TSRMedics™ What&#x27;s it like to work in a GP / hospital during a pandemic?

I'd say: things that have improved are escalation protocols in terms of staffing, PPE supplies of course, and our knowledge of the disease. Our ability to do remote medicine via phone or video call has also surged forward, and this will probably translate into more patients using apps/digital platforms to track their symptoms and more patients being able to access their own results too. All good things.

Medical applicants and nursing applicants have also surged, so its been positive in terms of recruitment by that measure.

What has got worse is staff fatigue, and waiting lists (+++). I wonder if that will translate into more doctors and nurses retiring/switching careers. Education has also been really badly affected - both in terms of students and staff e.g. junior doctors, who have had exams cancelled, teaching cancelled, and their rotations where they're supposed to be learning e.g. about gastroenterology or cardiology, instead they're doing HCA work on ITU.

What hasn't changed at all: Surge bed capacity for when disasters happen, surge staff capacity for when disasters happen, oxygen supply to wards, ability to store PPE, amount of space to avoid transmission between staff on wards and in break rooms. All things that we probably should address/already be addressing, but in reality will just be ignored of course.

Reply 543

Just wondering what it's like to work in a hospital as a FY1 when there isn't a pandemic.

Obviously there's less seriously ill patients, less deaths, less appalling and intense pressure in ITU, less PPE.

But is there the same understaffing, shifts never finishing on time, no time for lunch, feeling isolated on call/shift cover etc.

What was it like being an FY1 when it was "normal" ?

(edited 3 years ago)

Reply 544

Original post by meddad

But is there the same understaffing, shifts never finishing on time, no time for lunch, feeling isolated on call/shift cover etc.

Yes, yes, yes, and yes.

Remember some departments are actually quieter than normal, what with cancellation of elective surgical procedures, non-urgent medical appointments and some patients being scared to present to healthcare with non-covid problems. I'd go as far as to say a lot of on call rotas have a lot more senior presence and there are a lot more reports of adequate/over-staffing than I've ever seen! Though I'm 100% certain some places are worse too though, not least ITU nursing rotas.

I think social isolation, especially for people who have moved across the country to a new region to start a new job in August, is probably the most consistent impact?

Reply 545

Original post by nexttime

Yes, yes, yes, and yes.

Remember some departments are actually quieter than normal, what with cancellation of elective surgical procedures, non-urgent medical appointments and some patients being scared to present to healthcare with non-covid problems. I'd go as far as to say a lot of on call rotas have a lot more senior presence and there are a lot more reports of adequate/over-staffing than I've ever seen! Though I'm 100% certain some places are worse too though, not least ITU nursing rotas.

I think social isolation, especially for people who have moved across the country to a new region to start a new job in August, is probably the most consistent impact?

The young (to me) FY1's I know have been most of their time on busy COVID wards but not ITU. It has sounded quite grim, but probably worse elsewhere. With no previous experience to draw on, it's difficult for them to judge what's normal senior support for on call shifts. There has almost always been a helpful reg on the end of a phone when required, but still stressful when you lose 3 patients overnight on the same ward (worst example).

You're absolutely right with regard the lack of ability to socialise, not much scope to make new friends or switch off with an evening out. This has undoubtedly made things seem worse.

Thanks for your insight :smile:

Reply 546

Original post by meddad

The young (to me) FY1's I know have been most of their time on busy COVID wards but not ITU. It has sounded quite grim, but probably worse elsewhere. With no previous experience to draw on, it's difficult for them to judge what's normal senior support for on call shifts. There has almost always been a helpful reg on the end of a phone when required, but still stressful when you lose 3 patients overnight on the same ward (worst example).

Its going to depend so much on where you are isn't it, hard to comment.

As a doctor you get used to death, and will probably come to realise that its not always a bad thing. Plenty of people having to learn this very quickly though! And unexpected deaths - well those are a whole different game really. We were just talking about this on the doctor's society actually.

Reply 547

Original post by nexttime

Its going to depend so much on where you are isn't it, hard to comment.

As a doctor you get used to death, and will probably come to realise that its not always a bad thing. Plenty of people having to learn this very quickly though! And unexpected deaths - well those are a whole different game really. We were just talking about this on the doctor's society actually.

Yes, I had already read some of that... interesting perspectives which made perfect sense.

I think it articulated well how quickly most (not all) medics become "accustomed" to expected death, and how unexpected death can be more difficult to come to terms with.

I'm not sure yet how you adjust to questioning yourself over whether you could have affected the outcome if you had acted differently or more quickly. I'm sure the answer in the vast majority of cases is that it would have made minimal difference or no difference at all.... but is it common that you take that question home with you, review it, lose sleep over it etc.

Sorry, that's an unfair question. Of course, it depends on the individual. Just wondered how common it is, and whether that experience also changes with time and experience.

Reply 548

GANFYD

Original post by meddad

Yes, I had already read some of that... interesting perspectives which made perfect sense.

I think it articulated well how quickly most (not all) medics become "accustomed" to expected death, and how unexpected death can be more difficult to come to terms with.

I'm not sure yet how you adjust to questioning yourself over whether you could have affected the outcome if you had acted differently or more quickly. I'm sure the answer in the vast majority of cases is that it would have made minimal difference or no difference at all.... but is it common that you take that question home with you, review it, lose sleep over it etc.

Sorry, that's an unfair question. Of course, it depends on the individual. Just wondered how common it is, and whether that experience also changes with time and experience.

This is so dependent on personality, but also on experience.
I have (very) historically lain awake at night worrying I was deficient in some knowledge or skill that might make a difference, but now, work is left firmly at work. I have accepted I am not infallible, but that I always try to act in what I believe is my patient's best interest, knowing I work hard to keep myself up to date and informed. I tell patients I do not have a crystal ball. I share my thought processes and the decision-making with them and then we deal with the outcome together.
Generally, I have learned to trust myself, to remain humble and seek advice wherever needed, to learn from everyone and that patients (and their relatives) will accept that we are not God and things can go wrong, even with the best of care, but also that Drs are human, and will make mistakes like everyone else. But when they can see you have listened to them, considered the options and taken their views into account, and, rather against my character on here, that you care about them and their health, then they accept our fallability, which has certainly helped me to accept mine!
Being old does have some advantages!

Reply 549

Original post by GANFYD

This is so dependent on personality, but also on experience.
I have (very) historically lain awake at night worrying I was deficient in some knowledge or skill that might make a difference, but now, work is left firmly at work. I have accepted I am not infallible, but that I always try to act in what I believe is my patient's best interest, knowing I work hard to keep myself up to date and informed. I tell patients I do not have a crystal ball. I share my thought processes and the decision-making with them and then we deal with the outcome together.
Generally, I have learned to trust myself, to remain humble and seek advice wherever needed, to learn from everyone and that patients (and their relatives) will accept that we are not God and things can go wrong, even with the best of care, but also that Drs are human, and will make mistakes like everyone else. But when they can see you have listened to them, considered the options and taken their views into account, and, rather against my character on here, that you care about them and their health, then they accept our fallability, which has certainly helped me to accept mine!
Being old does have some advantages!

Wise words as always. Of course you know me well enough that you also know why I'm asking.

"Being old" and having the benefit of experience can seem a long way off for a FY1.

Reply 550

GANFYD

Original post by meddad

Wise words as always. Of course you know me well enough that you also know why I'm asking.

"Being old" and having the benefit of experience can seem a long way off for a FY1.

You just have to learn from all the experience you have, at whatever level. And remember that the knowledge and skills expected of an FY1 are not the same as those expected of a Consultant (except maybe by over-achieving FY1s!!!!).
I am pretty confident that your reason for asking has no glaring deficiencies in their knowledge, learning or actions and the angst relates to an over-abundance of caring and drive to do the best and be the best, as well as a sprinkling of Impster Syndrome. Holding ourselves to high standards is good, believing we are infallible is a road to madness. But they have the experience and wise counsel of other people they can benefit from :smile:

Taking care of ourselves is improtant for everyone, but particularly those in high-pressure, high-stress situations

Reply 551

Original post by GANFYD

I am pretty confident that your reason for asking has no glaring deficiencies in their knowledge, learning or actions and the angst relates to an over-abundance of caring and drive to do the best and be the best, as well as a sprinkling of Imposter Syndrome.

Yes, indeed

Reply 552

GANFYD

Original post by meddad

Yes, indeed

Wonder where they get that from?

Reply 553