I Still Don’t Like Psychiatry

I didn’t have a great start to this rotation because I was told 10 days before I started that it was changing from a community to an hospital based post, but the upside was that I didn’t have to do on calls. I was also told that I could do outpatient clinics weekly if I wanted to, and I agreed to do one a week under supervision of a Consultant Psychiatrist.

3 days before these clinics were to start, I received an email informing me that I was now doing two clinics a week. No explanation or apology for the late notice; it was pretty much a ‘For Your Information’ thing. Ofcourse I was not having it, and refused to do the extra clinics because this wasn’t what I’d agreed to, it hadn’t been discussed with me, and it was unprofessional and just plain RUDE that this was being sprung on me like this.

I feel like this just sums up life as a junior doctor because you’re made to feel like a name on a spreadsheet being moved for service provision, without any consideration of the inconvenience or unfairness of it all. I have a life – being a doctor does not define it! It’s very unfair and I think I was absolutely justified in responding with emphasis on my disappointment in the poor communication and how badly it had all been handled. I am a doctor and deserve to be treated like a professional – the infantilisation and how junior doctors are treated in the NHS is really not okay.

So what was the resolution?

I decided to do the extra clinics because they’d already booked patients for them, and it would have been unfair on the patients to have their slots moved. If they hadn’t already booked these appointments, I would have definitely fought it more, but I chose to let it go.

Psychiatry 2 – 0 Tai

If they backtrack and say I have to do oncalls though, it is definitely NO and I’m ready to escalate to the BMA if necessary. Enough is enough!

Some Ways I’ve Made a Difference For Patients This Week, To Remind Myself That I’m Not a Bad Doctor

1. The patient I saw on a home visit and fought to get an ambulance to bring him to hospital, because I was concerned that he had bowel obstruction and his wife couldn’t drive him in. Spoiler alert: He had bowel obstruction.
2. The 1 year old I saw in clinic and referred urgently to Children’s A&E because they had an injury that didn’t add up with the explanation given. Safeguarding monitoring has now been put in place.
3. The patient who was embarrassed about her prolapse and cried because she was worried it looked “really bad”. My clinic overran by half an hour because I spent extra time reassuring and explaining it all to her, because she needed more time to settle for an examination of the prolapse. She was very grateful and shook my hand at the end to say thanks.
4. The teenager I saw for a follow up of her heavy, painful periods, who got embarrassed when her Mum told me that she said I was her favourite doctor because her periods were the lightest and least painful they’d ever been since starting the medication I prescribed.
5. The patient who made an appointment to speak to someone about her fear of dying, because she’s recently been referred on a 2 week wait pathway for suspected endometrial cancer. I sat with her as she cried, and she was grateful that I had asked her about her children, because no one else had considered how scary the thought of leaving a 7 year old and 11 year old without their Mum would be.

Today was not a good day at the office, but I am not a bad doctor, and though some days of GP training are harder than others and I feel like my brain will burst from all the things I need to know, God is good, and tomorrow is another day.

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: That Time I Had To Hide From A Patient

Every now and then, I take a break from updating this blog when I feel like there is too much going on for me to write about. I usually describe this as “when my head gets too loud,” which means I need to take some time out to silence the noise. So that’s what I’ve been doing over the last couple of weeks, because if I’m to be honest I’ve been struggling a bit.

Psychiatry is hard. And very very emotionally draining. The events of the last week haven’t made things better to be honest – I am tired. It is very tiring to be a black person in the UK right now, in the light of the Meghan and Harry revelations. It is tiring to be a woman right now following the tragic Sarah Everard news. I’m just tired of it all.

Psychotherapy has been helping a lot. One of the positives of being on Psychiatry is that we (junior doctors) have mandatory psychotherapy sessions every two weeks, which involve us talking in groups about our struggles, difficult patient cases we’ve been involved with, and sharing coping strategies. The sessions are facilitated by a trained therapist, and they have been so helpful with dealing with stress and quieting a lot of the noise in my head lately. Which brings me on to the topic of this blog post – yes, I really did have to hide from a patient.

Why, you ask? Allow me to explain.

On the ward right now, there is a patient with severe health anxiety. This patient is convinced that they have every possible condition you can imagine, and constantly insists on being examined/having blood tests done/having scans requested. There have been no indications for these investigations, but still, this patient is determined to keep repeating them, threatening to kill themselves if we don’t agree to their demands. And this is why they have been admitted to the ward.

The nurses are usually able to calm this patient down and distract them when they get agitated and distressed, but all these efforts come undone when they see a doctor. And this is where I come in. I am the most senior doctor on the ward the majority of the time, especially after the patients have been reviewed by the Consultants in the morning, (yupp, #psychlife), so when this patient sees me, they immediately become more anxious, insisting that I do blood tests and examine them.

This patient is intense and unrelenting – they scream and shout and accuse me of not caring and being a terrible doctor, because I firmly remind them that there aren’t any indications for the investigations they are requesting to have done. It got so bad that I actually cried because of some of the awful things they were saying to me. I know it’s not the patient’s fault – health anxiety is a really debilitating mental illness, but I am still only human so sometimes the words get to me.

The nurses picked up on this, and deduced that my presence was most definitely a trigger of this patient’s anxieties, so they suggested that I make myself scarce on the ward when the patient is around. This has led to me having to hide from the patient in a side room on my own when I have to do jobs on the ward. Yupp, this is really truly my life right now, but I guess I can see the funny side to it. And to be fair, it’s working – the patient is a lot more calm and rational in the absence of doctors so a win/win situation, right?

Join me next time (hopefully sooner rather than later), as I continue with recounting the ups and down of life as a junior doctor. To all my dedicated readers, your comments and messages are very much noted and appreciated.

The End of My Time in GP

Officially rotated to Psychiatry this week and it is quite a change from life in General Practice. I really enjoyed my time in GP though- even more convinced that it’s definitely a possibility for me in the future, exciting times!

So here are some of the highlights from my GP rotation:

What was I good at? – Managing to keep within time constraints of my consultations. I started off with half an hour allocated for appointments, and by the end of November I was seeing patients in 10 minutes and having full clinics like the actual GPs, so that was quite a huge improvement in my history taking and assessment skills.

What made me nervous? – Seeing babies and children. Everytime I saw a child on my clinic list I got a bit shook, because I was worried I didn’t know enough to assess/diagnose correctly, as well as nervous about dealing with anxious parents. I ended up bringing most children in to see in person just in case, and they ended up being some of my most memorable appointments because little kids are so cute and hilarious.

Useful thing I’ve learnt? – How to do smears and vaginal swabs! My gynae confidence has really improved because I’m now much more experienced with vaginal examinations and managing gynaecological conditions.

The last time I cried at work was? – About two weeks ago, when a patient kept shouting at me because I didn’t prescribe what she’d read about online. She accused me of not caring about her condition, threatened to kill herself, saying I would be to blame for this, and then hung up on me. It was AWFUL. My supervisor had to get involved and the patient eventually apologised but my gosh, I was very upset by it all.

My happiest work moment so far was? – When I followed my gut and fought for a patient to have an urgent scan- he’d had a fall a month prior and I was calling to review his hand. It was only towards the end of the call that he mentioned in passing that he’d been having headaches since the fall, and this rang alarm bells for me. Anyway, he sent this to the practice after the scan confirmed he’d had a subdural bleed; my first patient thank you letter 😊 We thank God!

A memorable non-med related thing I have done: Got back into baking my signature banana breads in lockdown, but Boss bakes so much better than me and my efforts really pale in comparison to his. Sigh.

Junior Doctor Anecdotes: The Patient Looking For Quick Gains

Four months later and I’ve come to the end of my time in GP; what a rotation it’s been! I’ll do a separate post reflecting on my experiences later, but I just had to share one highlight from a clinic last month.

Me: Hello, how can I help you today?

Patient: Yeah I’m calling to get some steroids.

Me: Erm, we don’t usually prescribe steroids without an indication for them, can you tell me a bit more about what’s been going on with you?

Patient: Can you just give me some please? I need them.

Me: Like I said there are many different reasons we prescribe steroids, so I’ll need to know a bit more about why you’re asking for them first.

Patient: Well my mate said my legs have been looking small and weak lately and I can’t go to the gym because of lockdown, so he said my GP can give me steroids to build me up?

(Reader, it took all my strength that morning to reply in a composed, professional manner).

Me: … I’m sorry but that wouldn’t be a reason for me to prescribe you steroids. I think your friend has been misinformed because that’s not what GPs are for.

One Year As A Doctor

I started life in GP land as an FY2 doctor last week, and it’s been a welcome break from how hectic hospital life has been over the last couple of months. I’m now fully registered on the GMC register, meaning that I can now discharge patients on my own, as well as write out paper prescriptions, so it’s only up from here tbh.

Still can’t believe I’ve been working as a doctor for a year now, and what a year it has been! From moving up north on my own, to dealing with the COVID pandemic and the exhausting changes it brought to our rotas, it has really been quite the start to my medical career.

As always, the glory goes to God for seeing me through it all; a year on and it still feels surreal to introduce myself as an actual doctor. It sometimes feels like a dream to be doing what I’ve wanted to do since I was 5 years old, and I feel so so blessed everyday.

I definitely feel like my confidence in my abilities has sky rocketed too. I had a lot of imposter syndrome when I first started, but I can say with confidence that though I may not be the “smartest” doctor, I am a good and safe one; being a good doctor is about more than being able to reel off facts about disease pathology. So for new doctors, don’t stress out if there are things you don’t understand, no one can know everything.

So, some reflections after my first year:

Current job – General Practise

Useful Things I Wish I’d Known Earlier: 

1. Some nurses can do skills like venepuncture, cannulas and ABGs, so that’s another reason to make sure you’re nice to them, because they will help you when you struggle.
2. Before you call to make a referral or seek speciality advise (ESPECIALLY from Micro), make sure you have all the bits of information about the patient ready, or you will get absolutely wrecked by disgruntled seniors. Trust me, speaking from experience #peak
3. TRUST GUIDELINES. Not just for antibiotics, but step-by-step guides on managing electrolyte disturbances, diabetic patients, ACS protocols and so much more can be found on the Trust intranet pages, so it’s always helpful to look there first before calling busy medical registrars…

What am I good at? – Speaking to patients and putting them at ease. Shout out to the years of experience working at my local theatre because it really helped build my people skills, as well as my confidence with speaking on the phone. I can now also say that I don’t struggle with cannulas as much as I used to, yay! The struggle was so so real but finally got there in the end! I had to swallow a lot of pride, and kept asking colleagues to watch me do cannulas to give me improvement tips, and they really helped. So I must stress that asking for help is not a sign of weakness.

What makes me nervous? – Signing off on chest x-rays on my own; always the creeping fear that I’ve missed a small pneumothorax…

The last time I cried at work was? – My last day on the Respiratory ward; the Discharge Coodinator got me chocolates as a leaving present and told me I was her favourite junior. It was the loveliest surprise after what had been a pretty busy day, and a great end to my time on that ward.

A memorable non-med related thing I have done: I went to the beach on my own during one of my days off and it was so great. Got some fish and chips and read for hours by the beach and it was brill. Will definitely do more solo days out in the future!

 

9 Months As A Doctor

Time flies, right?? Can’t believe I’ve been an F1 doctor for more than 9 months now- seriously WHAT THE HECK.

I’ve been resting at home over the last couple of days and it has been so great. Sleeping, reading, watching TV and films, and just having so much needed down time has been much appreciated. I’m definitely feeling more refreshed and ready to go back to work tomorrow.

As I did at the 6 month mark, I thought I would reflect on my milestones so far. So here we go:

Current job – Officially still Respiratory, but based on a Gastroenterology ward most of the time, and I cover Renal and Respiratory during my on call shifts.

What am I good at? – Getting patient discharge summaries done/prepped on time- no patient waits for their TTOs on my watch! Also good at speaking to patients/their families, especially when it comes to difficult conversations – shout out to the years of working in customer services at the theatre for this.

What makes me nervous? – Still annoyingly very hit/miss with cannulas tbh, grrrr. Much better with ECGs now though (yay), but liver patients and their clotting abnormalities also make me v. nervous.

Useful thing I’ve learnt? – I CAN DO ASCITIC DRAINS 😀

The last time I cried at work was? – Last week, when one of my favourite patients finally got discharged after spending nearly two months with us. A very pleasant 95 year old man- he would always take the time to ask everyone he spoke to how they were, continuously thanking us all for his “excellent” care. We were all sad to see him go, but very glad that he was finally getting to go home, and COVID negative too!

My happiest work moment so far was? – I know I keep going on about this, but putting that drain in successfully on my first attempt was such a satisfying moment. The Registrar supervising me thought I did really well too, so I was very very happy after this.

A memorable non-med related thing I have done: Just before we went into lockdown, I was able to go and surprise my little brother at one of his university art shows, so that was pretty fun. He had no idea I was coming, and I was able to see some of his work- he is so SO talented! Don’t just take my word for it, you can check him out here, and here.

(Side note, this is also my 300th post! COOL).

“Did you hear about the F1 doctor who cried on the phone to HR?”

Yupp, that F1 doctor was me. Allow me to explain:

As I mentioned here, my rota has recently changed, which means that I have been working more shifts with less breaks in between them, and all annual leave has been cancelled indefinitely. Work has been draining and I have felt so so tired. As in so tired that I was struggling to sleep, because the thought of going to work the next day filled me with trepidation that kept me awake, making me even more tired at work. And the exhaustion meant I was slower at my job because it was taking me twice as long to do things, and I was constantly worried about making mistakes. It was awful.

So on Tuesday (my one day off this week), I called my hospital’s HR department (a.k.a Medical Staffing), and asked them about my annual leave requests, because they had been cancelled, yet again. I was told that they can’t give me any days off because of low staffing levels on my ward; I tried to explain that with the way the new rota has been done, the staffing levels on my ward will be low till August, so did this mean I wouldn’t be getting a proper break till then??? I wasn’t even demanding like a week off or anything like that- all I wanted was at least two days off in a row to catch up on sleep.

The lady on the phone couldn’t give me a straight answer, so I was put on hold while she went to get her supervisor, who relayed the same information back to me. By this point, I had had enough and felt so fed up with everything… so you can probably guess what happened next. (Hint: It’s in the title.)

Yupp, I started crying and I couldn’t stop- it was actually soooo embarrassing. I then went into a massive rant about how I just wanted to sleep, how exhausted I was, how I have never taken a sick day but might have to take one soon to rest, because if this continued, I would not be safe to look after patients; tired doctors make mistakes!

The lady on the phone was definitely not expecting that, and she was so apologetic after this. She said she would get back to me, and lo and behold in less than an hour she had arranged for me to have the next day off, in addition to four days off next week, as she explained they would get locums to cover my shifts (I cried some more after this).

I’m grateful to have some time off because this new COVID rota is A LOT. And I’m not the only one who thinks so- a lot of my junior doctor colleagues at my hospital are just as tired as me, and this is an issue we have been raising to the medical staffing team; I shouldn’t have to be in tears to get time off, that’s not okay.

There is to be a meeting next week to re-evaluate the rota, staffing levels and pay for junior doctors, because we’re not even getting overtime for all these extra hours and shifts we’re doing, which makes it even more rubbish. So I’m really hoping for a positive, less tiring outcome from the meeting.

I’m feeling much better now, so I will conclude with a reason to be cheerful: I learnt how to put in an ascitic drain this week, and did one by myself!!! SO MUCH FUN.

Junior Doctor Anecdotes: A Rare Compliment

I’m currently on long days in the Acute Medical Unit and ‘long’ is definitely right because two days in and I’M SO TIRED.

Anyway towards the end of my shift yesterday – it had been a pretty hectic day with some breaking of bad news to patients that was really tough, and so many jobs to do that I didn’t have lunch till about 5pm, my Consultant pulled me aside and said, “You’re good, very good, and you’ve done well today. I just wanted to let you know that, well done.”

(I cried).