that are going on to try to optimize that patient's well-being while they're in hospital and hopefully get them well enough to go home. One of my favorite things on medicine has been being on take. So when patients initially come into the emergency department with some kind of issue, they will initially be triaged and seen by an emergency department doctor and they'll take a history and do an examination and decide which specialty the patient should be sent on to next. So they either decide, okay, should the patient be discharged home? Should they be referred to the medics or should they be referred to the surgeons, whether that's orthopaedics, general surgery, vascular surgery, or somewhere else. Then when you're on take, then the medical registrar will delegate different patients who've been referred from the emergency department to either the F1 or the SHOs. SHO stands for senior house officer to be clocked in and seen. I've actually found that this is the best place to learn because you actually get to go see a patient, take a full history, do a full examination and then come up with your initial management plan. Then you go and present this to the med reg who will maybe tweak bits of your management and give you some feedback on things like that. This is probably my favorite part of working in medicine, when you have this little team of people on take and you can go clock in patients. Otherwise, when you're just working on the ward, you make sure that all the bloods are taken, all the scans have been done, and you review every single patient daily and see them on the ward round. My absolute favorite things so far have genuinely been the team vibes and working with a team of incredible doctors. Some of the people I've worked with, I have so much admiration for their extensive knowledge of their specific area, whether that's in orthopedics or whether it's in general medicine, they really know their stuff and just seeing them at work and seeing them making those decisions, it's just amazing. It's really inspiring, genuinely incredible. The hardest parts of the job overall have probably been the lack of autonomy over when you actually have free time. And so having to put in annual leave requests and having a leave denied, not being able to make it to friends' birthdays. Or I know friends who had to miss Christmas or New Year's. That's actually a huge sacrifice. Another fun aspect of starting F1 that has actually been a bit of a surprise is all of the doctor's mess activities. So the doctor's mess is essentially the social side of the doctors that work at the hospital and they'll organise little pub trips or events or parties and getting to know more of the F1s and doctors that I work with has probably been one of my favourite parts of starting work because they're your colleagues but they're also your friends and they're going through the same experience as you. Okay, so that's probably enough of me just using the camera as my therapist. Let's answer some of your questions over on Instagram. Okay, a question from Anita. Was it worth it? Would you do this choice of going through med school again? So I guess there's two separate questions here. The first question is was it worth it? I think that's a hard question to answer at this stage because I feel like I've only just scratched the surface and only just gotten started. But would I go through this choice of doing med school again? 100% yes. Because medical school taught me so many skills and changed me completely fundamentally as a person. I met so many amazing people along the way and also the person I am today would be completely different if I hadn't gone to medical school. Sorry about the whirlwind of lighting. Okay, right. So, yeah, other reason why I thought I'd film this on holiday was because I wanted to film this at the six month mark when I'd actually hit six months as a doctor and I thought it was quite relevant actually because this is the first time I've really taken an extended holiday out of medicine, longer than like a couple of days. So this has been a good opportunity to actually reflect and assess how things have been going. Do you like it more as a doctor or a medical student? This is a great question because actually I'd say that from a learning and just experience and chilling kind of standpoint, being a medical student is way more chill. You can have much more flexibility. You just have the responsibility to study and pass your exams. But from a sense of actually being part of a team, I love that being a doctor, you actually feel like a valuable member of the team, actually contributing and bringing value to your patients and your colleagues. And that's something that I've really enjoyed about being a doctor you actually feel like a valuable member of the team actually contributing and bringing value to your patients and your colleagues and that's something that I've really enjoyed about being a doctor How does it feel to work a night shift? Not gonna lie, working my first set of nights was really a stressful idea in my head because I need my sleep and I'm very dependent on good rest to function and actually be able to make good decisions and I was thinking my god if I'm just staying up throughout the night How am I going to make good decisions and actually be able to make good decisions. And I was thinking, my God, if I'm just staying up throughout the night, how am I going to make good decisions and actually be able to make safe decisions? In the end, I would just sleep as far as much of the day as possible before my night shift. But even having slept beforehand at around 4 a.m., 5 a.m., my brain just starts to shut down. And honestly, it feels really exhausting and just really tiring. On some level though, working nights is a bit more fun because you're literally, there's just an F1, two SHOs and a med reg in the entire hospital covering all of the medicine patients overnight. And any of the medical emergencies or referrals that come in all come to your team. All of the ward issues, everything. So you tend to get referred slightly more interesting things because the more basic or less urgent things that can be dealt with during the daytime will be saved until then so you only get the really pressing things which is actually kind of when you really learn. So it's a bit of a mixed bag but overall a really good experience and a really good learning experience. What do you do to feel better after a bad day or you realize some mistakes in your management? This is such a good question, so so important because I've had this experience so many times when I felt like I've had a really stressful day or a bad day or maybe did things in a way that looking back I would actually want to do differently and it's all about accepting you know what that happened and acknowledging that it was difficult and acknowledging the things that you wanted to go differently and then also just moving on and thinking how you can rest and recharge from that point on and I think having a good support network, good friends and family that you can speak to and you feel comfortable talking to about the difficulties you've had in your day is really important. So often I'll complain to my family or like tell them about things I've been experiencing at work. Alternatively, another thing that's really important for me is bullet journaling and being able to journal about how I felt or what went on and having that safe space to have a reflective practice is a really good way to decompress. Finally I think self-care is so important and taking that time for yourself to actually unwind and de-stress is so healing. Also sorry I'm kind of filming this in the dark, there's no lighting at the moment so I'm just using the kind of natural twilight, post sunset glow in the sky to light this video. Have you ever been exhausted working as a doctor? Yes, absolutely. There's times when I've been working maybe like 60 plus hours a week, sometimes 70 hours in a week, and then I'll just be exhausted. And I know some people work more. I'm not saying that that's a crazy number of hours, but to me that is exhausting and I would just feel completely dead at the end of that. Is it easy? I feel like it's an overwhelming job. It is an overwhelming job. It can be overwhelming but there's a lot of support from colleagues and from friends and families which makes it doable. What does work-life balance look like for you? What are healthy work-life boundaries? This is so important and I think the main thing here is when you are at work, you're at work. When you're not at work, when you're finished, you switch off and you don't worry about the things that are going on. If I'm completely honest though, my work-life balance isn't great, and I think it could be improved a lot. Okay, so I think that's about all I have lighting for, because the light outside is fading very rapidly. There's a couple more questions, but I'll answer those in a future video. Make sure to follow me over on Instagram if you want to get involved with future Q&As or other polls I put out. That's pretty much my reflections on six months of working as a doctor. Overall, it's been really tough, but also really rewarding, and I've grown so much as a person and also as a clinician in this short time. This is one of the periods of the most rapid growth that I've ever experienced and looking back at it it's actually been a bit of a roller coaster. Thanks for bearing with me getting a bit emotional in the middle of that and also thanks for bearing with like the very variable lighting. It's been a bit crazy and a bit up and down as the sun's been setting as I've been filming this video. I've been trying to turn on various other lamps to keep it somewhat illuminated in here. This has been a bit of a chatty, relaxed video. I hope you enjoyed it. Let me know what you think of this style of video down below. If you enjoyed this video, I think you might like this video over here where I answer a couple more questions that you guys asked. Thank you so much for watching. Take care of yourself and remember that the journey is the destination. Bye. that you guys asked. Thank you so much for watching, take care of yourself and remember that the journey is the destination. Bye!

https://www.youtube.com/watch?v=6RLdRauWegI
My First 6 Months as a Doctor (what it's really like)