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'Seeing someone who was very ill being discharged and knowing you made a difference to that person's life is really fulfilling'

They are among the most familiar faces to patients in hospital, as junior doctors work long hours and cover night shifts. Three who are working in Northern Ireland tell Laurence White about the strains and rewards of their careers

Dr Molly Kerr at the Ulster Hospital in Dundonald
Dr Molly Kerr at the Ulster Hospital in Dundonald
Dr Stephen McAleer at the intensive care unit in the RVH
GP trainee Dr Trevor Killeen

At this time of the year junior doctors face the real world of medicine, having left medical school and gone onto the wards in hospitals. They begin a rotation around various specialties until deciding what area of medicine they intend to make their career in.

Here, three junior doctors tell of their experiences - how they face up to the pressures in busy hospital departments, if medicine fulfils the ambitions they hold, and what is the best part of the job.

Dr Trevor KIlleen (44), single, is a GP trainee and lives in east Belfast.

I am originally from Wicklow and always wanted to do medicine, but I did not do well enough in my leaving certificate examinations as a teenager to get into medical school.

I went to England and entered the hospitality industry, ending up as a hotel manager before returning to Ireland. I took the opportunity to gain qualifications in holistic therapies and make-up artistry and taught for four or five years.

At the age of 34 I decided to try medicine and did an access course and then studied at Norwich Medical School and did my foundation year as a doctor in Norfolk, before coming to Belfast last year. Initially I worked in the city as a locum and now am training as a GP.

For me, medical school, for the most part, was a pleasant experience. When you have left studying behind, as I had done, it is a bit more difficult to get back into it, but overall medical school was a positive experience. There was a diverse student group with a higher proportion of mature students than I expected, so that helped me.

Becoming a GP was my preferred option, but another choice would be emergency medicine. It is something that I might well do alongside my GP training.

The best moment of being a doctor is seeing a patient who had been very ill leave hospital better and knowing that you had done what you were supposed to do. On the other hand, being on call in the middle of winter is one of the hardest things to do. However, it is a very rewarding career.

As a doctor in training there is always a moment in the first couple of months after medical school when you are standing in the middle of a corridor in a hospital and think to yourself: "Gosh, I am a doctor." This is what all the studying was building up to and what you wanted to be. As a junior doctor, if that is what you really wanted to do, that is a good time in your life. You experience so many different things.

Currently I am working in psychiatrics at Knockbracken in east Belfast and conduct clinics and home visits alongside the team I work with. The patients' conditions range from depression to dementia and some have long-term psychiatric problems.

It is quite challenging work, but will be useful as I go through my GP career, as these are the sort of problems you see frequently in general practice.

The great thing about being a GP is that you can take an interest in a wide variety of areas aside from general practice. You can obtain extra skills and these will be useful. As a GP you need good diagnostic skills, as you will be dealing with a huge range of patients, from babies to 90-year-olds.

People don't realise there is an awful lot of work that GPs do which they never see - home visits, referrals to hospital and following up on discharges from hospital, legal forms that need to be filled in and shared care of patients.

There are very few areas of medicine that have a typical day, as no two days are ever quite the same. It is a dynamic, challenging, but very rewarding career, especially as a general doctor.

However, there are problems within the NHS at the moment, with increasing demand for services and not enough doctors, but the good times outweigh the bad times.

Becoming a doctor is something that I wanted to do from the age of 12.

I graduated at the age of 42, so it was a 30-year dream that eventually came true. I took a circuitous route to this point and I am glad that I did.

Dr Molly Kerr (23), single, lives in Belfast and is a Foundation Year 1 doctor based at the Ulster Hospital.

Although I had no family background in medicine, when I was growing up I enjoyed science and speaking to people and the idea of making a difference to them at some of the most vulnerable times in their lives. Ultimately, I wanted to combine science with meeting people and medicine ticked a lot of those boxes.

I studied medicine at Queen's University medical school and that prepared me well for life on the wards.

One of the most challenging aspects of life at this stage is being left in charge of wards during the night, but there is always someone to call for help. You just ring them and they will advise you or come to your aid.

I have not yet done a night shift as a Foundation Year 1 doctor, but I have plenty to come up. I have spoken to a few other junior doctors who have done night shifts and they say that the first night can be daunting. Any time you do something for the first time, there is a daunting side to it.

As regards the best moment of my career to date, it is difficult to pick out one in particular.

Like most doctors, the best experience is following a patient's progress from when they are admitted to hospital until they go home with their symptoms cleared after treatment. You have made such a difference to that person and seeing that whole journey is fulfilling to me. In surgery, for example, you can fix patients quite quickly, but then you have to follow up to see how they have come through their operation or if they need further scans. That all feeds into the feeling of having made a difference to them.

I cannot pick out a bad moment in my career to date. My experiences have not been terrible.

A lot of people say medicine is really stressful, but I have really enjoyed the last few weeks. It has been difficult at times, but not the worst experience ever.

On a typical day I have a ward round at 8am, but I come in half-an-hour earlier to get my patient list sorted and planned and find out what happened to the patients overnight.

A ward round can last from one hour to four-five hours.

I collate all the jobs for the ward round, for example, if blood samples were taken, what fluids were prescribed, if patients need to be prepared for theatre, ordering scans and prescribing medication.

During the ward round I am part of a team consisting of a consultant, senior house officer, registrar and myself, the Foundation Year 1 doctor.

A daytime shift is supposed to finish at 4pm, but that has not happened to me yet. It could be 5.30-6pm before I can leave or it could be later, depending on how busy we are and what needs to be done.

At times you have to make a conscious effort to sit down and have something to eat, even if the break is only for 10 minutes.

It is still early days for me to choose which career in medicine I will follow, but if I had to pick, my choice would be general practice.

That is because of the variety of the work and the continuity of care that you can give and you can also have special interests as well. I have at least a year to make up my mind before making my final decision and there are a lot of other things you can do before deciding what training programme to go on.

People talk about the NHS being under pressure. At the moment, every publicly funded service faces pressures and it is just a matter of how individuals cope with those pressures and how that reflects on the service provided.

A bit of pressure can create a bit of healthy stress and actually pushes a lot of people to be better at their job. However, systemic failures harm a service and when the pressures become unhealthy, that is when problems set in.

Dr Stephen McAleer (28), single, is from Dungannon and is a clinical fellow in critical care medicine at the Royal Victoria Hospital in Belfast.

I am a junior doctor who looks after patients in the high dependency or critical care units. These are patients who are ventilated by machines or receive dialysis or have lines (tubes) inserted to give them medication and keep their hearts pumping and their blood pressure up.

I wanted to do medicine because I wanted to make a difference. My long-term aim is to do anaesthetics in intensive care medicine. This is where the sickest patients are brought into hospital and it is rewarding to see the difference you can make. You see them come in at death's door and after treatment so many are sent to general wards and ultimately leave hospital.

I have done two years of foundation training medicine and surgery, two years of care medicine and the last six months of intensive care medicine. Medical school prepares you as best it can, but it is only by working day to day in the hospital environment that you can acquire the skills you need. No two days are ever the same.

When you start out working as a junior doctor you have more senior doctors to help. On your first patient encounter, you have someone to run ideas past so that you do the right things. There is always support.

It is different at night, when there are no support staff actually about (although some are on call) and you have two or three junior doctors looking after a large number of patients across the hospital. Wards are always bursting at the seams because of referrals from the emergency department. Being a junior doctor is intense, challenging, but rewarding.

The best time for me is when a patient is brought into intensive care. They are so seriously ill that you initially fear they may not survive, but over days you find their vital signs improving due to your interventions and then after a few days they are able to leave the critical care unit.

The worst part of working in the health service is meeting rising demand for services with so few resources. There is so much pressure on hospital beds that only the sickest patients remain in overnight.

Finance is not the only factor, but we need extra investment to increase the number of doctors, otherwise it will not happen. We need more doctors and also to ensure that as students go through training we don't lose them to other countries or from medicine entirely, because of the pressures they face in hospitals here.

After the first few years of training, a significant number of junior doctors take time out to do other things or go abroad to gain other experiences. One of the reasons is that they don't feel valued in the workplace.

They have large student fees, expensive professional fees, indemnity costs and lots of courses to undertake, e-learning and quality improvement projects and audits to undergo. All these are often done in a doctor's own time.

On a typical day I perform a wide range of procedures, from taking blood, to administering medication intravenously, to carrying out a tracheostomy.

A shift is supposed to run from 8am to 6pm, but they often overrun. You have to stay until all the work is done. You don't hand over patients who need treatment. I find the work very rewarding and am gaining lots of experience performing procedures.

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