As my four months as an FY2 (SHO) in the ED at Virchester’s Southern Sister Hospital come to an end, the St Emlyns’ team asked me for a few thoughts about life as a junior doctor in the crazy, but incredible world of Emergency Medicine. These have probably been the most influential four months of my medical career so far and working here has been a wonderful opportunity. Not only have I learnt a lot and feel like a much more competent doctor, it has made me realise how much more there is to learn! Here are a few tips to help you settle in and get the most from it all…..
Your first shift- enjoy it!
Your first few days are daunting for a number of reasons. The relentless induction, with facts both clinical (how to make sure no one dies) and non clinical (what to do if the hospital is on fire!) being thrown at you. With my brain reaching full capacity it’s hard to know quite what to focus on, but I figured that patients were my priority and worked hardest at remembering the medicine, figuring the fire brigade could sort out the inferno. The ground is unfamiliar with new people, new systems, and new questions, but don’t forget, everybody is happy to help. I realised that the ED nurses are very used to this constant flow of new faces and all of them were kind and patient with any questions I asked. And I asked lots of questions!
Take care of yourself
I know I should really put something about patients here, but you are no good to them if you don’t look after yourself whether at home or at work. It is important to eat enough, sleep enough, and stay hydrated. Take regular breaks! (this is encouraged by seniors – the consultants need you at your best) Make sure you eat enough carbs as you will be standing up a lot and walking constantly. I like to prepare my food at home to save money. The shifts can be unsociable, and it is a difficult balance to ensure you rest (and sleep) enough before your shifts, yet see friends or family or that hobby that you enjoy doing. This is possible, although you may need to plan ahead with friends with more of a “9 to 5” existence. On the plus side, with weekdays off life’s “practicalities” are much easier and it’s never a problem to visit the supermarket when everyone else is at work.
The rota is infamously brutal, although the “rotamasters” (one of the ED consultants) do all they can to make it bearable, but the good thing is that you get at least two long periods off amongst the other days, and you can swap shifts…but don´t swap too many, as it will make you tired.
Work as part of a team.
You are working with a great team with lots of senior support and many comedy moments. Always ask for help if you need it, everybody is happy to help. Take opportunities to get stuck in, ED is a great opportunity for procedural practice, and to deal with sick patients in resus. At the start of every shift say where you would like to go. Very few of us do this but it is one of the things I wish I had done more.
Good timekeeping is vital – As a key part of the team, you are letting people down if you are unnecessarily late. Be early for work, you will feel more relaxed, and your colleagues know they can depend on you. You will also be grateful when, at the end of a night shift, they reciprocate and you can leave on time. Obviously if you can´t help being late or unwell, inform the clinician in charge that day as early as possible. You must also finish your shift on time. Without making the most of your rest time “work life balance” can become, well, unbalanced and that is not good for you, your colleagues or your patients. It’s hard to do this at first – the urge to finish everything completely is very strong, but you will soon get used to handing over patient’s care before they are fully sorted: it’s part of the job.
Use your intuition
If you don’t feel right about a patient, seek senior advice. Your intuition, that “end-of-the-bedogram”, can be pretty accurate and you should act on it. There are some cases you will be asked specifically to discuss (children under 5, patients with chest pain, etc) but it should not be limited to these. In fact I would suggest you discuss everything, even obvious stuff, when you start. You will never be criticised for asking and above all never compromise patient safety despite all the pressure to work quickly.
Enjoy it!
Enjoy the banter with your colleagues (even the consultants have a sense of humour!). You need to have a giggle in this job (and lots of Domino pizza and Costa parties in the middle of the night).
Enjoy the excitement of getting to work and having no idea what is going to happen. Unlike some other specialties you are much better supported “out of hours” (we have consultants on the shopfloor seven days a week from 8am til midnight) so I actually quite like working them!
Enjoy the life experience. If you have any issues at work, it´s worth reflecting on them with someone. I´ve felt particularly sad about some of the cases I have seen, but having time out and speaking to others definitely helps the situations. Your educational or clinical supervisor, with years of ED experience, is always able to chat, but if they are away the other consultants and senior nurses will always be happy to listen and offer a supportive shoulder.
And most of all, enjoy working with one of the best teams in the hospital. They will support you through both the good and the bad times, you will learn more than you thought possible and be a better doctor for the experience.
Charlotte Wyatt
Ed – And don’t forget to listen to the podcast and blog post on getting started in EM
