Helen Macdonald: Dunce hat until April

Out with pacey surgical ward rounds; pain controlled, E+D, BO, OE – alert, obs stable, neurovascularly in tact, plan – drain out, fluids down, OT/PT, home when safe, OP 6/52. Out with debates about thromboprophylaxis, clotting and bleeding. Out with preadmission clinics. Out with being the crash team leader – I’ll not be sad to relinquish that duty. And in with a new hospital, a new team, and a new specialty.  I packed my bag after my night shift as the orthopaedic SHO oncall, left for good, and began preparations to start in paediatrics the next day, whatever that entails.

I’m a GP trainee, and along with numerous other junior doctors of various specialties and grades, I have to move jobs – again. Job change season is a mixed bag of feelings. At the end of most jobs you feel happy, confident, get a nice pat on the back and tick on the e-portfolio to say all is well. But as the switch date draws near, it is easy for feelings of uncertainty, self doubt, and job dread to creep in.

I would like to be good at a new job straight away (like most doctors); I don’t want to feel that my performance is compromising care. But the unwelcome reality is that it will take time. In the meantime I will don a dunce hat and have to ask a lot of questions. I have had urges to make a panic online purchase of a new Oxford handbook or paediatric app of some kind to boost my intelligence.  But then I would have had the the dilemma of whether to read it and get ahead in paediatrics, or put it away and eke out the last valuable nuggets from orthopaedics. Paralysed by indecision, I bought nothing; although the presence of a paediatric textbook from medical school in my cupboard has been a comforting thought.

For part time GP trainees like me, there is also déjà vu. The feeling of being stranded on a never ending ladder of junior doctors’ hospital jobs stretching in front and behind me. In happy, confident times of the job cycle the opportunity of experiencing such a wide variety of specialties is a privilege to me. But just now, the feeling of being doomed to dunce status every six months is stronger and is pretty unpleasant. It is worsened as I wonder how the last of six months of orthopaedic spinal surgery is going to help me with the average paediatric admission. My short term memory is already deleting dermatomes and Cobb angles, pending the insertion of some developmental milestones and the normal physiological parameters of a 2 year old.

I have mentally dusted off my dunce hat ready for the paediatric wards, and the unknown that lies ahead. On the plus side, my hat is well worn, and comes with a special coating of extra thick skin. It has been with me through 10 job changes and under pressure sometimes whispers half remembered secrets from medical school, or encouragement in dark moments. If my memory serves me correctly, with good humour and humility, by the time the next batch of junior doctors arrive in early April, the dunce hat will have slipped silently from my head and taken itself off to storage for a few months’ peace.

Helen MacDonald is a GP trainee and assistant editor, BMJ