The idea for this article came to me after a week of pretty intense night shifts just after the new year. Many of you will know that my day job is that of a junior doctor, and that I’m in my third year practising full-time. I work in a busy tertiary Dublin (Ireland) hospital, and bar six months in a peripheral placement that was part of my training, I have been based in the same hospital, and I’m very grateful for that. It’s a brilliant place to work, one of the best in the country by objective and subjective opinion, and I love it there.
On New Year’s Day, I started the first of seven night shifts straight, and like I say, reflecting on that on my week off afterwards brought the idea to write about what it’s like to actually BE a doctor to me. Television programmes like Grey’s Anatomy, E.R. and House give the world an impression of what we do day to day, but trust me, that’s a glamourised, shiny view, and besides that, watching these shows still doesn’t reaaally explain what our day job involves. So, after hearing ‘What is being a doctor like?’, or ‘So you did medicine…so are you a doctor now or…what do you do?’ many a time since I’ve graduated, as well as receiving a fair few messages or comments on social media from people considering pursuing medicine and wondering what it’s like, I figured it might be helpful to reflect a little on just that. In this article, I’m going to share with you, under three headings or points, what it’s like to be a doctor and why I love it (and why sometimes I don’t), and I hope you find it useful and/or interesting to read!
Before I get onto the three points below, I’m just going to explain very briefly how I trained to qualify as a doctor. In Ireland, we apply to medical school from what’s called ‘secondary school’, and so unlike in the U.S.A., we can study medicine at undergraduate level as well as the option to pursue post-graduate medicine. I applied to Dublin medical schools, and in my year, there was a change in application requirements, meaning that you now had to do an additional ‘aptitude test’ called the Hpat, or Health Professions Admissions Test, the result of which would be combined with your final exams score for your application. The Hpat, on which I have mixed views, ‘assesses areas like problem solving, logical reasoning, non-verbal reasoning and the ability to understand people’s thoughts, emotions and behaviour.’ I use quotation marks because that’s a quote I’ve taken directly from their website. Personally, and this is all I’ll say from my experience I don’t believe it’s a good test of whether you’re suited to medicine, or any health profession. The first year I sat it, despite working my butt off in my final exams and achieving what was essentially a perfect score, my Hpat result mean I was two points short of enough for medicine. I was totally gutted. So I took my second choice of college course, which was Human Nutrition and Dietetics, and although I was fascinated by and loved my first year, I decided to re-sit the Hpat. On this second time around, I did online question banks and a two-day course. My score improved hugely. I got into medicine at Trinity College Dublin on my second application. The fact that I, and many others, could improve via practise, proves to me the Hpat isn’t perhaps the best assessment. But ANYWAY. I studied medicine for 5 years in Trinity College Dublin, and absolutely loved every minute, even when it was at it’s toughest. I made some amazing friends both in and outside of my course, and those five years (three of which I spent living on campus) hold memories I’ll keep forever. Don’t get me wrong, studying medicine is a tough gig gang. If you’re thinking about pursuing it, absolutely go for it, and I’m delighted you’ve made this choice – but be ready to work hard, because you really do get out what you put in. So! Onto my three nuggets of wisdom from the day job itself – from my short experience to date!
Being a doctor puts you in a privileged position – to hear the problems of others, and have the opportunity to help them.
This is perhaps the most important point I will talk about, and definitely the hardest but most rewarding part of my job. Day to day, my time is spent with both my patients and my colleagues, pretty much in equal parts. I am training in a general internal medicine programme, and by that I mean I’m NOT training in surgery, general practice, obstetrics/gynaecology, or paediatrics. My current programme is two years in duration, and I’m eighteen months deep right now. CRAZY. I change specialties and teams (i.e. a ‘rotation’ every three months – so I’ve worked in areas such as endocrinology, nephrology, general medicine, geriatric medicine, emergency medicine and oncology to date.
But day to day, what do we do? Well, I’ll share a typical day in my working life with you! My title is a Senior House Officer (Year 2) at the moment. My day starts anywhere from 7.30 to 9am depending on the rotation I’m on, and finishes anywhere from 5 to 8 or even 10pm, depending on whether I’m on call, or if it’s a quieter or busier day. I work Monday to Friday, and per rotation, I work a full weekend on call (two fourteen hour days), a week of seven night shifts (usually 10-12 hour shifts) and a few evenings on call until 10pm. Who I work with is, on a basic level, my senior consultant, my senior registrar (s), my fellow S.H.O.s and my junior intern (s) – but that’s just my doctor team! Of course, I work with a range of other allied health professionals (nurses, physiotherapists, radiographers, occupational therapists, clinical nutritionists, speech and language therapists) and administrative staff. My day will start with either a ward round to review our in-patients (the number of which can be anything from 10 to 40) with my team, or an out-patient clinic, and similarly the case in the afternoon. In between and during the hours of the working day, I’m answering bleeps, booking investigations, taking blood tests, inserting intravenous lines, taking patients’ consent for procedures…no day is the same! Often during the day we will have lunchtime or an early morning teaching session (e.g. Journal Clubs, Grand Rounds where cases are presented by consultants), as well as multi-disciplinary meetings (MDT) about our patients’ progress. A huge part of how any team I’ve worked with runs efficiently is delegation and co-operation. We always have a list of our patients, and each patients needs our help in some way – whether that’s a change in management, a scan like an MRI or ultrasound, or a family meeting – so it’s essential to have our team work together to achieve these tasks everyday.
Hence this first heading. Listening to the symptoms and signs our patients experience and express, and working together to form a differential diagnosis of what could be wrong, and a plan to both find out and help solve the problem, is the basis of each and everyday. It’s a really privileged position you are in as a doctor to be exposed to those at their most vulnerable, and to be able to try to help. That’s what each day boils down to, and I always try to remember that, even when things are busiest.
Being a doctor means you often do not get to put yourself first – but you will learn by experience when you need to do just that.
This is very very true, and I don’t want it to sound like I’m giving out about it either. But it is worth mentioning. Recently, after seven night shifts, I was reflecting on this point, and knew I had to include it in this article. During each of those nights, which were eleven hour shifts at a minimum, I had, overall, about 30 minutes each night for a ‘break.’ I can’t sugarcoat that one, it sucked. Who’s fault is it? No ones. Two of the nights, I didn’t really have a break, and ate a protein bar to keep me going. To put this in context, I was working in A&E admissions during peak January flu season, when the news headlines about over-crowding are everywhere, and the demand on acute hospital services is overwhelming, to put it mildly. But it doesn’t change the fact that our needs as doctors were entirely secondary. Now, that’s a staffing issue, and perhaps critics would argue we should have just been pig-headed and taken 45 minutes for ourselves, or an extra shorter break or two during the night. But that guys is a lot easier said than done in the real life situation.
However, I’m becoming rant-heavy, so I’ll get to the point! During the daytime, there are usually enough doctors and staff in general around, and on a typical day, I can definitely grab 40-45 minutes for a lunch break with my colleagues, and we often grab a quick coffee or tea to regroup during our ward rounds too. Breaks make us more efficient thinkers, that’s a proven fact in any profession. When things are really crazy though, you do put your patient first, always. If a patient gets unexpectedly unwell at 1pm, you don’t say ‘Sorry, it’s the lunch hour, I’ll be back in 20.’ Hells no. You stay, you ask for help, and you help your patient, because in that situation, their needs are primary. Working in healthcare in general is known to be a self-less profession – your patients’ needs are the focus of your day, and it’s really admirable to work hard for that.
Being a doctor does not mean one single thing forever – you are always learning, always striving to be better, and if lucky, you will find your niche as a doctor that marries your passion with your career.
This is the third beauty of a career in medicine. You never stop learning. You always strive to be better, to know more, to be able to help more using your knowledge and experience. Sometimes that drives me crazy, mostly because I’m a self-confessed perfectionist (I’m nothing if not honest guys), but actually, it’s awesome. Because basically, we are pretty much ALWAYS out of our comfort zones. Not all day everyday, but at some point everyday, we ask senior advice, or we review guidelines, or we learn something new at peer-to-peer teaching sessions. We are constantly challenging ourselves – are we providing the best care? Should we consult a specialty service about this patient’s current issue? Do we know enough as a team to manage it ourselves? When escalate care if someone becomes unwell? There are many questions in everyday, and I always head home having learnt something new.
Finally, ‘being a doctor’ does not mean one day job forever. As we junior doctors gain experience in training after our intern year, whether that’s training in medicine, surgery, G.P., obstetrics, paediatrics or anaesthetics, for example, we are encouraged to think about the area we want to specialise in in the future. Do we want to be a cardiologist, gynaecologist, or cardiothoracics surgeon? The options really are endless, and that can be the hardest part sometimes – finding the area within this vocation that you really are passionate about, that you want to spend your life working in, learning about and ultimately improving care in. For me, I think I’ve finally found that area in Public Health – but it’s taken just under a year to figure that out – and I haven’t even applied to the Public Health scheme yet! Many still don’t know at my level, while some have loved an area of medicine since college. To explain how it works for me, in Ireland if you want to work in any specialty area of ‘medicine’ (e.g. cardiology, respiratory, endocrinology, oncology) you have to complete the two years of basic medical training that I am doing right now, and then you can apply to higher specialist training for your area. Specialist training is usually 5 years, and during that time you work of course, and undertake research too, changing hospitals during this time as well. Ultimately, you aim to become a ‘consultant’ or even higher ‘professor’ of your area.
PHEW. Bet I’ve turned you right off the doctor day job now right? I’m kidding. I really hope I haven’t, because I love what I do. Is it intense? Yes, both to get there, stay there and progress. Is it tough? Yes. No doubt about it. Is it rewarding, and worth every minute? Always. I feel really lucky to have found my passion in medicine in the area of preventive medicine (sometimes called ‘lifestyle medicine’) and health promotion, and I plan to pursue Public Health as my career specialty, as this calling is something I can’t ignore.
I really hope you found this article interesting, useful and/or helpful, especially those of you working in medicine or considering pursuing it! If you have any extra or more specific questions, just leave a comment, DM me, or email! You know where to find me – @theirishbalance on Instagram/Twitter/Facebook!
Dr. Ciara 🙂 x