Wear Sunscreen: Tips for New Doctors

It's that time of year again; the medical new year where 5 years of medical school comes to fruition and students become F1 doctors.  I've thought back to my time as an F1 and here's 50 tips.  If you don't get the Sunscreen reference then I'm officially old...

  1. Medicine is a noble art dating back throughout humanity.  We will outlive any government or Health Secretary.  I've never not experienced anything other than respect from lay people when I've told them I'm a doctor.  We get cynical in our bubble but what we do is amazing.  Don't forget that.
  2. Make your intentions noble.
  3. Chocolate will always go down well with your new colleagues.  Tea and coffee or at least the offer of them will go down well with your patients and relatives.  
  4. Chest pain always needs an ECG.  Regardless of description.
  5. Abdominal pain and trauma rarely present in a straightforward way in the elderly.  Have a low threshold to CT scan and always discuss with a senior.
  6. Beware posterior STEMIs.  If you see regional ST depression look for ST elevation in other leads.  Make sure you check if any LBBB is old or new.
  7. Know your trust's PCI, Stroke and Upper GI Bleeding protocols early.  Don't wait until it's 0300 and you're with a poorly patient to find out.
  8. Back pain + Collapse = AAA until proven otherwise.  
  9. 'Nurse' is not a first name.  Learn the names of your colleagues.
  10. All women are pregnant until you prove otherwise. 
  11. Don't forget the aorta.
  12. If you think it's a PE it probably is.
  13. 'Senior Review' is not a plan.
  14. 'C?C' is not a diagnosis.
  15. 'Acopia' does not exist.
  16. It's never alcohol until you rule out everything else.  If it is alcohol consider Chlordiazepoxide and Pabrinex.  
  17. Gastritis is not an F1 diagnosis to make.  I'd argue it's not an Emergency Department diagnosis to make.  Rule out more serious causes first.
  18. Know the head injury guidelines.
  19. You can't always cure but you can always be nice.
  20. Be judicious with requesting D Dimers.
  21. Analgese often and early.  Document it.  If your patient declines then document that too.
  22. Always listen to your gut - whether it's telling you your patient is ill or that you're hungry.
  23. Your nursing colleagues won't kiss you backside but will certainly save it.  Be kind to them. 
  24. Monitor your urine output and urine colour and hydrate accordingly.
  25. Don't just write ''ECG nil acute'' in the notes.  Write your findings even if it's just ''Normal Sinus Rhythm.''  Your colleagues later on will thank you.
  26. Remember to prescribe time critical medications - Anti-Epileptics, Anti-Parkinsons, Antibiotics and Insulin.
  27. Respiratory rate is often the first observation to go off.
  28. Remember mean arterial pressure.  Your patients brain (GCS) and kidneys (U&E/Urine output) need monitoring.
  29. Remember that amazing 360 degree human being you were on your application to medical school?  Who sang, played instruments, played sports, danced, had dreams and passions?  Don't forget that person.  Use your free time.
  30. Take annual leave. Travel.
  31. Not every patient is nice but they still deserve your best.
  32. Mental health and serious organic disease are not mutually exclusive.  Don't be biased.
  33. Don't say 'unresponsive'.  Use GCS.
  34. Migraine and epilepsy don't start in later life.  Rule out sinister causes first for new headaches and seizures in the elderly.  
  35. Don't wear suede to work.  
  36. How to SBAR: 1). Say who you are and where you are calling from. 2). Say the reason you are calling. 3). Then start your SBAR.
  37. Don't judge others with different values that you judge yourself with.  
  38. See the bigger picture.  This is one of my favourite pictures taken from the edge of our solar system showing Earth.  It reminds me to see the bigger picture, a very valuable lesson when there is a 10 hour bed wait or a 5 hour wait to be seen in the department.  Always see the bigger picture.  Remember the 18 year old you who was so excited to get into medical school.  

39. It's not OK to not be OK.  Talk to someone.                                                                                                   40. There is nothing more contagious in healthcare than emotions.  Smile.  Be positive and it will spread.  41. Doctors consistently are amongst the most respected professions.  Never abuse that trust.                    42. Remember #HelloMyNameIs.                                                                                                                          43. Always get your sleep.                                                                                                                                      44. Coffee is your friend.                                                                                                                                       45. You should always get more out of alcohol then it gets out of you.  If that changes get help.                  46. Pain and Urinary retention are two important causes of agitation.                                                              

47.  Be careful what you post on social media.                                                                                                                 

48. Not matter how hard breaking news is for you it is worse for the patient/family receiving it.                                                                                                                     

49. Chew your food.  Especially watermelon - trust me on this.                                                                          

50. Wear sunscreen.