It’s two in the morning and you’re one of three doctors called to an emergency resuscitation. Looking at your pager in dread – it’s the patient with upper GI bleeding you reviewed for hypotension two hours ago. When you arrive there is blood everywhere. You’re on circulation, but just cannot site the cannula. The anaesthetic registrar is too busy ventilating the patient to help. The ICU registrar asks if you know anything about the patient? You stutter an ISBAR handover. Next up is CPR. Your mind is racing – is it half or one third of the chest depth for compressions? The resuscitation is unsuccessful and the patient dies. Did you do something wrong?
Everyone leaves and the nurse asks you to fill out the death certificate, call the family and notify the consultant. You just want to disappear. Having never certified a death before and not even knowing the cause of death, you think of asking the medical registrar, but feel it’s such an obvious question. You wonder, could this be a coroner’s case? Should I call my medical defence organisation? Feeling overwhelmed, you dig into the jar of Allen’s snakes. No one has asked if you are okay.
Are you okay? The arrest alarm rings again and you’re relieved when it’s a false alarm. There are still five hours to go.
No matter how many years have passed, it’s hard to forget those adrenaline-charged times experienced as a junior, when we were berated for not knowing something. With constant sleep deprivation and a high patient load, it’s easy to forget how green juniors are and to be dismissive. It’s easy to start a sentence with “when I was an intern…” So are we guilty of perpetuating this negative culture? Yet when we do give feedback to a junior, will it be misconstrued as bullying?
As a GP registrar nearing the end of my training, I would like to share a few reflections I’ve had during the dreaded training years.
Finding that sense of belonging
As humans, most of us have a desire to belong to something; a sporting team, a choir or a club.
Working as a doctor is no different. One of the greatest fears about starting a new job is being alone. There is always that teething period until we make friends and find common ground with our team that we feel in our comfort zone. With each new rotation or hospital, it feels like an uphill battle trying to break into the crowd and culture of the workplace. We then feel that sense of control when we know which ward clerk to ask for a favour and which team consultant will make for a breezy admission. And when we find that sense of belonging, it’s invariably time to move on again.
We also gravitate towards the specialties that will nurture our personality quirks. But it doesn’t matter what and where we choose, the most powerful thing is the support we receive from colleagues, family and friends.
It’s okay to ask
As registrars and fellows, we are often that middle person between our juniors and consultants. We are both the messengers and the targets at family conferences. We hold the fort overnight, desperately trying to triage what needs to be seen first, and when is an acceptable hour to call the boss. Juniors expect us to know the answer and we do too. We don’t want to look incompetent in front of the consultant and nursing staff because it could jeopardise future training positions.
However, it’s really okay to ask. It’s okay to ask if you do not feel equipped to answer the question. Whether it’s the physiotherapist or the patient, it’s okay to ask for help. It’s a mark of knowing your limit, rather than a sign of incompetency.
If our collective aim is to provide the best patient care, then we should ask anyone and everyone it takes to get the best answer.
Remember, you’re always being watched
I remember witnessing an exchange where a medical registrar stomped onto the ward and remarked loudly, “that was such a terrible consult” to the Resident Medical Officer (RMO) in front of nursing staff and allied health. Unbeknown to the registrar, the RMO had been going through a difficult time at home and was embarrassed being berated in front of so many people. The RMO confided he was terribly depressed and wanted to quit his job. Patients overhead this exchange and wanted to lodge a complaint about the registrar’s conduct. The registrar had been battling her own demons; she hadn’t passed the written, again, and felt hopeless about her career prospects.
These are not excuses. We are all human and have good and bad days, so it can be helpful to think about what the other person may be going through.
What we do is contagious to those around us; the way we deftly handle a difficult patient or speak to our juniors. Whether we do that well or poorly, our juniors may look to us for inspiration in how they conduct themselves in the future. Sometimes asking yourself: “what are my interns learning from me?” can be helpful.
That doesn’t mean we shouldn’t give feedback to our juniors and colleagues. If we feel something is amiss, it’s our job to let them know. At the end of the day, it’s about patient care and safe medical practice. If there is an underperforming junior, you should take them aside for a confidential conversation. After all, that’s what we said we would do in the ‘struggling junior question’ when we interviewed for the job!
Look after yourself
It may sound ironic that the final point is essentially about self-preservation.
We often get lost in the care of our patients. We have to be better, work harder, do more research and complete our training quickly. We worry about a patient’s hypoglycaemia following an overnight fast, but we can’t remember when we last ate. We fuss over a patient’s urine output without minding our own urine retention.
If we don’t look after ourselves – who will? Sound physical and emotional health is paramount to providing the best patient care.
With the allegations of bullying and harassment among trainees coming to light, it’s emerging just how isolating and negative the culture in medicine can be.
Maybe it’s the right time to ask yourself the question – am I okay?
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