Tips for new doctors
Authors: Nicola Lennard
Publication date: 25 Jul 2016
Nicola Lennard gives advice for foundation doctors starting out in their medical careers
Your first job as a qualified doctor can be exhilarating and nerve racking. Years of study have equipped you with knowledge and practical skills, but there can be a huge learning curve in assimilating the practicalities of the job. Here are five tips for foundation doctors starting out on their careers.1
Communicate, communicate, communicate
Effective teams and successful patient relationships are built on open, honest communication. Working on your ability to build rapport with colleagues and patients, and developing your listening skills, will stand you in good stead throughout your career.
As the most junior doctor, you may be privy to information that your colleagues are not and that you need to share with them. You may be exposed to concerns and frustrations of patients and their families that may not be apparent to the rest of the team, and that can grow if not dealt with at an early stage.
Miscommunication can lead to adverse incidents. Avoid using jargon or abbreviations and check that there is mutual understanding of the information provided or action required. If there is any uncertainty or confusion it is better to double check than assume what you have said has been understood. Be clear about the limits of your knowledge and make reasonable checks to make sure any information you give is accurate.2
Develop your handover skills
Developing an effective, structured handover process is an important skill. Handing over patient care at the start and end of your shift may seem routine, but it is key that all information needed to safely care for patients is shared.
Similarly, care may be transferred from your team to the patient’s GP or to another hospital. You have an ethical duty to “share all relevant information with colleagues involved in your patients’ care within and outside the team, including when you hand over care as you go off duty, and when you delegate care or refer patients to other health or social care providers.”
Having a standardised method of communicating may help prevent important information from being missed. The Royal College of Physicians has published an acute care toolkit that includes templates of handover sheets that you may find useful. Your trust may have its own template, so check what your hospital handover procedure is.3
Put the record straight
Medical records are important for recording what treatment has been provided and may also play a central role in determining patient care. When writing your notes, try to put yourself in the place of the next doctor to see the patient and remember that, as well as the clinical details, they will need to know what the patient has been told.
Your notes must be legible, factually accurate, and made at the time of, or as soon as possible after, seeing the patient. Clearly identify who made the record, and the date and time that the record was made. Medical records are a legal document, and the patient can request access to them. You may also have to rely on the notes to provide a statement for a coroner or to respond to a complaint.
This task will be made easier if you have recorded your input clearly. If you need to make an additional note to record extra details, make sure that your new note is dated and timed and clearly marked as having been made in retrospect.4
Ask for help when you need to
When you’re starting out it’s inevitable that you’ll have questions or concerns. You may feel embarrassed and be reluctant to ask for help from your senior colleagues, particularly if they look busy or the question seems stupid. But it’s important to have a low threshold for asking for help from colleagues.
Bear in mind that all doctors, no matter how senior, need to discuss complex cases with colleagues. You have an ethical duty to work within your level of competence and consult with colleagues where appropriate. You could be criticised if you don’t speak up and a patient comes to harm as a result.5
Regularly reflect on your practice
You are now a qualified doctor, but this is just the beginning of your career, and you are expected to maintain and develop your competence and performance. You will need to obtain feedback for your annual review of competence progression and you may find it helpful to get informal feedback to help you reflect on your performance.
General Medical Council guidance also sets out a duty for you to reflect on your performance, values, and contribution and to ask colleagues and patients for feedback. If you receive negative comments, try not to take this personally but act to address any failings in your performance.
Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.
Nicola Lennard medico-legal adviser Medical Defence Union