This is the second part to the “How to be a Junior Doctor” series. See the first part here. Listen to our continued discussion below which focusses more on keeping a work life balance and some thoughts about what advice we have for you.
Regardless of the shift that you are on, any sick patient that you have been looking after will need to be handed over to the on call team. Even if there are no jobs that need to be done, the on call team should be aware of the patient in case they deteriorate.
Important information for the on call team to know includes: patient identifiable details; where the patient is; the current working diagnosis; the current management; and the plans for if the patient deteriorates. This is best done in the SBAR format: Situation, Background, Assessment, Recommendation. (See Call on Me! for more information).
Alongside handing over any sick patients that you have been looking after, any outstanding investigations (e.g bloods and scans) that may need to be acted on should be handed over. Always explain to the best of your knowledge what to do with the results. Don’t feel guilty for handing these thing over. If you’ve done everything you can to finish you jobs in the day, sometimes things are left regardless. There will be a time when these things will be handed over to you and it is part of the role of on-call ward cover and allows for continuation of care.
On-call – handover meeting
Often these will be relatively formal follow a standard format with the more senior clinicians handing over first followed by juniors. Commonly at night handovers, they will be attended by a larger team of “Hospital at Night” which includes other health-professionals and other specialities. Be respectful of everyone there and give them the same room to talk you would want.
Handover meetings are where the immediate priorities for the incoming on-call teams can be established. Any sick patients or those you have concerns about need raising in these meetings. You also have an opportunity to discuss plans with a group of people if you are continuing on shift after the meeting finishes.
Be sure to hand over any patients that have not yet been clerked and consider any that need seeing urgently as well as the investigations or jobs that are still outstanding from patients you have clerked or reviewed and what your expected actions would be. The handover meeting is also a good time to ask for advice or to clarify any non-urgent issues with seniors and remind or ask for workplace-based assessments to be completed.
Your first on call will seem daunting. They are unpredictable and the workload can feel insurmountable. Take a deep breath. You have 5 or more years of medical school training behind you. You are competent and able. You are a doctor.
At the start of your shift it is good to go through the list of jobs with others covering the same area and decide who will do what. Especially if you are new to being on-call, this is really useful to help you gain understanding of organising yourself and your responsibilities and know who is around you to help. It is also a good time to proprieties which jobs should be done first, e.g. reviewing a potential discharge or a sick patient.
Don’t forget to be nice to the nurses and auxiliary staff, it goes without saying how helpful and supportive they can be. You will feel under pressure and stressed but that shouldn’t stop you from being a kind person. Answer bleeps in a timely fashion and be polite when speaking to others. You will discover that a pleasant attitude is repaid in kind.
It can also be useful as you go around the wards to ask the nurse-in-charge to collate a list of all of the non-urgent jobs for you. Explain that you will go around and complete them all later on in the shift. This will save unnecessary bleeps and distractions for you. Just make sure that you do find the time to get round the wards and do the jobs.
Most importantly, you will need to take your breaks. A hangry doctor isn’t good! Food and water will not only give you energy for the rest of the shift, but a short break away from all of the work will enable you to focus better and complete your jobs in a more timely fashion. Where possible, try avoid excessive amounts of caffeine and sugary foods. Whilst these things will give you a welcome boost, the trade-off is a crash later. It’s easier said than done when in need of just convenience, but try aim to be healthy in what you eat and drink.
Your bleep on call can seem like it never stops ringing, and this can get quite frustrating as you don’t feel like you are able to progress with your increasingly growing jobs list.
However remaining polite, friendly and courteous to whomever is on the other end of the phone will ensure that staff will be helpful. Always give your name and role, sometimes they may have bleeped the wrong person and this will avoid an unnecessary request! Whenever someone asks for your help or advice over the phone, gain as much information as possible. This may include: the patient’s name, where they are, what the concern is, what you are wanted to do and when you are wanted to do it. When is important because you don’t want to be rushing to every request if some aren’t needed for a couple of hours. Don’t be afraid of asking for as much information as you need. Having more information can allow you to formulate a plan as you walk to the patient, allowing you to be more fluent in your reviews. Using the SBAR format again is really useful.
With all of this information you can then start to devise a list of possible problems and what you will do about them on your way to the patient. You can also ask the staff to perform appropriate tasks for you, e.g. an ECG, taking bloods or giving some treatments. Keeping a good list of jobs and how far along you are in completing them with the box system is essential. (See working 9-5…..ish… for more information).
Leaving on time is very important, mainly because you don’t want to burn out, but also because you have friends to see and hobbies to do. Keeping a good work/life balance will enable you to be a better doctor.
We all need to be able to switch off from work, so that we can switch back on when we are working. Making plans to either chill out or get away in the evenings and on the weekends are a good way to switch out and recharge. Occasional lazy days are very therapeutic, we all need them sometimes, don’t feel guilty for doing nothing and recharging yourself. If you have particular hobbies or activities that your engage in, focus on not slipping from them otherwise it can be hard to get back into them.
If something from work is bothering you, do talk about it with friends or colleagues. It is not worth worrying about it, it is better to talk it out and work out what you did right, wrong and what you can do better next time. Then you can move on and enjoy your time off. If anything is really worrying you, hand it over for someone else with a fresh set of eyes to review. You shouldn’t leave work worrying, handing over will stop this happening.
Plan leave as soon as you get your rota, both for a holiday and to break up a long stretch of shifts. It is really good to have a good break away from work where you can complete forget about it. You should escalate it if you are not able to take your leave.
What scares you?
A tough question to be asked and certainly a very personal one. Everyone, no matter how confident they seem will have an aspect of the job that does genuinely scare them. Here are our thoughts which no doubt will resonate with a lot of people.
Uncertainty of exactly what your job and role is going to be will make you nervous. Despite having spent time shadowing people before starting work, actually stepping up can be difficult. Until you start you may not fully know exactly what you’re going to be doing. Remember though, you have been to medical school and qualified because you are able so have some belief in your abilities.
The responsibility may seem daunting when you start. You spend your last day as a medical student and after just one night’s sleep you are a doctor. The doctor. With all the responsibilities that go with it. You will be expected to make decisions and act on them. You will be exposed to situations that can make you feel uncomfortable if reaching the limit of your abilities. Take a breath. You’ve been trained for this and there are people around you if you need help so call them.
What people think of you may play on your mind. It is a natural thing to worry about whether or not people think you are any good at your job. One piece of advice that Gareth gives (but didn’t say in the episode) is that a good junior doctor isn’t the one who makes the storming rare diagnosis, it’s the one who is organised, efficient and willing to learn. As Jack said, you will occasionally say or do something that may be seen as foolish, probably as a result of your inexperience, but embrace it and don’t dwell on saying the wrong thing in front of colleagues. As long as you are safe in your actions and considerate towards patients, their relatives and your colleagues.
As you move onward in your career, your responsibilities will increase. Along with what people think, you may become concerned whether people trust your decisions. Take your time and make considered choices. If you have any difficulty knowing your next steps then get advice from someone. You, as a FY1 in your first year, are not expected to make complex decisions alone and will quickly gain an idea as to what decisions you need someone else to help with. Ask for help if you think you need it.
All new doctors are new and any older doctors have been new at some point as well. Everyone around you is either in your position or has been whether recently or not. Talk to others about what it’s like for them or what they found useful. Support your colleagues, whether that’s by making sure they get breaks or by providing an ear to someone that needs it.
Final pieces of advice
Leave work! If you stay in on-site accommodation then it is important to get off-site otherwise you will feel like you never truly leave work. The balance between work and a life outside medicine is important and neglecting it will be of detriment to you.
You’ve been to medical school, so have some confidence. You have been trained intensively for this and are definitely capable.
Don’t be a martyr. If you are consistently finding yourself struggling then speak up. It doesn’t mean you are bad at your job. You may find that the workload is more than any one person can handle and if so, those in charge need to know.
We are advocates for our patients and to be so we must be advocates for ourselves even if all that means is getting outside to have a breath of fresh air.
We hope you have found these two episodes useful. We welcome any additional thoughts on advice for new junior doctors and will gladly add to what we already have.