Former nurse now medical student at Nurse to Doctor was wondering when it all starts to click into place. I thought as a final year medical student, almost a doctor I would be able to do most things a doctor could do! Instead I didn’t feel that it could do much at all. In fact when I qualified I was still at that rabbit in the headlights stage – where I didn’t feel I could do anything useful. I remember feeling that the nurses could do almost anything I could do and feeling pretty low about things. But over time things have clicked into place. There’s several things that click in one by one to mean that you feel comfortable about being at work and feel you could do a good job.
In the good old days this happened much more quickly, final year medical students were allowed to locum as junior Doctors, and if you were working 100 hours a week you fairly quickly got up to speed. Now some of the House Officers we get are up to speed, and some aren’t there just yet. It doesn’t matter too much - if they can’t do the job the rest of the team pick up the slack, it’s just frustrating for us, but we manage to keep it safe for the patients.
Confidence in diagnosis – this comes with practice of getting ’stuck in’ seeing patients and making a diagnosis. Clerking, devising a management plan, presenting to the seniors and seeing if they agree. In the old days at medical school the students would spend on a lot time on ‘take’ doing just that.
Some juniors don’t have the confidence in themselves to write their management plan so write ‘obs / bloods / sr rw’ as the plan for every patient they clerk! This is totally unacceptable – because if you don’t start to make a diagnosis you’ll never get there.
Confidence in prescribing: this really comes with practice. It’s all very well to know that diclofenac, tramadol and aspirin are all painkillers but which is best for pain from kidney stones? and at what dose. Often the ward nurses know what tends to work in this situation and will often advise what they would like prescribed. (Do check yourself in the BNF if you’re not sure of the dose).Prescribing really does get easier as you get more of a feel for how drugs work and what effect they have.
Not getting overwhelmed with the workload. There is sometimes a lot of things to do at once so this can be quite scary, a ward can appear to be a chaotic environment and it takes a lot of effort to manage to focus on one thing at a time with constant interruptions. You may have 20 or so patients under your care and you need to know what is wrong with them, what the plans are, what tests they have had done, what they are waiting for , what their Haemoglobin and potassium are.
Confidence talking to relatives – again this comes with time – you can be taught communication skills at medical school but until you are sure you know the medical issues this isn’t as much use as you’d think, though it is a very useful grounding.
Then there’s the confidence that you can deal with the worse case scenario – to the level expected of your grade. For instance if a house officer can do the ABC things competently and start of some management whilst calling for help then that’s pretty good. That takes time as well.
So bit by bit it will click into place for most doctors.
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