The Challenges Facing New Doctors

Only one more week until the changeover and the new FY1s step up and take over. The media seem to take of advantage of this, by coming up with 'shocking' headlines and describing August as "the killing season" in NHS hospitals. This doesn't really help the confidence of the new doctors who will already be nervous at the prospect of taking on massive responsibility. A column in the BMJ this week written by an inter-calating medical student talks about exactly this. What people often seem to forget is that we've been at medical school for 5, 6 even 7 years sometimes working up to this point, and the new FY1s will be much more prepared than they realise. Studies have shown that the care given by new doctors in training is comparable with that of their senior colleagues. I'm giving a talk to the new FY1s next week to give some advice on how to work as a save, effective FY1 doctor and I'll try and remember how I felt when I was in their shoes only a year ago. I'll be moving on to a new hospital on the 1st August and no doubt I'll have plenty of new challenges to get my head around. 

I presented the gentamicin audit which I talked about in the last post before the wedding to the department in June and it seems as if it was good timing to do an audit on gentamicin because the new prescribing form is being rolled out across NHS Greater Glasgow and Clyde next week. No doubt there will be a few speed-bumps initially as doctors and nurses get used to it but hopefully it'll lead to safer prescribing and closer monitoring of IV gentamicin in the long run. I'll try and recruit some of the new doctors in the hospital next year to repeat the audit next January to see if there really is an improvement with the new prescribing form.

The president of the Royal College of General Practitioners (Dr Iona Heath) this week spoke out in praise of young doctors. In a letter to the BMJ she wrote that too much emphasis from an early stage of training new doctors is on science and understanding. However science is never enough in a profession which seeks to try to alleviate human suffering. Students and doctors are not being encourgaed enough to think and question assumptions about the nature of science and medicine. She continues in the letter to talk about the erosion of continuity of care, and the lack of a 'team based' attitude to practicing medicine (only this week we had to our FY1 end of year ball due to a lack of interest from our senior colleagues). She highlights that with shift patterns and the European Working Time Directive, it is difficult to learn from our actions (I used to see patients on night shift and then wonder what had happened to them the following day - I would sometimes go and check out patients at the start of my next shift to see what had happened but often time wouldn't allow). 

She also argues that there is a rapidly changing culture in medicine of 'protocol and guideline medicine'. Many doctors are now afraid not to follow the guidelines and although I've only had one years experience, I am already starting to feel that there is a great deal of "over-treatment" and "over-diagnosis" in the NHS at times such as end-of-life care which can be dangerous and un-necessary. According to Dr Heath this is "destroying the confidence of many young doctors, so that they no longer feel able to make the courageous professional judgements necessary to tailor treatment to the needs, aspirations, value and context of individual patients". Finally she says "as I grow old and frail, I want a doctor who thinks and questions, not one who feels obliged to blindly follow protocols".