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    I started as an F1 in a large teaching hospital this august and I am really not enjoying it.

    Did anybody remember feeling the same? Does it get better? Or is this something I have to get used to?

    My unhappiness at work is partly due the unrewarding job of an F1 (in general surgery this includes ordering blood tests, being the ward round scribe, and being a clerking monkey in the acute assessment unit). I feel as though I use next to no medical/surgical knowledge at work.

    I also find the (NHS) hospital a demoralising place to work. It’s understaffed, so patients are left in pain and treatment plans set in place on the morning ward round don’t happen for hours or even days. No one seems to be accountable.

    Having worked in a number of hospitals abroad before doing medicine as a graduate, I can’t help but feel working in Aus or the US (where i have family connections) would be more satisfying. I am aware the grass probably isn’t greener. But working with staff who are enthusiastic and committed, as well as a well funded system would be a much more pleasant experience.

    I am set on a career in anaesthesia. Seniors have informed me that F2 is just like F1, but specialty training becomes suddenly much more enjoyable and engaging.
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    (Original post by Anonymous)
    I started as an F1 in a large teaching hospital this august and I am really not enjoying it.

    Did anybody remember feeling the same? Does it get better? Or is this something I have to get used to?

    My unhappiness at work is partly due the unrewarding job of an F1 (in general surgery this includes ordering blood tests, being the ward round scribe, and being a clerking monkey in the acute assessment unit). I feel as though I use next to no medical/surgical knowledge at work.

    I also find the (NHS) hospital a demoralising place to work. It’s understaffed, so patients are left in pain and treatment plans set in place on the morning ward round don’t happen for hours or even days. No one seems to be accountable.

    Having worked in a number of hospitals abroad before doing medicine as a graduate, I can’t help but feel working in Aus or the US (where i have family connections) would be more satisfying. I am aware the grass probably isn’t greener. But working with staff who are enthusiastic and committed, as well as a well funded system would be a much more pleasant experience.

    I am set on a career in anaesthesia. Seniors have informed me that F2 is just like F1, but specialty training becomes suddenly much more enjoyable and engaging.
    Yeah it's a rubbish experience, I don't really know anyone who properly enjoyed it except for a few very chirpy people who seemed to enjoy everything (which is probably an extremely useful mindset to adopt in medicine tbh). You're right, much of the job is pointless, menial, scary, and people treat you like crap just because they know you're at the very bottom and they can get away with it. Essentially, it's the massive comedown following graduation and that final summer of uni excitement.

    That said, you can still learn useful things - mostly how to negotiate the system and navigating all the bureaucracy, which despite how tedious it is, does actually help the patients. It's also helpful to become stoic in the face of how screwed up the system is and remember that it's not your fault - so try to develop a thick skin. But over the course of the year you will become more confident and efficient, and before you know it it will be August, you'll have done your ARCP and you'll be an SHO. In the mean time, get involved in med student teaching so you don't deskill, jump through the stupid ePortfolio hoops so you don't have an ARCP nightmare, and talk to the other FY1s about how you feel because I guarantee you they will all be feeling the same way too.

    I find FY2 to be nicer than FY1 and people are generally nicer too, but there's still a lot of boring chores to sift through - I spent today doing TTOs, chasing the lab, chasing radiology, and still finishing 45 minutes late.

    However, it's not always like that - last week I was in outpatients with my name on the door, dictating my own GP letters, and discussing the patients I'd seen with the consultant and learning interesting things along the way. These were definitely not things I got to do in FY1.

    Things do get better, but it takes a while. And if that doesn't help, doesn't it at least feel good to finally be getting paid?
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    F1 was a struggle for me for a lot of the same reasons. It was a massive jump from my expectations. And I found surgical placements particularly draining and felt disempowered a lot of the time.

    Right now the situation is pretty demoralising. But don't feel like you're alone in the way you're feeling because I promise you, you're not. I recently attended a Medic Footprints event with 300+ other doctors who are also feeling the pressures.

    Make sure you look after yourself and don't bottle it all in.
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    (Original post by Anonymous)
    My unhappiness at work is partly due the unrewarding job of an F1 (in general surgery this includes ordering blood tests, being the ward round scribe, and being a clerking monkey in the acute assessment unit). I feel as though I use next to no medical/surgical knowledge at work.
    Yes completely normal. As the FY1 the current setup means you don't learn anything at all - you're just there to do the mundane secretarial jobs the consultants don't want to. If 100% of your time saves 10% of the consultant's its considered worth it. Its frustrating to say the least!

    But honestly I found even FY2 substantially better. Suddenly you're 'SHO' and the seniors bother learning your name and you are trusted with a lot more. Still learn very little of course, especially as your rotations are unlikely to reflect what you actually want to do at all, but I found the autonomy more rewarding for sure.
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    (Original post by Anonymous)
    I started as an F1 in a large teaching hospital this august and I am really not enjoying it.

    Did anybody remember feeling the same? Does it get better? Or is this something I have to get used to?

    My unhappiness at work is partly due the unrewarding job of an F1 (in general surgery this includes ordering blood tests, being the ward round scribe, and being a clerking monkey in the acute assessment unit). I feel as though I use next to no medical/surgical knowledge at work.

    I also find the (NHS) hospital a demoralising place to work. It’s understaffed, so patients are left in pain and treatment plans set in place on the morning ward round don’t happen for hours or even days. No one seems to be accountable.

    Having worked in a number of hospitals abroad before doing medicine as a graduate, I can’t help but feel working in Aus or the US (where i have family connections) would be more satisfying. I am aware the grass probably isn’t greener. But working with staff who are enthusiastic and committed, as well as a well funded system would be a much more pleasant experience.

    I am set on a career in anaesthesia. Seniors have informed me that F2 is just like F1, but specialty training becomes suddenly much more enjoyable and engaging.
    I felt exactly the same way as you. I even considered quitting after the first 4 months! I’m glad I didn’t though because I’m now FY2 and working in GP. I really enjoy it and get a lot of autonomy with my supervisors always there if I need advice.

    I’ve also found a specialty job that I am really keen on, so it’s definitely worth pushing through these 2 years to get there.
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    Thank you so much for the helpful advice. It's promising to hear F2 is slightly better. I am also hoping core anaesthetic training will be more enjoyable and engaging, with more of a team feel rather than being some nameless F1.

    I do find it crazy that enthusiastic new medical graduates are forced to work as a medical secretary (F1). The equivalent in other countries seem to have a much greater role within a team than I do the NHS. Even 10 years ago, house officers were doing their own clinics and assisting in theatres.

    It's also very reassuring to know other F1s feel the same. I am quite a bit older than my F1 colleagues who all seem very empowered by their new "doctor" status.

    For now I am just keeping my head down and working hard. But as a very keen medical student I do feel quite deflated..
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    I feel like I'm not enjoying F1 for almost the opposite reasons.

    I enjoy the 'medical secretary stuff'. It's stuff that I can get on with and feel productive, but isn't too draining. I never thought I'd say it, but tagging along with a ward round and doing ward jobs is... well, at least it's easy and relaxing. Seeing patients by myself is emotionally/mentally exhausting in a way I'd never envisaged, and actually initiating medical management is dispiriting, because I have never once made a decision that hasn't been overturned in senior review.

    Don't mean to hijack the thread, but it's weird seeing people having kind of an opposite experience
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    Hello OP, I am nearing towards the end of medical school but I really feel what you're saying.

    I just want to add that the fact you are finding the work somewhat unrewarding shows (to a certain extent) that you are not finding the work difficult. That's an achievement in itself because being a newly qualified doctor is not always easy! In terms of making things more interesting - are you interested in medical education? Teaching medical students can be massively rewarding and it prompts you to update your knowledge base too!

    The NHS is definitely understaffed and it's hard to make institutional changes (...as we've seen with the recent junior doctor contract disputes). But I honestly think by being a compassionate doctor and doing what is required of you, you are making a massive difference in delivering good quality of care to patients.

    Hang in there!!! I hope things get better for you. : )
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    (Original post by Ghotay)
    ... because I have never once made a decision that hasn't been overturned in senior review.
    Doesn't mean you were wrong, of course. There are lots of 'that's just the way things are done' decisions that have no evidence and are done completely differently on other units. And where there is evidence, assuming your senior is more aware of it than you just by being senior is a clear falsehood.

    Its also definitely won't be true - you've made decisions like escalating vs not escalating, when to do bloods, how and when to communicate with nurses, how and when to communicate with patients, etc.
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    (Original post by nexttime)
    Doesn't mean you were wrong, of course. There are lots of 'that's just the way things are done' decisions that have no evidence and are done completely differently on other units. And where there is evidence, assuming your senior is more aware of it than you just by being senior is a clear falsehood.

    Its also definitely won't be true - you've made decisions like escalating vs not escalating, when to do bloods, how and when to communicate with nurses, how and when to communicate with patients, etc.
    Thanks.

    And yeah, there are a few weird ones on this ward. For example I don't think there's ANYTHING someone with a headache could say that wouldn't get them a CT and an LP in this place. It's very frustrating/confusing
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    (Original post by Ghotay)
    Thanks.

    And yeah, there are a few weird ones on this ward. For example I don't think there's ANYTHING someone with a headache could say that wouldn't get them a CT and an LP in this place. It's very frustrating/confusing
    Hmm? What do you mean by that? I would not be happy doing LPs for everyone...
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    (Original post by Ghotay)
    Thanks.

    And yeah, there are a few weird ones on this ward. For example I don't think there's ANYTHING someone with a headache could say that wouldn't get them a CT and an LP in this place. It's very frustrating/confusing
    I can strongly empathise! I'm on an ID ward at the moment and although i wouldn't go as far as what you say re: headaches, basically anyone with delirium gets an LP because 'it could be encephalitis'. There is also a consultant who says that anyone started on ceftriazone in A&E must have an LP because its 'medicolegally necessary'. The clinical picture doesn't matter whatsoever - could have CRP of 1, no other symptoms... LP.

    Its so bizarre - compared to literally any other ward I've ever been on, where 'delirium' and 'A&E be silly' are perfectly valid diagnoses/thoughts and such patients would never have an LP even considered.

    Also: are they doing the CTs just to clear for an LP? That's totally unnecessary and pretty disappointing if a unit that does lots of LPs is still insisting on irradiating so many people. At least they don't do that here.

    (Original post by ecolier)
    Hmm? What do you mean by that? I would not be happy doing LPs for everyone...
    I'm increasingly finding that specialist units sometimes lose perspective and have... unusual... approaches to routine cases!
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    (Original post by nexttime)
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    Don't get me wrong, I would love it if the world and their dog can do LPs - this "defensive LP" culture is certainly going to make this happen. However there are inherent risks (not small) associated with LPs, and done by the inexperienced it can be very dangerous.

    Doing CT to clear for an LP could sometimes be indicated - if you are worried about increased ICP, blindly doing an LP could cause coning. You would also definitely do clotting before an LP.

    Finally, for headaches the only indications for urgent LP (which I am assuming is happening here) is ? subarachnoid haemorrhage, or rapidly worsening papilloedema ? idiopathic intracranial hypertension.
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    (Original post by Anonymous)
    Thank you so much for the helpful advice. It's promising to hear F2 is slightly better. I am also hoping core anaesthetic training will be more enjoyable and engaging, with more of a team feel rather than being some nameless F1.

    I do find it crazy that enthusiastic new medical graduates are forced to work as a medical secretary (F1). The equivalent in other countries seem to have a much greater role within a team than I do the NHS. Even 10 years ago, house officers were doing their own clinics and assisting in theatres.

    It's also very reassuring to know other F1s feel the same. I am quite a bit older than my F1 colleagues who all seem very empowered by their new "doctor" status.

    For now I am just keeping my head down and working hard. But as a very keen medical student I do feel quite deflated..
    I know how you feel. Large swathes of FY1 are a **** show - I spent most of my time oscillating between feeling deathly bored (clerking the fifth heart failure patient in a row; bouncing around on a Saturday morning doing a solo phleb round for eight wards; sitting in x-ray meetings whose sole purpose seemed to be for consultants to quibble over radiological minutiae whilst paying no attention whatsoever to the juniors, who were nonetheless expected to sit and watch), and abject terror (being left alone with a 2-week old baby with neurogenic bladder whose UO has dropped off to nothing within the last two hours and the reg isn't answering their bleep; being left alone with a deteriorating middle-aged patient with bowel cancer and no DNAR and the reg isn't answering their bleep; being fast-bleeped out of hours to a SHEWS of 15 while you're the only doctor in that block, and that block is literally a five-minute run from any other part of the hospital and by extension from any senior doctors.. I sense a theme here).

    But.. it did get better. Surgical FY1 jobs are generally a bit rubbish. Of my medical jobs - one was ghastly and unsupported; the other was great, and the consultants were keen for you to take the reins, especially if you showed a willingness. So there were lots of solo FY1 ward rounds where you got to make the plans, but you had a range of seniors around to ask for help if you weren't sure what you were doing. It's so department-dependent.

    It's hard to say how FY2 is going to pan out as I'm currently in my community job, which isn't really representative of anything else. But the general consensus among the FY2s I know in hospital jobs seems to be that it's better than last year. And if it's any consolation, I have a bunch of friends who are in ACCS at the moment, and (AMU notwithstanding) they're mostly enjoying what they're doing.

    Keep on keeping on - prevailing opinion seems to be that it will get better.

    (Original post by Ghotay)
    I feel like I'm not enjoying F1 for almost the opposite reasons.

    I enjoy the 'medical secretary stuff'. It's stuff that I can get on with and feel productive, but isn't too draining. I never thought I'd say it, but tagging along with a ward round and doing ward jobs is... well, at least it's easy and relaxing. Seeing patients by myself is emotionally/mentally exhausting in a way I'd never envisaged, and actually initiating medical management is dispiriting, because I have never once made a decision that hasn't been overturned in senior review.

    Don't mean to hijack the thread, but it's weird seeing people having kind of an opposite experience
    That might partly be a symptom of being in your very first rotation.. you're still finding your feet, so the menial work can be weirdly comfortable, especially if you're mentally/physically tired. In my first couple of jobs (especially the first one), the on-calls made me feel physically sick, and every morning on the day job I'd find myself hoping that it was going to be one of those days where you can just get your head down, plough through a ward round, and then order and chase tests. By the end of FY1, the on-calls still left me feeling a bit nauseated, but there was also a bit of curiosity and job satisfaction thrown in there. You'll find it weird looking back in a year's time and remembering how you felt now - promise.

    And definitely don't feel disheartened by having your plans changed - (a) it happens to everyone, (b) as nexttime said, it doesn't even mean the senior decision was the right one or that yours was the wrong one, (c) at least you're getting feedback/getting to see what's been changed - one of my jobs had virtually zero feedback for the on-calls, meaning I had very little idea whether I was just making the same mistakes ad infinitum, and (d) it'll make it all the more enjoyable when you make a plan and get it spot on first time, as you'll have come to realise just how tricky that can be.

    As above - hang in there!
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    (Original post by ecolier)
    Don't get me wrong, I would love it if the world and their dog can do LPs - this "defensive LP" culture is certainly going to make this happen. However there are inherent risks (not small) associated with LPs, and done by the inexperienced it can be very dangerous.
    Also very time consuming. When the defensive consultant was on we were doing about 2 per day (usually get 4-5 admissions per day, so half the patients) and as most of them are morbidly obese it can take an hour+ to consent, find the (inevitably missing) equipment, have a few attempts, and then if still unsuccessful an additional 30 mins to try to persuade radiology to have a go.

    Doing CT to clear for an LP could sometimes be indicated
    Sometimes, but most frequently not. Its clearly established that no neurology and no papilleodema is sufficient for safety.

    if you are worried about increased ICP, blindly doing an LP could cause coning.
    No convincing evidence for this. Unwell patients with intracranial complaints sometimes cone, regardless of doing an LP or not. There is an interesting pre-CT study of 400 patients who had LPs. These patients were all known to have intracranial masses and 32% had papilloedema, but they did it anyway (!). Only 1 patient had a complication.

    But its 'accepted wisdom' so yes you'd be crazy to go ahead and do an LP anyway!

    You would also definitely do clotting before an LP.
    That is definitely important though yes. Although you don't need a clotting prior to most surgical procedures (the odds of an undiagnosed clotting abnormality outside DIC are tiny), LP is one of the procedures where you actually do need it.

    Finally, for headaches the only indications for urgent LP (which I am assuming is happening here) is ? subarachnoid haemorrhage, or rapidly worsening papilloedema ? idiopathic intracranial hypertension.
    Or ?meningitis. Even in the absence of fever, CRP, neck stiffness, photophobia. Perhaps not an actual indication but IRL: yes I've seen it done.
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    (Original post by nexttime)
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    I agree - I would like to work in your hospital though Where I work no one does LPs and they refer to us for ?? LP. Also I am thinking "isolated" headache - obviously if it's possible meningitis it needs to be done.

    At the end of the day, most referrals to me ?? LP I would say no need to do (after history and examination of course).
 
 
 
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