Last summer, I received the rota for my first FY1 job in forensic psychiatry. I've always been intrigued by psychiatry, especially forensics, so I set to work preparing for the role, adding books on the psychology of murder and the social determinants of violent offending to my summer reading list.
When I started work, I quickly realised this hadn't exactly been necessary, as my only psychiatric 'input' was to scribe the ward round in the mornings. This was not to say that the work was not equally as challenging as I'd expected, it just turned out to be challenging in a slightly different way.
My main role involves dealing with the day-to-day physical health needs of the patients, such as assessing patients, interpreting investigations, and writing referrals and discharge summaries - everything medical school had prepared me for! Or so I initially thought.
As psychiatry foundation doctors, not only are we the go-to practitioners for physical health, but we're sometimes the only practitioners for physical health, as the duty doctor covers seven other wards.
This can be a heavy burden for a newly qualified doctor - what do you do when you're unsure whether your patient's ECG shows new left bundle branch block or whether it's just artefact, but your senior hasn't read an ECG in 30+ years? Or when your psychotic patient is refusing antibiotics but has capacity to make that decision, so you spend every night for a week fearing they will wake up with sepsis?
These are just some of the questions that plagued me during my first few weeks working.
I quickly found support in my relationships with colleagues, which are based on mutual trust and respect, and which form naturally in such intense settings. Other doctors are generally incredibly helpful, occasionally offering words of reassurance that can release an entire day's pent-up stress.
The nurses and administrative staff have saved me countless times, either through repeatedly taking time out of their days to help me to find blood bottles, torniquets, or the patients themselves, or by showing me how to work the printer or the phone or whatever new IT system is in use that week. I know that myself and other juniors would be utterly lost without such patience and kindness.
Working collaboratively with colleagues can be a challenge, however. Like in any profession, people can be irritable or even rude. Often, they're just tired, and always busy, but it can still be difficult to keep a thick skin when a sharp comment is directed towards you.
Difficult encounters are, thankfully, rare, and minor in comparison to all the positives that come with starting work. I go to bed most nights feeling like I've made a positive difference to somebody's life, however small, and I don't think that sense of achievement will ever wear off.
I think what has surprised me most about becoming a doctor is how little I take the work home with me. As an anxious person, I thought I'd be up at night worrying about mistakes I may have made in a consultation, or whether I'd made the best possible management plan, but with such a competent team and structured handover, it's not been an issue. This, combined with having more free time in the evenings and at weekends that used to be taken up by impending deadlines and exams, has left me with a clearer head than I've had in years.
If I could say one thing to my first-year self, it would be this: yes, being a doctor is difficult, but being a medical student can be even harder in its own way. Constantly being treated as lesser on placement, getting in the way, and struggling to balance stresses can be so disheartening. But it's all worth it once you gain confidence, and step onto the ward as a competent clinician in your own right, knowing your worth and your value.
Trust me, it gets better.
Here are my tips for transitioning to FY1.
- Get used to keeping on top of your portfolio - it doesn't end after medical school!
- Be actively involved in patient care wherever you can and be reflective in your learning.
- Organisation is key as an FY1 and will be your biggest asset.
- Practice clinical skills, handover skills, and task prioritisation - your seniors will handle the medicine.
- Value every member of the MDT - nurses will save you more than you know.
- Prioritise self-care. You can't care for others if you can't care for yourself.
- There are no prizes for muddling through things alone - always ask for help when you need it.
Join the MDU for your first foundation year and £5 from your £10 FY1 subscription will be donated to RMBF.
This page was correct at publication on 09/02/2023. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
by Hannah Gleeson
Hannah is currently working as an FY1 in West Yorkshire, having graduated from Leeds University. Her main interests are in acute care, and she hopes to specialise in anaesthetics, emergency medicine or intensive care medicine. She is also passionate about tackling social inequality and hopes to continue her charity work with others as she progresses in her career as a doctor.
Outside work, Hannah enjoys reading, climbing, wild swimming, and pub quizzes with friends.