Five years ago this evening, I was pacing around my flat.
Shadowing week started the next morning, and I was dreading it.
I kept telling my friends I didn't think I knew enough. What I really meant was: what if something happens and I can't remember what to do?
I'd just moved. I was living out of boxes. I wasn't sure I had the mental — or even physiological — resilience to do the job at all.
Some of you are reading this in exactly the same situation.
A few weeks ago, I asked everyone signing up to our FY1 webinar series what frightened them most about starting. The commonest answer, by a distance, was one word:
Everything.
I couldn't see it back then, but as an FY1, I was frightened of the wrong thing.
Very little of getting through your first few weeks as a doctor depends on knowing things. It depends on adjusting. Acclimatising. Being tired and slightly overwhelmed, but turning up again the next morning.
What you do need is to notice when something is wrong. Recognise a sick patient. Know the A–E basics. Know how to escalate, and who to escalate to.
That is most of it. It's why I built these sessions around the parts of FY1 that aren't medical knowledge.
The rest is learning to hold yourself steady while a lot changes at once — and while the responsibility of being the doctor gradually rewires everything you already do know into something you can use in front of a real patient.
Nobody can do that part for you in advance. It only happens by starting. But please remember:
You will never be the only person responsible for your patients. And you will be supported.
And on that note: look after yourself, and look after each other.
Ask the questions you think are too stupid to ask. You won't be the only person wondering, and nobody senior will remember for more than a minute.
Some seniors may be stressed or impatient. Occasionally, one of them may make you feel as though you don't know enough.
That is on them, not you.
You got through medical school. You do not need to arrive as a finished doctor. You need to be safe, honest and willing to learn.
One last thing: make the most of it.
You will never again be surrounded by quite so many people at exactly the same stage. By the time you're an SHO or registrar, you may be the only doctor of your grade on the ward. It can be a lonelier job.
Some of the people you meet over the next few weeks will become your closest friends.
And in five years, you may find yourself thinking back to the night before it all started — remembering how frightened you were, and wishing you could tell your past self that you were going to be all right :)
Before Monday
You do not need to memorise another textbook this weekend.
But it is worth spending ten minutes looking through bleep.guide: see which checklists exist, how they are organised, and where you would find them if you needed one during a shift.
The app is essentially the notes and scribbles I've been collecting on my phone since FY1 — now formalised, shortened and referenced back to the guidelines.
It works directly in your browser at bleep.guide. Once you've signed in, it also works without Wi-Fi — which, given NHS Wi-Fi, is rather the point.
Try it now: sign in, put your phone into airplane mode, and open it again. Everything should still be there. You can also add it directly to your home screen.
New on the app this week
We've added eleven more scenarios, taking the app to 79 in total — all short, scannable and designed to be read on a phone during a shift.
There is now a surgical section for problems that commonly land on the medical take:
- Abdominal pain
- Acute limb ischaemia
- Hip and pelvic fractures
- Lower GI bleed
- Diverticulitis
- Hypokalaemia
And five more overnight calls, named roughly as they'll be phrased to you:
- Asked to write up fluids
- Asked for something for pain
- Nausea and vomiting on call
- Low urine output and retention
- Patient wants to self-discharge
Two sessions left in FY1: The Missing Manual
More than 1,400 of this year's F1s have now joined us — over one in eight of everyone starting in August, which I honestly did not expect.
We have two sessions left:
Clerking for FY1s — Monday, 7pm
How to see a new patient, make a safe first plan and present it before senior review. This session stands alone if you missed the first two.
Two Weeks In — Wednesday 19 August, 7pm
A panel of SHOs and registrars answering whatever the first fortnight has thrown at you.
Both sessions are free. Register here.
Missed the first two? The full session notes and Q&A write-ups are here, with no login required.
If there is something specific I can help with, reply to this email. It comes straight to me.
Good luck on Monday.
One foot in front of the other.
— Oliver
Maker of bleep.guide; med reg in Cambridge :)
