Starting out in the NHS
Guest Blog: Mahua Chakrabarti, Chair, Trainees Committee, Royal College of Physicians and Surgeons of Glasgow
I started my career in the NHS as a junior house officer in the General Surgery department of the Glasgow Royal Infirmary in 2002. My day was much like everyone who starts a new job I imagine. We were gathered together as a group of new doctors and were sent to sit and listen to a number of lectures on fire safety, how the labs work and numerous other talks which seem to go on forever. I remember constantly looking around me to look for faces I might recognise. I turned and said hello to the girl next to me. I had never met her before, but she became one of my best friends who I trained with and still work with today. Having been on placements at the Glasgow Royal Infirmary, I did not feel new to the hospital but the responsibility of being a doctor did not really hit me until I started on the ward mid-morning. My recollection is of mostly feeling nervous, apprehensive and excited all at once. My SHOs were busy passing information to me from their ward rounds, while nursing staff were busy asking for drugs to be written up and discharges to be written. I put my big girl pants on and suddenly had to ‘man up’! I laugh now, but the first drug I had to prescribe was paracetamol, and I had to look up the BNF to do so. I smiled at everyone, kept the calm exterior while I panicked at the smallest thing inside. Goodness, is that rash meningitis? Nope, just from the dressing. What’s that tube thing? Oh, that’s what a drain is. I quickly learnt I did not need to know the answer to everything and that my seniors and nursing staff were to be my best resources. The first day passed quickly but I left late to ensure the next day would be more organised. I did not remember the name of every colleague or nurse that helped me that day, but it felt so good to be driving home thinking I had just started an awesome adventure.
The job has not changed so much. FY1s still prescribe, write discharges, review patients, plead with radiologists for scans and make fearful requests for reviews from departments they know will shoot them down. Technology has moved on but most of the core jobs of an FY1 are the same. I used to make paper requests, hand write discharges and ensure x-rays were in the right dockets for each patient. All of these are now electronic. Certain jobs I may have needed to do such as making up IV bags of drugs are almost all done by nursing staff now. This does not mean FY1s do any less however. Hours of work have changed and the introduction of their portfolio work to pass FY1 year has led to other requirements in their time. The first year is still a large learning curve for each new doctor, but the changing demands from a changing NHS means the lessons learnt from the year are a little different from the past.
The biggest advice I can give to new FY1s starting in hospitals everywhere is to ask for help. The best people who will give you advice are those sharing the responsibility of looking after the patients with you. The nursing staff have years of experience ahead of you and can at least point you in the right direction. Make them your friends. From nurses, pharmacists, healthcare workers and domestics, they all work in the same ward as you, and are all there for the patients. Respect them all, and when you need them, they will help you. Be organised, have a routine and prioritise. Making a plan of how you will execute the day means the most important tasks are done first and any unforeseen circumstances will stress you less. Keep your seniors informed and ask them for any advice you need. Be smart, it gives you confidence as well as gives people confidence in you. Remember to eat, drink and go to the bathroom! The ward will not fall apart for the 15 mins it takes but it will be enough to keep you sane. Having time with fellow FY1s gives you time to laugh and offload. A spirit of camaraderie really helps everyone feel they are not alone. Above it all, take time to speak to your patients while you do jobs for them. I have never had so much time with patients since being a doctor. Putting in the 8th venflon for a patient builds rapport. It gives you a glimpse of a life seeking help from you, and makes you realise the privilege you have of being a doctor getting to meet every walk of life.