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Surviving and Thriving in a Foundation Junior Doctor A&E Job

Many of us hear 'horror stories' from colleagues and the media about working in A&E as a junior doctor. Tough rotas, high-stakes and work-life stress: is the nightmare a reality? Nat Jansen, an A&E F2, offers his tips on making the most of the job...

*Disclaimer: Despite all the horror stories: I actually would love to do Emergency Medicine (EM) as a career, and have so far have enjoyed my 3 months as an FY2 in the Emergency Department (ED). This is a guide listing the main dos and don’ts if you want to not only survive, but thrive, in A+E.

Throw yourself at it
I once got told that 'if you give 40% you’ll only get 40% out, but if you give 100%...' you get the idea. Although I’m not sure it was particularly relevant at the time, James Blunt was playing at LiveAid and I’d decided to use that as a good time to sit down. The statement is definitely true for the ED. You need to go at it full throttle if you’re going to get anything out of it. So buckle down, it’s a bumpy ride.

Plan Your Time Off
Time off in A+E: a mythical beast. Surely it doesn't exist? It does. It might be a random Thursday or a Tuesday morning pre twilights, but you do get some time to yourself. Use it wisely: go and see your friends and family, exercise, learn to knit, go on holiday. Whatever interests/life you had before A+E you need to squeeze into a lot less time, so make sure you can and make sure it’s away from medicine! Loneliness can set in quickly if you don't make an effort: many a time the lost souls of A&E have been spotted wandering aimlessly around town, looking exhausted and vaguely traumatised. So it's a perfect time for a brunch date! On that note...

Make Friends
Sounds silly, but think about it. One of the main things I hear when I talk about how much I enjoy A+E is: “yeah, but what about the rota?” Yes, it is anti-social. Yes, you’ll miss out on stuff (I missed a friends wedding due to being on nights), but if you plan your time off as stated above, and make some friends in the department, then you’ll quickly find it becomes one of your more sociable jobs.
That Friday night shift you’re working? Guess what? There’s at least 20 other guys and gals on it with, and that’s just in a small DGH. Get to know them, chat to them about stuff outside of work, and you’ll soon find you actually look forward to going to work.
I worked nights last weekend, the clocks went back, so we had a buffet party in the break room. Doesn’t sound too unsociable to me.

I know I said earlier to give 100%, but you need to do that whilst staying chilled out. (somehow!) ED is a high pressure department with waiting times often longer than breach, and having to harrass different specialities just to get a patient with a EWS of 8 a bed. If you're constantly stressed, you will no doubt burn out.

Don’t worry.
You can only see one patient at a time, and they need as much care and attention as everyone else. So as long as you’re giving your all, your colleagues, and the “hierarchy” will appreciate that, even if they don’t show it.

Don’t 'Patient Dodge'
We've all seen it: a 'tricky' presentation pops up, someone looks at the triage notes and decides to take a tactical toilet break. Do it too often though and you’ll get found out. Things can turn ugly from there, need help from a colleague or a nurse? Good luck, shirker. So don’t do it. Use it as a learning opportunity. You took on the challenge and will be appreciated for that. For the rest of the shift you’ll be on easy street.

Listen to the Nurses
You’ve spent 5-6 years at medschool, have a certificate that allows you to call youself doctor, and might even have 1 or 2 years under your belt, but none of that is as valuable as the front line experience ED nurses have. Some of these nurses will have been in the ED when you were in nappies, which as cliched as it is, means they’ll have forgotten more than you know. Listen to them, and take their advice, if they want you to skip the queue to see a quick one that’ll free up bed space, it’s probaby wise to do it. If they come to you because they are worried about someone, you better start worrying too (on the inside of course.) Yes at the end of the day it’s your name against the patient, but they’ll save your bacon more times than you do theirs.

Enjoy it.
Simple. You’ve ended up with this rotation, so you might as well enjoy it. Be it 4 or 6 months, in the grand scheme of things it really isn’t long, so make the most of it and you’ll find you’re through it in a blink of an eye and onto that dream rotation in histopathology.

Guest Blog: Nat Jansen, 08.11.2016


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