Moving on is a feature of the trainee doctor’s life, and next week sees another transition point for thousands. I found it both stressful and innervating, and I’m sure the adaptability that being forced to change institution every twelve months is a good thing. Yet the need to leave a familiar environment, trusted colleagues and patients whom one has been caring for, exposes some human challenges unique to medicine.
Ward doctors get to know their patients for relatively short periods of time, sometimes only a day or two, sometimes a month (if they are very ill, or if there are delays in discharge). But there is barely time to warn them that you will not be there come change over day. This can feel like a form of minor deception. On the last day you know that whatever undertakings you make, whatever promises to come back with tests results or other information, it won’t be you who fulfils them. We know that of all the things patients value, continuity is high on the list. Yet the faces they come to know best, those of the F1, F2 and core trainees, disappear at a stroke. Others remain, the registrars and consultants, and they try to ease the transition by saying things like, ‘Change over day today, you’ll be seeing lots of new faces!’ I wonder how patients react, privately, to this shift. Employees everywhere move on, but I can’t think of any other arena where those providing such an emotionally complex service, in a time of great stress (illness), appear to float off with barely a by-your-leave.
If you happen to be on-call the day or night before change over, your own questions about patients may remain unanswered. If you are unlucky with timing you will finish a night shift, clean your teeth and drive off to the next hospital in one seamless marathon. I remember calling in from the atrium of my new hospital during a break in the induction program, to find out what a brain scan had shown in a young man with strange paralysis. I could not get through to anyone. Then I remembered – most of the doctors at the old place were new too. My old registrar might know the answer, but she was undoubtedly running around trying to see all the patients on her own. None of the doctors who had replaced me would know who the hell I was. I was gone.
There may also be a sense of frustrated responsibility. I had a vitally important message to hand over to another team about one of their ward patients. A blood result had come through – or been noticed – late on the final night indicating that a patient’s kidney failure was due to a rare condition, vasculitis. She had to be referred to a specialist kidney hospital for a biopsy and immunosupression first thing in the morning. But I had to go; in fact I had to leave an hour early to drive to a new county. So I wrote in the notes (underlining the result five times), asked the nurse in charge to grab the medical team as soon as they arrived, and sped to the new hospital. Between induction lectures I tried to contact the team. When I got through the new doctors didn’t even recognise the name of the patient! At last the registrar came to the phone – the one constant at this time of potential chaos. (Barring the consultant of course, but I wasn’t going to call him was I?) The registrar knew what was going on. He had already made the referral.
‘Thank God,’ I sighed. He laughed, and said,
“Hey, don’t worry. We’ll manage. The show goes on!”
After that, I worried less about moving on.