The Junior Doctor’s Journey

By Dr Seth Forster

There was no lightbulb moment for me when I realised I wanted to be a doctor. It was something that came on slowly, over time, and I couldn’t necessarily even explain why. Apparently, the first time I’d mentioned it out loud was at a careers meeting with my school and parents, who were shocked. They probably thought I’d been watching too much Holby City, and they were probably right. They say every journey starts with a single step, I suppose that was mine.

We started looking into the work required to apply to medical school; UCAT or BMAT exams, interview courses, interviews themselves, personal statements to pad out with all sorts of musical or sporting achievements, volunteering to show how conscientious and caring an individual I was. I put in a lot of work back then, that’s before all of the revision and schoolwork I was doing to actually make sure I got the grades I needed.

I remember the feeling of excitement I got when I got an email inviting me for a medical school interview, the feeling when I got an offer of a place to study and I remember even better the feeling of results day, my mum coming to wake me up and telling me to check online because UCAS had been updated and seeing I was in medical school.

I was very proud of myself and my achievement! Looking back though it wasn’t really my achievement, well not mine alone at the very least. So much was thanks to those around me, my parents first and foremost who kept motivating me when my confidence was low, who funded my exams and interview preparation, took me to my volunteering, interviews, and much more. My teachers too who helped with extra-tutoring or extra-curricular studies. I hadn’t realised at the time how much support I had needed to get in and how fortunate I was to have that available. Hindsight has given me a much greater appreciation of the access to medicine/foundation courses many universities now have available.

The 5 years at medical school flew by. My first year I jumped straight into work and revision. Obsessively making sure I properly knew everything that came up in our lectures, even lectures on molecular bonding which was never going to have any use on a ward round. As I got older and wiser, I learnt the benefits of working smarter not harder and how to have a work-life balance. University became a lot more enjoyable after that, my grades improved too!

All too soon I reached final year and the time had come to apply to start working. It was a stressful time, working out how many points I had to apply with, which deanery I was likely to be successful getting into and why the SJT answers never seemed to be the same!

I was fortunate that the deanery I wanted was one of the least popular in the country with lower competition rates. After that I had to pick which jobs I wanted for my foundation year. Each offer for a foundation place comes as a set of six rotations over two years. The rotations are fixed so you have to pick ones which include the most specialities you’re considering for a career and the fewest you dislike. You do this whilst balancing which locations actually offer them. Deaneries can be spread out over many towns and cities so where you end up can be very varied. You rank your options, hundreds of them, and hopefully end up being given one near the top of the list. I ended up with geriatrics, orthopaedics, paediatrics, urology, GP and A&E.

August came and I found myself living in a small town in the Midlands which I hadn’t heard of until a few weeks previously. We had an induction, meeting all of the other new FY1s, many of whom were local graduates and knew each other. I didn’t know anyone. We were all in the same position though, excited to start, eager, and a little bit scared too. After a few days of introductory lectures we started our shadowing.

We had 5 days following the current FY1s on our first job whom we would soon be replacing. It was very similar to being a final year medical student, joining in the ward rounds, trying to note down what the consultant was saying as he walked along, scribbling it in the paper, trying to make it legible enough to see what the days jobs were. There was little real responsibility though at the time, we just felt that we were helping out. That soon changed.

The first Wednesday of August came around quickly though and all around the country it was time for the newly qualified doctors to start work. I arrived early, read through some of the notes and got ready for the ward round.

Geriatrics is an unusual speciality in that, although many patients are very poorly with complex needs, others on the ward are well enough to go home after treatment but are waiting for carers to look after them or a care home bed. For some patients the ward round was more of a chat whilst the occupational and physiotherapists did the real work. For really ill patients though the senior doctors had long complex discussions about treatments I’d hardly heard of, with occasional breaks to ask me or the other FY1 about an obscure medical question we wouldn’t know. Those ward rounds made me feel like I was still at university, a student tagging along. The one time I had a smart suggestion about something we could try, I got a response, “go on then, you’re a doctor now!” That was the first time it hit home for me. I gave myself a little smile as I walked off to do it.

There are a few common jobs to do as an FY1. There are always more blood tests, cannulas to replace (usually just before home time for some reason), scans to request and chase, referrals to make, discharge letters and paperwork to be done. I’d never liked taking bloods or cannulas at university. There was always a safety net of there being an actual doctor around to do it if I missed the vein, and so I often did. Finally, that person was me and the added pressure was helpful, it was either that or the extra practice, but I soon started settling into the role pretty well.

Most of the time as a medical FY1 job you’re on the ward. Following a senior around, making notes on their plans and then carrying them out. Every so often though you get to be on-call. Its one of the few times as a very junior doctor you get to have your own (semi)-independent practice. Referrals come from A&E about patients that are too unwell to go home. You see them, take a history, run the tests you think are needed, make a diagnosis and start your own plan. It’s the exciting part of being a doctor and what we all signed up for, diagnosing and managing a patient on our own. At least until a registrar or consultant has time to come round, review and tweak or completely change your plan, depending on how good it was. These are tough shifts, 12 hours long if you leave on time, carrying a bleep so you can’t hide, lots of unwell patients to try and juggle with. They were the best part of FY1 though.

One of the jobs at my hospital of being on-call was being part of the cardiac arrest team. I remember the first time my bleep went off, panicking that I’d been called to get to a part of the hospital I’d never heard of, asking directions then running over hoping I wouldn’t be the first to arrive and have to manage it on my own. We all have a job to do in a crash, some people taking blood, others doing chest compressions, some people timing when the shocks are due and others taking notes to know what has happened and when. I was the latter to start with and it wasn’t until a few arrests later that I actually got to do any chest compressions. The first time doing this was quite a surreal experience. Nothing like the simulation training we had done, but I suppose it never could be. I felt very detached from it all, not really appreciating the enormity of what was going on but doing my best to help out. I was a 23-year-old, involved in life or death decision making, I felt much younger than that. Very few cardiac arrests end up in success stories, certainly not like the Holby City I used to watch.

When we talk about the doctor’s journey, there’s a lot more than just the emotional and educational change, but a lot of physical travel too. FY2 came around and that meant moving to a whole new hospital, city and county. Away from all my new friends, starting over again. This time however I was starting as an SHO, slowly moving my way up the medical ladder. I would have an FY1 that I was senior for coming to me for advice and I would be the first port of call in the hospital for urology advice out of hours when I was on-call. A lot of responsibility for someone with absolutely no urology experience; I grew into it though.

A placement in GP came afterwards, having my own clinic, seeing patients on my own, making plans then going through them all with a proper GP. Finishing off with A&E, mostly in the minors department but sometimes having the excitement of resus and cardiac arrests. Out of all of the jobs I’d picked for my rotations back at the end of medical school, the ones I’d actually enjoyed the most – geriatrics and urology – happened to be the only two I wasn’t looking forward to. Its strange how sometimes life can work out like that. I’d finished all 6 though and my foundation years were finished.

I knew I wanted to do an FY3 from the start, a year out of training to gather my thoughts, try and pick up enough portfolio points through audits and papers and to take a break from medicine. It had been a long journey from all the way back in school, all through the Covid years and I knew it would be tough, but I hadn’t anticipated quite how much. Working far more hours than I was actually contracted for, or paid for! Working on projects in my own time just so I could have points for training applications, moving from ward to ward, city to city and never really getting to keep up the relationships with people I promised myself I would.

Whenever I get together with another medical friend we find something about work to whinge about with a smile. Everyone I know has thought about leaving medicine and finding a new career. I’m no different, most days walking home from work, late again, I’d be considering what else could I do with myself, plumber or marine biologist were high up on the list. I’ve given it a lot of thought so far. Is this really what I want to do for the rest of my life?

To quit or not to quit? That is the question. Its still very early to decide. Some days I go home feeling a real high after making a difference for someone. Other days I walk home, disappointed that I’ll have to do it all over again tomorrow. The NHS isn’t a perfect place to work by any means and the job certainly isn’t how it looks on TV. I still have lots to learn, and there’ll be plenty of new challenges to face over the next few years. I‘ll keep on doing my best.