Junior Doctor Anecdotes: The Thoughtful Security Guard

As part of GP training we have to complete at least 72 hours of out of hours shifts as trainees, and these can include home visits, telephone triaging, or seeing patients with out of hours GP services.

I’ve now completed 42 hours, so I only have 30 left to do, which is quite a good position to be in, thank God! As we can only do these out of hour shifts in GP rotations, I can meet the requirements in my current job, or when I get to ST3, where I will be spending the whole year in one practice.

I did a 12 hour night shift with the home visiting service last night (so much for no more nights lol), but overall it wasn’t too bad – my GP Supervisor and our driver were very nice, so it went quickly.

On my way home from the shift, I found myself thinking of an encounter I had had after one of my previous out of hours shifts. I had finished around midnight and was waiting for my lift home, and was startled by a knock on the sliding doors of the building I was waiting in front of.

I turned around to see a security guard, who immediately apologised for startling me, and told me that he was looking after the building overnight and had seen me on the security camera, so wanted to check I was okay.

I told him I had just finished a shift and was waiting for my Uber to pick me up, to which he replied that he could wait with me if I wanted, as it was dark outside. I thanked him for the offer, and told him it was fine as was my ride was less than 5 minutes away. After confirming that I was okay, he then said that he would be keeping an eye on me on the security cameras with his team until the Uber came, as an added reminder that I wasn’t on my own.

Maybe it was tiredness after the long shift, but this really moved me. It was a much needed reminder that people can be kind and considerate of others, as the security guard could have just ignored me and got on with his job, but he went out of his way to check on me, and kept an eye on me until I was safely on my way home.

2023 has been a year of many highs and some lows, and it can be easy to become cynical and disillusioned by the state of the world. However as we step into 2024, I hope you remember that there is still good in the world, and that a single act of kindness can go a very long way.

Happy new year, everyone, and God bless – here’s to a better 2024.

Junior Doctor Anecdotes: Finding My Voice Again

Last week, I visited an end of life patient at home to review how they were getting on.

I found reviewing their symptoms and making sure they had anticipatory medications prescribed pretty straightforward, as this is something I have done a lot with end of life patients in hospital. I was also able to clarify and document that they had a RESPECT form in place and that they had capacity to decide that they didn’t want to be admitted to hospital again, preferring to be treated at home for any emergencies.

What took me by surprise was the patient asking if I could sing for them, as during my review the television was on, and they mentioned that Carousel was their favourite musical, so they wanted me to sing their favourite song from it.

Anyone who follows this blog will remember that I used to enjoy singing to patients to help them relax whilst having cannulas inserted, but a couple of months ago, an inappropriate patient made me decide to never do this again, as they had attempted to grope me when I was singing to them.

So for a moment I hesitated when this patient asked me to sing, because I was taken back to that inappropriate patient and how they’d made me feel.

But then this patient asked again, and I remembered where I was and the fact that they were dying. Their physical needs had been met and they had all their medication prescribed, but holistic care is about the whole patient, so going the extra mile to address their other request (singing their favourite song with them) was the absolute least I could do.

And that was how I was able to forget the awful experience I’d had with the other patient, and focussed on the patient in front of me to sing You’ll Never Walk Alone from Carousel, which they were quite moved by and appreciative of – we were both tearing up by the end. Their family were outside the room while this happened, and the Palliative Care Nurses had also arrived at this point, and they too were moved by the patient’s reaction.

As doctors it can be all too easy to only focus on the clinical aspects of patient care, so it is important to remember that patients are individuals with interests and lives of their own before they become unwell, and I will make sure I always keep that in mind.

Highs and Lows: From Compliment to Complaint

It’s been quite a tough week.

I’ll start with the good:

A patient with severe agoraphobia came to the GP for the first time in years and was booked in with me. I was running very late that morning and feeling very overwhelmed so the message they left really made my day:

And now for the not so good: I had my first complaint this week.

A patient sent an email to the practice with a complaint about her experience with me, as she had been unhappy about her management.

It really took me by surprise and made me feel very sad initially, because I have never received a patient complaint directed solely at me before, so I definitely took it personally. I was particularly hurt by her dismissal of me as a ‘junior’ doctor, as she implied that I didn’t know what I was doing.

This was frustrating because my supervisors agreed with the management plan and didn’t think I had done anything wrong, so I feel like it’s harder to come to terms with complaints in cases like this, as maybe it might have been easier to accept if I had made an error.

It did knock my confidence at first, as I felt like my abilities as a doctor were being dismissed, which is something I’m a bit sensitive about, as I tend to get this a lot from patients, who sometimes question whether or not I’m a qualified doctor because I “look so young.”

I’m so SO glad I documented well following my consultation with her, as looking back in the notes showed that I’d managed her appropriately. So my supervisor was very supportive with this, and wrote back to the patient to resolve things.

It just reaaaalllyyyyy sucks that I now officially have a complaint in my record and I’m still so gutted. I guess this is a good lesson to learn early on in my career – not every patient will be happy with what I do, so I mustn’t take it personally.

Life goes on, and I thank God for getting me through this week of nonstop Ls. It is well!

Musings On My First Month in GP as a GP Trainee

Any keen followers of this blog will know that this isn’t my first GP job since I qualified, as I did four months in a practice up north when I was an F2 doctor, but GP definitely hits different when you’re actually in specialty training. So here are a couple of my thoughts on it so far:

1. Home visits make me feel like I’ve stepped back in time some days. I have at least one visit a day, and with working in a deprived area, I feel like I’m in Call The Midwife when I turn up at patients’ houses sometimes. A lot of them have their extended family there as I take a history and examine, so getting used to having an audience has been quite something! I have a snazzy bag with all my equipment, which definitely makes me feel and look official as the “Doctor calling!” I forgot my ID in my first home visit though, so convincing the patient I was really a doctor was quite a memorable experience that I will not be repeating again.

2. Portfolio is the bane of my life. As GP trainees, we have certain requirements, clinical assessments and mandatory training that we need to evidence in our online portfolios to be able to progress to the next year of training. Did I mention that we also have to pay for these portfolios as part of membership of the Royal College of General Practitioners (RCGP)? £291 registration fee then £423 per year as a trainee 🙃🙃🙃

3. Love that we have whole day teaching every 2 weeks, and LOVE that it’s mostly virtual because not only is the teaching quite useful stuff, I can catch up on life admin/chores as I listen. Love that for me!

4. Had to break bad news on the phone re: possible endometrial cancer, as the patient couldn’t come in person and we had to urgently refer. It was awful and thinking about the patient’s gutwrenching sobs made me struggle to sleep that night. She called back the next day to tell me how much she appreciated how I broke the news to her, giving her space to cry and ask questions. (I cried.)

5. When I tell patients I’m a GP in training, they assume I’m still in medical school, and are quite surprised when I tell them I’ve been a doctor for nearly 4 years now. They then try and guess how old I am – no one has guessed right so far.

6. Slowly building confidence with my intimate examinations – my supervisors have been so supportive, and I’ve now been signed off to do breast and rectal exams without needing supervision. Still not fully confident with vaginal and speculum on my own yet (#noregrets for not doing an Obs and Gynae job though), but slowly getting there!

7. Started off on 30 minute consultations and now down to 20 minutes, with the aim of getting down to 10 minutes by the time I get to ST3. I’ve found this tough, especially when patients turn up late and still need to be seen, grrrr. Make sure you’re on time to your appointments, people!

8. And last but most certainly not least, being in GP so far makes me happier than my hospital jobs did, so I’m very grateful to God for being in a specialty training post that I enjoy.

Special mention: A child I saw with his mum called me a “cheeky doctor” because I was making him laugh as I was examining him. At the end, while he was distracted with the stickers I gave him, his mum said that his previous experience with a doctor had not been positive, so she was grateful and relieved that I’d given him a happy memory. What an honour, really made my day!

The Last Two Weeks In Pictures

Joined the picket line in my home town for the second round of junior doctor strikes:

The Keen One a.k.a Kenny’s hen parties were super fun – planning was stressful at times, but I took my responsibilities as Chief Captain of the Bridesmaids VERY seriously, and it all came together in the end!

Things I Won’t Miss About Being a Hospital Doctor

As of last weekend, I am officially DONE with hospital jobs! My first GP rotation starts tomorrow, and I’m super excited- praying it goes better than my last job did, and I’m definitely looking forward to having even more evenings free, yay!

To summarise my time in hospital, here are some of the things I definitely won’t miss:

1. Ward rounds. I’ve never been a fan of how long and tedious they can be, especially when you’re just writing in the notes and not learning much.

2. Consultants borrowing my stethoscope and not wiping it down when they’re done- I’m very possessive over my stethoscope so this is really annoying.

3. Discharge and Flow Coordinators hounding me for patient discharge letters. Unwell patients are a bigger priority than those well enough to go home, but sometimes the need to clear beds and improve patient flow causes people to forget this. Grrrr.

4. The chaos of medicine ward cover and being bleeped for silly jobs- I’ve definitely become more blunt and firm because of this. Like, why are you bleeping me at 5:30pm to prescribe sleeping tablets for a patient??? NO.

5. Understaffed wards that meant I ended up doing the work of 3 doctors and didn’t get a proper lunch break sometimes.

To end on a positive note, here are some things I’ll miss:

1. Being on nights. I’m actually more of a night person and actually feel more awake during night shifts, so I tend to be more productive during them.

2. Watching patients interact with each other in their bays and become friends/make plans to meet up after discharge. Always so heartwarming!

3. Doing cannulas. Who would have thought that I’d miss THIS? I guess I’ve come so far since I used to struggle with them (we thank God!), so I now find them much easier and quite satisfying to put in.

Ahhh, what a journey it’s been. We had a team takeaway during my last shift and it was very wholesome. My last AMU weekend was with an Endocrine Consultant and Registrar, so atleast I got to have some Endocrine and Diabetes teaching in the end!

NO MORE HOSPITAL JOBS WOOOOOOO (But I’ll definitely be back to locum in ED, ofcourse 😉)

Why I Am Striking

Exactly 10 years ago I had my interview for medical school, and over the next three days I’ll be joining the junior doctor strikes. My 17 year old self would have never seen this coming – refusing to go in to work, really? Goody-two-shoes me who has dreamed of becoming a doctor since she was 5? Never! But nevertheless, here we are. So I thought I should explain why.

First things first, a junior doctor in the UK is any doctor who isn’t a Consultant or GP. It annoys me that the media tries to put across the narrative of junior doctors as ‘young’ or ‘inexperienced’ doctors who are fresh out of medical school, and this isn’t true. I graduated 4 years ago and I am still a junior doctor. My Registrars who are nearly 10 years post graduation are junior doctors. I know GP trainees and doctors who are in their mid/late 30s – we are all junior doctors, so let’s get that straight to begin with.

Next, let’s talk about pay- since 2008, pay for doctors has gone down by about 26%. So a newly qualified FY1 doctor, after 5-6 years of medical school and graduating with nearly £100,000 in debt, gets paid about £14 per hour. As an ST1 GP Trainee with nearly four years experience as a doctor, I get about £19 per hour, and a Registrar (ST6-ST8 with eight to ten years of experience) gets £28 per hour. The BMA is calling for pay restoration, to bring junior doctor pay back to the level it was in 2008. This is because with the cost of living crisis and the cost of being a doctor (many people don’t know we have to pay hundreds of pounds yearly for exams, indemnity insurance, and to keep our registration), a lot of doctors are struggling.

It’s due to this that many are leaving to work in Australia and New Zealand because doctor pay is better, as are working conditions, because as you can imagine, people are more willing to work if they know they’re getting what they deserve for their skills.

Now I’m well aware that I’m so blessed to have a secure job, and many people can only dream of getting what I get paid. But being a doctor isn’t an ordinary job – it comes with so much additional stress and responsibility, that I even struggle to talk about the toll it takes on me some days (I’ve always been better at writing how I feel). Knowing a decision you make could cost someone their life is so SO hard, and I feel like a lot of the general public just don’t understand this. So is it too much to ask to be paid to reflect this?

Having a National Health Service with the majority of services being free to access is one of the greatest things about the UK, and I’m so proud to be part of it. But without enough doctors to provide services, the NHS as we know it isn’t sustainable, and that makes me so sad.

But that’s not the main reason I’m striking. I’m striking because I think I’m beginning to show signs of burnout.

I’ve been more irritable and snappy on the wards, and I’m worried that this is slowly starting to creep into my life outside work because I’ve been getting more short-tempered, easily annoyed with people around me, and I just want to be away from everyone some days. Also, I’ve been crying for no reason sometimes, what’s up with that??

We had a GP teaching day on wellbeing last week, and one of the talks listed symptoms of burnout. I cried because I could relate to quite a few of them.

You see, working on a ward with inadequate staffing means I’m looking after too many patients, and this is very stressful. It’s also really unsafe because if doctors are too stretched and tired because they don’t have time to eat or drink properly during busy shifts, things can get missed. And if there is no continuity of care because the ward has different locum doctors working there everyday, patient care suffers. This is what is happening across the NHS at the moment, because there just aren’t enough staff because the Government isn’t doing enough to retain them, and patients are dying because of this.

I knew very early on in medical school that I was never going to be top of my year or anywhere near that, but I knew I would be a good doctor because even though I wasn’t as “brainy” as some of my colleagues, I genuinely loved interacting with and spending time with patients. I’ve always seen being compassionate and empathetic as my strengths, and the day I start to lose that is the day something needs to change.

Well that day has come much sooner that I thought it would because I was snappy with a patient last week due to being stressed on the ward, and I actually made them cry. It was like an out of body experience because I felt like I was looking at myself and thinking, “Who are you?”

So I feel like the day for something to change is here, because if I start to lose my compassion then where does that leave me?

(P.S – I immediately apologised to the patient after snapping and she was so so kind about it – “It’s okay, you’re all doing your best, I know it’s busy.” Reader, I cried.)

Junior Doctor Anecdotes: YAY For Friends

Today on my ward we were understaffed (classic), with only two junior doctors (myself and an FY1) and one Consultant to cover 27 patients. During handover this morning, a locum FY3 doctor joined us for the day, so we were very glad to have someone else – I’ve been on the ward before with only two of us doing jobs after the ward round, and I’m not exaggerating when I say it was the worst day I’ve had since I started GP training in August.

Anyway when I got back from lunch, I found that the number of junior doctors on the ward had increased to 5, as two other locums had joined us. Turns out the FY3 doctor we had on the ward has friends who are also locums at our hospital, and because the wards they were working on had enough staff, they came to help their pal (and us) with the jobs we still had to do.

How sweet, right?

It took me back to when I was a FY1 doctor and my friend (and fave future obstetrician), Lisa, used to come help me with my cannulas, as if you’ve been following this blog for a while you’ll know that I used to really struggle with them. The shifts I worked with Lisa were some of my highlights as a FY1 doctor, as we used to help each other out with reviewing patient plans when clerking in AMU (it’s definitely less intimidating to present a patient to your friend than a Registrar/Consultant first), sharing food/snacks during night shifts and helping each other with jobs.

Work is so much more fun when you’re having laughs with your pals, so this post is dedicated to my dear Lisa – couldn’t have made it through foundation training without you.

4 Consultants in 3 Months during my 2nd rotation = 1 Stressed GP Trainee

HELLO. The prodigal returns…

It’s been a while, (sorry to my loyal readers) – as always I take breaks from this blog when there’s too much going on in my head, but I’m BACK and feeling a lot better than I did when I last posted on here, so thanking God for that.

Currently working on a general medicine ward (was supposed to be Diabetes and Endocrine but it got changed just before I rotated, grrrr) and it has been so chaotic. We’ve not had a regular Consultant since I started in December, we don’t have a Registrar, and most of the time we’re understaffed so I can be looking after between 9 to 14 patients on a normal day. I don’t usually get to have lunch till nearly 3pm, so yeah it’s been a draining rotation so far.

I’m counting down the days till I can move on to my GP rotation in April because work hasn’t been very fun lately, and I’m feeling myself becoming more easily irritated, less patient and definitely more stressed when I’m on the ward, which isn’t fair on patients. Unfortunately hospital medicine is looking more and more like this across the country, so this is one of the many reasons why a lot of junior doctors voted to strike, but more on that another time…

It’s not all doom and gloom though – being back on a ward means I have more of a routine compared to when I worked in A&E, so I’ve been able to start gym classes, get more involved with church, and also have more time to catch up with friends in the evenings, so definitely some reasons to be cheerful.

Other updates on the life of Tai:

• I was back up north last week to help deliver a lecture on racial microaggressions for gateway students as part of my role as a honorary lecturer, and it was very nostalgic seeing my old haunts again – so grateful to still get to do this. We’ve also gotten some good news about possible publication of the papers we’ve been working on so watch this space…
  
• So great to catch up with my fave future obstetrician, who has passed part 1 of her MRCOG exams – go Lisa!
  
• Went on a mini break with Starbucks Gal to Copenhagen a couple of weeks ago and it was SO MUCH FUN.

The Inappropriate Patient

Today I was asked to help with cannulating a patient who had difficult veins. When I got to him, four people had tried already and he was feeling understandably quite fed up. He also wasn’t a big fan of needles, but he really needed this cannula so I tried to put him more at ease by doing what I do with needle-phobic patients – ask them their favourite song and offer to sing with them as a distraction.

I’ve written on here about being successful with this in the past, and you can read about it here or here, so I thought this time would be similar. This patient really liked Oasis, so we chatted about the Gallagher brothers and his favourite Oasis song, Wonderwall, and he was more relaxed as he started singing it. Everything was going great – found a vein, and as I was about to put the cannula in, he made a comment out of nowhere about wanting to put something of his own in my *****. (I will not write the word he said here, but it’s spelt similarly to ‘funny’ if you change just one letter, which is ironic because it most definitely wasn’t funny) and then reached out to grope the front of me.

I was quick enough to move back before he could touch me, but I definitely saw where he’d been aiming for. I firmly said that it was absolutely not okay for him to say that to me, and completely inappropriate for him to try and touch me down there. And you know what he said? That we’d been getting on so well and I led him on by singing with him.

I was just doing my job and trying to help him not focus on the needle, and he thought that gave him the okay to sexually harass and attempt to assault me. You know what’s even sadder? This isn’t new – I was still a medical student when something like this happened on a ward I was on during placement, and I feel as sad and angry about it now as I did then. The worst part is the small part of me going over everything I said and did, trying to understand if there was anything I did or said that could have been taken the wrong way. And that really really sucks.

So yeah. I don’t think I’m going to be singing to patients again.