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I worked throughout medical school, stopping only in the last 6 weeks of my final year, although I would take some time off around exams at the end of each year. I was used to being at Uni or on clinical placement in the day and work at night, so thought I would cope well with being a junior doctor. I thought I understood exhaustion from working similar hours. What I did not anticipate, is how tiring it is to be thinking all the time, and constantly open to being called to act. Even the most menial of tasks require a level of thought, and while I knew before how to work robotically, and could usually produce correct work, what I never had to do before medical school, is have my brain turned on constantly, and I have found it to be a different kind of exhaustion.
I remember being told by an F1 about his excitement at first getting the bleep and how by the end of the first month, that had been eclipsed by dread. I remember comparing it in my head with when toddlers are so keen to help with the washing up, but as soon as they are deemed capable of doing the washing up unsupervised it becomes a chore. The dreaded bleep is no longer just a bleep, some places have a phone instead, and just like the bleeps, they haunt you.
You get called on the toilet, when you go to insert a catheter or do some other similar procedure in which you have sterile gloves, or the difficult cannula that just got flash back, that bleep is destined to go off. I do wonder how many of my nurses know that I’m answering them from the throne. The next problem, is that you have to answer each and every call, and there is little to no way to know if the call is to ask you to complete a number of small menial tasks such as re-writing drugs chart, or because one of the patients for which you bear some responsibility has taken a bad turn and you are needed quickly. Each call or bleep needs to be answered at the earliest possible opportunity.
I have read ‘The seven habits of highly effective people’. I have not read ‘Eat that Frog’, but got the general idea. In both, the idea of focusing on the tasks which best contribute to your highest goals and doing the unexciting stuff in a focussed way before being distracted and doing the urgent stuff. There is an allowance for doing urgent important tasks. The things is, as the bottom-most minion on the team what you might consider most urgent may not meet the definition supplied by the nursing staff, the phlebotomist, the physiotherapists, the dietitian and everyone else who also needs to be involved in your patient care. Beyond that you cannot just put the phone or bleep on silent while you focus to clear these tasks.
Even before being an F1, I came to the conclusion that one of the worst phrases in the English language is ‘can you just ….’. You are in the middle of running about trying to get some of your jobs done, or are sat typing up a discharge summary, and the nurse comes along, ‘can you just come and prescribe Mr X some paracetamol, he’s in pain’, or ‘ can you just take a look at Mrs Y’s foot, I’m not happy with it’. Inevitably the nurses tend to be right, and would often help by telling me what I was looking at and why it was a problem so that I could ask someone cleverer than I what we should be doing about it.
Now there you are looking at why Mr X is in pain and if there is any reason to not give paracetamol, and the discharge summary is left, and someone else will come and ask ‘can you just…’. By the time you get back to the discharge summary you cannot remember your train of thought and have to relook through notes, and end up doing each job several times. Multi-tasking is a lie and rapid task switching inefficient, but it appears to be the full and accepted model of being a junior doctor.
As I have progressed in my career, I have added to the list of worst phrases ‘just to let you know….’. This one depending on the deliverer, can mean a multitude of things. Are you letting me know because you want me to do something about it? Are you trying to absolve yourself of responsibility for this information? Spread the brown stuff if something goes wrong? Or are you letting me know in case I have an objection, in which case what are we going to do if I have? There is an exception to this, which is when they are letting you know for educational purposes, then please do continue, but avoid interrupting a completely unrelated task, or bring a cup of tea.
Is it any surprise with all of the above, that it’s a different type of tired at the end of a shift of being constantly ready for action and brain turned on, unable to safely take a loo break without risk of bleep, or focus clearly on anyone thing for an entire working day? So what do we do about it at the end? Personally, I have found that I need some quiet time at least once a week to be able to turn off my phone and hide away without interruption. I suggest that anyone embarking on this career do the same, you will do much better for you and your personal and working life to have an interruption free safe space. As for work, unfortunately I am still looking for that golden strategy in which you can crack on with stuff without either dumping on your colleagues or being a crap doctor. I will let you know if I ever get there.
From the MR Revision Team.
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