So as those of you in the UK might know, the new generation of doctors is about to start. Typically we all “changeover” the first Wednesday in August but thankfully this is often combined with a “run-in” period for the new starters. So I thought I’d give my advice to those of you heading into hospital to learn about your new role tomorrow.
Firstly, tomorrow WILL be scary and next Wednesday will be even scarier. I am not the scaredy-sort and yet it is by far the most terrified I’ve ever felt about something I have relative control over!! However, this is a great opportunity to learn who your supports are and where everything is. We’ve all done this before too. So try to relax…
My ten top tips:
- Introduce yourselves.
- To everyone. The number of times doctors (even experienced ones) change over and the nurses and the ward clerk tell me in a miffed tone that they never introduced themselves… Introducing yourselves gives you a chance to win brownie points, look mature and feel welcome in the team.
- Ask for help.
- Learn how to bleep, especially your seniors and the ITU Outreach nurses. Those guys were my heroes when I first started and I learnt a lot from how systematic they are too- definitely worth seeing in action if you have a poorly patient. First and foremost though you should contact your seniors if you’re worried that someone is sick.
- Ask when you don’t know something.
- There is never any shame in not knowing something, only in not caring to ask. Medicine is a huge field. There will be things you don’t understand. This is fine. We expect that. It also gives us a chance to teach you and you a better chance of learning. When I first started my consultant asked me to order a “Whole Body CT.” I suspected he didn’t mean that but I didn’t get chance to ask and so I just wrote it down. I got a call from a lovely radiologist later explaining that that wasn’t a ‘thing’ and telling me what to order. My registrar cried with laughter.
- Please try to do a cannula at least twice before you give up. Then ask a senior on your team. They can ask an anaesthetist if they’re struggling. I was that anaesthetist at one point. I rarely used an ultrasound machine. I simply took a bit of time over it. Most patients are happy for you to learn too and appreciate that you’re new. People generally are quite nice. Just don’t make them a complete pin cushion- agreeing a limit with patients usually works. And NEVER give up just because a patient tells you they are tricky. You need to have a go.
- These folks are your BEST FRIENDS. Whether you’re just starting or you’ve been a doctor for a while. The collective noun is Gaggle (many agree). They will be doing to you what you will learn to do to them at first- sussing you out. They need to know they can trust you and you need to know which of their opinions you trust. Sometimes they just need to know that you will ask a senior and get back to them- that is perfectly fine, you just need to get back to them.Be considerate, they are often doing ten things at once. Be visible if they need you. There are some healthcare professionals (HCPs) that will over-react to a poorly patient but if any of them ask for your help, you respond. Over time, you will learn which of them has a good head for spotting a sickie. Take time to teach your nurses too- at first they will know LOADS more than you and I’ve often found nurses to be fantastic teachers when I’ve been learning; return the favour if they need support.
- Learn the coffee rules.
- Rule one: do you need to pay for staff coffee? Rule two: whose turn is it to bring biscuits if that’s the gameplan? Rule three: offer coffees/teas to those in the immediate vicinity and don’t expect the HCA or nurses to make you one if you won’t return the favour. You’re a team. Oh and use the Mess. Your seniors probably won’t. When you first start though, it’s a great way to all meet each other and relax and share experience.
- Share out skills.
- When you first start, even pronouncing a death can be daunting and a new ‘skill.’ If you can, share out any new skills experiences/ go together. Don’t steal skills either. When I first started, one of my colleagues, by her own admission, wasn’t always a team player. One of the patients I was looking after needed a lumbar puncture. She tried to put herself in line to do. Not overly cool (and to be fair to her, when I pointed that out, she apologised so we were ok). But just remember that you’re all excited and everything is new. Support each other. And ask your senior to DOPS you before you do it.
- Learn something unique about your patients.
- I believe this comes from Atul Gawande. I’ve not got round to reading his books yet but another doctor taught me this. Consequently, I’ve met a patient who owned a cow called Daisy, a patient who was an award-winning tailor, a patient who was a well-known film score composer… It makes for a more interesting handover sometimes too!
- Learn to negotiate, be respectful of everyone’s priorities and remember everyone in the team is working for the patient’s best interests.
- The guy in the mortuary might be calling three times a day but that’s because a grieving family needs the certificate. The radiographer might seem to be making an excuse not to do your xray but that’s because a sick patient needs a portable x-ray first. Negotiate your time and do as you say or let that person know if you are waylaid. As an aside, the mortuary team are often lovely people to debrief to when you lose a patient; you will sadly feel grief throughout your career- this is normal and makes you human.
- Take a deep breath and start at ABC…
- Whatever happens, don’t panic. Panic clouds the mind and is not helpful for you or your patient. There’s an episode of Scrubs when Elliot tells J.D. that when things get manic and someone’s sick, she takes a slow deep breath in and out and everything seems to slow down for her. I STILL do this sometimes. It focuses your mind while you look at the patient even before you start your A-E. Be systematic and don’t skip steps.
You are about to embark on one of the best careers EVER. You will meet an array of people, sometimes 20 new people a day, and each of them will teach you something if you want to learn. If you need any tips, feel free to drop me a message on Instagram.
Most of all, enjoy yourselves.