The #TipsForNewDocs I Wish I Knew

Aug 7, 2018

To all of the newly minted doctors commencing their internship, I extend a hearty congratulations. This year will be challenging and rewarding, energising and exhausting. It will be a period of rapid learning and adjustment, with decisions to be made and skills to be learnt.

The presence of an effective mentor is invaluable in your development as a doctor. The #TipsForNewDocs hashtag distills pearls of advice from a tribe of mentors, who not too long ago stood where you are now.

I have mined the collective wisdom of the Twitterverse to provide you 9 tips that I wish I knew when starting as a junior doctor.

1. A diagnosis is not always the end game

#TipsForNewDocs   Patients don’t come to see you because they want a brilliant diagnosis. They come to see you because they just want to feel better.   #Meded 

— Gavin Preston, M.D. (@GavinPrestonMD) 18 November 2017 

There is power in diagnostic uncertainty. It should be embraced rather than shunned.

You should become comfortable with writing ‘chest pain of uncertain origin’ rather than ‘costochondritis’ or ‘musculoskeletal pain’. Maybe the patient discharged home with the label of ‘musculoskeletal chest pain’ is having an early myocardial infarction. Maybe the patient chooses not re-present because due to false reassurance that it’s “just muscle pain.”

Some patients’ may expect to leave hospital with a label for their symptoms. However, these labels can sometimes cause more harm than good.

Perform a thorough history and examination, rule out the serious causes, provide symptomatic relief and provide reassurance. Become confident in communicating diagnostic uncertainty.

2. Failure can be the best teacher

It’s not mistakes or failures that should concern you; it’s your response to them that will define your journey as a doctor#TipsForNewDocs 

— Damian Roland (@Damian_Roland) 2 August 2017 

Skills are learnt by doing, not by observation. This means that you are going to miss a few arterial lines along the way. You’ll have to pass the laryngoscope to your supervisor more than once.

You’ll feel ordinary at the time.

Fight this instinct. Learn to fail the right way.

This involves failing in the safest way possible. Have a go, but know your limitations. Strive to do no harm with your attempts. Go away and forensically analyse why you weren’t successful. If you are deliberate about your practice, you’ll be well on the path to expertise.

3. It is a team game

Wise words from consultant on#juniordoctors. Nurses spend all day with a patient, doctors see them for brief encounters. If they are worried, be worried. Their assessment is just as important as yours#TipsForNewDocs 

— Dr Sammy (@sbattrawden) 10 November 2017 

The nature of our work involves us seeing a snapshot of the patient’s illness only. We spend a bit of time with the patient on the ward round before moving on to the next. Your nursing colleagues are with the patient and their family all shift. Their observation of your patients’ progression is priceless – ask for their help, their thoughts, their opinions.

Nurses will often become familiar with the patients’ values, needs and fears through this continuity.

And generally, if your nursing colleagues are concerned, you should be concerned too.

4. Communication is the key to ensuring appropriate care

Let us not forget that bedside skills such as#endoflife discussions as important as procedural skills #MedEd#TipsforNewDocs 

— Melanie Sulistio, MD (@melsulistio) 25 October 2017 

Our population is ageing. It is our responsibility to ensure that the care we are providing to our elderly patients aligns with their wishes and values.

Develop the communication skills that allow you to ascertain these values. Encourage your patient to discuss this with their family and loved ones. The greatest tragedies I’ve seen have been of too much medicine in this vulnerable population.

It is good practice to ensure that goals of care are discussed and documented for all patients admitted to hospital. For those that are discharged, encourage follow-up with their GP for these conversations.

5. Remember why you started

“Find meaning and purpose in your everyday work” –@MichaelKidd5#TipsforNewDocs 

— UofT Family Medicine (@UofTFamilyMed) 30 August 2017 

There are a lot of menial tasks that are essential to the smooth running of a medical team. A lot of them will fall to you.

When you’re snowed under by discharge summaries, recharting medications or your tenth after hours cannulation, take a step back and look at the big picture.

Think back to why you started this journey. Start with why, and carry on.

6. You’re never too important for the small things

Don’t ever be too big to do the small things for your patients.

— Sam Ghali (@EM_RESUS) 23 August 2017

I have been in so many situations where fetching a warm blanket or a cup of tea can provide more relief than anything you prescribe. Do the little things to make the big difference.

7. Hospitals can be big, scary places

What has become routine for us may be one of the scariest times in our patient’s life. Never lose sight of that.

— Sam Ghali (@EM_RESUS) 3 August 2017 

Do you remember your first visit to the hospital? Before you became desensitised to the monitors, needles and organised chaos?

Think back to those days, and do your best to put yourself in the shoes of your patient. Take the time to explain things. Your routine may be someone else’s nightmare. 

8. Look after yourself

#TipsForNewDocs Talk to your friends, your family, seek help, be kind to each other. 

— Christopher Mowatt (@desnremi) 2 August 2017 

This year will be testing.

The pressure can build and sometimes become too much. That’s okay. What is not okay is trying to solve these problems on your own.

Make sure you take your meals breaks. Stay hydrated. Take a deep breath every now and again. Exercise when you can.

Having your own GP is essential. Make time for friends and family. Be intentional about your work life balance. Look out for your mates – we’re all in this together.

9. And most importantly…

Enjoy it.#TipsForNewDocs 

— David Little (@DrDLittle) 1 August 2017 

Avant and onthewards partnership

Avant has partnered with onthewards, a free open access medical education website dedicated to creating resources for the doctors of today and tomorrow. onthewards was developed to address the gap in formal education specifically designed for, and aimed at, medical students and junior doctors. Educational topics are selected by junior doctors for junior doctors.

What started as podcasts for junior doctors grew into a website available to everyone after increasing interest from doctors across different hospitals expressed their interest. Avant and onthewards have committed to working more closely together to develop risk management content tailored for junior doctors.

Avant sponsors onthewards as part of our strategic partnerships program.

The blog has been republished with the permission of onthewards. The views expressed do not necessarily represent the views of Avant. Avant is not responsible for the accuracy of any information contained in the podcast.