“Just get through written
finals and you're on the home straight . . ."
It was a little over
12 months ago that I had completed part one of final MB and I was
assured that if I survived those it was plain sailing from then on
it. Effectively the hard part was over! (?)
How long this honeymoon period was to last was
never fully timelined.
Yes I passed written finals and survived my final
clinical exams. However I now feel that I took for granted the
significance of the transition that awaited me in the first week of
August, as I went from carefree medical student to a newly
qualified F1 doctor with all the responsibilities and stresses
that accompanies this role.
The transition can be especially more
challenging when relocating to a new specialty/hospital/deanery and
getting to grips with the subtle differences that exist.
The unfortunate labelling of "Black Wednesday" by
the media does little to alleviate these difficulties.
I quickly learnt that five years of medical school
taught me a great deal, however it can be quite challenging to
combine such a wealth of information whilst trying to familiarise
yourself with the onslaught of never-ending discharge letters,
e-portfolio, prescribing night sedation at 3am for the first time,
pacing yourself for the dreaded 12 day runs in your rota and
ordering CT scans at weekends... face to face with a bemused
radiologist knowing full well you aren't entirely sure of the
indication for this imaging request.
Same rickety boat
It has been a steep and at times incredibly
stressful learning curve, however (without sounding too clichéd) I
feel that I have subsequently grown and developed as a result of
these past four months.
One important aspect of being a new F1 and
certainly in a new city/hospital is that your peers are all in the
same (relatable rickety) boat and are an excellent source of help
and support. It's important to avail of this even if it's just
sounding off to a good friend over a Starbucks (or any other
generic/fairtrade coffee house) after a particularly stressful
It's important that junior doctors continue to
support and look out for each other as the stress amongst the
medical profession is well documented.
Nearly half (44%) of the 368 doctors that the BMA
surveyed in a study in 2013 said that their stress levels were
worse or much worse than they were a year before, while similar
proportions said that work-life balance and morale had worsened
(39% and 40%, respectively).The BMA has said that the working
patterns of junior doctors have turned training into a “trial of
Practitioner Health Programme
The need to address these issues is
encapsulated by the work of the Practitioner Health Programme
(PHP).This is a free confidential service founded in 2008 for
doctors and dentists living primarily in London who have mental
health and/or addiction concerns. The PHP recognises the need for
Doctors and Dentists to have the same rights to confidential
healthcare as the rest of the population.
It is led by Dr Clare Gerada, former Chair of the
Council of the Royal College of General Practitioner who has found
that since the service began, an increasing number of doctors have
presented with mental health problems — 242 in 2012/13 compared to
195 in 2008/09. It should be noted that 55% of the patients
presenting to the service in 2012/13 were aged 25 to 35 while only
22% were aged 46 or over and it is important that this is put into
context as under 35 year olds represent 28% of those on the GMC
It is well documented that Doctors are at
higher risk than the general population of developing stress
related problems and depression, and of committing suicide.
The PHP has identified two key areas which
attribute as to why doctors are especially vulnerable to developing
mental health problems – these being occupational and individual
risk factors respectively.Doctors and other health professionals
report above average levels of stress—28% compared with 18% in the
general working population. (4)
Occupational risk factors include the
emotional demands of working with patients and their families, as
well as dealing with their high expectations and pressures. This is
coupled with structural risk factors such as the heavy workloads
and unpredictable working hours, as well as the often limited
At the individual level the personality traits
of many medical professionals, such as perfectionism, can result in
them becoming increasingly self-critical, developing self-doubt or
guilt for things outside of their own control.
Not eating right/enough,
smoking and drinking alcohol in excess are easy but unfortunate
ruts for stressed junior doctors to become stuck in as it is
believed that one in fifteen doctors develop a problem with
drugs or alcohol at some point in their lives. (5) It is therefore essential to maintain good physical and
mental health in order to function to the best of your
Letting off steam
From personal experience I have found that it
is vital to sustain the interests and activities you had before
starting work as a F1 - whether this is playing sports, going to
the gym, heading to gigs or being a part of other
clubs/organisations. More often than not these activities provide
the perfect outlet for letting off steam and getting rid of built
up stresses and worries accumulated over the working week.
It is also essential to sustain
friendships/relationships in the midst of working in the busy f1
rota. Trying to keep in touch with uni mates based in other
hospitals or friends who aren't medics can be particularly tricky
especially when you are working long anti-social shifts. It is key
however that you make time for these people - especially non medic
friends as they quite often help distract from the constant
onslaught of hospital chat and provide some refreshing perspective
and a non-judgemental ear.
It is making time for this, that is the key and it
is incredibly difficult to strike a good work-life balance when you
struggle to finish on time in the midst of a hectic shift.
These things can't be helped and as a new F1 it's
important to accept that clinical situations become distorted
constantly at an unpredictable pace.
This summer prior to starting work in august, I
read "Trust me I'm a junior doctor" written by Max
Pemberton – the pen name of the well-known British psychiatrist,
author and journalist.
It is only now having retrospectively re-read
the book in the midst of making the transition that I fully
appreciate the brutal honesty and stark insight into life as a
newly qualified doctor and the challenges that accompany
One of the main things I have learnt from my time
as a newly qualified F1 is acknowledging when you are out of your
depth - whether this is in an acute clinical setting or after a
particularly challenging time at work. There are support services
available - occupational health, your clinical and educational
supervisors as well as other f1 and more senior colleagues.
BMA services are a constant source of help and
guidance for doctors and are easily accessible through their
website. Exploring such avenues and seeking out help should not be
viewed as a sign of weakness but rather one of strength and
self-awareness in knowing your own capabilities and where your
The past four months have been both the quickest
yet most intense I have experienced - certainly since the build up
to finals. I have however learnt a great deal not only about
medicine but about myself and where my strengths and weaknesses
I am sure my next rotation will provide me with
equal insight and a variety of new and challenging experiences
ahead which I relish in anticipation.
1. Health Policy
& Economic Research Unit. Cohort study of 2006 medical
graduates: 7th report. BMA, April 2013.
2. Gerada C,
Jones R, Wessely A. Young female doctors, mental health, and the
NHS working environment. BMJ Careers 9 Jan 2014.
Schernhammer ES, Colditz GA. Suicide rates among physicians: a
quantitative and gender assessment (meta-analysis). Am J
4. Firth-Cozens J.
Doctors, their wellbeing, and their stress. BMJ
5. Watts G.
Doctors, drink and drugs. BMJ Careers 2005; 331:105-6.