Helen Carnaghan’s transition from medical student to junior doctor

Helen Carnaghan Over the past seven months my life has drastically changed having gone from a perpetual medical student to junior doctor in the blink of an eye. Looking back on the transition from a more settled position I can see the old adage of “don’t get sick in August” is a true reflection of the fears held by all newly qualified junior doctors.

Transition began with the standard series of lectures on handwashing, sharps injuries and the all important compulsory fire safety talk to which the fire safety officer forgot to attend! The only difference between this and medical school was the glorious fact that I was being paid to sit and do nothing – oh sorry, correction, I mean learn.

The easy life of the lecture theatre soon faded when the following day I enthusiastically strode onto the respiratory ward with my shiny new Dr Carnaghan ID badge, carrying my old faithful Oxford Clinical Handbook and wearing a slightly dazed expression of what am I supposed to do now. My entrance was swiftly followed by “Thank God doctor you’re here! My patient with severe COPD has dropped their SATs…. what do you want to do?”.

As I look around to see who the nurse was talking to it dawns on me she was talking to me. Fortunately at that moment the registrar enters the ward, took the situation off my hands, and I breathed a deep sigh of relief.

The rest of the day entailed a mammoth ward round, working my way through a list of jobs that seemed to only increase in length and answering bleeps regarding patients I barely knew.

It wasn’t until my first on call evening shift that I realised the true meaning of the phrase “a list of jobs a mile long.” With my bleep going off what felt like every 10 seconds it soon became apparent that I was quickly drowning in a sea of jobs, all of which seemed of equal importance to my inexperienced eye. Then the bleep of “doctor my patient is tachycardic with a MEWS (modified early warning score) of 3” came through and my heart sank.

At least I knew how to prescribe fluids, antiemetics, analgesia, warfarin and sort out the other jobs thrust upon me for simply being a doctor on a medical ward past the hour of 5pm, but a MEWS of 3? What am I supposed to do with that? Panic started to edge its way in as I walked down the corridor trying to remember a medical school lecture that involved how to review patients whilst on call. I arrived and decided the best approach was ABC and then a full head to toe work up, following which I was still none the wiser.

Plan B; I asked the nurse who helpfully replied “oh don’t worry about a MEWS of 3 doctor. I just had to bleep you for legal reasons – he’s an anxious chap and I’m about to give him his diazepam that usually works.”

Lessons learnt from my first on call: 1) Patients won’t die of dehydration if I don’t instantly prescribe fluids. 2) The nurses know more than me. 3) The way to survive is to take a deep breath in and prioritise.

So now I am half way through my first year as a junior doctor, thinner than when I started in August, very slightly more experienced and here to write about the issues and challenges faced by newly qualified junior doctors in modern medicine.

Helen Carnaghan is a Foundation Year 1 doctor in the Eastern Deanery and a member of BMJ Junior Doctor Advisory Panel.