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Surviving your foundation years

Post date: 22/07/2019 | Time to read article: 5 mins

The information within this article was correct at the time of publishing. Last updated 22/07/2019

Congratulations, you’ve passed your finals! You’re finally a doctor, but that was the easy bit – now the real work begins.

Medical school is a necessary evil to obtain the prestigious title and status of doctor, but I will warn you – everything you learnt in the safety of the lecture theatre will be forgotten as soon as you set foot on the ward. But never fear, this is normal! All you need to know to be a good doctor you will learn by working in hospital.

Foundation year one, aka the dogsbody year, is definitely the deep end: you have to learn to swim fast. It sounds scary, and it feels it. But it gets easier, I promise!

You may feel despondent during your first weeks as a new doctor, when your first patient dies, when your consultant throws a strop, or when you’ve had a beastly on-call and you haven’t even had time to pee, but remember this mantra – “It gets better as I get better”. It does and so will you.

Your first day

On your first day you are likely to have to ask how to spell paracetamol and then have to look up the dose too, in secret. The BNF is every doctor’s best friend, and will be for many years. Don’t be ashamed to use it for every drug you prescribe if need be. It’s the only way to learn practical pharmacology and be safe for your patients.

F1s are newbies, the babies, and hence can expect to be treated as such. However, you will mature quickly and this lowly status and work life will improve as the year goes on, as you earn trust and respect from the already hardened NHS workers.

Handling seniors

It is normal to get grilled by seniors – in every department, in every profession – and though you may feel tiny at the time, you will learn quickly how to survive future grillings.

Preparation is key. If you know you have to go and discuss a patient with another colleague, be prepared: know your patient’s details inside out. Bloods, images, home situation, which leg is weak, which arm hurts, how the problem started, what their favourite hobby is, whether they’re big or small, whether they’re claustrophobic, etc.

The senior doesn’t need to know all this gumph 99% of the time, but they will ask for it just to make sure you don’t cut corners and are kept on your toes, so make sure you can surprise them!

Coping with stresses

When you get home you will want to vent about the strains and idiocies of your day, so warn housemates, spouses or parents that being a doctor will turn your home life into a rant zone! There’s nothing worse than bottling up fear, frustrations, anxieties and stresses. You won’t last the year. Get it off your chest somehow. Taking it out on the nurses and patients the next day will only come back and bite you harder than you can imagine. Although it can be necessary to let off steam, avoid going into the kind of details that compromise patient confidentiality.

From my experience, the best thing I ever did was live in the hospital accommodation. No-one will understand how rubbish your day was better than someone who has gone through it too. It’s soothing to be able to vent your frustrations about the day, the patients, the staff, the seniors, the system and the canteen food to someone else who has also witnessed it.

Acclimatising to life outside the hospital

At the end of a day you will be so tired you will be willing to watch anything on TV, including The One Show. You will not be able to get the hospital smell out of your clothes or off your hands until the weekend. You will bring up inappropriately graphic topics and stories at non-medical dinner tables and in the pub (but, a word of warning, never, ever breach confidentiality).

A few tips – lay folk don’t appreciate you saying that Holby City is medical tosh; TCP is not an acceptable odour to wear in public; and describing what colour vomit you got on your shoes today at the dinner table is not acceptable – unless you’re with other medics.

On the plus side, as a junior doctor you have few outside work commitments, so relish it! For the first time in five years you have no homework, no assignments due, no tutor chasing you, no exams looming. In the words of Ferris Bueller: “If you don’t stop and look around once in a while, you could miss something.” Embrace this freedom and enjoy it.

The Wider Picture

Being a real-life doctor is not glamorous; it is hard work and can be an unforgiving and thankless task at times, but it can also be extremely rewarding if you go about it in the right way. Respect your colleagues, treat others the way you would want to be treated, and above all treat yourself to the canteen pudding at lunch and you’ll enjoy work much more, guaranteed. Good luck, and remember – it gets better as you get better.

Here are my top tips for "newbies":

  1. Nurses are your best friends – You are not above them and you never will be. Keep them sweet, ask them for their opinion (even if you decide not to follow it) – they have been there a lot longer than you! Buy them the occasional box of biscuits and ask about their weekend. Treat a nurse like a slave and you will NEVER have a peaceful shift.

  2. Locate the nearest BNF – and don’t be embarrassed to use it!

  3. Wear comfortable shoes – You will walk miles every day. Ladies, beware of heels; it is very embarrassing to walk down a quiet ward in clip-clop heels.

  4. Smile – You’ll get away with (almost) anything.

  5. Communication is the magic word – To ensure what you want doing is done, communicate it! Write instructions down CLEARLY (there is no excuse for illegible handwriting). Hand it over, inform the nurse – every time.

  6. Ask for help – You’re new. You are not expected to know everything (or even anything in your first few weeks). If you are struggling with the workload, tell someone. What’s harder, asking for help or explaining to the boss why it all went wrong?

  7. Don’t stay late – Well, don’t make a habit of it. No-one will thank you for it and you will hate it. Good handovers are essential. Don’t handover daytime dross though (like drug charts and TTOs); it will come back to haunt you.

  8. Lunch and pee-breaks come first – If you don’t eat you are no good to anybody. The only reason to miss a lunch break is a crashing patient.

  9. Get an Oxford Handbook – The Foundation Programme Guide is excellent. Have it nearby, particularly if you’re on-call. It’s a godsend. I still use it now.

  10. Be organised – To your team, you are the dogsbody, the “Gofer”, the team PA. You need to know who your patients are and where they are, so keep an up-to-date list every day. Have to hand: investigation results on all patients, a spare pen, a stethoscope and a tourniquet. Know where your registrar and consultant are to ask for advice and to avoid when you’re on a break. Also, you’ll see many, mainly female, junior docs carrying around little shoulder bags brimming with stuff; I just recommend pockets and belt-loops. Bags get in the way when leaning over patients all day long.

Dr Davison, Consultant anaesthetist

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