Working During COVID: FiY1 Perspective

Written by: Anand Morarji FY1 Doctor

As you are all aware, COVID-19 has brought change and uncertainty, with both individuals and the healthcare sector having to adapt quickly to manage this new and unprecedented threat. In this post, I will share how changes related to the pandemic affected me – a final year medical student who graduated early to take up a position as an interim FY1 doctor at Lincoln County Hospital. It wasn’t until mid-March 2020, on the last week of my Obs&Gynae rotation, that I first truly appreciated the reality and imminency of the COVID-19 threat: During a ward team meeting, the nurse in-charge informed the team that the first patient in the hospital had died as a direct result of the virus. Things quickly escalated following this, with the University informing us that placement was being cancelled, and finals were to be combined into a single, online MCQ paper. Following this exam, a few weeks of an assistantship, and a couple of emails later, I had officially graduated and was provisionally registered with the GMC. Two weeks later I had moved to Lincoln and was starting as an interim FiY1. Following on from a brief induction, myself and a fellow FiY1, LP were given a few sets of scrubs and dropped off at the entrance to the respiratory ward. As with all “first days”, there was an element of apprehension stepping onto the ward, but this was soon mitigated when meeting SL, a locum FY3, who had been based on the ward for several weeks. SL was friendly, approachable, and happy to answer the many questions that LP and I had daily. He showed us how to use the systems, where equipment was located and introduced us to the respiratory team. The first two weeks consisted of preparing notes, scribing consultant discussions/plans, carrying out basic jobs and performing simple procedures. Soon enough, we were looking after our own bay of patients, completing junior ward rounds, pushing for investigations and referrals, and seeing patients that the nurses flagged up as unwell. To summarise, the first few weeks as a doctor were great – a gentle start to working life, working 9-5 with no on-calls, a regular senior guiding us when needed (which was incredibly frequently), and also getting paid as an FY1 (finally got a switch, dm me if you have cherries on ACNH…). Fortunately, Lincoln had been relatively unaffected by COVID, with the total number of COVID positive patients in the hospital rarely exceeding single digits at any one time. At first, the main impacts of COVID on my day-to-day work life included: short delays in discharging patients to nursing homes while awaiting negative swab results; the mild inconvenience of wearing a mask, or full PPE when in the proximity of aerosol-generating procedures (palpating veins is hard as it is!); and most devastating was the burden of having to listen through the 4-minute long warnings and guidelines every time I needed to contact a GP. However, the most significant impacts of COVID on healthcare provision appeared later on in my placement, and those were issues with the rota and staffing. To manage the peak of cases during earlier stages of the pandemic, greater numbers of doctors were scheduled on the wards at any one time, with holiday leave cancelled for many. As great as this was earlier on, it later resulted in numerous doctors having accumulated annual leave towards the end of their placement, meaning there were increasing issues with staffing as the August rotation date drew closer. Due to this, and with both SL and LP moving to different hospitals in early July, my ward was consistently left on minimum ward staffing, with juniors regularly being moved to different wards throughout the week, resulting in a lack of continuity of care. Because of these reasons, and the absence of any registrars, it was not uncommon for my colleagues and I to be finishing late during the last few weeks of my interim period to make sure all urgent jobs were completed or handed over. Following reflection, I decided to raise my concerns to my clinical supervisor as I did not think that the workload and responsibility of the ward jobs were fair at the time. So, in conclusion, GP is the way to go.

#UoBGPSociety Joking aside, my concerns were escalated and acted on – the consultants had a greater ward presence, and carried out further full ward rounds between then and when the new doctors started on the first week of August, which definitely made a difference.

Although difficult at times, my interim job has been an incredibly useful and rewarding experience. It feels great to finally put into practice what I have spent the last 5 years learning, and I have greatly improved in areas such as prioritisation, time management and procedural skill. Being directly responsible and involved in healthcare provision is a privilege, and unlike my previous jobs, the hours go by especially quickly when working in such an interesting and fulfilling role. Three moments that have given me particular joy were: when regulations were relaxed, and loved ones were allowed to visit patients again (in time-restricted slots); when one particularly sick patient made a remarkable recovery and was discharged home; when LP and I couldn’t help but cry laugh at how ridiculous and unmedicallysounding the phrase “swinging and bubbling” is in regards to chest drains (I swear it was funnier in person).

Overall, I was incredibly grateful for the opportunity to work as an interim FY1, alongside so many great people at Lincoln County Hospital, and I look forward to what the future holds. Stay safe. Anand