How to do it: be a new doctor

I'm not really sure how I should write this piece on my

®rst week as a Pre-Registration House Of®cer. I mean,

approximately seven days ago, I was driving to my

chosen Hospital with the theme music to Mission

Impossible on my car stereo, somewhat struck by a

certain level of irony. I don't think that this was just

due to the fact that, after 6 years at medical school

(student � social class 5) I was now a fully ¯edged

doctor ( � social class 1), or due to the sense of

impending professional doom, or even down to the fact

that, for the past year, my friends in the year above had

usually given us every gory detail about how bad things

were going to be, whilst forgetting to mention the good

things. The feeling was more that of someone who has

spent a signi®cant period of their life getting to the top

of a mountain and then ®nding themselves right in the

foothills again. That was me. Doctor Sisyphus with my

career-shaped boulder. And it scared the life out of me.

So, casting my mind back to the heady days post-

®nals, I remember being asked to write this ± an insight

into my ®rst week as a House Of®cer. How I was

struggling to ®nd my feet in and around the crazy world

of my ®rst appointment. So it was somewhat disap-

pointing to ®nd out that my Consultant is on holiday

for the ®rst two and a half weeks, and that we only have

six patients on the ward (at the time of writing, I may

have whittled that down to four). Whilst my house-

mates are busily telling me about their 30 or so patients,

I'm having to keep fairly quiet, so as not to upset them.

And let's face it, I'm hardly helping the Junior BMA's

calls for better pay and less soul-destroying hours, am I?

So I was left with a little bit of a dilemma. An article

telling you the best way to deal with six patients in a day

isn't exactly going to set many pulses racing ± and that

is exactly what I was thinking of when the Ward Sister

leaned over and asked me to prescribe some analgesia

for a patient. And then, the sheer terror returned.

Because it doesn't matter how many therapeutics lec-

tures you've been to, or how many clinical attachments

± they were all somehow separate, safe in the knowledge

that anything like that would be someone else's prob-

lem. But, oh no, I'm that someone else now. And, with

my Therapeutics tutor's words still ringing in my ears

(`The majority of medico-legal problems for House

Of®cers come from prescribing mistakes'), and having

decided that I couldn't really pretend to be a visitor (the

name badge gives it away), I tried to bleep anybody who

could spoon-feed me through it. Eventually, having had

no reply, I turned to the Sister, and, somewhat

desperately, said, `What would you recommend?'. The

question sort of trailed off, and I was half expecting to

be the object of much ridicule. Instead, she looked at

me, smiled wearily, and suggested Voltarol, even giving

me the dose. That was the ®rst important lesson that I

learned. I'm not expected to have an encyclopaedic

knowledge of every drug, dose or disease. What I do

have to be able to do is treat patients to the best of my

abilities and safely. And if that means asking someone

for help, well, that is ®ne. I think that we all face

moments like that at the beginning of our careers ±

chances are a lot of people face the same things at the

ends of their careers (timely or otherwise ± but the latter

group are probably the ones that do not do the right

thing at these moments¼) ± and we have to learn that

asking for help is not a sign of weakness, but rather, the

opposite.

This episode also taught me another thing, and that

is, although, at the end of medical school, some people

tend to emerge with egos that are somewhat in¯ated,

we are the smallest ®shes in scarily large ponds. And,

continuing the metaphor, the best way for us to survive

is to seek shelter with other, larger ®shes. The most

successful doctors can only be successful by relying on

the team of people around them. By that, I do not mean

just the other doctors, but everyone else ± nurses,

physiotherapists, social workers, occupational ther-

apists, porters, secretaries, phlebotomists, canteen staff

± this is by no means an exhaustive list, and I apologise

if I've missed anyone out. And just in case people think

I'm being sycophantic ± well, I am. But let's face it,

when I'm on call, it's the nurses that determine how

much sleep I get; when I want to go home, I hope that

all the bloods for that day have been done; when I want

someone else to go home, their home and living

arrangements will have to have been checked by

someone else. Somewhat cynical, I admit, but there you

go.

I think there is one other lesson, that I am still

learning, even though I started learning it about a year

ago, when friends of mine started being `proper doc-

tors'. This is it: it doesn't matter what you do during

the day, or what goes wrong, or who you've argued with

± at the end of the day, when you go home, the most

important thing is to relax and unwind (however, youCorrespondence: Dr Oliver Grant, Homerton Hospital, Homerton Row,

London E9, UK

Christmas stocking

Ó Blackwell Science Ltd MEDICAL EDUCATION 2000;34:1037±1038 1037

want to do it¼). Being a doctor is very tiring, even

when you only have six patients to look after, because

being a doctor is very different to most other profes-

sions on the planet. And the learning does not stop

when you ®nally step up on to that podium and receive

a warm handshake from someone you've never met

before. Nope, that's just the beginning, if anything¼

Having learnt how to be a medical student, now I have

to learn to be a doctor.

That said, and regardless of the bad press at the

moment, I'm really very excited and proud to be one.

Oliver Grant

London

1038

Ó Blackwell Science Ltd MEDICAL EDUCATION 2000;34:1037±1038

How to be a new doctor · O Grant