i apologise if this has been done before

anonymous asked:

I hate that even after working 2 extra unpaid hours I still feel guilty for leaving before my two seniors even though they were okay with me leaving. I feel like I have to set my foot down and say I'm sorry all my jobs are done I have to go but there's this huge pressure of teamwork as well you know. And it's a difficult balance. I hate being taken advantage of by the system and I also would hate to be seen as a crappy team member. Sorry this has turned into a rant now. #F1 problems :/

No need to apologise! I’ve been there. You have absolutely no reason to feel guilty, but I completely know where you are coming from, because I have been there. And I’m sure a lot of us have. Even when you know that the understaffing/overwork situation is in no way your fault, you still feel that it’s your job to sort as much as possible. And whilst the really important jobs and general overseeing falls to your registrars, there is usually a small army of FY1/SHO jobs that are delegated to the juniormost, and these also need to get done. And a lot of the time we struggle on until they are done. Sometimes that’s down to us being slow at first, or not knowing which jobs can safely wait til tomorrow, and sometimes it’s down to fundamentally not having enough junior doctors for the workload.

At the start of the strikes, there was a website where juniors could log the unpaid hours that they’d worked, and it quickly racked up significant amounts of time; all over the NHS we are working many thousands of unpaid hours, probably millions over the course of a year. This is labour for which we will never be repaid, and for which we aren’t covered legally, however we still feel a huge pressure to help out as much as possible, because we know the NHS is struggling and we know the only way to avoid harm to patients sometimes is to work longer than we should. And you are entirely justified in your anger, because this should not be happening.

Although a senior could do a junior’s jobs (when my job is busy, the registrars even do ttos, cannulas etc), the things that fall to your registrar generally can’t be taken on by someone more junior. Meaning that, even if you want to, there’s usually very little you can do to ensure your registrars or consultants leave any sooner! It’s understandable that you’d feel guilty leaving before them, but they did the right thing to send you home. We’ve all felt the guilt, but you deserve what everyone else takes for granted: to go home at a reasonable time after a hard day at work. You can’t stay forever, and tiring yourself out by working too long runs the risk of affecting the quality of your work, both in those extra hours and the following day.

Thinking back to my surgical firms and that of my friends, I’ve noticed surgical jobs tend to be particularly demanding; there’s a real sense that lists need to be updated before the ward round, and daily bloods requested before you leave, so that despite dashing around the wards all day you still end up coming in early and leaving late nearly every day. Some of my friends had additional problems; if their consultants happened to notice their FY1/SHO was still around at 6 or even 7, they’d still ask them to come and ward round again. Despite the fact that their poor junior had clearly already stayed two hours late! Which, frankly, I think is inappropriate of the seniors; a consultant is perfectly able to write their own notes every now and again, and let the nurses or on-call know if something needs actioning; there is simply no need to get their junior involved 2 hours after they should have left! My own seniors were good in this respect and it was rarely something I had to worry about, but I learned an important lesson from my friends: don’t be around any longer than you have to, because work has a way of finding you if you are around any later than you have to be.

For this reason, I recommend staying off the wards once you should have left. Even if you have a TTO or some blood forms to write, find somewhere out of the way, preferably where your seniors or the ward nurses won’t easily stumble upon you, and focus on getting those tasks done. Out of sight means out of mind; when you are somewhere easily visible, you become a magnet for every job and it becomes impossible to complete the few tasks you are actually staying to do!

Now, patients somehow always manage to get sick at 4:45 when you leave at 5pm. It just happens; I have a personal rule that I’ll sort out one patient who falls sick just before I leave, but anything else that kicks up on the ward has to be escalated to the on-call. I’ll do my absolute best to ensure the ward is left in a sensible state for them, and I’ll try to esure that nothing horrible is left for them to do at 5 (including that patient who decides to suddenly score a NEWS of 8 at 4:45), but I’m not staying all night to do the evening doctor’s job.  It is absolutely right and acceptable for you to ask whichever colleague is handing you jobs after hometime if they can ask the on-call doctor to do it instead. This works better for some specialities than others, as not every team has constant on-call cover and some are covered by other specialities/departments out of hours. Whenever I was on-call as an FY1, and even now, my first priority is to make sure the day team leave at as reasonable a time as possible. There are times when this can’t happen, and I think we’re all sensible enough to know when it’s only fair that we stay to help the on-call team out, or deal with a complicated case which we are the most familiar with. But many jobs which people end up staying late to do don’t actually fall in these kinds of categories.

I do recommend teamwork in the sense that colleagues of the same grade should leave together. It’s practically a law that if you stay on the ward alone even for 5 minutes to complete a TTO, you have somehow invited one cardiac arrest, two cannulas falling out, at least three abnormal blood results and a patient falling out of bed. It just happens. The last person on the ward will become a magnet for anything that goes wrong (rather than the ward calling the on-call, as should happen), so it’s only fair for the juniors to leave together to avoid someone being guilted into a pile of jobs. Look after each other, and encourage each other to stick up for your rights; there’s being a team player, and there is being taken advantage of. Too often, we’re told we’re not being a team player if we refuse to be taken advantage of, when really, the demands are unreasonable to begin with. I have met very few junior doctors who really are lazy and ‘not team players’, so I certainly don’t think most people are shirkers. If anything, I think most of us are far too accommodating of unreasonable demands at work, and in turn we risk making the situation worse by entrenching such expectations further. It’s not really juniors’ faults; good seniors shouldn’t have unfair expectations to begin with, and the best seniors think about the welfare of their underlings and do their bit to ensure that their team aren’t bullied into working when they shouldn’t.

With practice, we also get better at working out what can wait til tomorrow, and what has to be done right now. At first as FY1s, our inherent fear drives us to do everything ASAP, but you slowly figure out what can wait. Of course, this depends on how sensible your seniors are; we’ve all had that one consultant who insists that every! Single! Job! Has! To! Be! Done! Now!, which is a lot easier to ask for if you never have to go through the logistical nightmare of actioning all the jobs.

My registrars have always made it clear that part of a senior’s job is to make sure their juniors are doing OK; that also means things like checking your juniors haven’t forgotten to eat, and making sure they don’t stay any later than absolutely necessary. A good senior makes sure their juniors don’t get pulled into staying any longer than necessary, because they’ve been there, and know that it’s really hard to walk away until you’re given leave to go. I guess this reply turned out into rather a rant in itself, but I’m sure any junior has a LOT to say about staying late. I could go on, but I think that’s enough for now…