F1: any thoughts on making it home on time?

TL;DR: Since starting, I've been working up to 2+ hours beyond end of shift to finish the day's tasks. In my position, would you just leave at end of your shift or would you feel obliged to finish the day's jobs?

I'm on 'gastro' (general medical) at the moment and have not made it home on time once since starting last week. I'm so constantly inundated with tasks that I've missed lunch on most days and still end up finishing late.

Officially my normal working days are 9-5, but generally my colleagues and I (another F1 and an F2) tend to stay up to 2+ hours until the day's jobs are complete. On the plus side this helps patients, though unfortunately this leaves me utterly drained each day and I'm hating going in to work. I'm planning to give it a month and then consider quitting if this is still happening as at least I'd have given it a good go.

If you were in my position; would you just leave at 5 or would you stay to finish jobs?

Reply 1

Helenia

What sort of tasks are keeping you there? Are your seniors also staying?

You will get more efficient as you get used to the job but it is tough at the start. I did paeds as my first F1 job which was relatively chilled and then got plunged into gen med/gastro in the middle of winter, it was horrible. In general, if it's a sick patient, you should stay until you can hand them over to the on-call team, but a lot of admin work can wait, or be cut down as you get slicker. Good luck!

Reply 2

Democracy

Original post by Anonymous

Gastro is a busy job wherever you work, and it's also your first week. This is not to dismiss your concerns, but it's worth stating first and foremost.

I would try and work out whether you're staying two hours late because the work on your word is simply unmanageable and beyond the handling capacity of your team, or if it's because you're all still adjusting and finding your bearings. What sort of work is it that's keeping you late? Paperwork? Stuff that can wait for the next day? Conversations with relatives? Stupid bleeps? Are you handing over to the on call team?

If it becomes apparent that you're being kept late because the work is all necessary but simply too much for your team to handle, I would keep a diary, exception report, bring it up at your next junior doctor forum (results highly variable) and also discuss it with your educational supervisor, and if necessary, guardian for safe working hours.

If you're being kept late because you're still working out what you can and can't handover then this will come with experience. Do your jobs in order of priority so that you're not being kept late with important jobs at the end of the day which never get done and then turn into a viscous circle. Referrals, discharges, TTOs, investigation requests and all other time critical jobs come first. Don't be afraid to hand things over to the on call team - do this judiciously and sensibly, but absolutely do it, that's what they're there for.

In general, unless someone is peri-arrest, there is always time to get lunch or to try and leave reasonably on time (but don't turn into a clock watcher). I know this sounds like one of those statements doctors only a few years ahead like to say with a maddening air of wisdom, but it's actually true. There will always be work to be done on the ward. You, on the other hand, do not have an infinite capacity for working. Keep yourself hydrated, have a sandwich, have a pee, go for a walk or sit in the mess for 30 minutes. You will be far more productive afterwards, I promise you.

Reply 3

Etomidate

Original post by Anonymous

until the day's jobs are complete

I'll let you in on a secret which will completely change your entire medical practice.

Spoiler

The sooner you realise that, the better. Also, the most powerful word in the English language is "no". And believe it or not, it's a complete sentence also.

At 4.15pm, your only priority is tidying up loose ends. Don't take on any other jobs unless someone will literally die overnight. When the clock hits 4.15pm, it's a 45 minute race to get your **** done and be out the door by 5pm.

Reply 4

Ghotay

Original post by Democracy

Keep yourself hydrated, have a sandwich, have a pee, go for a walk or sit in the mess for 30 minutes. You will be far more productive afterwards, I promise you.

Although I agree with this 100% and always encourage others to take breaks, I usually l find I feel more tired after a break than before. When I’m running on empty I feel like sh*t but I just keep going. After lunch I’m usually ready for a nap...

Anyway OP it DOES get better. But it might take longer than a month

(edited 4 years ago)

Reply 5

Anonymous #2

Original post by Etomidate

I'll let you in on a secret which will completely change your entire medical practice.

Spoiler

How feasible is to actually achieve as an fy1, especially right now at the start of the year?

I would have thought that senior colleagues (and even the other fy1 and f2 that the OP mentions) would not be happy with me leaving at 5 if they are staying 2 hours late to complete jobs

I know it sounds a bit ridiculous but would people perceive me as lazy and not wanting to help the team/pull my weight by me leaving at 5 rather than staying as long as they do? I am in complete agreement that the jobs never end though and there has to be a limit to the working hours - I'm just not sure how possible it is to leave on time

Reply 6

Ghotay

Original post by Anonymous

After a while leaving late becomes a choice. I have worked on surgical wards where the surgical regs would regularly stay 2+ hours late, and work full night shifts then stay for a full day’s surgery. They are making that choice, they could leave on time if they wanted to. One of them did - she got everything done never stayed a minute late. I don’t know how she was perceived by the other regs/consultants, but I do know she viewed her life and her health to be more important than her work

You get workaholics at every level, and they may well perceive you as not pulling your weight. You can’t please everyone, and in the end you need to live your life

Reply 7

Smile88egc

It's completely understandable that you might feel uncomfortable leaving when your colleagues all stay later, but maybe they are all thinking the same as you?
You are contributing to the culture in your team as much as you are affected by it. Give each other permission to take breaks and to leave on time. Maybe work up to it gradually and start leaving a bit earlier each day. Exception report all of your late working so that trust leaders can see the pressure your team are under.
Totally agree with everyone above, the work is never done.
And the more we all keep staying late, the longer we cover up the need for more clinical staff. We're not doing our patients or the NHS any favours by doing this in the long run.

Reply 8

nexttime

Brand new FY1 on gastro? If there is a doctor that's going to be staying very late its that one.

Perhaps you don't appreciate this now, but you are almost certainly being very slow with jobs at the moment. That's normal and fine and not a criticism, but its true. What that means though is: it gets better.

An additional possibility is that things will change when the consultant changes. Some are job-creating machines, some just make everyone med fit and that's the end of it.

Stop writing 300 word discharge summaries, stop doing 12 handovers/catchups per day, stop fretting over every phone call or email, start doing jobs as the ward round is happening rather than standing there like a lemon, start prioritising your efficiency as well as just task urgency, and start exception reporting.

Things will get better.

Reply 9

ahorey

Original post by nexttime

Curious - why would the gastro fy1 be the one most likely to stay late? Medical gastro, not the surgical side.

Reply 10

nexttime

Original post by ahorey

Curious - why would the gastro fy1 be the one most likely to stay late? Medical gastro, not the surgical side.

Just its been known as clearly the busiest FY1/FY2 job in a couple hospitals I've worked in.

Surgical jobs can be busy, but can also be incredibly quiet too. You don't really get that in medicine. In general, there is more you can do as a medical FY1 and hence I think they tend to be busier? Certainly my busiest FY jobs were the two medical ones, by a long margin.

(edited 4 years ago)

Reply 11

Democracy

Original post by ahorey

Curious - why would the gastro fy1 be the one most likely to stay late? Medical gastro, not the surgical side.

Gastro patients are often quite unwell and need lots of things doing. The pt population can also be challenging - EtOH, IVDUs, etc.

Reply 12

girl_in_black

Original post by Anonymous

You shouldn't just get up and leave, you should encourage your colleagues to leave as well. There will most certainly be someone on-call who you should be handing over to. What are these jobs that everyone is doing 2 hours after the end of their shift that can't be handed over?

Reply 13

ahorey

Ah ok, thank you! Scared me a bit as I move to gastro next week for 4 weeks, then off to resp team for a while.

We’ve hospital at night who start at 5 so quite lucky and we’ve all sort of managed to leave before 6 most days, we do any insulin/fluids as soon as on job list check if they have bloods back so we don’t hand a boat load of them over to person on long. Discharges take so long atm as don’t know any of patients so trawl through their notes takes time. Although I’m back to my med school trick of asking what the patient came in with/how they’ve been while taking their blood lol.

Reply 14

Ghotay

Original post by nexttime

Just its been known as clearly the busiest FY1/FY2 job in a couple hospitals I've worked in.

Surgical jobs can be busy, but can also be incredibly quiet too. You don't really get that in medicine. In general, you are trusted with more as a medical FY1 and hence I think they tend to be busier? Certainly my busiest FY jobs were the two medical ones, by a long margin.

I had the opposite experience of being very handheld as a medical F1 - mostly TTOs and admin/secretarial work. I would clerk patients on my acute med job but they would have a consultant or sometimes reg review within the hour usually Compared to my surgical job where I often wouldn’t see anyone more senior than the F2 between 9am and 4pm. Surgical patients were USUALLY simpler, but when they were unwell there was limited senior support. I have generally heard that as more typical?

Reply 15

nexttime

Original post by Ghotay

Yeah you're right actually I guess I misphrased. I think there's just... more that a junior can do in medicine (i.e. TTOs scan requests bloods writing in notes on 8 hour ward rounds) versus surgery where its often short sharp ward rounds then... not too much else?

Although like I say, there definitely are busy surgical jobs out there, and they certainly can be/usually are stressful due to feeling alone.

Reply 16

Anonymous #3

Original post by nexttime

Funny, my surgical F1 job was busier than my medical ones. In my deanery, surgical F1 jobs are widely considered (much) busier than medical ones.

I guess these things can be quite variable.

Reply 17

nexttime

Original post by Anonymous

Funny, my surgical F1 job was busier than my medical ones. In my deanery, surgical F1 jobs are widely considered (much) busier than medical ones.

I guess these things can be quite variable.

That is interesting.

Both the busiest and quietest jobs I've come across have been surgical.

In the JR in Oxford the vascular FY1s were expected to do loads of ABPIs for outpatients... who were a 10 minute walk away on the other side of the hospital. They were just really busy with admissions in general. They claimed they were working on average 16 hours on a normal 9-5 day (so staying until midnight), and they had just had their hours reviews and had their staffing increased by 150% (2 FY1s to 3 FY1s, a reg and and ANP), so evidently the trust believed their claims. To start after that batch of FY1s had their rotation, of course.

For breast surgery in Reading there was a dedicated FY1. They were expected to assist in theatre two days per week, but the other three days their only duties were looking after the inpatients. Of which there was almost always 0.

Variable.

Reply 18

girl_in_black

Original post by Anonymous

Funny, my surgical F1 job was busier than my medical ones. In my deanery, surgical F1 jobs are widely considered (much) busier than medical ones.

I guess these things can be quite variable.

It's all very variable and largely depends on staffing as well. I did a placement on a 40 bed resp ward that had 5/6 juniors and a daily senior ward round. I've also worked on a 30 bed resp ward with 2 juniors and twice weekly senior ward rounds. Same specialty, very different experiences.

Reply 19

TheRabbit

Original post by Anonymous

You've had lots of replies already but thought I'd put in my tuppence worth, especially as someone who finds it hard to leave!

I would hope over the next couple of weeks you would get more efficient and better at prioritising so you aren't staying so late, although there are always going to be the odd days you might choose to stay a bit later to try and tidying things up.

The work is constant and the key is figuring out what definitely needs to be done that day and what can wait if required. Obviously you have to do some of the jobs which might wait otherwise they stack up, and will also delay the management of that patient. For example in medicine for the elderly patients will require things such as MOCAs or MMSEs, or collateral histories, and whilst these are important it is ok if these take a day or two to be organised.

If you take computer on wheels on the ward round then try to do discharge prescriptions, investigation requests, email referrals etc on the ward round as you go round with your senior/consultant. As well as being efficient with all that dead time there tends to be on the ward round, if you get your investigation requests and inter-speciality referrals done in the morning you will have answers and plans for people by the end of the day.

Similar to Etomidate, I would recommend stopping and thinking around 4pm, writing a handover at that point then spending the rest of the shift making sure that loose ends are tidied up as much as possible and that the ward is safe to leave overnight.

Out of hours cover is there to look after sick patients, so so long as they've been assessed, there is a plan and you have handed over, don't feel you need to stick around 'until the end'. Whilst it is very easy to keep doing the odd jobs that come up (like cannulas and that sort of thing) it is perfectly acceptable to ask the nurses to contact the out of hours team otherwise there are some wards you will never leave.

Ideally your F2 should be helping a bit with managing the workload, but as they are also new to being an F2 this is probably quite challenging for them and something they will gradually get better at supporting you with. I say this as a senior on a medical ward as I would never expect my F1 to work for 2 hours beyond time. I start making noises about 'why are they still here' after 10-15min after the time they should have finished, and try help them prioritise and see if I can take on any tasks to help them get out the door - but I didn't really have to look after an F1 until I was more senior than F2.