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How to be a good junior doctor (ft. That Medic)

2018-10-13 · Podcast or interview · Ali, That Medic · recording, 17:55 · watch on YouTube

Topic: Medicine and his doctor years · mode: Conversation and interview

Ali, an F1 junior doctor in Cambridge, asks That Medic (Mohammed), a second-year foundation doctor in London, how to be a good F1: seek feedback, suggest a solution when asking seniors, never rush at the cost of patient safety, involve and help the nurses, and prepare for night shifts.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — Ali introduces That Medic and praises his medical-school highlight reels

  • ★ Ali, a junior doctor in Cambridge, talks with Mohammed, known as That Medic on YouTube, a junior doctor one year senior to him, about how to be a good F1. — 00:00:00 · Cambridge
  • ★ That Medic (Mohammed) is a second-year foundation doctor working in London who also makes YouTube films about medicine, travel and lifestyle. — 00:00:58 · London, Foundation Programme
  • ★ Ali praises That Medic's editing: he filmed footage throughout his five years of medical school and edited it into highlight reels for each year. — 00:01:20

00:01:50 — Be vigilant, learn from mistakes and seek feedback

  • ★★★ That Medic's top tip for a first-year foundation doctor (F1) is to be vigilant and to learn from mistakes. — 00:01:50
  • ★★ That Medic says that a junior doctor living the job first-hand struggles to see whether they are doing it right, so should step back and ask from a third perspective whether this was the best way. — 00:02:19
  • ★★★ That Medic says an F1 is the least experienced doctor in the hospital, so should seek feedback from everyone, nurses included, actively or through the Foundation Programme's case reflections and case-based discussions. — 00:02:48 · Foundation Programme
  • ★★ Ali thinks senior doctors are generally reluctant to criticise, but would probably appreciate a junior openly asking what to do differently to be a better doctor. (hedged) — 00:03:32
  • ★★ That Medic says British people are bad at giving and receiving both compliments and criticism, and so bad at feedback altogether. — 00:04:02
  • ★★ That Medic advises a junior doctor to seek feedback from the right person, such as a registrar they get on well with who will feel comfortable giving frank feedback. — 00:04:02

00:04:31 — What makes a good F1: seek advice but also suggest a solution

  • ★★★ That Medic says many F1 questions can be answered with a bit of research in a book or trusted websites, so a good F1 seeks advice but also suggests a solution, the best way to learn. — 00:04:59
  • ★★ Instead of asking a registrar for the answer, Ali looks it up and sends a suggestion on WhatsApp, such as a dose of co-amoxiclav (as heard), for a yes; he finds this easier for them and he learns. — 00:05:28 · WhatsApp
  • ★★ That Medic says that when a patient has an overnight episode of leg shaking, a good F1 takes a history, examines and lists the differentials before calling the registrar, rather than only escalating. — 00:06:17
  • ★★ That Medic thinks proposing a diagnosis and plan to the registrar is probably the limit for an F1; as a senior house officer (SHO) from the second year one can start some management alone. (hedged) — 00:06:46
  • ★★ Ali sums up the advice for junior doctors asking seniors: take the initiative and offer a default option they can correct, rather than just asking the question. — 00:06:46

00:07:13 — Mistakes made when rushed: a warfarin dose and a discharge on three blood thinners

  • ★★ That Medic says his own mistakes as a junior doctor came when he was rushed, on call and late for handover, doing a half-hearted job; others such as nurses or the patient often caught them. — 00:07:13
  • ★★ That Medic once prescribed a jaundiced surgical patient her usual warfarin dose without checking her liver function, which could have made her dangerously prone to bleeding; his SHO caught it. — 00:07:55
  • ★★ Early on, rushed on a busy ward, Ali discharged a patient on three blood-thinning medications, missing a note that one should be stopped; the pharmacist had not checked the drugs and the registrar explained the error to him. — 00:08:45
  • ★★ Ali says his discharge error was partly a fault of the system: the checks were in place but did not happen that day. — 00:09:25

00:09:57 — Patient safety before the bed managers

  • ★★★ That Medic says a doctor's job is the patient's safety and care, not managing beds: if a same-day discharge would compromise care or safety, avoid it. — 00:09:57
  • ★★ That Medic says audits and research always show that people make mistakes when they are rushed and pressured. — 00:09:57
  • ★★★ Ali says doctors are in charge of the care of the patient at hand, so patient safety is his number one priority, above the bed crisis and other pressures. — 00:10:46

00:11:12 — Getting on with the nurses

  • ★★★ That Medic's first rule with nurses: nurses run hospitals and doctors just work in them, since nurses spend the whole day with the patients and know them well. — 00:11:15

    “nurses run hospitals doctors just work in a hospital”

  • ★★★ That Medic gives the nurses an update on each patient and the rationale for tasks after the consultant's ward round, making them part of care planning; they sometimes suggest better ideas. — 00:11:39

  • ★★ That Medic advises junior doctors to do small jobs themselves, like a bladder scan or wiping down the cannula tray; nurses notice such things and it gets them on your side. — 00:12:59
  • ★★ That Medic advises junior doctors to compliment the nurses and get to know the team's stories and interests; he greets nurses who love Friends with "How you doing". — 00:13:40
  • ★★ From next week (week of 15 October 2018) Ali has his first set of night shifts as a junior doctor, five in a row. — 00:14:09
  • ★★ That Medic's first step for night shifts is a set of blackout curtains, which Ali already has. — 00:14:09

00:14:20 — Tips for night shifts

  • ★★ That Medic: To shift the sleep cycle for night shifts, That Medic stays up the entire night before the first one, so he is tired enough to sleep through the day. — 00:14:53
  • ★★★ That Medic: On a night shift That Medic prioritises the handover job list: reviews of sick patients first, then time-critical medications and chasing X-rays, CTPAs and other scans, then tasks such as rewriting a drug chart for 6am or preparing a TTO. — 00:15:23
  • ★★ That Medic says the night on-call doctor should do only the critical jobs; with experience you filter out what can wait, such as a sodium of 113 that had been that low for three years. — 00:16:24
  • ★★ That Medic advises going through the night job list with an SHO or someone more experienced, as a second pair of eyes on what to do first. — 00:16:24
  • ★ Ali and That Medic also made a video on That Medic's channel comparing King's College London (GKT) and Cambridge as medical schools. — 00:16:45 · University of Cambridge, London, Cambridge

00:17:12 — Ali's takeaway and sign-off

  • ★ Ali says he got lots of actionable tips from That Medic that he is taking forward in his remaining time as an FY1 junior doctor. — 00:17:32

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Mentioned

Central: That Medic

Also: Cambridge · Foundation Programme · Friends · King's College London · London · WhatsApp

Only in the description or credits: University of Cambridge

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