Tips on
Preparing for
Help! I’m a medic,
get me out of here
I am a preregistration house officer and
recently changed from a medical to a surgi-
cal job. I don’t think I could have even
begun to contemplate the different, curious,
and complex world I have now entered.
As a medical house officer you have no
real conception of what a surgical house offi-
cer actually does. I rarely saw our surgical
counterparts during the past six months.
They were either in theatre, in the doctors’
mess, in bed, or had already finished for the
day just as I was starting.
After my surgical induction day, however,
I started to find out what life was like on the
other side. Our introductory spiel by the lead
surgeon gave me some subtle clues as to
what to expect. If I was ever seriously consid-
ering a career in surgery, I was instantly put
off it forever by his “welcoming” talk. His
tone even upset the diehard surgical
wannabes among us. I don’t think we trained
for six years to be patronised like this:
“House surgeons are called house surgeons
because they used to live in the house; we
did a one night in two on-call and never left
the hospital site in case we were needed.
People lived and died by our blade. There
was no way you could get a weekend off, and
if you wanted to get married you had to ask
your consultant’s permission.”
It was clear that his tone had infected the
whole department. Recent changes such as
protected sleep time for juniors (between
2.30 am and 8.00 am) were viewed as
pathetic, and even the most minor mistake—
common when beginning a new job in a new
hospital—would receive a major bawling.
Many have cried, and many have turned to
the medic’s friend, alcohol.
Not only was the attitude arrogant but
also some surgeons clearly have no idea
about the medical world close by—a world
that I believe is hardworking and far more
intellectually and emotionally stimulating.
Some surgeons feel that surgery is God’s
own work and we are basically there to fetch
and carry and tend to their egos.
This attitude and way of life is outdated
and counter productive, and it seeks to
STUDENT BMJ VOLUME 12 FEBRUARY 2004 studentbmj.com
exclude any keen, young, hopeful doctors
who may be considering surgery, because
there is no attempt to forgive a reasonable
quality of life.
The worst things are the personalities and
attitudes of some surgeons. Medicine is sup-
posedly a profession where the central theme
is care and, although a cliché, wanting to help
patients. I have met few surgeons who want
to help anyone other than themselves. There
is condescension towards “ignorant, stupid”
patients and continual arrogance in their
behaviour—a cross between prima donna
histrionics and stunted child development. I
don’t have to say much more about this
because we all know that this stereotype
exists, just as we know that “sympathetic
surgeon” is an oxymoron.
I am bewildered. I don’t really do any-
thing within the confines of my role as a sur-
gical house officer. There is a ward round
every morning at 8 am, which is finished by
9 am. Then perhaps some blood tests to do,
followed by going to the mess and rolling
around with complete boredom because I
have only four patients on my list. I have the
option of going to theatre and holding a
retractor for two hours, but that quickly loses
its appeal. If I was back in my original job as
a medical house officer I would have no time
to sit down and drink five cups of tea. I
would be up and about tending to my 80
patients, organising everything, and loving it.
Why is there this fundamental split in the
attitudes of physicians and surgeons?
Surgery is undeniably a technically difficult
and arduous career. Surgeons save many
lives. An operation may fix someone who is
unwell, but they may not feel better if they
have been psychologically mistreated.
Surgery has closed its own door on me. I will
keep my head down for the next few
months, learn how to drain abscesses, and
plan my medical career, knowing that I will
have let myself and my patients down if I
ever behave like the stereotypes I have come
to know.
The author wanted us to publish this anonymously
a consultant
ward round
If you have ever been the junior doctor
on a nightmare ward round, here are
some tips to make the next one go like a
dream.
● Know who your patients are and
where they are. Ask the bed man-
agers to find out where your patients
have been moved to. Do not drag
your consultant round in circles
looking for his or her patients
● Ensure that case notes and radio-
graphs are available and on the ward.
Drum up help from the ward clerks
the day before to find any old notes
or radiographs
● Find a nurse who knows your
patients and invite them on the ward
rounds with you. They may be able
to provide answers to some of the
questions that you are struggling
with. Ask them to have drug and
observations charts to hand
● Have all key investigation results
ready to hand. Give yourself time to
telephone for results before the
round starts. You get extra points for
flow charts to illustrate trends in
blood results
● Summarise case histories and results
into clear, concise points. This will
enable you to update your consultant
quickly without frantically flicking
through pages of notes and investi-
gations
● Liaise with the multidisciplinary team
to find out more about your patients’
needs. Your consultant may think a
patient is medically fit for discharge,
but you should be aware of any social
or physiotherapy matters that may
delay discharge
● Find out whether your consultant
likes to speak to relatives during or
after the ward rounds and make the
necessary arrangements if requested
Faiyaz Mohammed specialist registrar in
gastroenterology, Trafford General Hospital,
Davyhulme, Manchester M41 5SL
safai@hotmail.com
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