By Dr Joel Conway
Joint 2nd Place in the "Voices From the Frontline" Essay Competition 2023
I had fallen prostrate into bed after a day of doubt, anxiety, and toil. "Did I really win the ‘SJT lottery’ when I was allocated a house officer position at this lively East London district general?" I thought to myself. [The SJT was the exam, based on soft skills, that, for the last decade, had dictated where British medical graduates start their careers.] One could argue that the workload of a junior doctor is often overestimated. This perspective may hold some truth; nevertheless, I could not deny the fleeting moments of self-loathing and burden I felt at that time, all stemming from my career choice. This feeling is fleeting because I swiftly recover when reminded of the immense satisfaction and warmth that accompanies a fruitful family discussion, a successful insertion of a cannula, or that special moment when I check off the final item on my daily to-do list. Yet, it is also accompanied by self-loathing, as I am haunted by the guilt of prioritising my drive to emulate my ideal of a conscientious physician over the vague allure of other career paths I may occasionally regret not pursuing on a given day. If someone reading this shares these pensive moments, then I hope they have at least started a journey of reconciliation similar to that which is described in this essay. Learning to effectively prioritise served as sure-footing for correctly utilising channels of escalation, impartially dividing labour and effectively allocating time. In turn, I have begun to value the role of a junior doctor, and my individual role, in the multidisciplinary team and have maintained both my personal health and professional development throughout my early career.
In hindsight, I now understand that the relatively lighter workload was likely due to the regular junior reviews. In my view, the complexity and attention to detail in the assessment and planning of a newly qualified doctor differs from that of an experienced one, potentially resulting in longer job lists.
Throughout medical school, I had a sense of having time at my disposal. However, in my first year as a doctor, it felt like time managed itself. The common warning was that working beyond five o'clock would be the norm during your debut month as a doctor, but during my initial stint in general surgery, staying late was a rare occurrence. At the time, I credited this to the dedication and hard work of my colleagues. In hindsight, I now understand that the relatively lighter workload was likely due to the regular junior reviews. In my view, the complexity and attention to detail in the assessment and planning of a newly qualified doctor differs from that of an experienced one, potentially resulting in longer job lists. My approach to managing a straightforward case of healthcare-acquired pneumonia, for instance, typically involved three key steps. First, administer antibiotics, a fundamental practice ingrained during medical school. Second, write up intravenous fluids to prevent the night team receiving any calls regarding a hypotensive patient unable to tolerate oral fluids. Lastly, consult a senior colleague. I was confident that any potential medicolegal repercussions would be evaded if you document the line ‘discussed with senior’. However, upon entering my first medical rotation, I discovered that a respiratory physician might offer a more comprehensive approach, encompassing blood and sputum cultures, atypical screens, a detailed radiograph review rather than just relying on the radiographers' report, and other valuable insights.
When a dedicated physician takes a patient's history, conducts a thorough examination, and truly delves into their problems, it's nothing short of inspiring. It's a moment where things change, and the patient feels genuinely cared for. However, this meticulous approach did have an unintended consequence - a remarkably long plan at the end of that day’s page. (During my early hospital roles, I had no choice but to rely on paper notes, which offered an alternative to the convenient and legible electronic documentation I'm now accustomed to). Striving to meet the high standards set by well-meaning consultants meant juggling extensive collateral histories, detailed referrals, and frequent communications with the laboratory to follow-up samples sent "x" days ago. I felt compelled to complete these tasks promptly, I knew they did not need to be done the same day but when left undone it felt like I was not working at my full potential. I eventually learned that this wasn't the case.
