I often try to remember my first day as a doctor, and in all honesty, I can’t remember anything about it. Like being born, your first day as doctor is so stressful that it becomes very difficult to recall it clearly. Day 1 doctoring was ever thus, and nothing I can say or do will prevent it.
However, there are some important themes that more experienced doctors should note. The transition from the old cohort to the new cohort is always bumpy - a group of people who are freewheeling their way through the days depart, and are replaced by nervous novices. That makes life a lot busier for those who do know what they are doing. Over the years, I have realised that the best way to deal with this is to take the first two weeks of August off on holiday, and thus miss the worst of the transition period.
For those who remain, it is important to observe that although much of the time will pass in a blur, the new house officers will recall clearly forever those who take the time to give them the support and guidance they need. I recently bumped into a consultant, who was the registrar the first on-call shift I ever did. The only memory I have of that day is that right at the very start he sat me down for five minutes and explained to me exactly what it was I supposed to be doing. I think I love him for taking that time.
I overheard one of the new house officers say today that she wasn’t worried about the medicine or the knowledge, but was worried about knowing how to get anything done. I didn’t have the chance to check whether her confidence about her knowledge was down to her knowing it all (a worrying sign) or because she knew she would be well supported (a more reassuring sign), but it resonated with a memory that much of the stress was seated in the uncertainty; as a house officer this manifests in many ways, and it is only when the sources of uncertainly diminish that one begins to feel at home wandering the corridors of the hospital.
I often think that being a good doctor means being good at dealing with uncertainty, and the mark of an excellent doctor is one who helps his patients and his colleagues deal with theirs too.
Nothing is given in medicine - every time you think you know what could happen, providence throws you a curve ball. Growth is measured not so much by knowing the answers, but rather by knowing how to approach the problem, and for all house officers, this will be huge source of anxiety. Many will deal with the challenge of how to approach problems by cramming themselves with as much knowledge as they can (that is often the medical way), while the really savvy ones will observe that the people they look to for answers often do not know the answers themselves, and will keep their eyes open for the ways that risk is managed and solutions sought.
We all have the chance to forge our own path and develop our own styles. There is no one, right way to practice medicine, and I hope that the new class of 2011 has as wonderful a time as a house officer as I did.
ps - Riaz will be on holiday for the first two weeks of August