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The most pressing concern once you've started working in the NHS is whether or not you are being a 'safe doctor'. What we will outline in this post is what it means to be a safe doctor and how one can go about ensuring that they are doing right by themselves and the patient.
What does it mean to be a 'safe doctor'?
Safety first starts when you realize that you are a human and can only do so much during your shift. Never try to overwork yourself and pile on tasks without asking for help, because it's not sustainable in the long run. You need to be able to fully focus on your work, so don't be afraid to seek advice or slow down if it is necessary.
As doctors, we often feel obliged to be on our toes 24/7, not taking into consideration our own health and well-being. Unfortunately, we can only do as good as we feel, so never think that you need to sacrifice your own physical and/or mental health for a job.
Tips and Advice for being a safe doctor in the NHS
Take everything in stride
If you’re in a new setting or this is your first job, take everything in stride. You can't always expect to be the one who knows all the answers or where to look. When you're in a new environment, it can take time to settle in, so don't think you need to be at 100% from day one.
Even at day 21, if you feel like you aren't quite settling in:
- Identify what is causing the issue
- Is it the communication with your colleagues or other healthcare professionals?
- Are the computer systems too difficult to maneuver?
- Are you not understanding the accents of different people?
- Do you not know who to ask for help?
- Do you feel homesick?
- Try to find what could be the best possible action towards a solution
- Be polite and ask any colleagues or other healthcare professionals to repeat if you are not sure about something that you were asked to do.
- Whenever you are stuck with something in the computers, ask the next person politely to show you.
- If you find it really difficult to understand a patient, you can very politely ask them to repeat. If you still don't understand, you can always take a chaperone (e.g. HCA or nurses or even colleagues) to help you understand them.
- Your supervising consultant will be the first person, if you can't confide in them you can always contact 'Freedom To Speak Up Guardian' of your trust.
- Make a routine time to call home, if provisions apply then do video calls. (I used to keep reminders to call home)
Know your limits
Know your limits and don’t try to overwork yourself, thinking that you will gain brownie points by working longer hours or seeing patients faster.
If there is something that you cannot do or are unsure about, don't do it until you are fully confident in your ability. It can be dangerous if you try and complete a task you're not well versed in just because you think it can impress your registrar/consultant. Along those lines, if you are scheduled to work up to a certain time, and you've completed all work that can be done within that time, handover anything that is left to be done and go home.
No one will pat you on the back for staying longer. While there is the option to complete exception reports (for those working in England) if you have to stay longer than you're scheduled rota, if it is a recurrent thing that is found to be more due to lack of your time management skills or unwillingness to handover rather than increased workload, it will not be in your favor.
Taking breaks every 4 hours, handing over when appropriate, and knowing when to step back when things are too much for you to handle - is what a safe doctor does. No one will judge you for taking the correct precautions to make sure you don’t make a mistake, but don’t let your being new hamper you from learning.
There is an appointed 'Guardian of Safe Working' whose job is to ensure that junior doctors are abiding by their rota and that their working conditions are safe for the doctor and the patient.
Don’t be afraid to ask questions, but at the same time, don’t keep asking the same questions over and over again.
I like to keep a small notebook with me (I wear scrubs, so it’s small and fits in my scrub pocket) where I list how to do certain things that I could forget after just learning it once so that the next time I have a source of reference.
Take notes on how to do certain tasks, and have someone show you how to do something so that next time you are able to do it yourself.
Alternatively, you can see if your hospital offers any course booking within the medical education department on doing certain tasks you feel you need practice. You can always ask your colleagues, the nurses on the ward, your registrar, and even occasionally your consultant (if it’s appropriate) if you have any questions or concerns about a particular job that needs doing.
Make sure you take your days off as days off. A safe doctor doesn't stress out about work unnecessarily. Find ways to spend your time creatively. It's important to have an outlet to let of steam or just laze about when you need to so as to not get to the point where you have a ton of pent up anxiety/tension/worries that then begins to affect how you function.
Is there anything else to support me?
You can ensure you are first being safe by following the general tenants outlined above as well as listening to your instincts about how things should proceed. With that, there are some organizations and institutions that can help you if ever you need it.
British Medical Association (BMA)
The BMA is a great professional association to join when you start working in the UK. It provides you with information and support throughout your career, and can help if ever you need help regarding your contract, pay, bullying, etc as well as offering things like BMJ learning and free CPD events.
It is a fantastic resource to have on hand and to be apart of if you're not already a member, as it can be a great source of help when you're unsure of what to do in a certain situation. They can also help ensure you are getting what you deserve in terms of your work, as well as legal issues that you may need to use.
Join the BMA if you've not already done so!
Indemnity insurance is your extra coverage to protect you in case of clinical negligence claims. Yes, your Trust will have provided you with coverage, but this coverage is more about keeping the hospital happy and safe than it is about ensuring your well-being. That being said, this coverage also only takes into account claims from contracted NHS duties. So let’s first list out what IS NOT covered by your hospital’s indemnity:
- defense of medical staff in GMC disciplinary proceedings for stopping at a roadside accident and other good Samaritan acts not listed in your contract
- clinical trials not covered under legislation
- work for any outside agency on a contractual basis
- work for voluntary or charitable bodies
- work overseas
So at the end of the day, it’s better to be safe than sorry, and by keeping an extra coverage over your work, you are ensuring your security.
For more information regarding indemnity, including which service to take, please check out our article on applying for indemnity coverage.
Know the role of a junior doctor in the NHS
To talk a little more to what was mentioned earlier, don't expect yourself to be some sort of superhero that needs to take charge of every situation put forth and that you need to be the one to solve all the problems. Take everything as it comes, and a safe doctor remembers the importance of a multi-disciplinary approach to your tasks. Everyone has their part to play and that’s how NHS provides care harmonically.
To understand your role better, head over to a junior doctor's role in the NHS.
Seeking help outside your hospital
If you ever feel completely overwhelmed or are having difficulty coping, do not feel out of place to ask for help. With it, if you feel that you may be getting depressed, or having intrusive thoughts, don't be afraid to reach out. There are many organizations and groups that can be of assistance such as Tea & Empathy and Local Mind.
Frequently Asked Questions
Absolutely, yes. My monthly BMA fee when I started working in the UK was less than a pizza. But the amount of support in terms of rota checking, acclimatization, contract checking, BMJ learning etc that I got during my non-training job helped me tremendously to settle in.
Again, yes. Even if there is a state-backed clinical negligence scheme for the trusts that you will be working in, that is not as individualized as what third party may provide you with. GMC strongly urges for all the doctors working in the UK to have adequate coverage for their practice.
Bullying can involve arguments and rudeness, but it can also be more subtle. Other forms of bullying include:
- excluding and ignoring people and their contribution
- overloading people with work
- spreading malicious rumors
- unfair treatment
- picking on or regularly undermining someone
- denying someone's training or promotion opportunities
This can hamper your effectiveness to work safely to a great degree and put a toll on your mental health and wellbeing. Please check this NHS page to know how to stop it, and advice on getting support.
We hope you won't have any bumps in your road whilst you work in the UK, and that these tips will help you settle well into the system! If you're starting a new job soon, you will definitely benefit from our article on your first day on the job.