Name: Dr Nadia Stock
Speciality: Acute Medicine
Deanery: North East Deanery
Being the medical registrar puts a lot of people off – why not you?
As surprising as it may sound there are some of us who do love being a medical registrar because of, rather than in spite of, the challenges it brings! Yes, it may be one of the busiest jobs in the hospital (or at least that what we like to believe and often portray) but it is also one of the most interesting and rewarding. The role certainly brings with it a fair degree of responsibility which can be both a positive and a negative factor. It is easy to feel harassed when it seems that everybody wants a bit of you, but if you can get past that and realise that the reason people are looking to you for advice is because you CAN help fix/sort it then you can gain an immense sense of satisfaction at doing so. Being a medical registrar is fun, honestly!
Why AIM and not another speciality?
As a medical SHO I realised that my favourite days were always my on-call days spent on AMU, and there was no ‘–ology that I could envisage doing for the rest of my career. AIM means you get to deal with the best (acute!) bits of the medical specialities all rolled into one. I enjoy working as part of a team, sometimes dealing with very intense or difficult situations. I take pride in looking after the junior members of the team – from simple things such as making sure they get a lunch/coffee break to doing debriefs after certain difficult situations or ensuring they can get their workplaces based assessments completed. Watching the junior doctors develop their skills and confidence during their rotations can be really rewarding.
In an average week I may deal with everything from helping get a critically ill patient to intensive care, to instigating palliative care in end of life patients. I might review unwell patients on surgical/obstetric/orthopaedic wards, or look after the more “well” patients on ambulatory care. There are often practical procedures to be done on AMU including lumbar punctures, chest drains and ascitic taps which I enjoy either doing myself, or teaching the junior members of the team to do. Many trainees are learning to use ultrasound. For myself that is particularly for thoracic pathology/pleural drains, whereas other trainees are also learning to use cardiac echo.
Isn’t it just old ladies with UTIs and DVTs?
Nope – although we do get a lot of referrals for “UTI?”! You have to approach patients with an open mind, especially if they have already been ‘labelled’ as a UTI as unless you are careful you can miss a whole host of pathology. ln the last few months our “UTIs?” have subsequently been diagnosed as having large bowel obstruction, ischaemic bowel, spinal cord compression, and a renal cell carcinoma with hypercalcaemia. A proportion of our ambulatory patients are sent in as DVTs but in my unit they are often clerked by the nurse practitioners and we just get involved if they have a positive scan, or if they need to be seen after a negative scan to come up with an alternative diagnosis. Ambulatory care can be quite a nice change of pace from AMU as the vast majority of our patients there are quite well and just need some out-patient investigations. The patients and local GPs really appreciate our service as we can often get things sorted for them very quickly.
Isn’t being on-call a lot miserable?
I’m not usually on-call any more often than any of the other -ology
registrars. Most of my rotas have been very manageable and because it is sessional work it is often more convenient for flexible trainees than some of the other medical specialities. Plus, because the AMU team tend to get to know me better than some of the other registrars who only come to the department for on-calls I probably have a stronger working relationship with the nurses and other AHPs which can be a real bonus when things are busy.
What do you see yourself doing as a consultant?
All acute medicine trainees get to study for a “special interest” – usually gaining a diploma level (or equivalent) qualification in a variety of subjects eg management, teaching, tropical diseases, toxicology etc. Most acute medicine registrars are fortunate enough to have job plans that allows time for these interests. My teaching commitments help to give me a more balanced timetable and allow interactions with undergraduate students as well as junior doctors. I am planning to finish my Masters in medical education this year which will hopefully help me cement a role for education as part of my Consultant job plan in years to come. I have just spent a year as a simulation and patient safety fellow at a Trust in the North East and am very keen to incorporate aspects of that into my Consultant role. Acute medicine lends itself really well to these sorts of special interests because of the sessional nature of the job.
What advice would you give to others thinking about AIM?
There is so much scope to develop new services and projects in AIM that there is plenty to get involved with. The current job prospects are probably better than for most other medical specialities and the job plans available are very varied. If you enjoy working as part of a team, in a busy but very stimulating environment and being the person who gets to make the initial diagnosis and management decisions then AIM may well be what you are looking for!