There is loads of tips for new doctors out there (see #tipsfornewdoctors), and I get lots of useful advise about what to do when you are a middle grade or consultant. But there is a weird bit in the middle, no one is deeming you an official “senior” but you are still giving out advice to other juniors doctors and are making decision independently that are still really important to patient outcomes. This ambiguous level is what I have been bumbling through the last couple of years. Here’s a few things I have learnt
“I don’t know!”
Remember when you had just started out and you thought your seniors knew everything; that’s you now. But of course you don’t, and you never will. So being humble and stating when you don’t know is the first step in finding the right answer.
Show where the knowledge is hiding.
I know a few guidelines off by hand by now, but if asked, it is always nice to pull this up and check. Not only does it show your college where to find this information for next time, it also demystifies you as a senior; you are not somewhere who has all the answers offhand, but just some-one who has been doing this a couple of years longer and knows where to look.
Make the safe decision
Most of the time you end up “acting up” is out of hours. This makes a lot of decisions simpler. Discharging patients or sending them home is always optional. This can wait until the morning, as can many finely balanced decisions. The least medicine that is necessary is usually the best option.
Divide and conquer
A speciality opinion can never hurt. It may seem like a silly question, but until you’ve have worked it that other speciality it is difficult to really get a feel of what is urgent, what needs investigating and what doesn’t matter at all. Asking with humility and intrigue is always well received.
Collect as much information as possible before calling for help
If you know what the boss would say, do it, then call . This simplifies the decision making process for everyone. Ten minutes getting a blood gas and a chest x-ray let’s your boss make a single informed decision in one discussion or if in doubt…
“I don’t know what is wrong but something is…”
You know your gluteus from your olecranon by now. Your senior’s trust you. If you think something is wrong then say so. You don’t have to have all the answers. Every senior worth their salt wants to know the unwell patients under there care.
But challenge when you think things are wrong
This is difficult; surprisingly so, even with very approachable seniors. But if you think a wrong decision is being made, either on ethical or clinical grounds it is important to politely and with humility raise this until you are satisfied. Either your release that your boss didn’t have all the information to hand, you fill a hole in your knowledge or the decision (especially the grey ethically tense decisions) get a more appraised approach.
And don’t forget your juniors
Especial for those freshest out of medical school, it is easy for corrections to be interpreted as criticism, or advice to seem like admonishment. Ensuring compliments are metered out when deserved and the many daily successes are emphasised should be a daily focus. Equally the trials of tribulations of working in a imperfect system are they are not yet used to can be taxing. Maintain positivity is something I often fail to do, but is something we all should strive for.
Seniority comes gradually with experience. It is not binary. In a good system the ascent should be should gradual as to not noticeable. Hopefully the view from the top is worth it.