There has been a lot of chat on social media, and in the regular media, about the contract, pay, and working conditions of junior doctors. We have seen truths, half-truths, bare-faced lies and misconceptions. There has been spin and counter-spin. Quite frankly, I’m dizzy, and I’d like a few facts on the table. In the words of Harper Lee, through the immortal voice of Atticus Finch, ‘you never really [know] a man until you [stand] in his shoes and walk around in them’. So, to mix my literary metaphors, I invite you to put on my shoes and come and join me down the rabbit hole of life as a junior doctor in the NHS.
I graduated as the most junior of junior doctors in June 2007, and 2 months later, fresh-faced, bright-eyed and bushy-tailed, set off to work in a busy district general hospital in central Scotland. I started work on nights. Needless to say I was petrified. My first task on the job was to prescribe some paracetamol – I checked the dose in the BNF. My second task was to confirm that someone had died.
It was a great hospital to work in. Life was split into two halves. The days consisted of a ward round of all the inpatients, mostly led by consultants, registrars or senior house officers. After seeing the patients, it was time for the jobs: blood tests, cannulae, requesting scans and reviews from other specialties, re-writing drug charts and TTOs, endless endless TTOs. ‘To take outs’ – discharge prescriptions and brief letters to the GP. Days were easier; many people are admitted with a problem, say pneumonia, they’re treated with antibiotics and oxygen, get better and go home. Many people however do not have a simple inpatient stay, and need lots of tests and thinking to work out what is wrong and how to treat them.
Which is part of what made the on call side all the more interesting and difficult. Part of it was seeing the new patients, or ‘clerking’ them – talking to them about what was wrong, examining them, working out what the diagnosis was, or the differential diagnosis and which tests to do to work out the problem. The other part was looking after the wards out of hours, prescribing fluids and warfarin, and also reviewing patients who were unwell out of hours, ladies and gentlemen who woke in the night with fevers, chest pain and shortness of breath, amongst other things.
Sometimes it was fine. As time goes on, you get more used to dealing with these things, and know what you can deal with alone, and when you need to call for help. Sometimes it was not fine. I remember being bleeped urgently away from a cardiac arrest (where you try desperately to restart the stopped heart of a patient) to someone who was unconscious because of a low blood sugar, trying and trying to insert a needle into their vein to give them some glucose before they developed permanent brain damage.
Thankfully the needle eventually went in, the patient was recovered without complication, and I learned to always ask for help when I needed it.
The first year was a whirlwind of activity. You learn so much – both medical and non medical knowledge, vitally important wherever you go. Important things I would tell anyone starting their medical career: eat when you can; accept all offers of tea; if you need to go to the loo, just go, there are no prizes for going into urinary retention; if you’re carrying the cardiac arrest bleep, ensure are wearing shoes you can run in; again, no prizes for leaving them scattered in the corridor as you sprint across the hospital. Oh, and make sure all your clothes are machine washable. Nurses can supply bags that dissolve in the washing machine for when it all gets a bit grim.
A lot of time has passed since those days. I’ve meandered a little bit through my career. There was a sharp detour through Emergency Medicine training; I knew after a fortnight on the job it was not for me, but I chose to stick it out for two years, to learn more particularly about intensive care medicine and anaesthetics, which has been invaluable when taking care of the sickest of sick patients – it’s all about knowing when, and who, to call for help.
Seven years later, and I’m still classed as a junior doctor. My days are very different, and rest assured for the more junior junior doctors out there, life does get better.
Monday mornings bring handover from the weekend. I work in a tertiary centre with generally between 40-60 haematology inpatients, and we are split into teams looking after different patient groups and diagnoses. Currently I work on the transplant team. After handover, there is a discussion about all our patients with consultants, registrars, senior house officers, the ward sister, dietician, pharmacist… and then we go on the ward round with the attending consultant, or consultant looking after the ward that month. A similar but smaller meeting happens later in the week, and the other days either I or one of the SHOs lead the round.
Ward rounds provide the main bulk of the inpatient work. If you’ve been in hospital, you’ll have experienced this: we go round, see all the patients, examine them (not every day). The aim is to ensure the patient is getting better, that treatment is progressing as required and any complications are detected and managed as quickly as possible. We may not spend a long time with each individual patient, particularly if all is going well, but rest assured we remain vigilant for any problems.
Lots of our patients are in hospital for weeks at a time, undergoing intensive chemotherapy for potentially life-threatening conditions, so there’s a lot of talking too. We chat about the significant things, death and finances and how to talk to children about the end. There’s a lot of chat about the little things too – books, cakes, socks, all kinds of things – if you’re stuck in a single room for six weeks (with a rubbish view most of the time), part of my job is to bring a little bit of the outside world and normality in every day.
We deal with a lot of outpatients as well. I love this part. It’s a combination of meeting new patients, working out what’s wrong and how to fix it, and reviewing patients you’ve known for months or years, meeting children and grandchildren. I love seeing that the treatment has worked. Life is for living, this is my philosophy on everything I do in medicine. Frequently there is short-term hardship for long-term gain in quality and quantity of life, and we need to go through all of that and explain it to patients, so we are all happy they are making the right decision for them.
A discussion of life as a junior doctor would be incomplete without mention of out of hours work. For many specialties, this involves an on-call rota where you are scheduled to be in hospital seeing new admissions and reviewing sick patients. In haematology, we do 24 hour on calls, with a ‘first-on’ on call from home. There are SHOs in all the time; on my on call days, I leave when the work is done (normally about 7-8pm), and sit and wait for the phone to ring. Sometimes it’s only a couple of times, frequently there are a few calls in the evening and then 2 or 3 overnight; about one night in three the phone does not stop ringing.
The cats love it, they have some company and cuddles in the middle of the night (although a kitten purring on your chest as you’re on the phone apparently gives a lot of interference on the line). My husband loves it less – I’m told I have no indoor night-time phone voice. I’m yet to have to full hat-trick of badly timed calls (in the shower, doing the cat litter trays, in the loo), but it’s come close and I’m sure it’s only a matter of time. Luckily my colleagues are lovely, and if one of us has had a dreadful night, we try to let them get home early for a bit of sleep.
I’d love it if our only aim was to get people better. I’d love it if we could fix everybody. Sometimes, the treatment does not work. The cancer comes back. The only chemotherapy available would kill the patient. There is an infection we cannot treat, or one or more organs fail. That is the inevitable downside of the job. You build relationships with patients, and it genuinely feels like you’ve failed them…. I still believe that life is for living; Dame Cicely Saunders, my hero and founder of the Hospice movement, said her aim was to help people to live until they die. If I can help someone through the transition from being well to having a terminal illness, and make the most of the time they have left, then I have done my job well.
There have been times in my career when I’ve looked to leave. They say medicine is a transferable skill, but I’m not sure to what. At my lowest, I found that whilst I remained capable of going to work in clean clothes, all other activities were impossible. Food came in the form of oven-ready pasta bakes, cleaning went out of the window, and friends and family were neglected. There was no left over energy for anything more than a superficial browse of fish4jobs.com, followed by hiding under a duvet. Those times are thankfully over for me, but if they ring true for anyone else, then I’d suggest a trip to the GP and perhaps a little time off might be in order.
I’m so glad I came through that and have found a job I love and one I’m good at. Hopefully in a little while (2 years, 10 months and 11 days, not that I’m counting), with the last massive exam passed, I’ll be a consultant, with all the trials and triumphs that will bring. In the mean time, I’ll remain part of the NHS junior doctor contingent, proud to treat anyone and everyone who comes my way.
PS Yes those are my real work shoes. They get squirted with Scholl shoe spray when the cats start to growl at them.
PPS I promise my stethoscope will be cleaned with industrial strength detergent before it goes anywhere near a patient.