forgot about this little blog but made it into IMT (to start in August!!) and have done a whole year of working as a doctor in sunny sunny Australia :)
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@scrapingthroughmedschool
forgot about this little blog but made it into IMT (to start in August!!) and have done a whole year of working as a doctor in sunny sunny Australia :)

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being a medical student is a horrible existence
âWhat matters most of all in life is being able to make that contact with another human. Otherwise you are dead, like so many people today are dead. But if you can take that first step toward communication, toward understanding, toward love, then no matter how difficult the future may beâand have no illusions, even with all the love in the world, living can be hellishly difficultâthen you are saved. This is all that really matters, isnât it?â
Ingmar Bergman, from an interview conducted c. October 1964

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you need to start believing that nothing is too good for you
yesterday a young patient's (for whom I put out a met-call as she was losing a lot of blood+needed emergency surgery) mum came up to me and said I had saved her daughter's life and I've not been able to stop thinking about it
Liz Fosslien Â
6 months into being a doc
I completely forgot about this little Tumblr blog but here I am 6 months down the line.
Enjoying the job, falling in love with medicine and actually finding it so much more interesting now that I'm working... I love all my seniors and colleagues and have been taken care of so well. I'm learning so much all the time, and I do love it.
The hours can be tough, but I'm grateful all the same. Proud of how far I've come and wish I hadn't been so petrified of becoming a doctor... it really isn't as scary as I thought it would be.

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doing my first set of nights as a doctor
i saw a quote that said âi feel like iâm constantly worrying about the next part of my life without realizing that iâm right in the middle of what i used to look forward to.â and i felt that.
Hey! Hope you're well. I was wondering what sorts of tasks you had to do as an F1 or F2 on nights on call. And when would you involve someone more senior?
Hello! It depends on what kind of Hospital At Night protocol your hospital has. But broadly speaking, itâll be things like:
re-siting cannulas, if your nurses canât do it. Because those IV antibiotics canât give themselves.
Prescribing paracetamol for people who are in pain/ have a headache/have a temperature of 37.5. Do this, but it will never be your first priority.
Someone will want tablets to sleep. Have a high threshold for starting these.
âThis patient hasnât opened their bowels for 10 daysââŚ. and people decide to tell you at 5am.
This chart needs rewriting. Yes, really. You will curse the day team for not doing their job, but eventually youâll probably go and do this anyway.
This patient needs to go home but the TTO isnât done. Nobody cares about the fact that you donât know the patient or anything about their 6 month stay. You might get time to do this eventually, but clinical needs will have to come first. This will not be a popular decision.
Someone wants opioid pain relief. Unless it is an urgent acute medical emergency in which opioids are indicated as part of best practice (like sickle cell crises, burns, MIs,) use your WHO pain ladder. Be VERY wary.
âDoctor, this patient is agitated, canât you give them something to calm them downâ. Remember that a good calming chat has much fewer side effects. Tell them to call security, and encourage adequate nursing staffing/requests for extra staffing if patients need 1 on 1 care. If you must use pharmacological means, for their best interests, check your hospitalâs sedation protocol before you give anything.
You do not have to prescribe anything you do not feel safe prescribing. It is your name on the prescription. Your GMC number.
Do not take patientsâ or relativesâ words on dosages; if you donât have a report from the GP, or a box with a label on it, be careful. People often think they remember their dosages, and some do, but many are⌠somewhat confused about what they take.
âDoctor, the fluids ran out for Bed 7 on ward 8, would you like some more fluids written up?â. Donât prescribe any fluids without a look at someoneâs U&Es and their fluid status/ a listen to their lungs. Iatrogenic fluid overload and hypokalaemia/hypernatremia are a real thing.
âThe bloods just came back from the lab, and the creatinine is 400/ potassium is 8 / D dimer is 5078 / Troponin is 497âł. The day team should have handed over the case and why they did these tests, but now youâve got another thing to sort out.
Early on in your shift there might be at least one set of patient relatives who donât know that the patientâs actual medical team have gone home, donât listen to what the nurses tell them, and ask for âthe doctorâ to come and tell them the same thing. You might have time to speak to them (doubtful); I usually warn the nurse to tell them that I will be around if and when I can, but they may not still be there, because Iâm dealing with sick patients. And that the best thing to do would be for them to call the ward the next day to book a meeting with the regular doctors.
Never say ânoâ to a nurseâs request for you to come do something. Be polite when they bleep you, let them know you will come as soon as you can. If itâs low on your list, warn them you may be some time.
prescribing the warfarin that people forgot to write up duting the day. Whatâs the INR? Who knows? Protip: be careful about changing peopleâs dosages in the middle of the night if you donât know the entire history.
dealing with hypoglycaemic patients; hours of coaxing patients to eat some toast already.
dealing with hyperglycaemic patients; is it DKA or not?
Everyone is Falling Down, falling down, falling down. Falls reviews will be your least favourite job, because they could have been avoided.
Someone has melaena! Or haematemesis, or both. Oh no. Upper GI bleeds will buy patients an OGD in the morning and possibly a blood transfusion overnight.
Oh, the haematuria! Is it because they use their catheter as a stress toy, or is there something sinister?
âDoctor, we canât catheterise this patient because of something to do with their prostate, so please come and do it.â
This patient has been coughing for 3 days, and youâll never guess what their saturations are doing now! (spoiler alert: they have HAP)Â
Someone is having chest pain and their ECG is kinda funny; the only time you will see a STEMI outside of the cath lab is on the ward. This is what calling your reg is for; you can give the initial treatment but they will need to get them a ticket to the cath lab stat.
This patient is having SOB and everyone thinks itâs pneumonia, but the surgeons gave them 8L of fluid today; Flash Flooding of the Lungs.
Sepsis! At the disco. Sepsis! on the ward. Sepsis! is basically hiding everywhere. Have a low threshold for diagnosing sepsis.
âDoctor, something just doesnât look right about this patient.â Have a very low threshold for calling for help on this one. Nurses know.
Somebody had a seizure, and by the time you get there, they no longer have a seizure. If they are still having a seizure, put out a crash call for status epilepticus.
This patient is DNACPR and for ward based care, so they are almost at he limit of what we can do, but now they look peaky and their blood pressure is dropping, can you please do something? You will, but they will probably die anyway. Do not be afraid to ask for senior help, even if they tell you âyouâre doing all we can doâ. It always feels hard when you reach the limit of what you can do.
Somebody died, but itâs OK, because they were expected to die. You just need to certify them at some point. Worry about your living patients first.
CRRAAAASH CAAAALL! ALL HANDS ON DECK! Everyone will show up to this one.
Those are the kinds of things you might see on nights, but by no means an exhaustive list. Your bleep will keep on ringing. Make sure to take time to eat and pee at some point. Prioritise things in order of clinical urgency. The key is that you get as much detail as possible on the phone from the nurses. The patientâs name, hospital number, DOB, ward number and bed number. Then their observations and situation. When you go there, assess them through an ABCDE framework. If they are stable, examine them then look through their notes. This is the time when you make a judgement of how ill they are. If they are stable enough that you donât feel they are about to die on you, then you can start treatment or investigation then discuss with a senior. But if they are really unstable, there is nothing wrong with calling the SpR even then, or putting out a peri-arrest call. If you need to initiate a treatment, then you start it.  If you need investigations, then you take and send them. Most of the time, this will be enough.If they are unstable, you need to ensure that they are improving before you move on. If your initial treatments donât stabilise the patient, then you should reassess them and call for senior help. If you are facing several very-sick sounding patients, then call your other colleagues; the SHOs on call, the reg. Donât be afraid to let your seniors know that you have 3 sick patients to attend and canât attend all of them at once. Your reg on call is ultimately your team leader on the ground, and they wonât know whatâs going on with you unless you tell them.If you need help, you can always ask for advice.
Your hospitla intranet will have lots of useful protocols on it. I kept the most common ones I needed printed out in my clipboard. A handbook of medicine (or acute medicine) in your bag/pocket can be really useful. I go into more detail in my posts about surviving nights and tips for new docs (can be found on my #tips for new docs hashtag). Hope this helps!
Junior doctors in England to strike for four days in April
British Medical Association accuses government of âdragging its feetâ by not presenting a credible pay offer
sitting the prescribing exam today and then after that... Iâm done!Â

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resetnyc
brunie.moodboard
For most first-and second- year medical students, residency is only in their imagination, and it is not truly until the third and fourth years that it becomes something they can imagine very well. It is the mystical land of having âmade itâ: getting through medical school, having the title MD or DO finally applied to you, and being thrown head first into the clinical world. Most medical students seem to think of residency with trepidation and cautious excitement. All that we know about it is what we are told by doctors who did it and older medical students who are about to do it, or what we see residents doing on the wards; rarely do they have much time to sit and talk about what it is like.
âI believe this message, more than almost any other, can benefit medical students. He says this: âWe start here, and we go there. But itâs not that simple, is it? Our paths may be circuitous or direct. We may gaze excitedly ahead, or cast our eyes regretfully behind. Until we reach our destination it exists only in our minds. It is what we have imagined it to be. And yet we tend to neglect the journey, which is real, in favor of the destination, which is not. For too long I neglected this journey. It was an obstacle to be overcome, an ordeal to be endured; for I had never chosen the journey, I had chosen the destination. But now that the journey has ended, I have discovered that here isnât so important after all. I find myself looking back with particular fondness for how I got here.â
Brent Schnipke at Boonshoft School of Medicine at Wright State University reviews the book Hot Lights, Cold Steel, which explains that we should appreciate the journey through medicine more than the destination we are trying to reach.