Black Wednesday

We all have to start somewhere

It's been a pleasure watching the fresh batch of baby doctors arrive on the ward, all wet behind the ears, lanyards tight around their throats. It makes me feel nostalgic, protective, and very old, all at once.

My colleagues before this lot were excellent, so the bar was set high. You can absolutely tell the new ones are new, but they compensate for the gaps with genuine diligence and a willingness to learn, which is all I can really ask.

Although "gaps in knowledge" is the wrong phrase. Talk to them for five minutes and the knowledge is plainly there, filed and indexed and ready to be recited. What makes an experienced clinician is the intuition about which parts of it apply to the person in front of you. Chess grandmasters famously don't calculate more moves than amateurs; they just see the board in chunks, and the bad moves never make it to conscious consideration in the first place. Medicine is like that, except the board is a 78-year-old with three comorbidities who has stopped taking one of her medications and hasn't mentioned which.

It's one thing to know the drugs and the diseases cold. It's another beast entirely to have a messy, inconvenient human in front of you, and that description covers the other doctors as fully as it covers the patients. Eventually, through sheer exposure, observation and practice, you just know. The relevant information stops requiring a search through your head, or a panicked Google in the loo (I am not above this). You build up what I can only describe as a mental cache, log(n) for the things that matter. Inconsistencies start to make you itch before you can articulate why.

Then there's the tacit stuff, none of which appears in any curriculum. How to refer to General Surgery without being swatted away. The exact words that make a busy Med Reg give a damn. Tactical phrasing that gets an urgent CT head done urgently rather than eventually. Presenting a patient so it parses for a doctor as exhausted as you are, who lacks the benefit of having spent the last four hours with them. Shortcuts through the hospital. Where to liberate your fair share of patient coffee, the single perk of the job. How to comfort the disturbed and disturb the comfortable, when clinically indicated. Which consultant will cheerfully field the silliest question, and which one will not suffer fools. The importance of booking annual leave early, so there is something to live for that isn't an ARCP. Getting along with your colleagues, because the NHS is a harsh mistress who will grind you down, and collegiality is a slow, reliable form of karma that they will be drawing on regularly. And, in due course, a tolerance for my worst puns.

I've been rather delighted by the FY1s and their impostor syndrome, which has a prevalence I estimate at 100%, give or take 0. They do their best to hide it, and you can always tell. I say that the shoe does fit, and eventually they'll stop noticing the blisters. They're fresh out of med school, and suddenly here is a human being who might die if you sneeze at them wrong.

Catch.

The most poignant case was the new core trainee. Lovely girl, fretting that she didn't know a thing. I told her, firmly, that if she knew everything already she'd be wildly overqualified, or at minimum a Senior Registrar. You're here to train, miss. It's in the name. You'll be fine.

On day one I told them that stupid questions do exist, and that I was issuing everyone a month of exemptions. The exemptions have been used. Expired ones remain welcome, because God knows I still ask colleagues, sotto voce, things I very much hope nobody senior overhears.

Sigh. I was there once, permanently braced for the moment someone worked out that I had no idea what I was doing. You pick up a few tricks, and hopefully avoid killing anyone en route. I think I've become the sort of senior I wanted when I started. Visibly stressed, clearly overworked, but always willing to make time for those need mine more than I do. I've certainly known worse.

As Black Wednesdays go, last week was far from the worst.