Category:Surviving the PRHO/FY1 year
The transition from being a medical student with no real responsibility to a doctor is difficult. The recent changes in working conditions have made the job of a junior doctor difficult in different ways from the past.
Working weeks of >100 hours are gone, but with the almost universal introduction of full shift rotas, the working day tends to be more intensive and you may often be in the position of looking after more patients, including a substantial number that you have little or no knowledge about. The administrative burden of junior doctors remains, in most places, considerable.
The pressure of work can sometimes be all-consuming and if you are not careful, it is easy to lose sight of your own welfare and, more dangerously, life outside of medicine. There are many other factors that compound the stresses of starting life as a doctor: Some people will do their jobs in an unfamiliar area. Living in hospital accommodation, now no longer free in many places, offers less privacy and less comfort than private accommodation, with the added misery of living and working in the same place (though it can be an excellent way to get to know colleagues). The job hunt for the next set of jobs often starts a few months into the FY1/PRHO year although the F2 year provides a much more satisfactory route to training than was available to previous generations of doctors. And, despite a regular salary, most people have so much debt that they do not feel financially secure till towards the end of the FY1 year.
For these many reasons, we hope these pages will help prepare you, in some part, for the stresses and strains of being a junior doctor.
Unless you have trained say in your final year at the same hospital, you have an entire new health care culture to fit into. The differences are challenging with different ways of doing the same thing being one of the joys of comparative healthcare. Try not to get overwhelmed with the responsibility and the unsaid expectations and priorities. While much of what you need to get around in the first month is a reordering of whats important in your mind do remember that the system makes some allowance for the increased mortality associated with change of house and is possibly improving. Suddenly remembering the task not done due to distraction is being human and a quick phone call or other action to double check marks a good rather than poor doctor.
Looking after Yourself
A tired doctor is an ineffective doctor. Important things include:
- Knowing when to ask for help
A wise senior SHO told me when I started my PRHO job: "Never stand when you can sit, never sit when you can sleep". It was sage advice.
Recognising and avoiding burn-out.
Get plenty of rest when off-duty, don't neglect family and friends, and above all remember that no matter how important your career is to you, nothing in life is more important than looking after yourself and those that you love.
Unfortunately, it takes some doctors many years to accept where their true priorities lie - learn the lesson early and you will be a well balanced human being as well as an empathic and dedicated doctor.
see also Practical procedures
Venepuncture | Intravenous cannulation | Arterial blood gas | Central venous access | ECG | DC cardioversion | Pleural aspiration | Chest drain insertion | Lumbar puncture | Paracentesis | Nasogastric tube insertion
You should be far more prepared than your colleagues of decades ago when they did their house jobs. However communication is value added time that may be divorced from easily measured productivity. It is worth asking if there were 5000 consultants in the NHS in 1948 and 40,000 now if the old style consultants would have had time for effective communication. There is a balance and the key of course is productive communication.
Working with Nurses
Nurses can be a source of experience and knowledge, helping the frightened PRHO to find their feet, or, the utter bane of your life! You WILL meet both types. Don't argue with the difficult ones - you never win! The cardinal rule is, NEVER take responsibility for the actions of a nurse. If you feel pressurized to prescribe by a nurse, speak to your SHO or registrar.
Most junior doctors start out wanting to please everybody, but rapidly discover than when the bleep doesn't stop, then a triage system of sorts is needed. Some jobs must be done immediately, others can wait, others can be left for the new shift or the patient's own team. Saying 'no' does not come naturally, but it is important for your patients that you prioritise your jobs according to clinical need. So long as you explain yourself and remain firm and polite, most nurses will accept your reasons (but you should always do what you have promised).
Pleasing your consultant
Consultants, like most human beings come in all shapes, sizes and shades of personality. If you try to be aware of what is happening with your patients, anticipate questions and offer ideas regarding investigation and management, and most importantly, display maturity and empathy in dealing with your patients, you will have little to worry about. If you do not feel comfortable doing something say so.
Referring patients all too often feels like trying to lobby more senior doctors to do things they would rather not do!
You will develop relationships with various specialities.
Know what you are talking about, present clear reasons for the referral, and make it clear that you are but the mouthpiece for your Boss!
Communicating with relatives
One of the most challenging tasks for the new Doctor is informing relatives of bad news. Make no mistake - relatives remember years later a moment`s kindness, gentle manner and care in dealing with them and their loved one. You have to develop skills of diplomacy very quickly as some people are a joy to deal with, whereas others would try the patience of a saint. Do not step beyond your level of experience in discussing prognosis or treatment - stick to what you know, and if questions are asked that would be best addressed by a senior doctor on the team, offer to speak to the boss and request an appointment.
Learning on the Job
Physicians are likely to expect their F1s to carry an Oxford Handbook of Clinical Medicine and to read it before they ask them something. Finding out your own answers by reading, thinking and coming up with a plan is part of your development and is much more memorable than being spoon fed. At some stage in the future you will be without someone to ask so you will have to find your own answers. Read read read read and then read some more...and don't go to bed without having learned something new every day.
- Accommodation - practical issues (e.g. contracts, minimum standards, when allowed to move in)
- Money - financial advice, pay off debts, consider critical illness cover, contents insurance
- Job issues - re-banding, internal locums
- Rota - design, EWTD/New Deal rules
- medical indemnity
- getting full GMC registration
- ↑ Jen MH, Bottle A, Majeed A, Bell D, Aylin P. Early in-hospital mortality following trainee doctors' first day at work. PloS one. 2009; 4(9):e7103.(Epub) (Link to article – subscription may be required.)