Reconciling with Reality

By Dr Alexandra Anglin

Before I began my journey into medicine, I viewed my future as a doctor through rose-tinted glasses; I would be the one helping people, making a difference in their lives, doing what no one but a doctor can do. Doctors were supposed to be altruistic, near-omniscient beings that saved lives, and did so with a smile – like all the best superheroes. However, I quickly realised that doctors were just ordinary people, often working under extraordinarily difficult circumstances to do their jobs.

No one goes into medicine thinking it will be an easy ride. In fact, you don’t even get into medical school without proving in some way that you understand the reality of being a doctor, and that you’re committed despite these insights. Moving from a tiny British Overseas Territory an ocean away, to live in a city of millions, I had had to venture far away to make my dreams a reality. Mine is not a unique story; the NHS workforce is increasingly attracting IMG doctors from the Middle East, South Asia and further. Even UK nationals are venturing away from home for years, as the GMC workforce report has revealed an increase in British doctors joining the workforce with primary medical qualifications from across Europe. We accept that this is an acceptable loss, given that the end goal is entering the most noble of professions; we make these sacrifices in order to be able to do the amazing work of helping and healing people.

It took eight long years of study, away from home and family to get to the starting line, as a Junior Doctor in the NHS, and it will likely take just as long to finish specialty training. I loved university loved learning new things – and so I found the idea of getting to enjoy that for the rest of my life exciting. In theory, it is! But the reality is, it’s exhausting. Having spent five or more years learning everything we need just to qualify to be a doctor, it feels like we keep rolling down one hill and up another as we progress through training.

Try as we might to retain all the years of knowledge, our clinical brains easily atrophy by virtue of the job role, leaving us feeling even less confident in our clinical acumen than we did in our finals. Thus, there is a necessity to devote even more time relearning just to keep up. The reality for junior doctors, after having spent five or more years attempting to acquire specialist knowledge, is that we don’t need to know the intricacies of our patient’s total hip replacement in order to write a discharge summary to their GP saying they’ve had one. In fact, we could see a patient for only one day of a month’s stay in hospital and still produce a perfect discharge summary – not because we have excellent clinical knowledge, but because we’ve learned how to assimilate a plethora of clinical information and condense it to contain only relevant particulars.

Another reality that we prepared ourselves for before entering the workforce was the long, almost inhumane shift patterns. But never did I think I’d be faced with the additional challenge of being pressured to skip my breaks, or having to stay hours after my 10 hour shift. At the start of F1, we feel a lot of pressure to prove to others – and ourselves – that we are actually competent. The expectations are extremely high, and it’s difficult not to give in to the pressure to meet them all. That makes us extremely vulnerable to abuse by colleagues.

We’re told things by ward staff like, “This patient might be medically fit tomorrow, and transport will be here first thing in the morning so you have to prep their discharge before you leave today!” As fledgling F1s, who are we to question a nurse with twenty years’ experience? And so of course, very naively, you take on that extra discharge, on top of the other jobs meant to be done that day which got put on the back burner because you spent the entire day taking care of a deteriorating patient by yourself because your surgical registrar was busy in theatre and you had to go back and forth getting advice from the medical registrar. We had already prepared ourselves for long shifts – what’s another hour on top of it?

And then there are times where every single department seems to be so understaffed and pushed to its limits that nothing seems to be getting done. In scenarios like these, junior doctors can feel the need to carry extra weight. A daily reality for us is to take on jobs that aren’t even ours, just to make sure that patient care can continue, and just to make sure that each patient is getting what they need. You spend hours trying to arrange an MRI for a patient who may need surgery depending on the findings – calling the MRI radiologist through the switchboard, who tells you every five minutes that the line is busy. When you finally get through and manage to convince the radiologist that the scan is even necessary, you have to grovel and beg the radiographers to schedule your patient in as urgently as possible even though they’re fully booked with other urgent scans and running an hour behind.

Everyone knows that the NHS is overburdened. But no one warns you that this means that when the scheduled time for your patient’s MRI arrives, there will be no porters available to take the patient down to the MRI, and if they miss that slot they’ll need to wait maybe a whole other day for it to be arranged again. So, you take it upon yourself to transport the patient in their hospital bed across the hospital to prevent this. It isn’t the first time and almost probably won’t be the last.

We didn’t anticipate that we’d be doing the job of a porter. It’s not that we think it’s beneath us. We’d be a porter every day if it meant our patients got what they needed in a timely manner. But it creates a knock-on effect, where other jobs which require a doctor are put on hold, and care for other patients gets delayed. In an ideal world they would be picked up by other colleagues, but the reality is that often-times you’re completely on your own – your seniors have gone to theatre, a colleague has called in sick and your consultants and rota coordinators have refused to put out a locum shift. So, after spending all of your time and effort taking care of one urgent patient, you then have to return to take care of the rest of your important jobs on the ward, which often include the responsibilities of someone else on top of your own share of work. It feels hopeless at times. How could we have anticipated this?

If there’s one thing foundation training teaches, it’s how to juggle all of these responsibilities at once. Unfortunately, sometimes you just don’t know how much you can handle until you reach that limit, and you break. For me, it came during my second set of on-calls as an F1 – four 12-hour shifts in a row. By day four I was exhausted and somewhat delirious, having worked below minimum staffing levels due to sickness and rota errors. The ward round that day was unpredictably hectic, as two surgical emergencies had come in. As I sat down after the ward round ended, after noon, and looked at my jobs list, I realised I couldn’t make sense of the words swimming in front of me. It was then that I realised that putting such long hours and so much responsibility on so few people with so little support wasn’t safe, for the patients or for us.

I didn’t feel safe taking care of such critical patients by myself for the second time during my four day on-calls, so I called the rota coordinator again. They replied, “The F2 is by themselves on the other ward, but we’ll tell them you need help.” When the F2 kindly popped their head into my ward, I thought, “Finally, some help!” The F2 said, “I cast an eye and everyone seems to be doing well. I’ve got my own jobs too so just let me know if you need me.”

I broke down. I cried because I couldn’t think clearly anymore, couldn’t focus, couldn’t function under so much pressure with so little time to rest. I couldn’t fathom that this was considered a reasonable expectation for a junior doctor, and that everyone else around me was also too overburdened and overworked to help.

As I sat there crying in the doctor’s office, surrounded by four close walls and no windows, my stomach growling to remind me I hadn’t eaten lunch, fighting the primal need to get outside for air when there was still so much to do, I couldn’t help but feel selfish. My imposter syndrome had never been so strong. As much as I wanted to be the F1 who didn’t need help from anyone because she was so exceptional, the reality is that I’m not. But I’ve learned that no one is. Everyone needs help, sometimes. In fact, it takes a lot of strength to recognise and admit when things are beyond your ability.

Another reality that we’re ill prepared for, is dealing with so much pressure at work, just to get home at night, beyond tired, with barely enough time just to shower, eat dinner, and enjoy an episode of whatever it is we’re trying to keep up with on Netflix with friends or family. We lament shelved hobbies, and mourn our social lives. We struggle to switch off because we care too much to simply put our faith in a broken system, and fear that if we’re not there our patients will only suffer for it.

Each day we grapple with a reality that we weren’t warned about, or that we tried to close our eyes to. In speaking with my colleagues, most have said that before entering med school, they thought they knew what they were getting into. But regardless of their confidence before joining the workforce, they all revealed that the reality has mostly been surprising. We reconcile the differences between our preconceptions and reality so that we can adapt and continue on. For others, reality has forced our hand and pushed us to seek options to continue pursuing this career elsewhere in the world. Reality is so polarising in some cases that our colleagues are choosing to leave the profession altogether.

When we started this journey, we knew that it would be difficult. But the reality of being a junior doctor in the NHS today is so far beyond anything we were prepared for. Many professions are challenging, but very few put such extreme pressure on their freshest employees for so little compensation. The NHS is collapsing, and we are often made to bear the brunt of the weight to hold it up. We’re at the mercy of a government that doesn’t care about our well-being, doesn’t care that some of us can barely stay afloat in the current situation we’re in. Some of us can reconcile with this, because we still want to help people, or because medicine is what fulfils us, or maybe we’re privileged enough to not be financially burdened on top of everything else. But more and more often the pressure is too great; this is why we need to continue to fight for change, or at least for the minimal compensation we rightfully deserve. If we do not succeed in these efforts, I fear the NHS
truly will collapse, and bury us all underneath the rubble.