Congratulations. You are now a doctor. You have a bleep that will ruin your life at 3 am, a rota that probably does not make sense, and a bag full of snacks you will forget to eat. Here is what you really need to know if you want to survive your first year. Long read — but print it, fold it, scribble on it, pass it on.
Look. Nobody loves forms, but your scan request is not just admin — it is the difference between a patient getting the right scan now or sitting around for six hours while your bleep goes off every twenty minutes asking “Has the scan happened yet?”
The radiologist is not your enemy, but they are the gatekeeper. If you give them waffle, half the time they’ll reject your request and make you rewrite it while the patient’s relative glares at you asking why the scan is not done. So give them a reason to approve it the first time.
How? Easy:
Write like they have no idea what you see at the bedside. Because they don’t.
Good structure:
Who is the patient (age, sex)
What are they complaining of (symptoms, time frame)
What did you find (examination that backs you up — GCS, neuro deficit, peritonism, whatever)
Relevant risk factors (smoker, trauma, immunosuppression)
What you’re actually looking for (the “? query” bit — be direct)
Bad: “Abdo pain ?appendicitis”
Better: “23F with sudden RIF pain and vomiting for 12h. Localised peritonism, positive Rovsing’s. Nil known medical history. Query acute appendicitis. Please abdo US if possible.”
You look switched on, you sound credible, and your scan actually gets done.
Bonus: mention relevant bloods if useful — CRP 180, WCC up, whatever.
Hidden truth:
Radiologists get annoyed when people try to hide the real reason. Just tell them the suspicion. If you’re wrong, fine — you did your job by asking the question properly.
And do not forget: do an exam first. If you get grilled for “What’s the GCS?” and you have to guess, you’ll hate your life.
One of the weirdest things about being an F1 is how often you find yourself acting like a middleman. The consultant might sweep past you on the ward round and say, “Get a CT abdo” or “Refer this patient to gastro” — and that’s it. No explanation. No clue what they’re really thinking.
Here’s the thing: if you just nod, run off and do it blindly, you’ll often get stuck when radiology or another team asks, “Okay, but what exactly are you looking for?” If you don’t know, you’ll feel like an idiot, waste everyone’s time, and risk the request getting bounced.
So build this habit now: politely ask what you’re querying. It’s not rude. It’s basic safety.
Examples:
“Could I just clarify — what are we looking to rule out with this CT?”
“For the MRI, are we querying spinal mets or disc prolapse?”
“Before I call gastro — what exactly do we want them to do? Scope? Advice on meds? Just follow-up?”
Nine times out of ten, the consultant will appreciate that you care about doing it right. Sometimes they’ll pause and explain their thinking, which is gold for your learning. Occasionally they’ll realise they don’t actually need the scan or referral at all.
It makes you look switched on, saves wasted scans, and saves you the embarrassment of standing in radiology muttering, “I… don’t actually know what we’re looking for.” Always worth that one question.
Picture this. You come in next morning, the ward round starts, the consultant says “What’s the repeat Hb on Mrs Smith?” and you realise you never ordered it. So now you’re sweating, apologising, grabbing gloves, trying to find a vein that has been stabbed eight times this week, while the phlebotomy team roll their eyes because “nobody told us”.
Happens daily to new doctors — but it does not have to.
End of your shift? Take two minutes. Pull up your patient list.
Who needs repeat Hb, U&E, LFTs, CRP, cultures?
Is the cannula still working? If not, can you do it now or warn nights?
Double-check: are you actually acting on this blood? Don’t be that person who writes “daily FBCs” forever for no reason.
Write it on the job list too: if the patient needs a new cannula or bloods, plan ahead. Nobody likes the “Can you please put a line in now?” game at 7 am when everyone is tired.
Tiny boring habit. Massive stress-saver.
Every F1 has faced the horror show: patient needs IV access, but every vein is gone. The nurse tries once. Twice. Three times. Senior nurse comes over. They can’t get it either. Now everyone turns to you.
If they could not get it, your chance is… optimistic. So what do you do? You learn to grab the ultrasound and get it done properly.
Real tips nobody says out loud:
Watch an anaesthetist do it. They’ll teach you all the tricks: probe angle, depth, tracking the needle tip. Buy them a coffee later.
Be patient with yourself. It’s fiddly. Your hand will shake. Fine.
Start with easy targets. Bigger veins first. Then graduate to trickier ones.
Always talk to the patient. “You’ve had a few goes — I’m using an ultrasound to see if we can get a deeper vein.” They love you for trying.
You’ll look like a hero when you secure the impossible line at 2 am. Also, you’ll get asked every time afterwards — so share the skill. Teach your mates. It pays forward.
You’d think the NHS would be fully digital in 2025. You’d think wrong. Some hospitals still run on notes that look like your grandad’s old library cards.
If your handwriting is half-dead spider legs, the nurse will call you asking what dose you wrote. Or worse — the pharmacist will reject your drug chart, and the patient won’t get their meds on time.
Nobody cares if it’s pretty. Just legible.
Block capitals for drug names.
Double-check decimal points — is that 2.0mg or 20mg?
Sign, print, and bleep number every time.
Take your time when you’re tired — tired handwriting turns into hieroglyphics fast.
Future you will thank you when you re-read it tomorrow and don’t have to squint.
Never ring a consultant or reg without knowing exactly what you want out of them. If you just read them the patient’s life story then pause and wait, they’ll hate you and ask, “Okay… so what’s the question?”
Have it ready before you dial.
Perfect example:
"Hello my name is X, F1 on [ward]. I’m calling about a patient with frank haematuria. Are you near a computer? here is the hospital number. He has visible haematuria, three-way catheter inserted, anticoagulants stopped. I was wondering if you’d recommend any further investigations or if urology needs to follow up?”
It shows you’ve thought about the basics, done immediate steps, and now want clear senior input.
Mini secrets:
Always get their name for your notes: “Thanks — who am I speaking to?”
Write exactly what they said. If they say “Monitor overnight”, document it.
Never hand over an incomplete referral: if you didn’t do the basic stuff (bloods, cultures, catheter), expect an annoyed “So… why are you calling?”
A good F1 job list is your entire short-term memory on paper. Without it, you’ll forget tasks, double up, or do them in the wrong order.
Classic rookie move: scrawling jobs on sticky notes you then lose. Don’t.
Solid format:
Name, bed number, job, urgency, tick box.
Keep urgent jobs at the top.
Rewrite it after the ward round — yes, rewriting is not wasted time. It clears your head.
Be honest about what you can do today. Sometimes you won’t finish it all. Prioritise safety jobs first.
No shame asking a senior: “Here’s my list — does this order look right?” Shows you care about doing things properly.
Best lesson you’ll learn early: your pen is your shield. If something ever goes wrong, your notes are your story. Without them, it’s your word against guesswork.
Family calls asking for an update? Write who called, what you told them, any new plan.
Consultant chats on the corridor and says “Let’s hold off antibiotics for now”? Write it.
Patient refuses meds or wants to self-discharge? WRITE IT.
Document in real time if you can. If you’re busy, jot a quick note on paper and transcribe when you get a moment. A small habit that saves you big stress when complaints come up.
You’ll feel it in your stomach — that “something isn’t right” feeling. If you ignore it because you’re embarrassed, you’ll regret it more than if you just said, “Hey, can you come have a look?”
No senior will ever shout at you for asking early. They will shout if you sit on a deteriorating patient alone.
Use your ladder:
F2 or SHO first.
Reg if you’re still worried.
Consultant if the reg’s not around.
And if you’re not sure who to call, ask the nurse in charge — they know exactly who’s on that night.
At night, the nurses are your eyes and ears. They’ll bleep you for high BP, chest pain, hypoxia, fever. Some calls are urgent. Some are “just check they’re alive so I can document I escalated”.
Don’t just run off blindly.
Always ask:
“What are you worried about?”
“Where exactly is the patient?”
“What do you want me to do when I get there?”
And trust me — it happens to the best of us.
I once forgot to ask for the patient’s name and bed. I turned up to a ward confidently asking, “I’ve been bleeped for hypoxia?” — only to realise I was standing in the middle of a respiratory ward where literally every patient is hypoxic by default. The nurse just laughed and pointed me to the next floor. Lesson learned: always get the name. Always get the bed number. Do not be that clown at 2 am.
Resident doctors have a weird guilt complex about sitting down. Don’t buy into it. If the patient is safe, you’re allowed to drink water, eat something, sit for ten minutes. Nobody wants a fainting F1.
Good teams cover each other so someone’s always free to bleep back while you scoff your sandwich.
Rotas can be wrong. Tax brackets can be wrong. On-call supplements can vanish into the ether. The only person who checks? You.
When you get your contract:
Cross-check your hours against the rota.
Count your annual leave days.
Know how many weekends and nights you’re owed pay for.
If in doubt, run it by your BMA rep. That’s literally what they’re for.
More residents get underpaid than you’d think. Missed shifts, wrong on-call banding, extra hours unpaid. Always check the full breakdown. If you did a Sunday or a night shift, make sure it’s there.
If something’s missing, flag it immediately. The longer you wait, the harder it is to get money back.
No doctor survives alone. The other F1s will cover your bleep when you run to the loo for a prolonged bowel motion after curry Wednesday. They’ll teach you tricks, lend you snacks, help you find the only working ophthalmoscope on the ward.
In return, be that colleague. Back each other. Offer to help when you’re free. One day you’ll be drowning and someone will step in for you. Karma works wonders in medicine.
bad example:
"I’m handing over this patient who’s breathless — could you review and order appropriate tests if neccessary?"
Translation: you did nothing, you want them to do your work.
Good:
"This patient came in with SOB and haemoptysis. We ordered a CTPA, it’s booked for 20:00. Please chase the result. If PE positive, start treatment-dose apixaban. If negative, no overnight action."
Clean. Actionable. No confusion. Your colleague won’t hate you when they read it. And when you’re the one taking handover next time, you’ll appreciate it too.
