Fulfilling, enjoyable and satisfying
By Professor David Galloway, President of the Royal College of Physicians and Surgeons of Glasgow.
My first day as a fully qualified NHS doctor could hardly have started in a more dramatic fashion. I was primed to save lives and my perception of the events as I look back at that morning of Monday August 1st 1977 – is that that is exactly what transpired.
Full of enthusiasm and ready for action, I arrived in the Emergency Department of the Western Infirmary in Glasgow just before 8am. My duty responsibility for that week was a pattern of 24 hours on – 24 hours off. No problem – I was ready for the challenge. The healthy concern I had which recurred to some degree whenever I went to work in a new unit or department was present of course. However, that soon evaporated when a call for immediate help came from a nearby clinical exam room. A man in his mid-fifties had suddenly collapsed and an arrest call was initiated. I was right there and went into action. A quick assessment of the unrousable patient confirmed the absence of any discernible cardiac output (In retrospect, I am pretty sure that there was a cardiac output but I did not detect it!). One brisk pre-cordial thump later and some signs of life returned. As the patient gradually came to I was feeling pretty satisfied with the result of my first therapeutic intervention and by the time the arrest team arrived I was pleased to take the plaudits of having successfully managed this emergency without the need of any experienced assistance. When the dust had settled I really think that the patient has suffered no more than a vaso-vagal incident and I had undoubtedly over diagnosed and over-treated the ‘problem.’ Nevertheless it was a high energy start to a long and satisfying day.
Looking back with the benefit of hindsight to a day some 40 years ago is fraught with the risk of having a rather filtered view of what actually happened. However, I do think that some important lessons learned in that initial experience of working in the NHS were important to pass on – they served me well throughout the rest of my career.
Lesson number one is to have an accurate view of your ability and your place in the firmament. it is best not to imagine that you come into the organisation at anything above the level of a basic learner. It takes time to find your way, build trust and begin to apply your influence.
As a new member of staff, lesson number two has to be to recognise that the established colleagues who know and operate the system are an excellent source of guidance and advice. The system and working patterns may not be perfect, indeed they may be seriously flawed, but it is essential to respect those colleagues- especially in other disciplines and in particular, the senior nurses provide a wonderful resource. It is really important to establish a good rapport, show respect and foster a healthy working relationship. Perhaps this is one of the most significant early lessons in the vital importance of good team working that I was to learn in the early days.
There were many other lessons, of course, coping with fatigue and stress. Learning how to communicate effectively can literally be a life saver. Showing compassion can sometimes be sidelined by the demands made on your time and energy. Coping with emotional challenges and confronting hard realities on a daily basis become less demanding as experience builds. Just remember, your patients won’t care how much you know until they know how much you care.
I doubt that there is a more fulfilling, enjoyable or satisfying role in the entire field of human endeavour – but I realise that is a biased view!