First Things First


Our Former Editor-in-Chief, Rob Ceaver is back as Doctors’ Mess Editor, continuing the ‘Diaries of an FY1’ series. Read on to find out his thoughts on the experience!

I am one of the doctors; a sentence that, for a while there, I wasn’t entirely sure that I’d ever get the chance to say. I’m now one of the gang. I’ve done the initiation rituals; I’ve snoozed through clinics, I’ve clung to ward rounds where I’ve been supernumerary, but now I can say that I am most definitely one of the doctors.

On paediatrics as an FY1, a freshly fledged FY1, I am well supported. Despite being thrown into the maelstrom of medicine, there is somebody to hold your hand through the swirling winds because at all times there is somebody on the ward a little bit more senior to discuss a patient with. However complex or acute a problem is, a registrar or consultant is just around the corner. Knowing that I’m not entirely alone is a real bonus because this early in training, where everything is a teeny bit terrifying, it’s better for me and my patients that I have that senior help to fall back on.

It is really rewarding to have my own patients at last. Responsibility is something that we’re seldom offered at medical school but as doctors you are supplied with a constant stream. On my first morning I was called across to a different part of the ward to see a patient who had just arrived on the ward that nobody else had had the time or opportunity to see. All I knew was that he needed some intravenous medication prescribing. I sat down, took a deep breath and got on with it. I did all the formalities and managed to squeeze a little chat about football in with him – no seven year old that I know wants to talk about their medical history! Despite taking a lot longer than necessary to calculate the dose that he needed, a couple of days later, after a particularly draining morning, I was handed a little envelope. Inside it was a lovely thank you card from the patient and his mum. I sat at the table in the doctors’ office brimming with glee. That was one of the feelings that I practice medicine for, the satisfaction of doing a good job at making somebody feel better.

One thing that is rather unsettling is that I have only signed a four month contract despite being signed up for a two year foundation programme. This is of course due to the ongoing contract debate between the BMA and the Government. In theory, when I rotate out of Paediatrics in December, I will sign a version of the new contract, one that has been mightily improved by BMA negotiation over the past 12 months. Of course, the echoes and whispers of the new contract exist in practice at the moment, even on the old contract. Rotas have been changed according to guidance on working hours in preparation. For example, our FY1 rota on Paediatrics now has our long days, all thirteen hours of them, in a very different spread than how it was for previous FY1 doctors. It isn’t a perfect system, some weeks I will work 71 hours, others I will work a much kinder 40, and others I will work 21. Those short weeks are the stuff that dreams are made of.

There are also the ghosts of GP trainees that never materialised, leaving gaps in the rota left for others to fill. FY1 locums are something that I hadn’t really thought much about before starting. In all honesty, I wasn’t entirely sure that they existed. Here however, to fill the shoes of the GP ghosts, FY1s can cover the hours between 5pm and 10pm at a very healthy hourly rate. Saving for a holiday may be a little easier than I thought!

Of course these are gaps that the Rota Coordinator and Consultant Paediatricians are trying to plug any which way they can. Locums are not the most cost-effective way of staffing a ward. Whether they can recruit other trainees on the GP training pathway I am unsure but, until then, those evening stints are ripe for the taking. Following the recent furore in the press over how much locum Consultants sometimes get paid, the public aren’t mightily keen on the idea that money that could be spent elsewhere within the NHS is actually being used to shore up the rota gaps. Understaffing has always been an issue in the NHS but in the current climate morale is especially low and an NHS job often doesn’t have the same attraction as it used to. Until we have a situation where all NHS staff feel valued by their Government, we are likely to endure further staff shortages.

Despite the teething problems of starting a new job, the nuances of the system, the problems with how it appears to be run, I am enjoying myself and I wouldn’t want to do anything else. There is a sense of camaraderie, of teamwork, and of siege spirit that is entirely infectious in spite of everything that is thrown at us. When people say that working in healthcare isn’t just a job they’re completely right; it’s a vocation and a way of life and one that, with my gang on the Children’s unit, is just what the doctor ordered.



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