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The Big Step Up: Reflections on Becoming a Doctor

Every August throughout my studies, the departure of the final year cohort into their FY1 year fills me with a deep gratitude that I am not in their shoes.

I love medicine; I love learning, revising and I love the communication aspects. On my clinical placements, I admire doctors of all levels. What then is the rationale behind my unease? Obviously it’s a big deal to be placed with the responsibility for managing people’s health, emotions and ultimately their lives, but shouldn’t I feel prepared for that? It’s been 6 years!

1. We have no way to ease into it (but we could)

My medical elective in New Zealand helped me realise that part of the apprehension I feel towards becoming a doctor in just a few weeks time is not so unfounded. The system in New Zealand allows for a year of paid shadowing after completion of medical finals, something they call ‘trainee intern’ (or TI) year. The TIs essentially have a similar role as an F1, but with considerably less pressure and responsibilities. They’re not allowed to prescribe, and they are expected to only manage one-third of the patients on their service. Furthermore, they have mandatory daily tutorials on a range of topics. In essence, this year eases them from medical school into the real world of medicine, making the step up seem a lot less intimidating.

In my opinion, this is a safer system to operate in. I accept that one can never be fully prepared to become a doctor. However, surely, it’s better to have a system which allows doctors to feel as prepared as possible, especially given the current pressures of the NHS. After comparing the UK system with NZ over a lunch break (yes, you heard me correctly – doctors in New Zealand have a lunch break!) all the TIs agreed that they’d much rather their system than ours.

On a side note, it’s really not at all encouraging to hear current UK doctors constantly advising to “go and enjoy what you have left of life while you still can!” and “take it from me, burn your elective return ticket”. Half the doctors in Dunedin Hospital in New Zealand were ‘NHS refugees’, telling me how I should seriously consider escaping. Whilst some of these comments may be in jest, there is an undercurrent of dissatisfaction with the quality of life that a medical career in the UK can leave clinicians with.

Having said that, don’t worry too much about your first months. If you take good care of yourself and maintain a solid support structure, you’ll be okay. Check out this clip, taken and modified from a past lesson of Preparing for F1 by Camilla Rhead.


2. Committing to the decisions I’ll have to make for my patients

Having the final say on decision-making surrounding patient care is also daunting. During a gastroenterology clinic whilst on elective, the doctor asked me to dictate the letters for patients, including my proposed treatment plan.

While I dictated the words, “her symptoms are of unclear aetiology, and unlikely due to sinister cause”, I suddenly became uncomfortable. I had already discussed this with the consultant who agreed with me, however the fact that I had seen the patient and that it was my name on the letter, made the decision very “real”. My relationship to medicine changed in that moment. It was no longer a quest to pass exams. Even the easiest MCQ question, when presented in real life, with real patients, suddenly feels awfully hard.

That small voice, that rings at the back of your head, “What if I’m wrong?”, now seems to hold a brand-new significance and that’s something which no amount of years in medical school can prepare you for.

3. Keeping my emotions in check

As embarrassing as it is to admit, there have been more than a few occasions throughout medical school where I have felt my eyes tearing up. Strangely, this seems to happen somewhat randomly and is not limited to particularly sad incidents, or even sad emotions, as one might expect.

As a medical student standing in the shadows, these moments of emotion never posed a real problem before, however now that I’m starting work, containing my emotions appropriately is a niggling worry for me. Not only do I worry that I will be able to hold myself together when breaking significant news, but also that when I am called to a sick patient, I am able to disengage from emotion and focus clearly on the job at hand.

Excitement: The Flip Side of Nerves

While I have spoken at length of my reservations about becoming a doctor – in all honesty – I always thought I would be more nervous than I am. I feel medical school has prepared me well and I finally feel ready to stop trailing behind the other doctors and to do some real work. The thought of being able to explain things to patients without giving my spiel about how, “I am only a medical student so cannot offer any official advice”, makes me genuinely excited and I can’t wait to introduce myself for real as a doctor.

Having an active life outside medicine will pose certain challenges over the next couple of years, however I am ready and excited to commit myself to work and embark upon the huge learning curve that awaits. As a good friend of mine said to me, “Believe it or not, now the real fun begins.”

To all my fellow incoming FY1s, remember – we’re all in the same boat. Let’s work together to keep it afloat!

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