Introduction to NHS for IMG doctors: Part 2

Today’s discussion is a very important topic for new starters in NHS.

Lets start.

How to cope in 1st month:

Its probably the toughest month in your entire life. Reasons being the grief of leaving family, extremely unfamiliar hospital system, difficult behaviour from NHS staffs initially, unexpected weather changes, comparison on what I have left behind and what I aspire to be, new language, loneliness – thousand more confounding factors.
What I want you to trust me is ” THIS IS WHAT WE HAVE ALL GONE THROUGH ”
This is not unique to you at all, this has been the case years after years, from the most smart to least smart, from the seniormost to the juniormost – THIS IS INEVITABLE.

Now, I can share how I dealt with it.

1st month, after getting your accomodation and banks sorted, concentrate on NHS.

1. Get a clear idea how computer system works, your password logins etc. Thats the 1st job. Call IT anytime if you have problem.
2. Colleagues are saviour at times. More easily u get along, easier u make ur life.
3. Never say a direct No to anything. Even u are overburdened, say politely that u would try to do that once u finish the jobs u r currently on.
4. There are 4-5 consultants in each specialty ( roughly ). You will definitely find atleast 1-2 who are friendly and easier to ask question for your learning. Pick them. Do not expose your weaknesses to them who u feel might not be helpful enough.
5. Get an educational superviser as soon as u join. Make ur agenda very clear to him/ her. Remember, your growth is their responsibility too. For example, u are struggling to do LP/ pleural tap, they can redirect u to an appropriate registrar to support u.
6. Be very gentle and polite to every single one u meet from doctors to nurses to ward clerk to pharmacist. Remember, u are being judged in your 1st month for your behaviour mostly, once u pleased most of them, job done. ( ignore politely the grumpy ones! ) Dont feel intimidated by matrons but they know the system better than we do, just dont engage in direct confrontation.
7. Responsibility is the key. Finish your work that you are responsible for. For example, u are supposed to chase an urgent set of bloods and till 5 oclock, it didnt turn up. Doesnot mean u have to overstay, but means u have to ensure someone on call chases it and acts upon it. Thats a good practice.
8. Documentation : this is ur GMC saver.
How to do it:

  • A. Time, date is a must
  • B. Mention ur name and grade on top
  • C. Mention the name specifically u made the discussion with – discussed with cardiology reg Dr. X, ( not just discussed with cardiology)
  • D. Detail the statement that can make you safe.
    Example : If u are managing a patient in AKI with heart failure and he definitely needs fluid, how will u make your management justified?
    “I have assessed this patient, AKI stage 3 on top of chronic heart failure. Currently patient is very dehydrated, hence I have prescribe x litre of fluid. needs assessment of fluid status with each bag of fluid and repeat U&Es after 12 hours / tomorrow morning- thats how I try to write to be safe.”
  • E. Try not to write anything demeaning to anyone as long as it is absolutely necessary.
    9. Pharmacists are there to help u with dosing. Dont hesitate to ask reasonable questions to them. But best trick is, read the guideline from hospital intranet and then discuss, u will understand better.
    10. Last but not the least, no human in the world who can deny a smiling face. Please do smile, greet everyone ( from doctors to cleaner ) and bring a happy vibe. I know it is difficult for some people, but worth a try.

Indemnity insurance:

Even though we are protected by NHS in our regular job hours ( not locums ), its best to have an insurance of your own. MPS ( Medical Protection Society) offers the cheapest of all i think and provides coverage. Please do google it, website states everything clearly.

Clinical Procedures:

Never attempt any procedure that you are not comfortable with. Be confident enough to say that u need supervision.
See one, do one under supervision and then attempt to do one.


I find reading trust guidelines thoroughly is very helpful for acute admissions.
You are not supposed to memorise everything. Say for example, u see a patient in hepatic encephalopathy – u dont remember what could the trigger, investigation or treatment be – do a quick read of oxford handbook, u will find urself in a better position when u present it in front of your consultant during post take.

About personal life:

There is no way u can deal with your sadness initially. And thats totally humane. Get along with people, talk to them, visit city or town centre, travel as much as u like, experiment cooking ( life saving! ), do photography and watch you tube videos. Trust me it takes 1-2 months and you will be sorted.

Get your priorities clear:

You are here to provide service and get optimum benefit for yourself with ur service. Work hard towards your Portfolio. I will talk about the portfolio in my next write up.

To conclude – life is never static. Good and bad events come in bouts and pass away and we move on. Not taking anything hard on yourself and take the postives in every event is the key to be a better living soul. You may not be successful in every attempt, but make sure you are content with all your attempts that you have given your best shot.

As I always say, we are here to help. Please kindly share your thoughts and difficulties u face. There is no shame or harm in it. So sorry I cant respond to all in my inbox. But if u post it here, you can get many diversified solutions. Please do share if u find it worth sharing as it can help many people who are not currently in the group.

Don’t forget to read Part 1

ST3 Trainee( East Midlands Deanery) 


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