🗒 Saving lives: An open letter to junior doctors

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Dear junior doctors,

You are young, enthusiastic and full of trepidation. I remember clearly the mix of excitement, fear and the huge sense of pride at having completed medical school, but also a sense of embarrassment in not knowing how to do the job despite all the previous years of study. The first year really is a period of contradictions, intensity but most of all of growth and transformation.

You go into medicine to become a doctor, on the whole, for altruistic reasons and the desire to help others, so despite the article being titled 'Saving Lives', I must admit I have exploited this fact to engage your interest and entice you to read my short piece. There is a small deception here though because my words of advice do not pertain to saving patients' lives, they pertain to saving your own.

The average doctor may not like to admit it, but they are very likely to be, what psychologists refer to as a Type ‘A’ personality. These personality types are dedicated, high achieving, highly self-critical with perfectionist tendencies. They are usually accustomed to acing tests, winning prizes and generally excelling as a result of their hard work. If you superimpose these traits and expectations onto a working environment as chaotic and imperfect as a large teaching hospital, you can see there is a mismatch. This can have a serious impact on how you navigate your way through this new landscape.

This is not an anecdotal account, abstract idea or personal opinion. You need only to search the web for ‘junior doctor wellbeing’ or 'junior doctor wellness' and there are countless articles on poor wellbeing, mental health and burnout. The harsh repercussions of transition from student to doctor are consistently documented. We are all in the business of saving lives and as important as that is, when helping to save the lives of our patients, we also need to save our own. You are a precious entity and should not lose sight of this.

What advice can I give you then for a safer more joyous journey working as a junior doctor? I hope you glean something useful from my tips and that perhaps my words will resonate with you.

Be kind to yourself

There are no expectations of you to know everything or get everything right in every instance. NO ONE working in your hospital will have this expectation of you, not the nurses, not the senior doctors not even the patients. Allow yourself the buffer that comes with being a junior doctor and allow yourself permission to not know the answer. Practice saying, "I am a junior doctor, I am unsure of the answer, allow me to consult with a colleague and get back to you."

Be realistic

Junior doctors may feel overwhelmed with a burden of responsibility on their shoulders, especially while on shift. However, it is important to remember that if you need to take some time off, the hospital won’t fall apart in your absence.

Don’t neglect your own needs

Get into good habits early! We expect our patients to heed our advice, keep up regular fluid intake, make time for lunch and don’t delay toilet breaks… take this advice yourself. You have a long career ahead of you. You want to be a well fed, well-watered, happy doctor, not a cranky burnt out one. There really are very few contexts in medicine where you should be regularly forgoing lunch and bathroom breaks. These are small things but observing them reminds you that setting boundaries for your own wellbeing is important and creates a healthier and better working environment. Start to engender this quality now and carry it with you in your career.

Ask for help if you need it

Feelings of stress, panic, frustration and confusion are all daily occurrences for a junior doctor and a normal part of an emotional response to an intense and unfamiliar situation. Persistent feelings of hopelessness, helplessness or suicidal ideation or intent are serious warning signs and warrant immediate review. The hardest part will be having the first conversation about it, the rest is much easier. I would remind you, seeking help is not a sign of weakness and is unlikely to adversely affect your future career (this is the most common concern for a doctor). Open the discussion with anyone with whom you feel comfortable; your consultant, your manager, your GP or your medical indemnity provider (who are exempt from mandatory reporting) and this will get the ball rolling.

Remember to make room for laughter and joy

Yes, medicine is serious, but it is also a great provider of comedic fodder and I have made a living out of sharing its funny side. As mentioned, you can have a long and successful career in this profession, and you need to find ways of making it sustainable. Humour is a good way of doing this. Having a private internal chuckle about something at work is healthy and normal and I would encourage it! Try to continue a couple of the hobbies and interests you came into medicine with whether that’s the clarinet or even twerking and make time for friends, family or lovers no matter how antisocial your roster.

I do hope some of my words have been helpful for you. Remember that healthy doctors make healthy patients. I congratulate you on the enormous achievement of qualifying as doctors and wish you the very best in your future careers.

MIPS recommends that members take necessary steps to seek appropriate assistance and help. As an indemnity provider, MIPS is exempt from AHPRA’s requirement to make mandatory notifications. This enables you to undertake a confidential discussion with experienced clinicians.

If you have any questions regarding your membership, please contact MIPS for Medico-Legal Support on 1800 061 113.

Dr Ahmed Kazmi is a GP and dermatology doctor who splits his time between the UK and Australia. When he is isn’t consulting, he moonlights as a stand-up comedian and cabaret artist. He has been a strong advocate for junior doctor wellbeing.

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