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This meeting is. Okay.

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Can you just start by saying your name and what you're currently doing in life?

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Yes. So I am a flint and I'm a first year psychiatry trainee at the moment.

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Okay. And what were you doing in Oxford in the last six years or so?

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So I studied medicine at Oxford.

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So I started there in 2014. And I yeah, So I did a six year medical course there.

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And then I did my foundation is also in Oxford, and now I've stayed to do psychiatry training in Oxford.

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So I've been there for a little while now. Right.

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Okay. So it's going back to the very beginning.

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How did you first get interested in in studying medicine?

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So I think I probably first started getting interested in studying medicine maybe when I was about 12 or 13.

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And I think I was thinking about what I would like to do. And I liked a lot of different subjects at school.

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I quite like languages and odd things as well as science, but I wanted to pick something where I felt like I could make a bit of a difference.

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I could do something that felt quite fulfilling and would involve science, but also would involve a kind of caring role.

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So it was obvious to think about maybe medicine or something like nursing midwifery.

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So I kind of considered all of all of those and also teaching and basically just did a quite a bit of kind of work experience.

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And it's a voluntary experience and that's what led me down the road.

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In the end, I really enjoyed it. So I decided in medicine.

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Mm hmm. Do you have any medics in your family? No, I don't.

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So I'm the first person in my family to go to university. And there's no one kind of medical or even in nursing or anything in my family.

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So it was a bit of a different path, I guess. They kind of.

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We didn't really know what it would be like going to university or studying medicine,

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and I think that made it quite difficult in a way when I was trying to decide because it was quite

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difficult to get work experience of things when you don't know anybody who who works in medicine.

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But I'm very grateful to, you know,

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I had a got quite lucky as I went along that I managed to meet people along the way where I if I kind of volunteered in

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one hospital and then there'd be someone who would be quite kind and realise that I didn't know anyone in medicine.

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So then they would suggest other opportunities and things like that.

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So, you know, that's why I always tell people if they don't know anybody and they're thinking about medicine,

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just take whatever opportunities present themselves because they'll be kind people on the way who kind of help you.

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What kind of volunteer roles were you doing? So I did a lot of work with children, with learning difficulties at a local a local school,

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which is it's kind of mixed abilities school, but they have a lot of special needs work, which was really interesting.

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And I also kind of unrelatable. And I did a lot of working with children just in a holiday club.

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And then I basically just wrote letters out to all of the GP practices in

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hospitals that I could think of that were remotely commutable from where I lived.

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And one hospital there was a a lady in the voluntary team there who saw the letter and got back to me and it was a I hospital.

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And so she just said, Oh, you know, I thought it was unusual that you sent a letter rather than an email.

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So I that's why I picked up on it. And so I was really lucky that she was so kind.

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And basically I, through that, managed to do some volunteering at an eye hospital.

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So I was helping patients, but just before they were going for cataract surgeries and things.

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So I just help them with kind of getting, you know, tea afterwards and helping them and their relatives feel relaxed before.

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But it meant that I had a chance to chat to some anaesthetists and kind of watch the videos of the procedures.

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So it gave me a bit of exposure. And then and then there was a lovely anaesthetist there who basically then said, Oh, you're interested particularly.

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And I was interested especially in obstetrics at a time when I'm delivering babies, which is why I was considering midwifery too.

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And so he had a contact who was a gynaecologist.

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So then I got a bit of work experience through that.

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So it was very much just kind of, you know, just being willing to do whatever and just kind of enjoying it for what it is.

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And then people seeing that you're interested. And then they were really keen to offer other opportunities.

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Hmm. And how did you go about choosing where to study? So I grew up in Slough, so not very far away from Oxford.

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So I mean, a big part of kind of deciding was.

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I wanted somebody quite near to home so I could see my family quite often, but also not not so close.

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So I didn't kind of have my own separate life and everything.

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So, you know, I wanted something relatively place and I really liked that Oxford was quite a

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traditional course in that it had a as a part of the course where you you work on,

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you kind of see bodies that have been dissected so that you can learn anatomy from them.

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I think that that was really appealing to me as a part of the course.

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I thought it would be really helpful and I really like the idea of the tutorial system and

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having that kind of close working relationship with with a tutor and a few other students,

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a bit more like a family sort of atmosphere. So those things really drew me about the Oxford course and yeah, so I so I decided to apply.

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I did, but I kind of thought that it was a bit of a long shot, given that my background and that I hadn't,

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you know, no, I didn't have much experience of what it might be like to go to university.

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But yeah, so I applied there and I applied to Cardiff, Leicester and Holyoke Medical School as well.

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And and you got in so that I mean, how did you find the experience of being a medical student at Oxford?

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I really enjoyed it. There were definitely difficult, difficult parts to it.

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I mean, it wasn't an easy road by any means, but it was really fun, really interesting.

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And I kind of I definitely enjoyed probably the clinical is more it's more what I'm inclined towards.

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But I did love the fact that we had a year to do a research project as well.

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I thought it was really important that we got that experience and exposure and I loved the tutorials of the first few years.

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Like I said, that kind of family atmosphere.

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I was at Wadham College and it's quite a close knit community that everybody knows all the different years.

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And I'd say kind of, especially the clinical years, I always say to students, I try to that now, so I'm a tutor at the college.

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I always say, just enjoy the medical school years because it's kind of almost a bit like

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you're a medical tourist in a way that you get to see all the most interesting

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and best bits of the different specialities and just have a bit of a taste of everything and just go where the interesting things are happening.

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So just make the most of it and you see some incredible things.

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So you're very privileged position to be in.

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And what did you do your research project on? My research projects.

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So I was because I was still quite interested in obstetrics at that time.

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So a lot of my research and things that I've done has been geared towards that.

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So that project was looking at endometriosis and so it was an epidemiological project looking at the relationship between endometriosis,

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so subtypes and severity and how it relates to metabolic measures.

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So kind of BMI and waist to hip ratio adjusted for BMI essentially because the genetic message is a snip,

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a genetic variant that seems to be associated both within Demetrius and with metabolic variables.

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Basically they think it's associated with obesity.

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So basically you tend to find that women who have a lower waist at ratio adjusted for BMI tend to have a greater severity of of endometriosis,

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although it wasn't a very I didn't really find a massively strong association, but that's the that was the working idea and it was quite interesting.

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It was, you know, I didn't really show much of significance, but it was an interesting idea.

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And has that made you think that research is something you'd like to include in your career as you go forward?

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So it definitely it definitely interested me, and I've done some other bits since and I did an academic foundation program,

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so I did a reset research and my foundation is as well.

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I would say I definitely wouldn't rule out, but I would say that the more I've done research, the more I've realised that to really, I guess,

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make the most of it and to really find it enjoyable and something that you don't mind going that kind of extra 110% for because you have to,

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especially if you're an academic clinician, because you will do a lot of it in your free time,

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You will do a lot of it on the evenings after you've already spent a really busy day in connected things.

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It has to be something that you're really interested in so, so much and that you find passionate,

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you're passionate about and you're you've got that drive for.

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And I guess I haven't found my area of that in research.

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Like I found things very interesting and really enjoyable. But I if I do it, I think I want to maybe come back to it later on.

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Once I found my niche in my clinical work that I then find that relevance for me.

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So I wouldn't rule it out kind of. I really had a thought for a while about whether I would do an academic clinic,

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clinical fellowship, go straight from the founder academic fellowship program to that.

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And then actually I thought, actually, I've done a lot of it.

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So I did a lot of work in the obstetrics and gynaecology,

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and then I did a bit in my academic foundation stuff was in paediatrics because I was thinking more paediatrics then.

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And actually now I've gone into psychiatry and I thought actually maybe just focus on the clinical for a bit and then come back to it later.

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If it's something grabs you when you're a registrar and then you know what you're going to

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be focusing on because then it'll be something you're really passionate and interested in.

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And is it the psychiatry that you think you're going to be sticking with, though?

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Yeah. So that's my that's my chosen speciality. Yeah.

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Yeah. That's exciting. And I noticed from your LinkedIn profile that you will said it's a volunteering as a, as a student, as a first responder.

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Yes. Yeah, I did. Do you have to tell me about that?

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How did that come about? So. So that was. So with the ambulance service?

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Mm hmm. So that was kind of a program that they've done for quite a few years where you can.

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Do some kind of basic training. And so first response of first aid.

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And so a day or two course, I think if I remember right and you pair up with another student,

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usually originally with someone who's a bit more experienced than you, but then eventually you can do it with your peers.

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And there's a little ambulance car that we have at the John Radcliffe and you sign on like a normal ambulance

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would date and make yourself available for calls and then they can send you to see patients and you will.

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The idea is basically that you might get there quicker because you might happen to be nearer to an emergency than an available crew.

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And you can give the first sort of treatments and first line response to the patients.

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And it's especially helpful if it's something like a heart attack, cardiac arrest, because you have a defibrillator.

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So if you can get a CPR and a defibrillator that quicker, you can really improve their chances of survival.

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But it's also obviously useful for other things, too, like if you can, you know, if you can find out that they've got low blood sugar,

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you can then potentially get them to have something sugary things like that where you can make a quick difference.

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And yeah, so I as soon as that was an option, which for me they piloted for the first time when we were actually still in the preclinical years.

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So in my third year I signed up to do it and so I did it from the third year and then up until the sixth year.

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And in my I think it was my fifth year, I became a team leader and I coordinated the program and trained the younger volunteers and I loved it.

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It was really interesting, good opportunity for students to get involved in kind of helping in that community

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and then getting some exposure to what medicine's like in the real world.

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So yeah, I would always recommend that to people. Yeah, Yeah.

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And getting, as you say, exposure to kind of frontline emergency care as well and see Yeah.

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And have having just a better understanding of how what life is like for your colleagues, what the job is like for your colleagues.

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Because I think that then later on when I've done jobs in A&E or in other specialities,

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I have a much greater understanding of what being a paramedic is like, what it's like managing patients in the community.

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You know, for instance, you go to a patient and actually if you make the decision that they can be managed in the community and not go to AMA,

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what that actually involves. And actually sometimes that can be, you know,

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even hours on the phone trying to sort that out for them just to save that one patient from going into A&E and and really relieve the work for A&E.

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But that's a massive undertaking sometimes and often a lot more work than just taking them into A&E,

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but having that appreciation of the fact that they have you know, they have that as part of their role.

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And if if they do manage to keep a patient out of A&E that's more appropriately managed in the community, that's often a massive undertaking for them.

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You know, things like that, it's invaluable to have that understanding. People, you know, work in roles.

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So let's arrive at 2020. So you you qualified essentially in this in the spring, is that right.

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Yes. So I base yeah. I basically when when things were sort of kind of hotting up about the pandemic in the UK sort of around March time

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and it was becoming more you know it was definitely the medical school staff to talk to us about some things.

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At that point, I had just essentially finished all of the compulsory parts of my course.

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There's kind of two groups of students in final,

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final year and you you do it on the different you either do your elective first and then you do the

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other bits of the compulsory course that you need to finish off or you do it the other way round.

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And I happened to be in the group that had done the compulsory bits and not be the elective period, so I just finished that.

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So And what were you planning to do for your elective? So I was going to go to Australia in New Zealand for three months and so I actually just and I.

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So it was a bit of a long story, but basically the short version is that I ended up in Australia and had to come straight back.

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Oh goodness. So I went to start my electives,

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but for an unrelated reason the plane was delayed and so during I missed my connecting flight from

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Singapore to Australia and in the kind of time that that delay cause they changed the rules,

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that meant that you'd have to isolate as soon as you enter Australia.

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So I did that with my friends and then shortly after arriving I placements cancelled and a lot of our accommodation cancelled and the UK was saying,

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you know, come back if you're, you know, if you're UK nationals in your abroad, come back because you might not be able to otherwise.

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But also I received an email from the medical school saying you would be able to help in an A&E because you've finished these compulsory parts,

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of course. So you're if you're able and qualified to help, can you help?

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So me and my friend made the decision that we need to come straight back.

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So we basically came back within within two or three, three days.

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So it was a bit unfortunate. But so I came back and I volunteered in the A&E during the time that would have been in my elective.

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That must have been well, on the one hand, very disappointing.

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But I guess knowing that there was something you could do helped a bit.

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Yeah, it was it was quite disappointing. And it wasn't a decision we took lightly because we we did think, you know, if we stayed,

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maybe we could spend some time in Australia or find something to be helpful with in Australia potentially.

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But we, we made the decision that especially as soon as we got the email saying that we could help and, and in Oxford that,

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you know, that was the place we wanted to be, that we could help and hopefully, you know, make a small kind of difference there.

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So yeah, it was really disappointing.

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I mean we'd planned it for two years and we'd booked everything that was a risk that we would lose a lot of money as well.

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Luckily, I travel grants basically covered a lot of the loss, but you know, we never got any money back for any of the flights and things.

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Oh goodness. They kind of gave credit which had to be used within a year.

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So obviously I could never use credit in Australia within the year during the COVID situation.

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Yeah. So, you know, it was you know, it was a big it was a big thing and it was a once in a lifetime opportunity, really.

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I mean, now that we're doctors, it's not like we'll ever have that length of time off again,

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on or off, but, you know, available to work in another country unless we take time out of training.

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Yeah, So, so yeah, it was disappointing, but it was, you know, an exceptional circumstance.

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And, and what I ended up doing was I felt really valuable for me and, and I felt that I could in good conscience be anywhere else, really.

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So indeed, indeed. So I mean, what I hadn't asked you a question I usually ask everybody first,

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which is what can you remember when you first heard that the pandemic was happening

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and how quickly you realised that it was something that was going to affect you?

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I think I remember first sort of hearing about in reference to to the situation in China maybe a couple of months before then.

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I don't know, maybe sort of late January, February, I can't really remember.

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So the time. Yeah. And I suppose the situation in Italy, you've come back.

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I suppose the situation in Italy was when it especially started to feel real here, but.

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I think I remember this sort of oddly.

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So there was still obviously events and things going on not very long before things started to close down in, in, in, in the UK.

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And I was at a concert in I think it was February or something like that.

189
00:22:42,870 --> 00:22:50,159
And I remember then that was the first time I remember thinking, Oh, actually this is this, this is a bit weird that this is happening.

190
00:22:50,160 --> 00:22:55,110
So and that that was the first time I was thinking, I think things are going to change.

191
00:22:55,290 --> 00:23:02,370
See? Okay. But, but, but all the advice you were getting was that you should still head off to Australia at the time.

192
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Yeah, exactly. And, and, and at the time there was See nothing wrong with that concert happening and things, you know, it was,

193
00:23:10,770 --> 00:23:19,080
there was no recommendations against the UK was very much still of the message going out was that there's nothing to worry about,

194
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there's minimal cases you know. So this was a massive concert in London that was just still happening and that I had no problem with travelling.

195
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And everybody said, go, you know, if anything go now.

196
00:23:33,690 --> 00:23:39,330
So it's, it just it was a situation that escalated very quickly, I guess, and that's why.

197
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And obviously Australia took a much more. Direct gas and quick response then.

198
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Then the UK did. So that's partly why I ended up coming back so quickly because they were having very

199
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clear rules and and actually I remember so because of the actual layover in Singapore,

200
00:24:01,660 --> 00:24:08,620
because of that delay that I mentioned. That was interesting because Singapore had already been affected quite significantly.

201
00:24:08,620 --> 00:24:16,089
So I remember being a bit concerned that when we had to go to Singapore that that would affect our ability to come back because obviously

202
00:24:16,090 --> 00:24:22,600
we had a documented record in Singapore and I know that some countries weren't accepting travellers from certain countries and,

203
00:24:23,380 --> 00:24:29,440
and then they were taking a lot more precautions. So they were already everybody was wearing masks, they were taking their temperature.

204
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If you went into anywhere, we weren't allowed into the hotel without having a normal temperature.

205
00:24:35,200 --> 00:24:41,080
You know, all the way they handled food was very careful about, you know, transmission of illnesses and things.

206
00:24:41,350 --> 00:24:50,650
So that was almost like seeing into the future of of of what the UK that ended up being like about, you know, six months later, really.

207
00:24:52,270 --> 00:24:55,380
So that was quite interesting. And in hindsight, yes.

208
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Yes. So when you got back, you kind of turned up for duty.

209
00:25:00,310 --> 00:25:04,380
What was what were they asking medical students to do?

210
00:25:04,390 --> 00:25:15,580
What kind of work? So so there were students being asked to help and eventually in all different departments.

211
00:25:15,580 --> 00:25:20,799
But the very first one that they started asking for help with was Amy.

212
00:25:20,800 --> 00:25:24,070
And that's where I ended up working.

213
00:25:25,840 --> 00:25:31,000
And so they were kind of three main roles that we helped with.

214
00:25:32,050 --> 00:25:45,280
And so one was helping at the reception desk with just getting patients booked in any administrative tasks that we could help with.

215
00:25:45,880 --> 00:25:49,480
One was helping in a sort of health care assistant type role,

216
00:25:49,480 --> 00:25:58,300
so helping with doing EKGs and blood tests and cannulas and urine tests and helping patients go to the toilet, things like that.

217
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And then the third role, which is actually what I spent most of my time doing, was manning the front door of Annie.

218
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And so the idea was that the medical students would take on a role that had been for a little while for a few.

219
00:26:15,270 --> 00:26:22,420
You know, they they instigated it maybe like a week or two before, had been run by kind of advanced triage nurses.

220
00:26:22,440 --> 00:26:27,050
They'd been triaging patients, entering the front door of the hospital.

221
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So the idea was that we could alleviate that role so that they could then go and do their usual role, I think was the idea originally.

222
00:26:35,400 --> 00:26:46,260
That was my understanding anyway. And basically we would sort of trained on how to follow a flow chart to say whether a patient

223
00:26:46,260 --> 00:26:52,499
coming through the front door needed to go to one half of the A&E or the other because they had

224
00:26:52,500 --> 00:26:57,629
been split in half based on whether they would have respiratory symptoms and could have COVID or

225
00:26:57,630 --> 00:27:02,610
whether it was something that we could pretty safely say We didn't think that they had COVID.

226
00:27:03,480 --> 00:27:14,580
And so they had drawn lines on the floor even, and different colours on the doors to indicate where the separations of the department were.

227
00:27:15,390 --> 00:27:21,540
And and they they made it so that everybody who entered the department came through the same door.

228
00:27:21,540 --> 00:27:28,830
Now. So instead of having sort of ambulances coming in one way, patients coming in another, everybody came through this one door.

229
00:27:29,190 --> 00:27:35,130
And regardless of what they came in with, we had to stop them and yeah, and decide where they went.

230
00:27:35,430 --> 00:27:39,690
And so even if they were on a gurney being pushed by paramedics, you still.

231
00:27:39,820 --> 00:27:43,150
Yeah, exactly. Exactly. Even if they were on a gurney.

232
00:27:43,170 --> 00:27:46,379
Yeah, exactly. You'd say, okay, one second.

233
00:27:46,380 --> 00:27:50,490
Do they have a fever? Do they have any breathing problems?

234
00:27:50,490 --> 00:27:57,210
Are they on oxygen, any cough, any you know, all we had like a set list of things we checked.

235
00:27:57,480 --> 00:28:02,950
And if the answers were all no, then they could go to the blue area, which is the normal way.

236
00:28:03,720 --> 00:28:09,570
If it was yes to any of them, then they would go to the red area, which was the the Kobe A&E.

237
00:28:11,100 --> 00:28:19,800
And the other part of that well was that if they had any relatives with them, then we had to ask them to leave.

238
00:28:20,730 --> 00:28:29,070
And there was some exceptions to that. And that kind of the rules around that changed over time as as as it became more apparent.

239
00:28:29,070 --> 00:28:33,930
Obviously, all of these things were measures that were were implemented really quickly.

240
00:28:33,930 --> 00:28:38,940
And to be honest, commendably, how quick, how quickly in the NHS,

241
00:28:38,940 --> 00:28:48,420
It was amazing how quickly we made these changes as a department because you know, often in the NHS things take a long, long time to change.

242
00:28:48,660 --> 00:28:53,969
But because of that there was, there was like learning curves to be had and, you know, things that needed to be adjusted over time.

243
00:28:53,970 --> 00:28:58,320
And you know, originally obviously the rules were just like no visitors, no visitors.

244
00:28:58,320 --> 00:29:02,580
But obviously it became very quickly apparent that there's some groups where that's not appropriate.

245
00:29:02,910 --> 00:29:14,010
And if someone's got learning difficulty or if they're at the end of their life or if if they're obviously a child,

246
00:29:14,010 --> 00:29:17,310
they would need a parent, you know, So there were rules that very quickly became apparent.

247
00:29:17,520 --> 00:29:26,130
There were certain groups of people, what they were allowed a visit to come with them, but it still meant that there were some.

248
00:29:26,790 --> 00:29:28,960
I think probably the hardest part of that role was, you know,

249
00:29:28,980 --> 00:29:38,490
there were still obviously some patients who didn't fall into those special categories, but that, you know, so they weren't allowed a visitor.

250
00:29:38,520 --> 00:29:46,330
But you felt for them because obviously. It was a really difficult situation and you can understand why they would want someone with them.

251
00:29:47,110 --> 00:29:51,340
So. And did they did the family members give you a hard time?

252
00:29:52,430 --> 00:29:56,290
Oh, some of them did, yes. Yeah, Mostly no.

253
00:29:56,440 --> 00:30:05,169
People were really quite understanding. If anything, it's you know, it's it's a bit difficult.

254
00:30:05,170 --> 00:30:10,540
But often, to be honest, the the patients and the families who were dealing with the most significant,

255
00:30:11,230 --> 00:30:15,100
you know, horrible things, often with sometimes the most understanding.

256
00:30:15,250 --> 00:30:20,800
And and, you know, that makes you feel even worse that, you know,

257
00:30:21,250 --> 00:30:26,920
in some ways that they're so understanding and they're in such a difficult situation and you really want to help them.

258
00:30:27,070 --> 00:30:32,110
And it goes against, you know, what we're trying to do really, you know, you always want to involve the family.

259
00:30:32,110 --> 00:30:35,200
You always want to keep families together.

260
00:30:36,010 --> 00:30:43,270
So, you know, that feels difficult. But, you know, the difficult ones were sometimes often people who were maybe dealing with things that were

261
00:30:43,270 --> 00:30:51,640
not quite as serious and sometimes might be a bit understandably frustrated at the rules.

262
00:30:52,870 --> 00:30:57,170
But, you know, taking it out on the the people in front of them, which, you know,

263
00:30:57,190 --> 00:31:02,319
you understand it's not personal, but it wasn't a pleasant part of the role.

264
00:31:02,320 --> 00:31:12,760
But. You know, it was something you just had to try and explain that it was to to help their relative and to help other people, too.

265
00:31:12,830 --> 00:31:19,730
Because if they go in with a broken ankle or they go in with a, you know, a cut on their hand,

266
00:31:19,820 --> 00:31:24,320
but then they come out with COVID, that's not a successful outcome really.

267
00:31:25,220 --> 00:31:28,580
Mhm. And how many of you would be on the dole at the time.

268
00:31:30,050 --> 00:31:40,190
So we, we did it deliberately so that we'd have two people so that you had that back up in case something was difficult.

269
00:31:40,190 --> 00:31:46,009
Or if the dole got really busy and lots of people were arriving at once or if you needed to go and check some things.

270
00:31:46,010 --> 00:31:53,809
So there was never the dole was never left, you know, not not manned because the shifts would well they were variable length.

271
00:31:53,810 --> 00:31:57,020
I can't remember how long I think they were usually about eight hour long.

272
00:31:57,210 --> 00:31:58,550
That's what I was going to ask you.

273
00:31:58,820 --> 00:32:09,080
I think they were I think they were usually about a but they they could be longer like 12 sometimes if you did a night shift, it was it was variable.

274
00:32:10,260 --> 00:32:14,210
And did you get a break in in an eight hour shift or was it 8 hours straight?

275
00:32:14,570 --> 00:32:18,920
So we would just like arrange it amongst ourselves. So you do it so there'd be two of you.

276
00:32:18,920 --> 00:32:26,000
But then so that way, if you need to go to grab some food, then you could say to the other one, right, you go, you go.

277
00:32:26,240 --> 00:32:29,959
And it really depended on how you, how you sorted it between you.

278
00:32:29,960 --> 00:32:34,790
So to be honest, for me, I never had like a break because then I was away from the door.

279
00:32:34,790 --> 00:32:42,229
Really? Unless I went to the loo. Because I usually, you know, because it was quite flexible.

280
00:32:42,230 --> 00:32:48,170
We tend to decide on with people that we knew or people that we'd done previous shifts with and got new.

281
00:32:48,170 --> 00:32:52,639
We got on well because sometimes it was super busy and sometimes there'd be, you know,

282
00:32:52,640 --> 00:32:56,690
downtime where you just that way you'd be able to chat with them and things.

283
00:32:57,200 --> 00:33:00,620
And so you want to it's quite nice if it's with someone that, you know, you get on with.

284
00:33:00,620 --> 00:33:01,010
Well.

285
00:33:01,250 --> 00:33:10,190
And so to be honest, all the people I did ships with, generally we kind of preferred being together in case we needed someone else there on the door.

286
00:33:11,330 --> 00:33:21,140
So we would do is we would generally bring our food to the to the door and just eat there and then, you know, work through all breaks, as it were.

287
00:33:21,950 --> 00:33:31,340
But, um, yeah, it was, I just remember it, to be honest, quite funnily it was, there was a lot of camaraderie and kind of a feeling that,

288
00:33:31,640 --> 00:33:36,620
you know, we weren't doing anything massive, but that maybe we were making a little bit of a difference and.

289
00:33:38,610 --> 00:33:41,309
I got to know a lot of the other medical students who,

290
00:33:41,310 --> 00:33:48,560
although maybe I'd been with them for six years in medical school, we looked from for various reasons.

291
00:33:48,760 --> 00:33:52,110
You don't always know everybody in your group very well.

292
00:33:52,140 --> 00:33:56,820
You know, you might be a different practical group, so tutorial groups and things.

293
00:33:57,180 --> 00:34:00,260
So it was nice to get to know some of them really well.

294
00:34:00,270 --> 00:34:06,210
And a couple of them I hadn't really known before, but now we're really good friends and we still keep in contact.

295
00:34:07,740 --> 00:34:18,270
So, you know, it was a very different unique experience and kind of, you know, you bonded over a unique experience.

296
00:34:19,170 --> 00:34:29,460
And how long did that go on? So that must have been three months or 2 to 2 or three months.

297
00:34:29,660 --> 00:34:40,520
Mm. And then in May or just well, I guess it would have been just before May we So some of us,

298
00:34:40,760 --> 00:34:49,070
those of us who who done all of the compulsory parts of our course, we were graduated early by the GMC.

299
00:34:49,610 --> 00:34:54,950
So normally we would have been graduated and given what we were graduated and then given GMC registration,

300
00:34:55,190 --> 00:34:59,090
but normally would have been graduated and given GMC registration and I think around July.

301
00:34:59,420 --> 00:35:10,489
But so I guess for me it must have happened late April because I remember on May the fourth that we started working as Interim Foundation Doctors,

302
00:35:10,490 --> 00:35:16,310
which was a new role that they made, which would basically be another foundation job.

303
00:35:16,880 --> 00:35:23,750
Before you start your usual foundation program to help in supporting with the work from COVID.

304
00:35:24,230 --> 00:35:31,160
So I started as an interim foundation doctor in A&E from May.

305
00:35:31,280 --> 00:35:36,050
And what the until August when I started my normal foundation program.

306
00:35:36,350 --> 00:35:41,780
Mm hmm. And what did they do working at you when you were no longer minding the door at that stage, presumably?

307
00:35:42,090 --> 00:35:45,590
No. No. So then actually so part of what we did in the last few weeks,

308
00:35:45,590 --> 00:35:55,280
working in the role of the volunteer kind of medical student volunteering role was we trained up then the fifth year.

309
00:35:55,520 --> 00:36:06,170
So they by that point, because medical school had been closed, basically, they were then free to to be volunteering if they wanted to.

310
00:36:06,500 --> 00:36:09,800
So we then trained them to take a verbal so that they carried on.

311
00:36:10,940 --> 00:36:14,180
And then we stepped up into these interim foundation roles.

312
00:36:14,600 --> 00:36:18,499
And so for me, I mean, it was very different depending on what department you helped.

313
00:36:18,500 --> 00:36:20,930
And again, but for me, being in a and a,

314
00:36:20,930 --> 00:36:28,339
I think there was maybe so maybe before there was like 30 of us also doing the front door mining from my year.

315
00:36:28,340 --> 00:36:34,700
But then most of them ended up then doing if they chose to work as an instructor, went to other departments.

316
00:36:35,000 --> 00:36:39,550
So it was, I think maybe seven of us in in Annie.

317
00:36:40,370 --> 00:36:47,120
So still quite a lot of us. And we initially got paired with a more senior doctor.

318
00:36:47,720 --> 00:36:57,230
And I guess the initial vision for that role was that we would help increase the efficiency of more senior doctors who had more experience.

319
00:36:57,560 --> 00:37:01,010
So the idea would be we'd be paired with them, we would go with them,

320
00:37:01,010 --> 00:37:05,239
we would do their writing for them, we would do whatever, take the bloods for them.

321
00:37:05,240 --> 00:37:11,560
If the Bloods hadn't been done, we would prescribe medicines, request X-rays,

322
00:37:11,990 --> 00:37:17,059
just do all those things so that the more senior doctor could just focus on the right

323
00:37:17,060 --> 00:37:20,930
deciding this is what the problem is and this is what we're going to do about it.

324
00:37:21,530 --> 00:37:26,510
And then we could see more patients as a paired than he could he or she could see on their own.

325
00:37:27,500 --> 00:37:31,040
That was the idea. And we did that a bit.

326
00:37:32,240 --> 00:37:36,979
Very quickly, I guess it depended on what consulting was on.

327
00:37:36,980 --> 00:37:42,260
But very quickly, the role kind of actually more went into just more traditional role as a doctor.

328
00:37:42,260 --> 00:37:46,129
And actually they were just like, actually, you know, you're qualified as doctors.

329
00:37:46,130 --> 00:37:51,470
Just go see patients on your road, you know, So so we would see patients,

330
00:37:51,470 --> 00:37:55,310
probably fewer patients than maybe a more experienced doctor would be able to do.

331
00:37:55,310 --> 00:37:58,459
But it was a really good learning role.

332
00:37:58,460 --> 00:38:01,840
And we were still seeing more patients than we would have seen if we weren't that.

333
00:38:01,850 --> 00:38:05,030
So it sounds like being chucked in the deep end.

334
00:38:05,900 --> 00:38:08,629
It was. It wasn't it? It wasn't.

335
00:38:08,630 --> 00:38:20,390
It wasn't like, I think the A&E, particularly the really supportive team and they, they were from beginning to end, to be honest and as an F1 job.

336
00:38:20,390 --> 00:38:28,430
So I actually later in my foundation years, I actually already had a foundation placement in a in a in that same department.

337
00:38:30,140 --> 00:38:36,410
So I, I came back into that role later on as well, many months later.

338
00:38:37,190 --> 00:38:41,269
But that role was very similar to what I did in the interim role.

339
00:38:41,270 --> 00:38:47,240
And basically any F1 role in any is essentially meant to be supernumerary because.

340
00:38:48,650 --> 00:38:57,920
They don't want you working night shifts all kind of out of hours because you need to have that supervision.

341
00:38:58,220 --> 00:39:07,310
And you're expected to discuss every case pretty much with with the consultant or with a senior registrar.

342
00:39:08,420 --> 00:39:13,010
And so it felt very safe and very a good learning opportunity.

343
00:39:15,380 --> 00:39:25,340
So so although it was a big learning curve, it was, I think, you know, a Yeah, very well supported.

344
00:39:25,340 --> 00:39:33,220
And that, you know, I never felt like it was unreasonable or risky.

345
00:39:33,230 --> 00:39:39,190
It was just a good opportunity. What were some of the weather?

346
00:39:39,340 --> 00:39:43,380
Were there any particularly memorable cases that you saw? Um.

347
00:39:45,240 --> 00:39:51,730
Oh, goodness. Trying to remember that now. I think.

348
00:39:54,800 --> 00:39:57,860
I mean, I remember this. This was from when I was an intern.

349
00:39:58,280 --> 00:40:04,070
This is from when I was. Volunteering on the on the front door.

350
00:40:04,100 --> 00:40:12,670
But I do remember one thing that that sat with me for quite a while was that there was a quite early into my row.

351
00:40:13,000 --> 00:40:21,310
There was a lady who came in who had was going through a miscarriage, and she was quite early on in her pregnancy.

352
00:40:21,760 --> 00:40:28,809
And so whilst if she was coming in, giving birth at the end of the pregnancy, she would be allowed to visit because it was not that case.

353
00:40:28,810 --> 00:40:32,650
She was having a miscarriage, she wasn't able to have someone with her.

354
00:40:33,730 --> 00:40:35,799
And so I found that quite difficult.

355
00:40:35,800 --> 00:40:44,740
And actually it was a day where I had a I was working the front door, so I was the one you had to kind of tell them that they couldn't have someone.

356
00:40:45,160 --> 00:40:51,850
And she and her partner were really very gracious about it and weren't, you know, kicking up a fuss or anything.

357
00:40:51,850 --> 00:40:56,020
But I felt bad because I felt like, you know, it was unfair in a way.

358
00:40:57,610 --> 00:41:00,849
But then I also did a health care system type shift later,

359
00:41:00,850 --> 00:41:05,409
so I made sure to check in on her and see how she was and kind of try and

360
00:41:05,410 --> 00:41:08,500
bring her cups of coffee and things because I felt like she was on that road.

361
00:41:08,710 --> 00:41:12,700
So that one kind of stuck with me. And I remember it was from that kind of time.

362
00:41:13,570 --> 00:41:18,639
I don't know if I, to be honest, I don't know if I remember any particular cases from when I was an interim doctor.

363
00:41:18,640 --> 00:41:23,410
But I just remember there being a lot of people coming in with COVID.

364
00:41:25,510 --> 00:41:35,829
A lot of. They need a lot less of that kind of the accidents, you know, and things because people weren't doing this.

365
00:41:35,830 --> 00:41:40,420
Many other extreme sports, motocross, things like that during the pandemic.

366
00:41:40,840 --> 00:41:51,430
But but still, obviously, people falling down outside quite a lot of and and a lot of elderly patients, particularly,

367
00:41:52,150 --> 00:41:58,450
who were confused and then didn't have people readily available either because

368
00:41:59,830 --> 00:42:05,680
in some cases maybe rules or in other cases because their families had COVID.

369
00:42:05,680 --> 00:42:08,379
So they couldn't come into the hospital and visit, for instance,

370
00:42:08,380 --> 00:42:17,620
and that being quite difficult and having to give bad news on the phone to families a lot,

371
00:42:18,730 --> 00:42:23,200
that was quite difficult as well because you feel like you're not maybe,

372
00:42:23,200 --> 00:42:28,550
you know, you're not doing justice to be giving, you know,

373
00:42:28,570 --> 00:42:36,700
really bad news about patients the coming end of life and things on the phone when you'd normally do that face to face.

374
00:42:38,070 --> 00:42:46,320
Yeah. So, I mean, did you actually have people that reached the end of their lives in a and even would they be moved on to another world by that time?

375
00:42:47,670 --> 00:42:59,250
Oh, yes. So definitely there was patients who passed away in A&E and who would be put on an end of life kind of pathway in A&E for sure.

376
00:42:59,580 --> 00:43:02,520
Obviously, it's more common maybe once they were under the medical team,

377
00:43:02,520 --> 00:43:08,669
but sometimes it would be apparent, you know, when they were still under our care.

378
00:43:08,670 --> 00:43:13,280
And certainly so there's a second part of A&E could be.

379
00:43:13,290 --> 00:43:19,169
So it's like the emergency assessment unit, the EU, and that's both medical and A&E.

380
00:43:19,170 --> 00:43:23,490
They share it and that's sometimes where patients will be.

381
00:43:25,380 --> 00:43:33,660
They'll be kind of held if the taking more than the four hour target, but they just have a few more things to tie up, say,

382
00:43:33,660 --> 00:43:45,270
and then they might be able to go home or have a, you know, a clearer view of where their care is going afterwards, but within kind of 12 hours.

383
00:43:45,510 --> 00:43:48,510
So. So they might be managed there.

384
00:43:48,510 --> 00:43:53,910
And so another role of this interim foundation job was often to assist with looking after those patients.

385
00:43:54,330 --> 00:43:57,950
And some of those patients were often quite unwell and, you know,

386
00:43:57,990 --> 00:44:06,059
kind of decisions being made about what was going to happen to them in terms of where they might go for end of life care and things.

387
00:44:06,060 --> 00:44:09,420
So. So.

388
00:44:10,020 --> 00:44:12,719
So it was definitely and you know, something that happened,

389
00:44:12,720 --> 00:44:19,120
it was something I probably faced a lot more when I then later on went into my medicine job during the pandemic.

390
00:44:19,920 --> 00:44:23,080
But it definitely was a feature of that first job as well.

391
00:44:26,340 --> 00:44:36,030
And, and does that p I mean, what what was it actually physically like to be going into work in A&E under those conditions?

392
00:44:36,030 --> 00:44:40,400
What what were the precautions you had to take? So.

393
00:44:41,090 --> 00:44:47,810
So when we first started, it's kind of difficult to remember that because rules changed so many times.

394
00:44:48,920 --> 00:44:50,239
So I hope I'm not remembering wrong,

395
00:44:50,240 --> 00:44:59,660
but I remember there being a lot of concern about whether whether there would be enough PPE generally from people working hospitals,

396
00:44:59,660 --> 00:45:08,180
care homes, GP practices. My experience of the John Ratcliffe was that I never didn't have what I needed.

397
00:45:09,470 --> 00:45:14,800
They always they always had what I needed when I was there, which was was really good.

398
00:45:14,810 --> 00:45:22,190
I think that maybe there was more problems in things like hospices and GP practices and smaller centres.

399
00:45:23,060 --> 00:45:30,410
But the John Ratcliffe had, you know, at least in A&E, they had obtained adequate PPE, but I remember.

400
00:45:30,410 --> 00:45:37,520
So we would usually on the front door, we would wear a mask and then an apron and gloves.

401
00:45:39,930 --> 00:45:46,319
To be honest, at that time, the rules were a bit unusual in that we would wear an apron and gloves.

402
00:45:46,320 --> 00:45:53,220
But, you know, obviously we were greeting patients continuously, so it wasn't like we could change it between patients.

403
00:45:53,520 --> 00:45:59,520
Whereas obviously the idea would be that now that you would change the gloves and the apron between each patient.

404
00:45:59,880 --> 00:46:06,930
But I suppose we were more protecting ourselves in terms of that rather than protecting the patients in that context,

405
00:46:06,930 --> 00:46:14,520
because you couldn't change it for, you know, that would be hundreds and hundreds of pieces of PPE if we were change and not practical.

406
00:46:14,550 --> 00:46:22,980
So I suppose that was fair. But what I do remember was that we have to be very careful with the masks.

407
00:46:23,400 --> 00:46:28,229
We we would give a mask to each patient as they came through.

408
00:46:28,230 --> 00:46:30,780
And if they were allowed a visit to the visitor as well.

409
00:46:31,230 --> 00:46:37,200
And whilst we did have enough masks, we had a very limited supply of the ones that have like the elastic straps.

410
00:46:38,790 --> 00:46:45,839
So for us, we obviously were familiar with the ones that you can tie behind your head from that you would use in surgery normally.

411
00:46:45,840 --> 00:46:48,959
And you know, even though they're a bit fiddly, we could sort them out with us.

412
00:46:48,960 --> 00:46:55,200
So we would use that for ourselves, but we had a lot less of the other kind.

413
00:46:55,500 --> 00:47:02,280
So we were kind of trying to make sure that if staff came past, they were that they didn't use that.

414
00:47:02,280 --> 00:47:05,519
And we were kind of instructed to, to, to do that.

415
00:47:05,520 --> 00:47:09,990
So I remember that being a kind of sort of not rationing, but something that we had to be mindful of.

416
00:47:11,670 --> 00:47:17,070
But we usually a few times we would run out, but we'd usually always find a box somewhere.

417
00:47:19,920 --> 00:47:25,590
And in it, when you were working in A&E itself, did you have to wear more comprehensive peace?

418
00:47:26,970 --> 00:47:33,060
So it was so it depended where where you were.

419
00:47:33,300 --> 00:47:38,880
So, again, I hope I'm not remembering wrong because the rules change so many times.

420
00:47:39,210 --> 00:47:44,590
But usually in the non-covid side of A&E, it would be very similar.

421
00:47:44,610 --> 00:47:52,260
We'd wear a mask all the time. And then if you went in to see a patient, you would put on gloves and an apron.

422
00:47:53,100 --> 00:48:00,179
And ideally, or if there was any, especially if there was anything that was, you know,

423
00:48:00,180 --> 00:48:04,480
if if they might, obviously they shouldn't be coughing if they were in that sort of any.

424
00:48:04,500 --> 00:48:08,069
But, you know, if you might give them a swab or do something that might make them cough.

425
00:48:08,070 --> 00:48:19,620
For instance, if you were in the the bedside, the bedside of a a I believe you had to wear an FFP three mask at all times.

426
00:48:19,620 --> 00:48:26,520
I think if I remember right in that side of and a and then if you went into a bay where.

427
00:48:29,360 --> 00:48:36,750
A patient was COVID positive like known, or if you were doing something that was an ever so generating procedure,

428
00:48:36,960 --> 00:48:44,330
then I think you had to wear level level two PPE. So you would have to wear the full length gowns and the long gloves.

429
00:48:44,340 --> 00:48:50,790
So for the gowns for visor, obviously still the FFP three mask.

430
00:48:52,350 --> 00:48:58,290
Like I said, I'm a bit hazy on exactly what the rules were when, because I know at various times over the course of the next few years,

431
00:48:58,290 --> 00:49:02,579
sometimes the rules change between you didn't have to wear an F 53 mosque in the area,

432
00:49:02,580 --> 00:49:06,270
but you did if you did an aerosol generating procedure or the patient was known COVID

433
00:49:06,600 --> 00:49:10,470
and that you could just wear the normal mask otherwise until you went in to see them,

434
00:49:10,710 --> 00:49:22,320
things like that changed a lot, I guess, you know, And the rules were just changing as, you know, as evidence came available.

435
00:49:22,320 --> 00:49:26,639
And to be honest, based on what I think probably realistically what PPE was available,

436
00:49:26,640 --> 00:49:34,590
they had to make decisions on a kind of global public health perspective for those in terms of, you know, the policy making.

437
00:49:34,590 --> 00:49:43,919
And also the other significant thing was there was big changes in the rules about CPR and protocols of that.

438
00:49:43,920 --> 00:49:48,480
So that was part of what we were told about induction. And again, that's changed quite a few times.

439
00:49:48,840 --> 00:50:00,840
But that was a significant change at the time that you you went to to basically start compressions, which this was the original rules.

440
00:50:00,840 --> 00:50:05,670
I think it's changed since follow on I go. I always have to keep updated notes the changes.

441
00:50:05,970 --> 00:50:12,960
But you weren't meant to start compressions until someone was in full PPE because compressions could be an aerosol generating procedure.

442
00:50:13,260 --> 00:50:21,749
So the idea would be that you would just put defibrillator pads on first until someone was in PPE and then could start compressions.

443
00:50:21,750 --> 00:50:25,350
So all of these things were having to constantly be revised.

444
00:50:25,380 --> 00:50:30,300
You have to constantly keep abreast of the changes to make sure you're given the best practice.

445
00:50:31,470 --> 00:50:34,530
So it was a challenge at the time. Mm hmm.

446
00:50:36,570 --> 00:50:42,180
And so your your role as an interim foundation doctor that lasted until that you say August?

447
00:50:42,660 --> 00:50:49,620
Yes. So I guess it was sort of March to May was when I did the voluntary medical zero, then May to August.

448
00:50:49,620 --> 00:50:52,769
And August is when the normal foundation programme starts.

449
00:50:52,770 --> 00:50:59,880
So I went into my job then. And what was your first placement as a foundation doctor?

450
00:51:00,450 --> 00:51:05,700
So that was gastroenterology at the jail. And so I did that.

451
00:51:05,700 --> 00:51:11,940
And then I went to General Medicine at the Horton and then back to A&E at the John Radcliffe.

452
00:51:12,210 --> 00:51:23,660
And then my second year was EMT at the j j R, a GP placement and then intensive care at the jail and the judge so.

453
00:51:25,680 --> 00:51:31,200
And so when you went back to A&E, how much of a problem was COVID still at that stage?

454
00:51:33,090 --> 00:51:36,630
It was definitely still there, but very different,

455
00:51:37,050 --> 00:51:45,930
different place to where it had been when I'd been there before because I joined the it was kind of coming back up to the summer months.

456
00:51:45,930 --> 00:51:55,440
So that was, you know, the winter had been I'd been in medicine in winter, and I think that had been a really rough job because of that.

457
00:51:56,370 --> 00:52:03,000
But when I went back to A&E, things were kind of picking up at the time that we still had.

458
00:52:04,430 --> 00:52:11,030
I believe if I remember right, we still had some separation of of kind of COVID side from some non-covid,

459
00:52:11,030 --> 00:52:16,820
but it wasn't as firm as it had been when we first had the complete split of the two.

460
00:52:16,840 --> 00:52:23,740
And. There was a lot more. Testing by then.

461
00:52:23,920 --> 00:52:36,450
Then there had been originally. People were more familiar with the P.A., I guess, and the expectations and also the rules about visitors.

462
00:52:38,750 --> 00:52:46,100
And we were seeing a lot more, I think, although COVID was still there and I think we'd had some vaccines as well.

463
00:52:46,100 --> 00:52:52,760
So that was helping in severity. But I think we were seeing a lot more of the other things, maybe the things that hadn't.

464
00:52:54,660 --> 00:53:00,900
The had had kind of built up from from covert I think that word opiate related.

465
00:53:01,140 --> 00:53:07,170
I think one thing I forgot to mention about the first time around and A was what was

466
00:53:07,170 --> 00:53:12,150
quite shocking sometimes was seeing things that haven't been really seen that often.

467
00:53:13,530 --> 00:53:19,520
And sort of in my my generation of medics because of modern medicine.

468
00:53:19,540 --> 00:53:31,270
So for instance, I know some of my friends who volunteered in cardiology, so a lot more ventricular wall ruptures following heart attacks.

469
00:53:31,590 --> 00:53:38,820
And so that's kind of like a late stage complication where if you don't get heart, a heart attack seem to sometimes the wall can literally tear.

470
00:53:39,180 --> 00:53:45,150
And mostly they do happen. But there are a lot less common nowadays because people get really quick attention.

471
00:53:45,870 --> 00:53:52,109
But they were telling me that they were sort of anecdotally seeing a lot more of these because they felt

472
00:53:52,110 --> 00:53:58,740
because people weren't seeking as much emergency help when they had a bit of a chest pain or a bit of a neck,

473
00:53:58,860 --> 00:54:02,210
they were more inclined to stay at home because of the worry about COVID.

474
00:54:02,580 --> 00:54:12,120
And so those kind of things, although rare, still were more anecdotally seeming more common during that first wave in comparison.

475
00:54:12,120 --> 00:54:16,199
Maybe the second time when I came back to A&E, it wasn't so much that kind of thing,

476
00:54:16,200 --> 00:54:25,800
but more maybe people managing chronic conditions who had a meant to have an appointment six months ago that for some reason didn't happen.

477
00:54:26,220 --> 00:54:31,960
And so they're still in pain and so they're getting quite frustrated and coming to A&E and things like that.

478
00:54:32,010 --> 00:54:41,520
I think little, little things that if you leave it a long time become bigger and that people get more frustrated about understandably,

479
00:54:41,520 --> 00:54:47,610
and people feeling like they can't access the GP, a lot of frustration about people feeling that.

480
00:54:50,080 --> 00:54:55,180
Maybe that they find it difficult to get through to their GP and get a face to face appointment so they come to you.

481
00:54:55,310 --> 00:55:00,130
A So that was a lot of what I was dealing with, I would say, in that second job.

482
00:55:02,020 --> 00:55:05,500
And your, your I don't know what you call it too.

483
00:55:05,800 --> 00:55:11,290
No, I used the word placement before when you went to intensive care.

484
00:55:11,770 --> 00:55:15,820
Hmm. Were there still COVID cases in intensive care?

485
00:55:16,390 --> 00:55:19,840
Yeah. So when by the time I came to intensive care.

486
00:55:19,840 --> 00:55:24,610
So that was this? Well, I suppose it's last year now because we're just into 2023.

487
00:55:24,610 --> 00:55:27,970
But yeah, that would, that would have been sort of summer of 2022.

488
00:55:28,300 --> 00:55:31,750
So it's quite far. And now we were still seeing COVID cases.

489
00:55:31,750 --> 00:55:44,590
However, the big difference was, to be honest, usually either they were they had COVID, but they actually were in ICU really for something else.

490
00:55:45,010 --> 00:55:56,860
And it was either an incidental finding or they had something and COVID or the people who had COVID very badly and they didn't have something else,

491
00:55:56,860 --> 00:56:01,660
it was that they were unvaccinated. To be honest, that was that was what we were saying.

492
00:56:02,140 --> 00:56:08,049
There were very few people who were there just with COVID. And if they were, they were almost always unvaccinated.

493
00:56:08,050 --> 00:56:16,030
And if they weren't unvaccinated, they usually had some other massive condition that meant that they were really immunocompromised,

494
00:56:16,030 --> 00:56:21,120
like, you know, chemotherapy or something like that. And that became that.

495
00:56:21,220 --> 00:56:27,920
That was really quite clear. But I would say most of the patients didn't have COVID most of the time, but we had these kind of over the four months.

496
00:56:27,920 --> 00:56:35,740
So it's the sort of peaks and troughs where, you know, occasionally so so what we kind of did was as if we just had one or two cases,

497
00:56:36,040 --> 00:56:41,200
we would put them inside rooms and manage them that way with enhanced PPE for the side rooms.

498
00:56:41,530 --> 00:56:44,950
But as more and more people would have COVID, if there were these peaks,

499
00:56:44,950 --> 00:56:53,410
we would then sort of cohort them all into one side of A&E and then make that A&E ICU and make that kind of COVID ICU.

500
00:56:53,440 --> 00:56:58,300
And then there would be a whole section where you would have enhanced PPE going into there.

501
00:56:58,630 --> 00:57:00,190
And then as the cases went down again,

502
00:57:00,190 --> 00:57:06,100
we would again move them into side rooms and then manage the rest of the department as non non-covid, if that makes sense.

503
00:57:07,300 --> 00:57:17,380
Mm hmm. Um, yeah. So it sounds as though your whole experience over the last two years has given you.

504
00:57:17,560 --> 00:57:21,010
Maybe it's always like this, but it seems to me anyway.

505
00:57:21,010 --> 00:57:27,909
Well, tell me this is real. The fact that there was a pandemic going on gave you a kind of enhanced crash

506
00:57:27,910 --> 00:57:32,440
course in practically everything you were likely to encounter in a medical career.

507
00:57:33,790 --> 00:57:39,909
It's really interesting one that you say that to be, to be honest, because I think people have very different opinions on it,

508
00:57:39,910 --> 00:57:51,219
because I've had quite a few seniors during the those two foundation is make comments either to me or kind of to the view that that

509
00:57:51,220 --> 00:57:58,900
they feel that actually our education has been really disrupted and that they feel that we'll be less qualified because of it,

510
00:57:59,740 --> 00:58:02,770
less, you know, less experience because of it, I suppose.

511
00:58:03,880 --> 00:58:09,040
And their reasoning is often because because we've been dealing with COVID,

512
00:58:09,340 --> 00:58:14,170
all we'll know how to deal with this COVID and we won't know how to deal with everything else.

513
00:58:16,620 --> 00:58:20,310
I think I can see kind of both, both sides.

514
00:58:20,400 --> 00:58:26,610
But I don't really I don't agree with that argument because I think we've seen a lot more than just cover it often,

515
00:58:26,880 --> 00:58:33,050
to be honest, especially the last year or so. Like I said, it's mostly been if they've got COVID, they've got COVID and something else.

516
00:58:33,060 --> 00:58:40,560
A lot of the time, most patients, especially with since since since people have had multiple vaccines, that's definitely seem to be the case.

517
00:58:42,720 --> 00:58:50,010
But what I would say is that I think that having seen what training used to be like when I was a med student for,

518
00:58:50,910 --> 00:58:55,379
you know, foundation doctors, you know, because when you're on the wards, you kind of, you know,

519
00:58:55,380 --> 00:58:58,500
you're pushed around very much So a fly on the wall and you can see what things

520
00:58:58,500 --> 00:59:03,930
are like and seeing from from the view of when I was maybe a fourth year,

521
00:59:03,930 --> 00:59:11,910
fifth year medical student, seeing what the training opportunities and quality used to be like for foundation doctors and core trainees.

522
00:59:13,020 --> 00:59:19,110
I think that there's a lot less training opportunities and I think that generally whilst there are still some

523
00:59:19,110 --> 00:59:25,530
amazing senior doctors who will take trainings under their wing and take the opportunities to teach in things,

524
00:59:26,340 --> 00:59:35,489
the whole system is so much more stretched now and everybody has a lot less time because we're dealing with higher volumes of patients,

525
00:59:35,490 --> 00:59:39,930
higher acuity of patients generally with fewer staff members.

526
00:59:41,490 --> 00:59:46,170
There's just a lot less time for training and I think that it's getting less kind of

527
00:59:46,170 --> 00:59:51,810
directed supervision and simply having to go from patient to patient doing the best you can,

528
00:59:52,410 --> 00:59:55,920
it feels. Yeah, to be honest, I feel like I feel like whilst.

529
00:59:57,170 --> 01:00:05,540
I feel like, you know, we're supervised from the point of view of making sure the patient care is safe, you know?

530
01:00:05,600 --> 01:00:08,690
You know, I will always make sure if I see a patient at this.

531
01:00:08,690 --> 01:00:15,260
Any questions I have that I'm worried about for that patient safety. I always make sure that they're addressed and I'll talk to a senior about that.

532
01:00:15,590 --> 01:00:21,890
That kind of supervision doesn't worry me. If you you can always access that some way if you need it, to be honest.

533
01:00:23,000 --> 01:00:29,770
But I think there's less supervision from the point of view of actually where's your training going?

534
01:00:29,780 --> 01:00:37,579
What do you need to do to become a better doctor longer term to get exposure to the

535
01:00:37,580 --> 01:00:42,350
things that interest you or the things that you haven't had as much experience of?

536
01:00:42,560 --> 01:00:47,030
Because there's just a lot less time and energy available for that.

537
01:00:47,030 --> 01:00:53,000
And I don't blame the seniors for it, and I don't blame my colleagues or myself for it or whatever.

538
01:00:53,300 --> 01:00:54,410
It's just the system.

539
01:00:54,410 --> 01:01:05,600
Everybody's so stretched that, to be honest, I do think that generally people are prioritising teaching junior doctors and I mean,

540
01:01:05,600 --> 01:01:10,009
I even see it in myself, although I desperately fight against it because I love teaching.

541
01:01:10,010 --> 01:01:19,520
And like I said, I teach it for my for my college. And if I ever have a foundation, doctors with me or medical students with me,

542
01:01:19,760 --> 01:01:25,100
I try and take as much time as possible to show them things and at least make that afternoon or whatever

543
01:01:25,100 --> 01:01:31,430
time they would me valuable in some way because I know how disheartening it is if that doesn't happen.

544
01:01:31,760 --> 01:01:39,260
But equally, when you're really stretched and really busy and you've got so much service provision to be to be doing,

545
01:01:40,490 --> 01:01:41,960
sometimes it's just not possible.

546
01:01:43,730 --> 01:01:50,480
And so, yeah, it does feel a lot of the time, like almost all of the job is service provision when actually we're in a training role.

547
01:01:51,380 --> 01:01:56,870
You know, it's a training post. And so, you know, if you're a junior doctor, you're still in training in some way.

548
01:01:57,140 --> 01:02:02,050
So there should be a certain amount of time allocated to learning and teaching as well.

549
01:02:03,590 --> 01:02:10,280
But it's very, very difficult because I think consultants, job plans and things are very stretched and the whole service is very stretched.

550
01:02:10,610 --> 01:02:14,530
Mm hmm. Yeah, I think it's it's you can do either way.

551
01:02:14,540 --> 01:02:19,100
I think we've in some ways had a very steep learning curve for those of us who started during the pandemic.

552
01:02:19,490 --> 01:02:30,649
And I think that I think that what we have gained is maybe a lot of experience of being flexible and trying to adapt and being used to

553
01:02:30,650 --> 01:02:40,640
rules changing all the time and keeping abreast of of changes and often stepping up into roles more senior than we would have otherwise.

554
01:02:42,050 --> 01:02:45,920
But then I think that maybe we've had less opportunities to do things.

555
01:02:45,920 --> 01:02:50,870
So if I was interested, I'm obviously doing psychiatry, so procedures aren't something, for instance,

556
01:02:50,870 --> 01:02:55,550
that I'm that interested in getting lots of exposure to when I was in foundation years.

557
01:02:55,850 --> 01:02:58,340
But for someone who is interested in doing medicine,

558
01:02:58,550 --> 01:03:05,090
I think there was a lot less opportunity to do things like lumbar puncture as chest drains and things like that.

559
01:03:05,090 --> 01:03:14,720
That would be really useful experiences because there just wasn't enough time and opportunity for seniors to to to supervise you for them.

560
01:03:15,260 --> 01:03:20,810
And that means that you will get core trainees in two or three years time who have a lot less experience of doing those things.

561
01:03:21,950 --> 01:03:28,250
Mm hmm. And what about the morale of the junior doctor workforce?

562
01:03:28,610 --> 01:03:32,600
I mean, are you seeing contemporaries deciding to throw it all in?

563
01:03:34,070 --> 01:03:37,820
Yeah, I think that's a really big issue, to be honest.

564
01:03:38,300 --> 01:03:47,840
And so I have got friends and colleagues who have already decided to leave clinical medicine completely and for

565
01:03:47,840 --> 01:03:58,430
various things to do research or management consultancy or I've got a friend who's doing med medtech and teaching.

566
01:04:00,990 --> 01:04:06,960
And and I've considered myself slightly leaving, you know, to be honest as well.

567
01:04:07,170 --> 01:04:09,990
I was quite close to leaving earlier this year.

568
01:04:12,480 --> 01:04:19,559
And whilst I love medicine, I wouldn't rule it out in the future as well because I think there's a lot of issues with staff,

569
01:04:19,560 --> 01:04:23,610
wellbeing, morale and you know,

570
01:04:24,570 --> 01:04:33,570
my close friends and also students that I've taught in the past who are now foundation doctors I see struggling really,

571
01:04:33,780 --> 01:04:44,100
really badly with mental health and with, um, with managing the expectations of jobs under such difficult situations.

572
01:04:44,550 --> 01:04:49,320
And, and I feel like I've been been there myself in these situations too.

573
01:04:49,740 --> 01:04:53,430
And I think I don't know what the solution is,

574
01:04:53,910 --> 01:05:03,899
but I think that the needs to be something major changing in the way that we we train doctors and we look after doctors.

575
01:05:03,900 --> 01:05:07,229
And I'm sure the same goes for nursing and other allied health professionals.

576
01:05:07,230 --> 01:05:14,940
But I feel like. Since the pandemic that we weren't in a brilliant position before the pandemic.

577
01:05:15,450 --> 01:05:22,110
And since the pandemic, it feels like everybody's been working at speed 110, and it's never really stopped.

578
01:05:22,200 --> 01:05:27,209
But yet the workload has increased even more because now there's all of the routine

579
01:05:27,210 --> 01:05:33,030
things that we're kind of put on a bit of a hold or were waiting lists were building up,

580
01:05:33,030 --> 01:05:41,640
for instance, over the time of pandemic, where understandably we had to prioritise the most emergency cases.

581
01:05:42,090 --> 01:05:46,350
Those things haven't gone away. They're still there and they're just adding to that workload.

582
01:05:47,610 --> 01:06:00,150
And I mean, you do see a lot of rota gaps, a lot of people needing to take to take time off, understandably, for mental health.

583
01:06:00,540 --> 01:06:10,230
And so I think that we are going to need to do something to invested in the wellbeing and morale of staff.

584
01:06:10,260 --> 01:06:14,510
I think otherwise it's going to just only escalate. Mm hmm.

585
01:06:15,480 --> 01:06:23,690
Yeah, That's not not a good picture. So just finally, I just got a few questions about what?

586
01:06:23,700 --> 01:06:30,120
How you found living through the pandemic. I mean, first of all, given the position you were in,

587
01:06:30,120 --> 01:06:36,480
standing at the front door of the hospital and seeing all these patients coming in, some of whom may have had COVID.

588
01:06:37,080 --> 01:06:42,410
How frightened where you live of actually being infected yourself? So.

589
01:06:43,070 --> 01:06:51,590
So I was I wasn't I was scared of of of getting COVID like I'm sure everybody was to an extent,

590
01:06:51,590 --> 01:07:00,830
but I wasn't really so much worried for me as worried that I would then pass it on to a patient or a friend or family or something.

591
01:07:02,060 --> 01:07:12,110
So I was living on my own at the time because my flatmate, she had moved in with her mum as kind of lockdown started.

592
01:07:12,710 --> 01:07:20,960
So I was living on my own. Um, and I know obviously lockdown rules change at different times.

593
01:07:20,960 --> 01:07:24,650
I can't remember exactly the timing, but I remember that I deliberately,

594
01:07:25,160 --> 01:07:32,240
even once I was allowed to go to see as my support bubble, as it were, which would have been my parents.

595
01:07:32,570 --> 01:07:38,690
I deliberately didn't see them for several months because I didn't want to risk giving them COVID

596
01:07:38,690 --> 01:07:47,180
given like how high risk I would be really seeing every person coming in through the hospital doors.

597
01:07:48,950 --> 01:07:55,880
I did actually become unwell during the summer with this respiratory illness.

598
01:07:56,510 --> 01:08:00,700
At that time we were only kind of doing it. We didn't have lateral flows, we just had the PCR.

599
01:08:00,830 --> 01:08:09,110
And so I had one PCR which was negative, but then I had all the symptoms of COVID, including really bad shortness of breath and exertion.

600
01:08:09,110 --> 01:08:14,360
So I really was like, I couldn't like if I walked from door to door, I would be like painting.

601
01:08:14,930 --> 01:08:18,739
So I actually had to take this loss of taste and smell that you lose taste.

602
01:08:18,740 --> 01:08:29,000
And still not that time I did, but I, I, I had basically everything else and I had the persistent cough, which I then had for eight weeks.

603
01:08:29,540 --> 01:08:36,469
So I don't know. Obviously the PCR was negative, but I don't really see what else it likely would have been,

604
01:08:36,470 --> 01:08:41,959
especially given that I was working through the day and, and seeing COVID is probably the most likely thing.

605
01:08:41,960 --> 01:08:47,750
It's more likely that I just had one negative PCR, which we know we're not, we're not infallible.

606
01:08:48,320 --> 01:08:51,920
So I had thought I was quite well with that for two weeks.

607
01:08:53,840 --> 01:08:58,090
So then, um. So then a bit, to be honest.

608
01:08:58,090 --> 01:09:04,270
After that I relaxed a little bit feeling that I probably had had it. Obviously, I was still obviously obeying all of the rules, etc. but you know,

609
01:09:04,300 --> 01:09:12,610
I felt a bit more relaxed and a bit less scared because I felt like hopefully that means that I've had it and that I've been okay in the end.

610
01:09:12,610 --> 01:09:14,080
But the calf lasts a long time.

611
01:09:14,770 --> 01:09:24,010
But then, yeah, I've had COVID twice actually positive swabs since I lost my taste and smell on one of those two times.

612
01:09:28,120 --> 01:09:40,890
Both, I think from from work. There were times when I was working in an environments where lots of people had COVID, either staff or patients and.

613
01:09:42,970 --> 01:09:46,810
So, you know, it's it's an occupational hazard in a way.

614
01:09:46,810 --> 01:09:51,340
But I suppose now it's circulating so much that anyone could catch it from anywhere,

615
01:09:51,340 --> 01:09:58,300
but at least by then, because I'd had COVID and then I'd had the first vaccine.

616
01:09:58,570 --> 01:10:00,490
The second time I had it, it wasn't as severe.

617
01:10:01,990 --> 01:10:09,850
So, you know, I think the vaccines have done a lot of good with with reducing the severity for people and sort of reducing.

618
01:10:10,930 --> 01:10:19,200
Yeah, reducing ICU admissions and. And.

619
01:10:23,610 --> 01:10:28,379
Yeah. I mean, I've been asking everyone this, and I guess you've partly answered it,

620
01:10:28,380 --> 01:10:32,100
but do you think the fact that you were able to work on something that was,

621
01:10:33,690 --> 01:10:42,750
you know, helping people doing good helped to support your own well-being, or was it so stressful that that didn't make much difference?

622
01:10:44,200 --> 01:10:51,590
No, I definitely think the like the medical student role and the interim foundation role I definitely think helps.

623
01:10:52,810 --> 01:10:59,410
It was difficult because obviously I was away from my parents and if I wasn't volunteering, then I could have been with my pet,

624
01:10:59,410 --> 01:11:05,530
with my family, my parents, and that would have helped kind of, I guess, my wellbeing in a different way.

625
01:11:07,270 --> 01:11:15,520
But if I was in the situation, I was where I was going to school and I was living alone, I was really glad to be honest,

626
01:11:15,520 --> 01:11:21,820
to have this role where I was able to leave the house and go into the hospital and see people and talk to people.

627
01:11:22,240 --> 01:11:30,850
And like I said, at that time, there was a lot of morale, like team morale and camaraderie right at the beginning and.

628
01:11:32,430 --> 01:11:39,720
I think I know a lot of people who kind of work from home, especially those who work from home and lived alone,

629
01:11:40,080 --> 01:11:44,459
really struggled during the pandemic with their mental health and understandably,

630
01:11:44,460 --> 01:11:48,690
because they couldn't socialise with people, they felt very isolated.

631
01:11:48,960 --> 01:11:58,350
And I definitely felt that being able to go to the hospital and see colleagues and talk to patients, that socialisation I really needed.

632
01:11:58,500 --> 01:12:04,740
So actually for me, as well as hopefully helping with the health care for these patients,

633
01:12:05,010 --> 01:12:10,830
it really helped me to have something that I felt like I was doing that was helpful and that meant that I could see people.

634
01:12:12,220 --> 01:12:15,220
Excellent. So this is the end. Okay, the final question.

635
01:12:15,220 --> 01:12:23,560
So has the experience of working through the pandemic changed your attitude or your approach to your work?

636
01:12:23,560 --> 01:12:25,990
And what would you like to see changed in the future?

637
01:12:27,920 --> 01:12:35,210
I think it definitely has in a in like a variety of ways, it probably wouldn't take way too long to explore.

638
01:12:37,070 --> 01:12:41,510
But I would say like so I'd say probably.

639
01:12:42,650 --> 01:12:48,020
One of the most notable is that it made me realise that I've got a particularly

640
01:12:48,050 --> 01:12:54,020
great career so I can take a quick check and forcer because I'll be cutting.

641
01:13:00,540 --> 01:13:11,490
So, so so one thing was that I would say is that it has made me realise how important the role of families and carers is in,

642
01:13:12,990 --> 01:13:20,910
in patients recovery and in making sure that people are happy with.

643
01:13:22,100 --> 01:13:31,340
The plan. And I think that being having to give bad news and things over the phone to relatives.

644
01:13:32,610 --> 01:13:38,670
And not being able to address kind of the psychosocial needs of a lot of our patients.

645
01:13:39,840 --> 01:13:45,419
Really affected me during COVID and I think really made me realise how much that's

646
01:13:45,420 --> 01:13:49,770
important to me and how we deal with things and how well you can do everything.

647
01:13:50,900 --> 01:13:54,590
Perfectly right in terms of right, I'm going to give you this medicine.

648
01:13:56,060 --> 01:14:00,140
We're going to get this investigation. We're going to book this clinic.

649
01:14:01,300 --> 01:14:04,570
People can still feel really unhappy with the care they're receiving.

650
01:14:05,530 --> 01:14:11,920
Or you can be completely missing the point or missing what's actually affecting them.

651
01:14:12,700 --> 01:14:17,260
If you disregard what's going on with their family or what's going on with their mental health.

652
01:14:19,670 --> 01:14:23,860
And I think a lot of the way the pandemic affected us caused us to have to

653
01:14:23,860 --> 01:14:27,520
work in that way by necessity because we were dealing with emergency things.

654
01:14:28,390 --> 01:14:31,090
And so I think that's what's led me to do psychiatry in a way.

655
01:14:31,660 --> 01:14:36,340
So I think that made a big change, changed me in the way I practice because I was thinking of doing.

656
01:14:37,280 --> 01:14:42,440
Mostly physical health medicine before and now have gone towards mental health.

657
01:14:42,980 --> 01:14:45,770
And I think that's because it's highlighted the importance of that.

658
01:14:46,900 --> 01:14:55,990
And then I think also it's really highlighted the importance of staff wellbeing and the importance of.

659
01:14:59,230 --> 01:15:09,990
That you can't you can't continue working at that kind of giving 110% pace for ever.

660
01:15:11,410 --> 01:15:17,380
There will be a point where that's not possible. And I think a lot of what we do in the NHS.

661
01:15:18,600 --> 01:15:28,440
Relies on the goodwill of people. People willing to spend that extra half an hour, hour, 3 hours of their own free time.

662
01:15:29,650 --> 01:15:34,660
To do what's needed to make sure their patients are taken care of.

663
01:15:34,660 --> 01:15:38,560
Well, which is admirable.

664
01:15:38,920 --> 01:15:42,450
And I've done it all My colleagues do that.

665
01:15:42,740 --> 01:15:46,540
You know, I don't think I could name a doctor who hasn't done that.

666
01:15:47,020 --> 01:15:52,750
Or does that hasn't done that. And it it's difficult because it's a vocation.

667
01:15:53,080 --> 01:16:01,570
So we obviously want to do that because we want what's best for our patients and then we care about them above, you know, above all else in a way.

668
01:16:02,950 --> 01:16:05,830
But you can't do that forever. And.

669
01:16:06,970 --> 01:16:13,660
I think what we'll need, what needs to change, I don't know how, but I think that the system, we need to have more doctors.

670
01:16:13,660 --> 01:16:17,110
We need to have more nurses. We need to have more.

671
01:16:19,960 --> 01:16:28,480
More support so that people are trained better and have more time for the training and the things that bring them enrichment in their job,

672
01:16:28,480 --> 01:16:29,770
whether that's, you know,

673
01:16:29,830 --> 01:16:37,270
a nurse having more time to look at her area or special interests or history or special interest or whether it's a cool trainee,

674
01:16:37,270 --> 01:16:41,080
be able to go and do that procedure with supervision or whatever.

675
01:16:41,860 --> 01:16:43,650
And then we need, you know,

676
01:16:43,780 --> 01:16:56,830
more doctors and nurses on the rotas so that people can hand over on time and leave on time so that they don't become overwhelmed with their work.