FOUNDATION YEAR ONE

Hello, I've just survived my first week ( well really 3 days, as 2 were induction) of being a House Officer, ie. FY1= Foundation Year 1. I think this is what the Americans call an intern.

Basically It is my first paid job in medicine, the first time I am permitted to use the title "DR" and the first time I have a role and responsibilities. I have a bleep too ( how exciting)

I've studied medicine in a big university in the United Kingdom for 6 years, involving 2 years of lectures, a Bsc degree year and 3 years of studying on the wards, I passed my finals and now I am qualified..

Qualified and terrified....
and learning how to be a doctor.

Unfortunately I don't feel very confident about being a Dr. You would think that after 5/6 years of training I would be ready. But no. I am shit scared. But I will cope!!

I must say, the system is crap. My shadowing week to follow around the person doing the job I now am doing was ruined by the fact the previous girl was on annual leave when I was supposed to shadow her. Great. All was not lost though, I followed 2 higher up drs- the SHOs or ST1s around instead. Also stupidly on our first day all the doctors changed over. This meant that on my particular firm no SHOs were around as they were in induction. They are also new, so have no idea how the system works in this particular hospital either or how to work the computer software. So it was just me on my first morning. The Registrar was in clinic, as was the consultant, and the SHos were away. So just me on the ward with a few nurses.!! It wasn't so bad in that the Reg started me off on the ward round. But crazy first day. Why don't they do sensible things like stagger when the doctors of different grades switch round. At least then someone on the team would know what they were doing!

As a student I followed around House Officers, but never for prolonged period of time, ie. I didn't have a month of shadowing. This meant that on starting my job in little district general hospital last week I didn't know what I was in for or what I needed to do! I've been making plenty of stupid mistakes, but I've survived so far ok. No patient has died ( I'm not being flippant!) No patient has complained about me and I'm coping ok- at least I hope so. Its helped that I'm employing stress relief mechanisms.. ie. exercise! At least an hour a day.

For any medical students out there, so far here is what my job seems to involve!

TTAs/ TTO ie. to take away/out. = form where write down the patient's diagnosis and hx, plus ix results and treatment received et.c, comorbidities and plans for after discharge and also the drugs they are on. This is so the GP knows what happened to the patient during their stay, so the patient gets the correct drugs and so in the future there is a simple document summarising what went on with the patient. These are really helpful in that they are typed, so easily legible. Thats cos some poor person ( ie. Me.. the house officer/ Fy1) has read through the illegible notes, deciphering to their best ability what has been written!

I've written lots of these TTAs this week, gauging from the notes the hx since I don't know who these patients are! I've only just turned up on the wards. Its guess work and detective work and an ability to summarise! Nobody has checke my TTAs, I have no idea if they are crap or not. I am trying to write them in the way the SHOs I shadowed showed me. I just hope they are ok!
Last week I screwed up by forgetting to merge the drugs document with the in patient discharge summary, so the TTA had no drugs on it!
Yesteday I missed out all the drugs from a patient's second drugs chart from their form. The forms must be done early or else Pharmacy is closed and they can't get their medications so cannot go home! This week I'm sure I'll be doing more of these forms. I only hope they are ok and the GPs and future drs seeing these patients find them useful!

Other tasks for me:

Rewritting drugs charts- they only have room for a few weeks of drugs. This is dull, just copying down things but I guess it helps to learn doses of drugs. It is also easy to make errors so I just check everything once I am done. I still get a thrill out of signing my name on drugs charts! After writing a new chart, one must put big crosses all over the old chart!


Also must write prescriptions and sign it. I had a surreal moment the other day. The head pharmacist asked me to sign the drugs chart for something she had altered for a patient as only the Drs are authorised to do this. Yet this woman taught me all the pharmacology I know the day before, and I had to ask her what she wanted me to sign and why cos of course, being a novice, I had no idea. Its crazy that I have the authority to sign and not the experienced, knowledgeable pharmacist!! Anyway, no matter, soon I will know what I am doing regarding drugs too :D

Writing up pain relief/ laxatives and fluids on drugs charts.


Vetting radiological investigations: ie talking to consultant radiologists and trying to persuade them to do the CT/ MRI/ US you require. They ask you about patient hx and won't do things unless you have a clear question you need the scan to answer. I had my first taste of this last week. I got one scan through the vetting! The other- had a heated discussion with the radiologist who refused to do the scan. Oh well. Its some crazy system where run around xray looking for drs, get them to sign the form, then drop it off with radiographers who try to undermine you further and say you don't need the form and why.

Putting in cannulas.. ie. drips. I was well chuffed as I put 2 in first time on Friday. Prob cause the SHO taught me to not bother pushing the tube in and pulling the needle out at the same time. He said just slide the tube down and leave the needle where it is to help guide the plastic tube. It worked great. Also only use one hand to put in the cannula. Use the other hand to hold the skin. It worked a treat!

The Registrar ( second in command) nearly lost it last week when after 4 attempts she got a cannula in successfully. She then told the nurse to remove the CATHETER ie. tube that goes into bladder to drain it of urine. Nurse misunderstood and removed said CANNULA instead. This woman has crummy veins and is really difficult to cannulate so the Reg was cross, although she managed to laugh it off. Nobody else on the team ( I didn't try as I'm the least experienced at this) could then replace the cannula. Without this the patient couldnt get the IV antibiotics she desperately required.

Chasing stuff- The HO gets ordered to phone people up such as secretaries and to fax inpatient consultant referrals. I've found that the hardest people to get hold of are psychiatrists- and they are often the people who are really needed.

Ordering blood tests on the computer.

Recording blood test results on sticky labels to be put in the notes. Checking blood results. Checking other results eg. radiology which can be checked early by running down to xray and looking at the "hot book " where the radiologist has written something before the official report has been produced.

Updating the patient list ( our list of all the patients where they are, their details, their problems ( ie medical and social) and plans/ jobs required.
Writing lists of patients for review by the weekend team and what requires doing and which grade of doctor would the patient require.. ie. house officer or proper Regsistrar.

Answering nurses requests :) Relaying requests of other staff to the team I work for.

Ward Round duties- ie. getting out notes for patients, wheeling the notes trolley around, recording patient observations ( as documented by nurses in the obs chart) an scribing everything the consultant says regarding the patient in their notes. Ie. you are the general dogsbody. Other role = to be patronised by the Consultant.


So far thats what I've had to do all week.

Other duties depend on being "on take" where have to clerk ( ie. find out whats the story) from patients down in A and E, examine them, come to a differential diagnosis and treat them there.


I cant wait.. :D

So tired now though.. European Working Time Directive insists we finish work at 5.3o as we can only do 48 hours work a week in the hospital. However, I finished practically at 7 pm for 2 days instead of 5.30. Hopefully this will improve when I get to know the job and get quicker at tasks.

For now.. must rest!