What Really Happens The Day Junior Doctors Start Work In The NHS

I’m convinced patient care suffers in August

I was on call consultant on 6 August, which is actually the first day most of the team hit the shop floor. The Wednesday is still mostly filled with hospital inductions. There was almost no senior (consultant) cover available, as many were on annual leave with their families.

It still saddens me that we insist on having the changeover in August in the middle of school holidays and by far the busiest month for consultants to take their leave. I know hospitals can be quiet at this time, especially as consultants reduce their elective practice, and I often appreciated this living and training in London. However, since moving to Swansea I’ve realised how busy the holiday season can be and I’m convinced patient care suffers, although I have no proof. Why can’t we move this changeover to the first Wednesday in September? I’m sure the recently qualified new doctors would love a month’s break before they start. Once you’re on that hospital treadmill you never really have a chance to get off.

Consultant, orthopaedics, Swansea

Doctors tend to put on a brave face, but I’d be surprised to find one who isn’t afraid on their first day

For me, every little setback in those first weeks made me feel like a failure

It’s a huge leap going from medical school to being a junior doctor. Nothing can really prepare you for it. In an ideal world you’d have a transition period of at least a month to shake that look of being a rabbit in headlights – the renowned stamp of being a new foundation year one doctor. But I didn’t. I had a couple of days of shadowing my team on the acute general medicine ward, and then it was time to start. But I never felt alone. I remember being struck but the kindness of my consultant, who I stared up at with wide-eyed reverence. Looking back, it’s all too easy to forget what it’s like in those first few days. A few years’ experience can make that chasm feel insurmountable. But those around me didn’t.

My hand was shaking with every drug I tried to prescribe, and trying to do my first cannula was a harrowing ordeal that I’d rather forget. My consultant corrected a prescription for me and took the time to explain how I should write it, despite the fact that the rest of the team was waiting and the ward round was taking twice as long as it should.

A little bit of time, a pat on the back, and some gentle words of encouragement will go a long way further down the line. Doctors tend to try and put on a brave face but deep down I’d be surprised to find one who honestly isn’t afraid on their first day. I’d be more concerned if they weren’t. For me, every little setback in those first weeks made me feel like a failure, not worthy to be wearing a stethoscope round my neck. But little by little we all got there, even if it was at different paces. I’ll never forget all of those – including patients, nurses and the rest of the staff – who showed a little empathy and patience during those first few weeks. I only hope I can do the same.

Nishma Manek, junior doctor ST1, acute general medicine, Oxford

Junior doctors, leave your hierarchical attitudes at the door and don’t underestimate nurses

I have been working in A&E for three years now as a staff nurse. Over these years I have come to notice certain trends when junior doctors hit the shop floor. Firstly, a lot of staff (not just nurses) take the so-called “Black Wednesday” off as holiday. Many people dread the day. When we have a new rotation start in the department, it does get more stressful. Waiting times increase and the nurses have to work to their limits trying to avoid patient breaches (over the four-hour wait).

What is perhaps more frustrating is that some of the doctors start their rotation having spent a year on the wards, where they have picked up a form of hierarchical attitude that just does not fly in A&E. A&E is a team – whether you’re a cleaner or a consultant, we all work together. The F2s in A&E are well-supported. They have an induction period and during their first few days in A&E are surrounded by an increased amount of consultants and registrars, as well as nurses who have a wealth of knowledge. Don’t underestimate us.

Staff nurse, A&E, Midlands

Junior doctors scrub in Junior doctors scrub in before surgery at the Whittington hospital, north London. Photograph: Martin Argles for the Guardian Junior doctors are there to be trained. Service provision is only one element of their employment

Induction days from medical student to junior doctor need to be increased – I only had two. Nurses are the most supportive. If you do not have supportive seniors, the first three to four weeks are terrifying. Good communication, rapport and confidence in your training (not overconfidence) will ease anxieties the patient, staff and more importantly yourself might have. If you are being under-supported, let the managers know, they will help you. Everyone knows it’s your first few days – do not be intimidated by people’s impatience (always ask if unsure, ask for support early). After the first few weeks, start thinking about what direction you want your training to go in. Is there anything you can do to keep yourself directed? You are there to be trained, you are not a staff grade. Service provision is only one element of your employment.

I had no idea what to do with this human being or how to solve the problem of her being on the floor

Senior house officer, general surgery, Wales

I emerged from my first day with my mind and career intact

It’s been two years since my first “Black Wednesday” and thinking back to it still induces a run of palpitations. I was on-call that day, which means that in addition to working a normal ward shift I had to stay in the hospital until 10pm dealing with out-of-hours medical problems. I remember being called to see a patient who had fallen out of bed and vividly recall that Damascene moment of realising that for all the lectures, revision, exams and mnemonics that had characterised medical school, I had no idea what to do with this human being or how to solve the problem of her being on the floor.

I think eventually some form of hoist was used whil e I stood on feigning an air of what I hoped was calm supervision. Later in the evening I got bleeped to see a dying patient and talk to their family. I remember them all huddled around the bedside of a pale, hyperventilating lady and thinking how crestfallen I would have been in their shoes seeing a boy in a green tunic walking into the bay proclaiming that he was a doctor. They turned out to be very nice and greatly appreciative of my efforts despite their own grave situation as I’ve since learned is generally the case. All in all it could have been worse and I emerged from the day with my mind and career intact in the same way that I’m sure all the junior doctors who start this month will as well.

Steven Moul, junior doctor F2, medicine, Devon

During my first six months, I know at least five juniors killed themselves or died unexpectedly. I could have been one of them

I started work as a doctor 20 years ago, when the start date was 1 August, regardless of which day it fell on. It was a Saturday. I had moved 300 miles for the job and knew no one. Home was a single room above one of the surgical wards, with a collapsed, plastic covered mattress on the bed, a worn sticky carpet and an ancient wardrobe and desk. I paged the outgoing doctor at 7.30am. She arrived, shoved her pager at me and a tattered piece of paper with about 12 names on it. “These are [the emergencies] all coming in this morning. There’s 18 people needing bloods [tests]. Get all the bloods to the lab by 8.30am or they won’t run them. I am never coming back to this fucking shithole.” She walked away.

I went to the first ward. A nurse turned from the desk and asked if I was the new house officer. I said I was. ‘Well, I’ll tell you now. you’re all fucking useless. We hate all junior doctors. And we didn’t want a bloody female one – at least the last guy was cute. Do what we tell you or we will make your life a fucking misery.’

I had an unbelievable day – it really was everything that I had worked towards

It was utter misery. I worked from 7.30am on Saturday to 7pm on Monday with no sleep, one meal and about eight cups of cold coffee. That was standard for six months. I have no idea what the patients thought. I passed the time in a haze of exhaustion, fear and misery. Support was almost nonexistent. The only thing that kept me going was the thought of the years and years of work it had taken to reach this point – everything I had given up through my teens and early 20s in order to pass one exam after another. During those six months I know that at least five first-year juniors killed themselves or died unexpectedly in the UK. I understand why. I could easily have been one of them.

Senior doctor, started in surgery

The best new doctors are the ones that admit they know nothing and accept advice and guidance

“Black Wednesday” is infamous among nurses, especially experienced ones (22 years) like me. The best new doctors are the ones who throw up their hands, confess they know nothing of their new speciality and openly ask for, and graciously accept advice and guidance. The worst are the ones who refuse to acknowledge they have any knowledge deficits, speak rudely to nurses who try to point out where they need help, and therefore piss the patients right off. To add to the fun and games, our senior doctor takes a fortnight off every time “Black Wednesday” comes around as she can’t be bothered with the hassle of teaching the new doctors, preferring to leave it to the nursing staff.

Nurse, addictions psychiatry, Newcastle upon Tyne

My first day was horrendous and I was left on my own to care for 30 patients. Times have changed

I was covering an elderly care ward of 30 patients by myself about seven or eight years ago. All the senior house officers and registrars were in trust induction; the consultant was running the trust induction. I had an associate specialist who was in clinic to ask if there were any issues. I started my ward round, this included one patient – I will never forget how sick they were. I would think twice about them now; in fact, I would send them to the intensive therapy unit. I went back to first principles, tried to work out what to do. I wasn’t sure so asked the specialty doctor who was in clinic - in hindsight, her advice was terrible. The patient did not come to harm, other than that her disease was doing to her.

At 5pm all the senior house officers (SHO) and the consultant turned up to introduce themselves, and cheerfully said they were going home and would see me in the morning. I nearly cried. One kind SHO, who I will never forget, asked me if there was anyone I was worried about, and I took him to see two or three patients, one of whom died later that night. It was probably as horrendous a first day as I could have feared (and then I was on call the second evening). Having said that, the hospital was a good one and I was well-trained. This type of first day shouldn’t happen and with the shadowing now being taken more seriously it probably doesn’t. Our shadowing involved a series of lectures over a week-long trust induction and two afternoons of ward work. I would not trust a first-day doctor with being on the ward by themselves, and I think times have changed even in the last few years.

I learned some of the most important lessons in my career – more to do with relationships than with physiology

Medical registrar, general medicine, Scotland

Dysfunctional hospital IT meant my first day got off to a bad start

The first five minutes of 5 August was taken up with printing off the patient list at one of the top five hospitals in the country. The power went down (for routine testing of back-up – could it not have been done at night/weekend/any other time other than 5 August?) as did the computer. The power came back on but the computer keyboard was broken. The computer printer was broken. The passwords given to us at induction didn’t work. I couldn’t call IT because the telephone broke. The day got worse from there.

Junior doctor F1, surgery, London

ward in a hospital ‘It was fantastic to meet patients and have them trust us. Nurses are the unappreciated heroes of the NHS.’ Photograph: Peter Byrne/PA I am a proud member of the NHS and I can’t wait to continue looking after patients

I had an unbelievable day – it really was everything that I had worked towards. It was fantastic to meet patients and have them trust us. Nurses are the unappreciated heroes of the NHS. Patients did their bit as well: thanks for waiting that little bit longer for a discharge, or not wincing on the third attempt at getting blood. Even though some politicians may want to drown us all, I am a proud member of the greatest institution on this earth, and I can’t wait to continue looking after patients.

Junior doctor F1, general surgery, Stockton-on-Tees

Either I grow a thick skin, or leave the NHS before I lose my identity

I got shouted at twice for a mistake someone else had made last week. It was heartbreaking for someone to come and scream at me when I had turned up early, got everything organised and did my best with no break in 11 hours. Oh well, that’s the NHS – I just need to grow a thick skin or leave before I lose my identity.

Junior doctor F1, surgery

My nursing staff mentors taught me some of the most important lessons in my career

I started work as a house officer 32 years ago in August 1983 on a general surgical ward at St Bart’s in London. As I write this, now a consultant neurologist and on vacation in Fiji, I empathise with my younger colleagues beginning that journey and I am thankful to those who helped me at the beginning of mine. That first arrival on that first ward is crystal clear. It was a one in two roster – every other night on call in the hospital. I received no mentoring or advice from more senior medical staff. The concept was anathema to a profession then steeped in a paternalistic tradition of infallibility. And to make matters worse having trained at a rival London medical school I was perceived as an outsider.

Related: I felt like a floundering fish as a junior doctor – until one patient encounter

No sooner had I walked onto the Nightingale-style, high-ceilinged ward of two rows of 10 beds with a desk at one end, a cupboard at the other and a palisade of windows on one side, then I was gently taken aside by (what would now be called) the nurse unit manager. She acknowledged how hard it must be for a newly qualified doctor and explained some practical aspects of my job that could never be learned in medical school, like how to order blood tests and X-rays, and the culture of the ward and peculiarities of the different consultants’ work styles. She informed me that whatever I needed to know (about her ward) no matter how trivial it seemed, her staff were there to help me. An amiable and professional friendship was quickly established between myself and the nursing staff that was based on mutual respect. Many times we all flew by the seats of our pants. I lived through terrifying moments during the steepest of my professional learning curves and was perpetually sleep-deprived.

Despite being surrounded by human frailty both in the form of sick patients and in the inevitable human error made by us, the carers of the sick, my nursing staff mentors created a strong, safe, caring and forgiving environment where I learned some of the most important lessons in my career. This was more to do with human relationships than with human physiology. I hope that my younger colleagues starting out this month find the right balance between apprehension and pride so that they can not only enjoy this experience as I did, but also provide their patients with the safety and comfort that is rightly expected during this challenging transition from medical student to professional.

David Rosen, consultant neurologist

There should be staggered starts for increasing grades of doctor

Everyone assumes “Black Wednesday” is an issue of brand new medical graduates starting as a doctor. It is not. The real issue is that someone thought that not only should newly qualifieds start on the first Wednesday of August, but also that everyone else should changeover on the exact same day. Apparently it doesn’t matter that on Tuesday you may be working in the Isle of Wight and the next day you are due to work in Edinburgh.

Every first Wednesday of August, the vast majority of the frontline doctors (FY1, FY2, core trainees, some registrars) sit in mind-numbing induction, tired from moving house and travelling the night before. Some are forced to start on a night on-call shift in a place they have never worked before, where they do not know how to use the computers, where to find the medical equipment, where to find the patients, who to call for what.

The worst thing about the whole thing is that the solution is simple. All it takes is staggered starts for increasing grades of doctor. The administration would be smoothed out. Doctors get actual time to move house and rest before starting a new stressful job. Induction can be safe and allow time to learn basics such as how the IT works at their new hospital.

Junior doctor F2, Essex

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