Things I wish I knew before starting my job

Looking back, there were several things that betrayed my expectations of a career in medicine. Here I share some of them.

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'Work life is not as stressful as student life'

Working as a doctor definitely comes with some stressful times, but generally I found it to be less stressful than being a student. I think the main difference is that your commitment ends after work, whereas as a student, you are expected to continue studying/preparing for exams after your lectures/placements. Yes, there are times when you have postgraduate exams and this can be a pain to juggle with your work, but it is usually only for a short few months. You also eat better and live better since you start having a steady source of income, and the satisfaction that comes with it (whether or not it is a reasonable amount is a debate for another time, but in my opinion still better than paying tuition fees to help out on placements).

'I have more time than I think'

This may vary from placement to placement but generally I find myself having time to wind down and pursue a life outside medicine. Bear in mind though that some rotas can be erratic with a stretch of on-calls so you'll just repeat the work-sleep-work cycle, but you would then get rest days in lieu. Planning around these can be a challenge, but not as unreasonable as I thought it would be.

The statement also applies to more short to medium term goals, of which the main hurdle is specialty applications. You really only have one year and 3-months or so to get your portfolio in shape (applications usually open around December time in F2), but that is less of a requirement, and more of an optional route for those who are really keen with set ideas for their future. On top of this, you can still apply and take the chance to practice for interview or the exams (e.g. the MSRA which doesn't cost anything), which will give you some experience under your belt when you eventually take your application seriously. Most people nowadays however opt for a year out (typically as an F3/clinical fellow), allowing more time to consider career pathways and consolidate their achievements.

'Communication skills are useful outside of OSCEs'

I always thought the typical challenging patient in OSCE stations was a myth. No one actually acts that way and a set framework of eliciting and addressing their ideas, concerns, expectations would never work. Well, it turns out that if you can use them in a more natural manner, you come across as more empathetic and are able to get through to patients/relatives. Skills like 'ICE', 'signposting', 'chunking and checking' has definitely served me well during my time in Care of Elderly, where the majority of my time is spent updating family members, a fair amount of which are understandably anxious (given Covid limitations around visiting) and it can require some time to address their queries. I also think the fact that most family communication is on phone now means that the words you say are the only way to get the message across. Note that there will still be few patients who stick to their ideas and refuse to change their opinion, but the majority can be convinced with proper communication.

'I will not be making many clinical decisions'

Having worked my ass off and graduating medical school, I thought I would come onto the ward and making life-saving decisions for patients. That's a bit of an exaggeration, but what I found working as an F1 is that I have a lot less say than I thought I would have. I think this is partially from medical school assessments, where you are always asked what you would do, when in reality, most of the time patient care involves getting specialist input for various aspects for their care. As an F1, you would pretty much escalate anything to your seniors. I used to think this is a waste of time (and some of it still is), but ultimately these discussions and referrals can improve outcomes since they have been reviewed by someone who is more qualified to make that decision, and it also provides you an opportunity to observe and learn from the thought process of an expert in that field. You can then apply the knowledge you've gained, during on calls and nights, which I rather enjoy for the slight increase in independence. Please just remember to always act within the limits of your competence.

'Things don't magically get done'

Another consequence of med school exams where investigations yield instant results. I find making plans is probably the least time-consuming part of the process (and this is what assessments focus on- your decision making abilities). The bulk of my time on the wards is spent ensuring these go as intended. You would spend around 10% of your time deciding someone needs a CT and fill out the request form, and the remainder ringing the radiologist to vet the scan -> call the CT to confirm a time and date -> ensure patient goes down for the scan (+/- needing IV fluids for those with concerns regarding renal function) -> chase the scan report, then finally act on the findings. Additionally, things can go wrong at any point which prolongs the results coming back. Understandably, it is unreasonable to expect this kind of realism in exams, but it has certainly skewed my perception on how clinical practice is.

'I will be meeting many more people and friends'

I am not the most social person. I hang out with the few close friends I have throughout my medical school years. I am still not sure what it is about the work environment vs campus life but you become acquainted with so many more people. I think it is partly because you need to communicate with the team effectively at work, whereas as a student, you can choose to be a lone wolf if you want to. I am still more introverted than extroverted, but I still enjoy being surrounded by interesting conversations and chipping in every once in a while.

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Comment down below if you agree or disagree with the above! Share some of the things you would want your younger self to know!