Don't panic!

Ah, August. After years of late-night revision sessions, exams, more exams and worrying about results, you experience the joy of finally achieving your goal; you made it. You're a doctor.

Inevitably there will be anxiety. No amount of shadowing (now common in the final months of many undergraduate programmes) quite prepares you for the moment you first prescribe something or do/say something to a person who is entirely depending on you to get it right, and then you sign your name. It's your responsibility.

I don't believe there is an easy way for that leap to be made. For some, the step is a small one, taken within their stride without a second thought. For others it feels like crossing a chasm. This difference is largely down to personality type and medicine is a broad enough church to need a good cross-section of types within its working ranks. Over-achieving and being over-confident are no longer prerequisite for pre-clinical applicants. There are many horror stories from the good/bad old days but going over them again is pointless, because the past is definitely another country and we did things very differently there.

Recent changes for the better include shadowing, no-one starting on their own at the weekend and having an induction, but we could still do better. Changing the start date away from children's school holidays is the first step. Given the age demographic of consultants, most will be taking annual leave during this time and unable to support their new team.

September would work much better. An embargo on annual leave for all middle grade and senior staff for that week would also be supportive. That embargo could also extend to senior nursing staff, who will find themselves 'holding the hands' of the new team. Their patience and experience is invaluable and I still remember several kind souls who showed me the ropes. I also remember the ones who called you urgently from across the hospital three times in the same hour. It may be sexist, but I think the better-looking male doctors fared a little easier.

Talking to others, including good looking male colleagues, I'm not far off. A bit of basic psychology training would benefit existing staff. A wise trainer once told me, "no-one ever made someone taller by telling them how short they are." Patience, thanks and praise (when due) all encourage new staff. I often see undergraduates in our surgery visibly grow when encouraged appropriately.

Of course, it would be great if everyone could just stop being very poorly for a few days, whilst newly qualified clinicians find their feet. In a service already stretched to breaking, it's really hard to squeeze out that extra drop of compassion for your juniors, rather than your next patient.

And the last sore point; the helpful news items talking of increased mortality rates during this time. The knowledge is all there, but as clinicians they are not yet complete. The missing pieces are about putting the knowledge to work in a hospital environment, juggling, prioritising and coping with unrelenting pressures.

I read a piece in the BMJ last week, written by clinicians who had come to medicine after doing other stressful jobs such as police, helicopter pilot or paramedics. Their piece was outlining why medicine was more stressful than their other jobs and cited reasons including personal responsibility, working patterns and multiple conflicting demands. Their previous jobs also had pressure points, but these were handled differently. One that stood out for me was the handling of personal responsibility. The authors felt protected in their previous roles by systems and protocols with clear boundaries which defined their responsibilities.

In an incredibly busy hospital environment, individuals are always asked to go beyond their limits. In what has traditionally been a macho environment of having to cope or you're not quite 'the right stuff', this has been the norm for years.

These days however, with increased workload and an older population with more complex morbidities, this is no longer tenable. I fear it will take years for the ghost to be truly laid to rest.


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