Top advice for an aspiring doctor

The seat of the wise ones...

So, I've been gathering useful bits of 'how to be a doctor' advice from wise people around the place since this medical quest of mine began with applications in 2013.  The first from a riverbarge at 3am, the last on a breathless trip up and down to the basement of the big QMC hospital in Nottingham.  Three years' worth of glimmering pearls follow.  My favourite?  Vicky's take on everyone quietly freaking out in the operating theatre on the inside during an emergency, but you'd never know it to look at them! As I walk the halls I like the idea of picturing the faces of these giants shooing me along...

Real people's advice (non medics!)
C (management team @ RCS) – remember, surgeons just love to teach.  They’ve spent their lives acquiring such a large body of knowledge; so they just want someone to tell their story to.  They want someone to listen, ahhhhh :)
LQ (engineer) – well-being guidance from your doctor is important; not just the information about how to avoid being ill.  This means lifestyle advice (exercise, sport, socialise, sleep), as well as some handy practical advice about what makes you vital.  Docs rarely cover this, but they're missing a trick!

SL (clinical psychologist) – beware the prospect of being a doctor turning into an endeavour in which you are simply a well trained algorithm reproducer – in which there isn’t creativity, but simply the ability to remember a series of instructions to follow.  There needs to be so much more than this.

PJ (diabetes nurse) – it’s personally safer to see being a doctor as being an advisor, you need to structure and provide the best advice possible.  The responsibility for enacting that advice lies with your patient, and you can’t allow yourself to be measured on whether they decide to follow it, else you may well end up frustrated and disappointed.

RB (midwifery lecturer) - we’re all judgemental.  We can’t help it – we do it every time someone comes into the room.  It’s important to notice it, accept it, be informed by it, but not let it affect the quality of care you offer or show on your face. 

Med Students

AL - remember when you’re choosing specialty, it’s not a case of whether you could do it (be aware that you’re fully capable of doing any specialty!), it’s a matter of determining which is the right choice for your life ahead.  Beastingly tough specialties don't necessarily make for a happy life!

JG - the type of hospital you end up working in matters – if you can be in a small district hospital, you can see and be responsible for a great variety of work – for some this can make all the difference, between a stimulating and interesting job, and a mundane one

Consultants 

LM (GP) – when you’re shadowing in UK or overseas, focus on maximising the amount you can contribute to the environment you’re shadowing in.  Don’t rock the boat either.  This will endear you to your seniors.

Unnamed (general surgeon) – keep patients’ thank you letters – they’ll help you smell the roses in the bad times, and you can count on it, there will be bad times. 

WD (obstetrics&gynae - cancer specialist) – sometimes the pregnant pause is all that’s needed to draw a patient out.  And if they’re particularly unhappy or complaining about something, keep asking them what they want you to do – if you put them in the driving seat, they’ll find it hard to complain.

JL (colorectal surgeon) – it’s the clinical skills that will stand you in good stead when you're actually practising, not the academic science.  Focus on the clinical areas and you’ll be well set.  Oh, and tick the boxes.  People jump through the surgical training hoops if they tick the right boxes...

DB (cardiologist) – some medical specialties are distinguished by certainty (e.g. specialist cardiology, hand surgery) vs uncertainty (e.g. infectious disease, GP).   And specialist wards are usually a better and happier environment than generalist wards – the ability to actually solve the problems faced avoids despondency!

DB (cardiologist, again) – GPs function best when they have a speciality interest to keep them motivated, if you're considering it, find that interest and hone in on it!

SS (paed surgeon) – it’s all about miles on the clock – it’s not how long you’ve been a surgeon, it’s how many cases you’ve seen and done.  That’s what makes you good.  Conducting surgery after surgery on the job can be the best way to build those skills (he talked of a hospital in the Kashmir).

KG (GI - functional GI specialist) – don’t judge patients’ poor lifestyle decisions by your own yardstick.  They aren’t necessarily in the habit of thinking for the long term, many of them have always lived from week to week, and what sounds like a reasoned solutions to you may therefore not be absorbed by them.  Give them a short-term reason to follow your advice.

Unnamed (online) – what makes a good F1 isn’t being a genius, but it’s someone who’s honest, reliable and trustworthy.  Be that guy.

Juniors

VW (ST5 obstetrics&gynae trainee) – don’t be fooled by the level of calmness on everyone’s face in the obstetric operating theatre.  If there’s a major haemorrhage, the anaesthetist will be freaking out, the surgeon will be freaking out, they’re just good at suppressing it.

FA (ST5 urology trainee) – don’t focus too much on the technical details of the procedures you’d end up doing in a surgical specialty.  All of these will become commonplace to you after a time.  Work-life balance and the future trajectory of your career are more important.

GB (ST paediatric trainee) – patients lie.  Teenage girls lie in particular.  If she claims she's had her body ravaged by disease / mauled by a tiger, don't trust it.  Equally, if he says he's fine, he's probably dying.  Ask a family member and trust the examination findings. 

GB (ST paediatric trainee, again) – don’t allow the trend of over-modesty and deskilling to seep into the profession of being a doctor ("oh, you nurses know so much more, you HCAs, you're all get the patients so much better than we do").  They're good, but they're not doctors.  Be confident about what docs can do.

RW (SHO genito-urinary medicine trainee) – know your emergencies section from the OHCM – that’ll cover you for F1.

E (MSF Amsterdam and GP trainee) – when you’re in GP, the biggest question on your mind should be: is this urgent?  Or can this wait.  If it can wait, breathe out, you can get them to come back…
RA (plastics trainee and journal founder) – contracts and cash are going to be a constraint all the way through your medical career.  Generate a secondary source of income to limit the impact of this.
HE (ST? geriatrics clinical-academic trainee) – don’t be afraid to step off the training pathway, it can really help you to figure out what’s right for you at each stage.  From all angles you'll get pressure to stay on it, but you’ll need to hold your nerve in the confidence that you’ll get a training number at the end of it.
AC (ST4 ortho -> HEMS trainee) and here's the most comical of the lot.  How to accept that you'll find arrogance in those surgeons who have to make massive life-changing decisions?  Remember, dear student, "The bigger the balls, the bigger the cock".  Priceless.

Nice eh?  That's it for now - Christmas is coming and these presents aren't gonna choose themselves...

Not much chance of one of these!