Take time to enjoy the ride

Advice for interns by Dr Arianne Kollosche

Starting out as a junior doctor is like hopping onto a rollercoaster—you graduate medical school and cannot wait to get on the ride.

There is the excitement at being allowed on the ‘big-kid’ rides, there is anticipation, and a lot of cotton candy—or cotton gauze in this case.

But then starts your first day of internship.

As you begin that steep climb, the nerves kick in and you catapult into the real world of medicine.

But through the loops of undifferentiated patients and the stomach-dropping moments of being on ward call, you know you are safe—you have your senior colleagues looking out for you, catching your mistakes and letting you learn.

Like any good rollercoaster, there have been times I felt like throwing up; there have been tears (both my patient’s and my own) and someone always wets themselves—at least on paediatrics.

There has also been lots of laughter, sighs of relief and screams of exhilaration as we have learnt what it means to be a doctor. I would not have changed a second of my experience.

I am sharing this advice with you during my Post Graduate Year 2 (PGY2) and I decided to stay on the rollercoaster for another go—only this time, they forgot to put the safety bar down.

“I was recently in Nepal taking time to enjoy my non-medical passion of trekking. Our guide would constantly say “bistari, bistari”, reminding us to walk “slowly, slowly”. Whatever stage of your career, hold on to my guide’s advice. Go slowly and enjoy the view.”

In the GP room

My second round on this ride of hospital training has involved a lot of rural relieving.
Before embarking out west, I mentally prepared for all the daunting scenarios I may encounter—a STEMI, multi-trauma, threatened airway, a woman in labour. I thought I was as ready as I could be.

What I did not think to prepare myself for was the myriad of patients walking into my GP clinic.
They carried in a new kind of stress—the stress of taking long-term ownership for my patients.

They were not “the” patient anymore, they were my patient.

During my intern year, I had begun to feel confident in my ability.

However, in my GP room, I felt like a fumbling new intern again.

This happens at every big jump you make as you progress through your career.

You accept a new level of responsibility and ownership for your patients, and by doing so, you increase your cognitive load.

As an intern, this leaves you awake wondering “did I check their renal function before giving fluids?”

However it is no better in the land of general practice.

Instead, the stakes get higher as you pray you made the right suicide risk assessment and hope that the patient was not lying about having no guns on the property.

It feels like someone suddenly turned up the speed of the rollercoaster, however, with time you get used to the new pace.

With more experience the uncertainty fades and you become accustomed to this new responsibility—that is until you take your next step up.

My advice for new junior doctors

If I could give any advice to new junior doctors, it would be to be kind to yourself and take your time. However, this advice applies to everyone.

The transition from medical student to intern is so much more monumental than you can ever anticipate.

Four years of medical school has prepared you to know what antibiotic to prescribe and how to site a cannula, but it cannot ready you for the weight of being responsible for your patients.

Take time to adjust and utilise the support team that will be around you.

You will have your fellow interns who are sharing this struggle; senior colleagues that are there to hold your hand as you learn on the job; family and friends that might not understand the details but are always willing to lend an ear.

In all this, do not forget your patients—they are your most important teachers.

While it can be hard in a busy emergency department or during a ten-minute appointment slot, remember to take the time to listen and learn from patients.

It is so easy to feel like you are stuck on a conveyor belt, focused on the next dip or loop ahead but it is important to take time to step back and marvel at the amazing ride you have been on and what you have achieved.

Since graduating I have felt this constant, but well-meaning, pressure to decide a specialty and begin a training pathway—but why do we have this urgency?

While it can be argued that training is getting more competitive, I believe that taking time to build a well-rounded and varied skillset as a junior doctor will benefit any career—even if that means spending a year or two extra as a house officer.

After all, this is a ride we plan on being on for the rest of our lives—so take time to enjoy the ride.

Dr Kollosche is a JHO at Toowoomba Hospital with a passion for rural healthcare and emergency medicine. Her involvement in GPSN as a medical student has facilitated strong advocacy for good primary care, especially for our Indigenous and refugee communities. Her self-professed achievements so far in her short career include surviving internship (with only one sneaky cry break) as well as successfully siting a 16 gauge cannula in a moderately unwell patient. Outside of medicine, she loves to hike and run, albeit slowly, for long distances.