Tuesday, 17 July 2012

Erm... that's Dr TTBAMS, actually...

It's true, I have finally done it. Dr TTBAMS at your service.

After five long years of medicine and two years of "extra", I have at last passed everything and am legally permitted to call myself doctor. Oh, and look after patients, under supervision.

People keep asking what I've done to celebrate, and although fizz bottles were waved around (my sister and I shared a tiny bottle of pink cava on a bus, and the other half produced a bottle of proper fizz and a bottle of French kids' fizz, which is the lovely non-alcoholic fruit juice version, wish they sold it here) I have done very little. I don't feel particularly celebratory - my main response was "well thank goodness for that". At least I don't have to go through that ordeal again. "That ordeal" can be either final year or the entirety of medschool, depending on how exhausted I'm feeling at the time.

Honestly, I am just so glad it's over. I have been thanking the friends who got me through that last exam, and the other half for getting me through the whole thing, but I haven't really reflected on my achievements. One day, when I recovered from the relief enough to actually think about it, but not yet.

Maybe that's partly because the celebration is tinged with trepidation and nerves in the "OMG now I actually have to go and be a doctor and have responsibility for people" kind of way but I haven't been dwelling on that. I think gynaecology is a good place to start - there aren't too many life threatening mistakes that a junior can make. Don't miss an ectopic pregnancy (then someone actually could die and it be my fault), and if there's any risk that anyone has a lady-cancer, get a senior to check them out. I think starting in Accident & Emergency (or the Emergency Department, depending on the hospital) would be a lot more scary.

And so, non-existent reader, you may be wondering what's next for this blog - clearly the title doesn't fit any more. You can't try to be a medical student if you're already a a doctor. Or you'd be a bit odd if you did. I have it all planned, I will be moving to pastures new, or basically nextdoor, to www.tryingtobeajuniordoctor.blogspot.co.uk when the time comes that I actually am a junior doctor (i.e. next week). Please do join me there, and don't join me in my hospital, at least not in August - being ill in August is statistically not good for you*.

* I intend to find a reference for this at some point! In the meantime, don't test my claim!

Monday, 9 July 2012

Leaving the wrong job....?

For the last 5 years, I have had a vacation job during university holidays: I work in a museum. Not the small stuffy kind, the large, over a million visitors a year, amazing site, kind. It's had minor ups and downs over the lsat five years, but overall I have totally enjoyed it. I've been very lucky.

 This is not my museum! But it is a good one. Thanks to http://www.nyeparry.com/?page_id=619 for the picture.

I went back to work there recently after many months away (final exams) and was struck by a number of positives in this job which don't exist in medicine. I should have blogged about it at the time, but perhaps writing now will jog my thinking.

I love how in this job there is a team spirit, sometimes it's us against the world/tourists/tour group leaders/supervisors/powers that be, and that can unite a team, and sometimes it's us generally putting effort into ensuring that tourists and customers have a memorable few hours at our site, together. As a student it's difficult to really be "involved" in any hospital team, but none of the teams I've had anything to do with have had a team spirit that I could sense from my position as a student at the edge of the team.

One thing that particularly struck me is the culture of respect. It's a big group of people so of course some people grate on others a little, but even so there is a sense that the staff respect each other. In particular, people respect the supervisors, but not just because they're supervisors, but because a) they're (mostly) good at their supervising, b) are nice people, and c) they respect us. In medicine it sometimes feels like the seniors are respected because they demand respect, not because they deserve it. It creates a very different culture. It's not a big deal, and it's only noticeable when you start to think about it, or when you've been working elsewhere that doesn't have such a culture.

Recently in the museum a slight change in the system was trialled, and the supervisor asked my group of assistants for our thoughts and feedback - the senior staff genuinely want to know what the "junior" staff, the people actually implementing the changes, think about it, and will take those comments on board. It's not often that I've seen seniors in medicine asking for juniors' thoughts and feedback, except in a grilling and knowledge-testing sense.

Even at the busiest and most stressful times, people are generally happy and still so willing to help each other out. Again, not always evident in medicine. But maybe the stress is different - in the museum stressful times means long queues, angry customers, obnoxious tour group leaders etc. In medicine stressful times can mean the weight of the responsibility for patient's lives, especially when the line between a patient living or dying starts to thin. Perhaps the difference is stress contexts explains the differences in atmosphere here.

A colleague, for whom this is also "just" a vacation job, asked me today if I don't find this job a bit menial, since I have a good degree and will be a highly qualified professional (clearly indicating he finds it menial for this reason). I first told him he needed a slap, then pointed out I have two good degrees! Just because I'll be a qualified professional, in a totally different area to this job, doesn't mean this job is beneath me. It has taught me a great many skills, such as: communicating across language barriers and cultural barriers, communicating with children, diplomacy and tact in customer service, particularly with difficult customers (which transfers to diplomacy and tact in dealing with patients, particularly "difficult patients"), conveying complicated information in a way the recipient will understand, and the ever-useful skills of voice projection and crowd control. None of these are medical skills, but all of them are likely to be useful during my medical career. That's not something to sniff at.
There is the additional benefit that this role has enabled me to be competent and above all, confident, in dealing with many, many people, and confidence is not something one can acquire overnight, or just by magic or good intentions. The confidence I've gained from putting effort into this job, and knowing from the responses from colleagues and customers that I'm doing it well and making a small diference to someone's day, is something I couldn't have gained simply from being a medical student. A medical student I've found is frequently too much of a fifth wheel to have much of a sense of achievement (that's not to say that achievements aren't made, but just not on the same level).

Now the terrible bit is that I realised recently how much I enjoy this job, and how many of the things are appreciate are not present in medicine. I could only wonder why I'm leaving a job I've enjoyed, for one that predominantly scares me, in an environment which I don't always enjoy or feel respected or comfortable in. It feels a little bit mad.

Perhaps part of the reason I've enjoyed the job is because I know I won't be doing it forever, and perhaps if I were I would have a different approach to it. But I hadn't really thought about the fact that I would one day be leaving this job, in order to take up my forever-job, (the one I've been studying seven year for) but now it's suddenly here, and I'm leaving tomorrow. I'm really not sure if I want to!

I can at least be thankful that I've had employment which I enjoy, to return to every holiday (and some weekends), in a group where I feel part of the team even if I've been away for months, and have been able to go through my education with far more financial security than I otherwise would have.

After all, if medicine all goes pear-shaped, I might always have a nice job to return to! I could be a museum-doctor.

First, I have to get through, and make the most of, my last day tomorrow. It feels like the end of an era, and it feels silly to leave a job I like*. Needs must....

(*It was suggested to me that I'd have enough holiday from my doctor-job to return to my museum job occasionally, but 1. I do quite like the idea of having a holiday which is entirely a holiday, no job or revision or essay-writing to have to do, and 2. most importantly, I couldn't justify it. I'd be on a nice NHS salary, taking part-time holiday work away from school leavers, students and other people who really need the money, when I really won't - that's not right, and I wouldn't have particularly wanted someone earning good money to take my shifts away from me the last few years, when I've needed the money.)

Sunday, 8 July 2012

Carer's holiday, and a holiday for the carers

As I discussed extensively with Steph at Steph's two girls, I have a sister with Asperger syndrome (an autistic spectrum disorder). This week we went on holiday together. It was the first time she'd been away without our parents, so while it was a welcome break for them, it was a bit of an adventure for her.

My mother was convinced we would come back not speaking to each other, but we were even still laughing with each other.

However, I've come back with a newfound respect for people who can organise and take responsibility for a holiday and for other people's needs, when the other people can't communicate those needs. Taking care of meeting someone's needs without knowing what the exact needs are at that time and place is a skill I haven't yet perfected.

I've also come back with a newfound understanding of the little difficulties in coping that, when added together, make an independent life currently impossible. And a wonder about how outsiders, such as the lovely people at ATOS who will assess her disability living allowance, can possibly notice or understand such minutiae, and comprehend how someone who at first seems competent if a bit odd, actually requires extensive support.

But we survived, and had a lovely (if exhausting) time. Would we do it again? Yes, but preferably with better communication on what each person's preferances, needs, and limitations are, with updates when they change. That would be the life...

And also ideally with a sense that all the independence training that the holiday involved was in some way wanted or appreciated. It's difficult to have no idea but feel the need to pursue the ideas of independence and gaining skills anyway.

But yes, we would do it again.

Monday, 2 July 2012

I get by with a little help...

...from my friends, and other medical students who I don't even know that well.

The burnout that I mentioned has really been affecting my ability to work. I'd got books out from the library, from which to re-learn everything I knew in January, and hardly opened them. When I did open them (following an extensive internal battle to make myself do some work), I either struggled to concentrate or just fell asleep. I needed to leech off other people's energy to get things done, as I didn't have any left of my own.

A few lovely friends had offered to help; I found this really useful. There was no internal battle to work, as I'd met with them specifically to work, so I had to do it, and they wanted me to. A friend played the patient and either invented a history or tookone from a book (book review coming soon!) while I played the doctor and took a full history, with OSCE-style strict time limits. Friends in my year who had passed everything gave advice on how I needed to improve my performance. I also practised examinations, such as orthopaedic joint examinations, again to time limits.

This was so helpful and avoided me having to motivate myself (unsuccessfully); I realised I needed more of this. But three friends couldn't provide the help between them, and I'd feel bad taking up so much of their time.

I posted a status on facebook asking if anyone could help over the weekend, and had conversation with a friend offering me advice, but nothing more. Eventually I realised that motivating myself was getting nowhere, and although having three friends to help was wonderful, it wouldn't see me through the exam. So I sent a facebook message to 16 other people, students in my year and the year below, good friends and less good friends. I explained my burnout and need for people to help, what I needed (extensive surgical knowledge not required!) and the times that I needed help. Within 24 hours I had seven wonderful replies, all encouraging and movtivating me, and each offering different times that they were free to help.

Just reading those replies made me feel that this huge task might be possible, that maybe there was a chance I could face this big exam with confidence, and succeed. All except one stuck to their word and came to help (the one who didn't, didn't live near and we hadn't made as concrete a plan), all for over an hour.

For a whole week I did no work on my own, and felt very little guilt about it, because I'd worked with nine different people, and the quality of the practice was so much better than anything I could do alone. Quality over quantity, number of hours less important.

I had a little further help the next week, to ensure that I maintained my history taking skills, which had improved greatly, becoming slick and fluent. I there had some confidence going into the exam, I  knew that I could do it because I'd done it many times before. There is nothing like preparation to grow confidence.

Failure lies not in falling down, but in not getting back up again. For me to get back up, I needed help. There is no shame in needing help, the failure is in not seeking help. Asking a whole bunch of people to help me was one of the best things I've ever done. If only I'd recognised the neeed and could have asked for it earlier. Oh, hindsight.

If you need help, ask, and keep asking. Ask for specifics - I told everyone what I needed, and when, in timeslots for people to choose (e.g. "I need Thursday evening, Friday morning and evening" etc). It was easy for people to help because they knew what I needed.

In paediatrics people sometimes talk of "the team around the child" (or the team around the family). I've had so much support the last two weeks it felt like the team around the [TTBAMS].

If I have passed, it will be thanks to all these lovely people, and because I asked for help.

That's "me" in the middle of the team huddle - having that much support feels amazing. (Thanks to the Nigerian football team for the picture)