Looking Back: One Month In

I’ve just finished my first month as a Consultant. It has certainly not all been plain sailing, and as expected there have been ups and downs as I’ve settled into this new role. So what things have I learnt so far?

Co-ordinating is harder than you think

I’ve had three shifts as “Red Leader” so far. This is when I’m on as the co-ordinating consultant and I, and the co-ordinating nurse, get to wear red scrubs so that we are easily identifiable. The plan is to manage the Department – allocate staff to specific areas and tasks, troubleshoot, manage flow(?!), provide advice to juniors….etc. These were all things that I had been doing comfortably as a Registrar on nights for several years, so I should be okay doing this. I mean, how hard can it be?

So, it turns out, that managing the Department as a Reg overnight is not quite the same thing as being the co-ordinating Consultant. Even those ESLEs where you get to “act up” for 2 hours don’t really give you a taste of what it’s actually like.

My first co-ordinating shift was nothing other than a complete disaster. We were crowded, resus was bouncing and there was no flow out of the Department. With sick patients left, right and centre giving advice turned into reviewing patients, then seeing patients, then running a Major Trauma. Whilst constantly being interrupted and trying to liaise with bed managers when I didn’t really know our escalation policies because I’d not worked in the trust for 15 months and frankly didn’t have the cognitive space to work it out. When the evening Consultant arrived for me to hand over to, I had to shamefully admit that I had absolutely no idea what was going on in the rest of the Department, as I was entangled with a tricky Trauma. I felt like a complete and utter failure by this point and was wondering why on earth anyone had ever thought that I’d be any good at this. I managed to escape to the office to get changed before I sat on the floor and cried, and then picked myself up and dragged myself home.

Generally feeling useless takes up bandwidth

Everyone expects the change in role and increased responsibility to be stressful, but actually it’s the constant small frustrations that have really got me. Please somebody just ask me a clinical question! I’ll either know the answer, or we can find it out together. Just don’t ask me to get you a connector for the bloods you’re taking, or to run a VbG because I don’t know where ANYTHING is, and although I actually know how to work this gas machine, I don’t have a pass for it yet. Similarly, I can’t even just competently see patients with out asking my Consultant colleagues questions that I feel I should know the answer to, like does chronic back pain come under ortho or neuro or medics? These constant small frustrations take up bandwidth and make everything seem that little bit harder. As I get used to the restructuring of the Department and the policies and protocols here things are getting better and that inner perception of “generally feeling useless” is starting to lift a bit.

Re-learning to say “no”

I thought I had saying “no” nailed. Throughout training I got exceptionally good at taking too much on until one day I realised that saying “no” didn’t have to come with any more justification than being too busy or even simply just not wanting to take something else on. That lightbulb moment was empowering.

On Day 2 of being a Consultant one of my colleagues suggested that I should take on a link role with another specialty. Suddenly, I wasn’t sure what the rule book was in relation to saying “no” in this strange grown up world where all of the Consultants have additional responsibilities. How do they get shared out? Fortuitously my CD answered for me, with a resounding “no”. When we sat down to talk about it, his advice was that it is 100% okay to say “no” to everything until I’m settled into role, with no requirement to feel guilty that my colleagues had extra things to do and I did not. There were additional responsibilities that needed handing out, and if I really wanted to do one of them, then “yes” was also okay – but I didn’t even need to give an answer straight away.

I’ve actually gone back and said yes to one of them – managing Consultant CPD sessions – because it fits in with my love of MedEd and it’s something I feel I can really add value to.

Emergency Medicine genuinely is the best job in the world

When I’m not being “Red Leader” I get to be a regular Emergency Physician. Yes, I’m giving advice and supervising juniors, but I’m also managing my own caseload. I’m leading trauma, assessing minor injuries, putting in difficult cannulas and doing all the sorts of things I loved about being a Reg, but without the gruelling rota. My practice hasn’t narrowed by becoming a Consultant, instead it has expanded, and in the same instance I get protected time to complete the administrative aspects of the job and even more to develop my special interest in Simulation.

The entire Department has been massively supportive

Nursing staff who I worked with first as a Foundation Doctor and then as a Registrar keep telling me they are thrilled to have me back, they are steering me in the right direction when I’m uncertain and putting up with all my “how does this work, and where does that live” questions with infinite grace. Established Consultants are popping onto the shop floor when non-clinical just to see if I need anything, or kidnapping me for a cup of tea whilst they check I’m doing okay. Juniors are helping me negotiate the unfamiliar computer system and readily forgiving me for not knowing every hospital policy and protocol inside out. Not to mention the secretaries, receptionists, plaster techs, housekeeper, porters and security who all make up #teamED and have welcomed me in my new role. There has been kindness in abundance.

It’s been a steep learning curve and a bumpy ride so far, and I’m sure there will be more ups and downs to come – I’ve not even done my first solo on call yet! If you want to follow me on this journey I’m collating one reflection, or thing I’ve learnt, or are grateful for, each (work) day using #KW5years on Twitter and I’m planning to write another blog a few months down the line.




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