My Last Day as a Doctor - Reflections - Ali Abdaal
My Last Day as a Doctor - Reflections - Ali Abdaal
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How to Figure Out What You Really Want in Life : https://dai.ly/x933hm8
How to Change your Life in a Year - 3 Simple Ideas : https://dai.ly/x933u78
dailymotion.com/arshian
How to guarantee you regret your life:https : //dai.ly/x93180y
My honest advice to a perfectionist:https : //dai.ly/x9319i4
My honest advice to someone who’s doing too much : https://dai.ly/x9319ty
My honest advice to someone who feels behind in life : https://dai.ly/x931a78
My honest advice to someone who wants financial freedom : https://dai.ly/x931ex2
If I Wanted to Be a Millionaire Before 30, I'd Do This : https://dai.ly/x931gzm
The Best Book I've Ever Read about Making Money : https://dai.ly/x931j9y
How to Go From $0 to $10,000 a Month in 4 Steps : https://dai.ly/x931kb6
How to Make $10,000 Month Writing Online : https://dai.ly/x931l42
How to 10x Your Income The 4 Ladders of Wealth : https://dai.ly/x931ldm
Why You Feel Lost in Life by Ali Abdaal : https://dai.ly/x933252
How to Figure Out What You Really Want in Life : https://dai.ly/x933hm8
How to Change your Life in a Year - 3 Simple Ideas : https://dai.ly/x933u78
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LearningTranscript
00:00Hey friends, welcome back to the channel.
00:01If you're new here, my name is Ali.
00:02I'm a doctor working in Cambridge in the UK
00:04and I have just finished my last day of work
00:07for quite a while.
00:09So this is gonna be a long, rambly, very chatty video,
00:13generally giving my thoughts and reflections
00:15on the last two years of being a junior doctor
00:17in the UK's National Health Service.
00:20It's gonna be quite long,
00:21but I'll try and split it up into different sections,
00:23which will be in timestamps over here
00:25and in the video description and in the pinned comment
00:27and hopefully the new YouTube chapters feature will work.
00:29So do feel free to skip around the video if you like.
00:31But yeah, people send in questions via Instagram
00:34and I'm just gonna generally be fairly openly
00:36sharing my thoughts on what it's like
00:38and how things are at the moment.
00:39So let's start with what I'm feeling right now.
00:42And I'm not usually one to talk about my feelings,
00:43so a skill to improve on like everything else.
00:48But I'm feeling a little bit sad
00:50because I've been at this hospital
00:52in this small town for the last 12 months.
00:55I was at quite a big hospital in Cambridge
00:56for 12 months before that.
00:58And I've just come back from work
01:00having said goodbye to all the other doctors and nurses
01:03and the consultants and stuff on the ward.
01:05And it just feels a little bit bittersweet
01:08because I've been kind of looking forward
01:09to this moment for a long time
01:11and thinking, oh, you know, just one month to go,
01:12just two weeks to go, that final moment of freedom.
01:15But I think it's sort of like,
01:16it's kind of like with exams, right?
01:18Like at least when I've always taken exams in the past,
01:22I've always hyped up what it would finally be like
01:24to be done with exams.
01:26Oh, you know, once that last exam gets out of the way,
01:28then I'll be free for the summer.
01:30And then you kind of get there
01:31and it's a bit anticlimactic.
01:32You're like, oh, well, I guess this is it.
01:34Now it's time for the summer holidays.
01:36So it sort of feels like that.
01:37Like it feels good in a way,
01:39like now being fully unencumbered
01:42and not having to go to work each morning.
01:44But at the same time, yeah, like for the last two years,
01:48kind of going the ritual of going to work each day
01:51pretty much and kind of building the rest of my life
01:55around the day job has basically been
01:58just kind of what I do.
02:00And it's something I don't have to think too hard about.
02:02And now the thought of tomorrow morning waking up
02:05and not having a job, a job to go to,
02:09just feels kind of weird.
02:10Like I'm really worried that I'm gonna wake up tomorrow
02:12and at some point and think,
02:15I don't really have a good reason
02:16to get out of bed right now.
02:17Just because work is such a huge chunk of our lives.
02:20And so that's the part of leaving the job
02:24that yeah, it just feels kind of weird.
02:26So it'll be interesting to see in a few weeks time,
02:28like I'm kind of trying to make plans already
02:31for all the ways I'm gonna fill up my time,
02:32all the different skills I want to learn
02:33and all the different videos and courses
02:35and all this stuff that I wanna make and all of that stuff.
02:38Yeah, I think from tomorrow,
02:40I'm gonna have this sort of hole
02:41that previously work filled with like something to do,
02:43something that was kind of fun,
02:44something that gave me social interaction with people
02:47that helped me use my brain some of the time.
02:48And I'm gonna have to replace that
02:50with a few different things.
02:51I don't really have any single thing
02:53that will completely fill that hole,
02:54which I think is fair enough.
02:56Let's not talk about,
02:57a few people asked why I'm leaving medicine.
02:59So I don't know what the title of this video is gonna be,
03:01but maybe we'll do something suitably clickbait.
03:04But essentially, so after these two years
03:06of being a junior doctor,
03:07of doing my foundation years in medicine,
03:09I've decided to take a break for at least a year.
03:13A lot of people do this, it's quite common.
03:15You take a year out.
03:16Usually people do something medical with that time.
03:18Like they'll go to Australia for a bit
03:19to do some work there or they'll do some research
03:22or they'll go to London and do a kind of one year job,
03:24like a temporary thing.
03:26Or some people just like travel the world and stuff.
03:28And so my plan before this whole coronavirus thing happened
03:31was that I was gonna travel the world.
03:33But now that the whole coronavirus thing is here,
03:35I'm not sure that's really gonna be possible anymore.
03:36And so I need to find something to do with my time.
03:39At the moment, lots of Europe is open,
03:42can go up and down the UK to visit friends.
03:44I think that'll tide me over for a little bit of time,
03:46but it feels kind of weird
03:49not having a specific medical kind of goal
03:52to be working towards.
03:54In terms of specialty,
03:55I made a video a few weeks ago
03:56talking about how I'm considering a move to America.
03:59That is the sort of thing that would take
04:00at least two or three years to actually sort out
04:02just because it's such a long drawn out application process.
04:05You have to jump through a hundred different hoops
04:07and I still haven't fully decided
04:08if that's the direction I want to go.
04:09So, you know, at least in the short term
04:11for the next few months slash for the next year,
04:13I'm gonna be preparing for the USMLE, the US medical exam.
04:16I still think I'm gonna do that.
04:18I think that'll give me some,
04:19at least something to do each day.
04:21And then beyond that,
04:22I'm thinking that it would be cool
04:24to go to Australia for a bit
04:25to get some emergency medicine experience.
04:27And so I'm in the process of applying to jobs
04:29and I've got a call with an agency tomorrow.
04:31If anyone is in Australia right now
04:32and you're listening to this
04:33and you want to give me a job at your hospital, let me know.
04:35Cause I think working in Australia
04:36and getting some experience in an emergency department
04:39there would be kind of fun.
04:40It would be interesting.
04:41It would be cool.
04:42So that's kind of what I'm doing.
04:44In terms of why I'm doing this,
04:47I've been thinking long and hard about this.
04:48And some of it I mentioned in my,
04:50why I'm moving to America video,
04:51but essentially when you're in medicine,
04:55at least in the UK,
04:56we go straight into medical school usually from high school.
05:00And so I applied to medicine when I was 16, 17,
05:03I got in 18 and from 18 to 24, age 18 to 24,
05:07I was a full-time medical student at Cambridge.
05:09And now from 24 to 26,
05:11I've been working full-time as a doctor.
05:12So it's a very sort of,
05:14you come in and then sort of almost before you know it,
05:17you're sort of on this conveyor belt
05:19that just kind of keeps moving forward.
05:20And having spoken to a lot of senior doctors
05:23and consultants and stuff over the last couple of years,
05:25and also while I was in med school,
05:27there's sort of two schools of thought.
05:29There's one school of thought,
05:30which is you want to get all of your training
05:32out of the way as soon as possible.
05:33You want to become a consultant.
05:34You want to become a fully qualified specialist
05:36as soon as possible.
05:37You know, the earliest you can get that in the UK
05:39is about age 33, 34.
05:42Once you're there, then you can start to enjoy life.
05:45I.e., you know, generally people say
05:47that the training is quite difficult.
05:49You have long hours.
05:50You don't really have much control over your rota.
05:52But once you're a consultant,
05:53at that point you have a lot more clout.
05:55You know what you're doing.
05:56You're actually being useful.
05:58And you can do things like drop your hours down
06:00or work part-time or, you know,
06:02do only the sorts of operations that you want to do.
06:04You know, it just generally gives you a bit more freedom.
06:06That's kind of one school of thought.
06:08The other school of thought,
06:09which is the camp that I'm in,
06:11is that there's no rush to be a consultant.
06:14Whether you're a consultant at 33 or 34 or 35, 36,
06:17or even 46, like no one actually cares,
06:19once you're there, how long it took you to get there.
06:21And so it becomes a case for thinking
06:24that this whole medicine thing is not a race.
06:26It's a marathon.
06:27This is a career that we're gonna be doing
06:28for the rest of our lives.
06:29What does it matter if I take a year out here and there
06:31to explore other interests,
06:33like making videos on the internet or traveling the world
06:35or doing whatever you want to do?
06:36Because my view of this is by the time
06:39I'm fully qualified as a consultant
06:41and whatever specialty I want to be in,
06:42you know, hopefully by that time I'll maybe be married,
06:45maybe have some kids,
06:46because I anticipate that'll be in my sort of late 30s,
06:50if not early 40s, that would be kind of nice.
06:52And at that point, once you're married,
06:54you've got a house, you've got some kids,
06:56it's a lot harder to just randomly travel the world
06:58because you feel like it,
06:59or just randomly stop working because you feel like it.
07:02Like, I get the view that you want to finish your training
07:05as soon as possible,
07:06but I think, especially given the position I'm in,
07:08I don't think that's necessarily the way forward.
07:10And I think it's much kind of better for me,
07:12at least this is my current view,
07:13to kind of take my time with it
07:15because it's really not a race.
07:16Like, I'm not in any rush to be a consultant.
07:18I'm not in any rush to be fully qualified as a doctor.
07:20I kind of more want to take it a bit easier.
07:23I quite like the idea of doing less than full-time training,
07:25which is a thing that a lot of UK hospitals
07:27and UK specialties are now trying to promote,
07:29just to combat the general burnout
07:31and attrition within medicine.
07:33Specialties like emergency medicine,
07:35like obstetrics and gynecology,
07:36are quite famous for having high burnout rates
07:39where the rotos are so tough
07:40and people will drop out midway through a training program
07:42because their priorities changed or whatever.
07:45So these specialties are kind of leading the way,
07:47and I think pediatrics as well,
07:48in terms of allowing people to work less than full-time,
07:50so maybe 80% rather than 100%.
07:53And if you work 80%,
07:54then it takes you 20% longer to finish your training,
07:56but you also have a day off every week,
07:58which is kind of nice.
07:59And a lot of people that I've spoken to
08:00who are less than full-time trainees say that it's great
08:03because they can spend that time at home with their kids
08:05or doing the thing that they love.
08:07And yeah, it takes them a little bit longer
08:09to become a fully qualified consultant,
08:10but who cares?
08:13When you're a consultant,
08:14no one is gonna be like,
08:15oh, well, you took 10 years to become a consultant,
08:17you only took five years, you're better.
08:18And the thing that I think about
08:19is that when I'm on my deathbed,
08:21I'm very, very unlikely to be thinking,
08:22damn, I wish I'd been a consultant for three more years.
08:26I regret traveling the world for that time,
08:27I regret exploring my other interests,
08:29and I really wish I'd just kind of gone
08:30into the world of work
08:31and put my head down and done the work.
08:33I don't think that is what I'd be thinking
08:36when I'm on my deathbed.
08:37And so those are the two kind of camps,
08:41the complete your training as soon as possible camp,
08:43and then the take your time completing your training
08:45because actually no one cares.
08:47Obviously, there's a spectrum
08:48and I'm very much towards
08:49the take your time completing training,
08:51enjoy life in the process.
08:53No one really cares, it's not a race,
08:54it's not a competition with other people, it's all good.
08:57So that is why I've decided to take this time out.
09:01The position that I'm in right now
09:02after two years of doing medicine in the UK,
09:04there's kind of a natural break
09:06whereby you then have to actively apply for a specialty
09:09and decide what you wanna do.
09:10So firstly, I don't really know what I wanna do yet,
09:12which is fine, people say.
09:13I'm strongly leaning towards emergency medicine.
09:15But having said that,
09:16I've never worked in emergency medicine before.
09:18All I know about it is what I've seen
09:20from being in the hospital generally,
09:22and what I've seen from,
09:24I've spoken to friends and colleagues
09:25who work in emergency medicine.
09:26And so one of my priorities for this year
09:28and moving forward is to try and get some experience
09:30in that, hence the idea of moving to Australia.
09:32But I don't really know,
09:33I don't really know what I wanna do.
09:35And my mom kind of talks to me about this some of the time.
09:37She says, you know,
09:38do you realise that you don't really have a direction
09:39in life?
09:40And I'm like, yeah, tell me about it.
09:41I don't have a direction in life.
09:42I don't know what I'm doing.
09:43But hey, it's fine, you know,
09:45just my view at the moment is that it's better for me
09:48to just generally try and keep my options open
09:50to just pursue the things that seem interesting
09:53in the moment,
09:53but that also have some kind of long-term benefit.
09:56So right now I'm thinking that this YouTube thing,
09:58you know, by the grace of God is going pretty well.
10:00While I'm here, I might as well take some time out
10:03to try and pour fuel on the fire,
10:05to try and diversify the streams of revenue,
10:06to try and get most of my eggs out of the YouTube basket,
10:09to focus on my blog, to make some more courses,
10:11to do these other things that will hopefully,
10:13A, be fun and enjoyable,
10:15because it is fun and just kind of cool.
10:16B, I can kind of travel the world while doing it,
10:18which is just kind of nice.
10:18And C, hopefully that'll be assets that compound over time
10:23that will set me up better for the future,
10:25rather than going straight into a training programme
10:28without necessarily knowing what I wanna do with my life.
10:30So that's kind of where we are right now.
10:32I just wanna talk a little bit
10:33about what it's been like these last few years,
10:35working these last two years, working as a doctor,
10:37and I'm gonna answer some questions
10:38from Instagram along the way.
10:39Reflections on your time studying and working in medicine.
10:41So we had lots of questions asking,
10:43what are the good and the bad parts about being a doctor?
10:45The good parts are that it's just generally quite fun,
10:48especially when there is stuff going on.
10:49I've had lots of days in my current placement
10:51of obstetrics and gynecology
10:52where I've had my patient list that is,
10:55and there is just enough stuff going on
10:57that I don't kind of get bored,
11:00that there's always something to do,
11:01but there's not so much that it feels kind of frazzling
11:04to try and sort of handle everything and juggle everything.
11:07And actually for me, I think,
11:08I'm the sort of person that I kind of quite like it
11:11when there are days where we've just got like,
11:13you know, 10 people that turn up at once,
11:15and then at that point it becomes a case of,
11:17okay, let's really prioritise,
11:19let's focus on triaging them
11:20and figuring out who needs scans first
11:21and figuring out what order I should do my stuff in
11:23to sort of minimise the amount of waiting time
11:26and all this, it's quite fun.
11:27So that's one of the nice aspects of it.
11:28Like when it's busy, I quite enjoy it.
11:32Another nice aspect is the teamwork.
11:32That's probably my favourite component.
11:34It's just really fun hanging out on the wards
11:35with other junior doctor colleagues and nurses
11:37and, you know, making friends with some of the senior doctors
11:39and kind of going for a coffee here and there
11:41and chatting over lunch to the other colleagues.
11:43And it's just a generally very nice, happy, chill,
11:46teamworky kind of vibe.
11:47On obstetrics, we've got the midwives
11:49who, you know, chat to here and there.
11:50On gynaecology, we've got lots of the nurses,
11:52who again, we chat to here and there when there's time.
11:54So the team working aspect is a really nice part of it.
11:56I also like the talking to patients side of things.
11:59One of the main reasons I did medicine
12:00was because I didn't want to be in a job
12:02that sat me behind a computer screen at all times.
12:04And there is a lot of sitting behind a computer screen
12:06as a junior doctor,
12:07because there's a lot of typing up you have to do
12:09and stuff like that.
12:10But then there is the aspect of actually talking to patients
12:12and it's just kind of cool,
12:13especially on, you know,
12:14being on obstetrics and gynaecology
12:15for the last eight months.
12:16The patients who are coming in
12:17are coming in with things like, you know,
12:20early pregnancy, bleeding,
12:21and potentially having a miscarriage,
12:23potentially having an ectopic pregnancy,
12:25which is like a big deal.
12:26A lot of gynaecological conditions as well,
12:27like pelvic infections or vulval cysts and abscesses
12:31and things like that.
12:32These are really difficult problems
12:33for patients to be dealing with, obviously.
12:35And it's a real privilege and joy in a way
12:40to be the person who's kind of helping them
12:42through that difficult time.
12:43And obviously kind of there's this whole,
12:45it's not an individual that is making any of the difference.
12:48It's the whole system, it's the whole team.
12:50But being part of that team feels quite nice.
12:53And especially on days where I feel like
12:56I have gone above and beyond.
12:58As a sort of junior doctor, as a foundation year doctor,
13:01it's not like a heroic going above and beyond.
13:03It's not like someone is bleeding to death in front of me
13:05and I've resuscitated them by myself.
13:07It's not really like that.
13:08It's more like, you know, we're approaching 5 p.m.
13:10The scanning department is already closed,
13:12but I know that there's two people in there
13:14who are still kind of wrapping up
13:15and I have good relationships with them.
13:17And I know this lady is gonna feel a lot better
13:19if we can get a scan to reassure her
13:20about whether her baby's all right or not.
13:22And therefore I will run to the scan department
13:24and be like, look, please, this lady, you know,
13:25she really needs a scan.
13:26I know it's out of hours, but please, can you do it?
13:28And then they'll be like, all right, then.
13:29And then that is the sort of stuff that makes me feel good
13:32because I feel like in that circumstance,
13:35I as an individual could actually make a difference,
13:37but like not in a way that I would have expected.
13:38I would have expected, you know,
13:40sweeping like Derek Shepard, Grey's Anatomy, whatever,
13:42save the day.
13:43But it's more about figuring out how the system works
13:45and then kind of twiddling the rules of the system
13:48such that you can occasionally bend rules for patients
13:52if you have that chance.
13:53So that's the kind of stuff
13:54that I feel a sense of fulfillment
13:56when I've had a day where I can do something like that.
13:58Or for example, if I've had a day
13:59where lots of women have come in
14:01with like early pregnancy bleeding or whatever,
14:02and I've got enough experience
14:04that I kind of know what's going on
14:06and I've kind of seen them, examined them,
14:08made a plan, arranged their scan,
14:10looked at the scan and sort of put a good picture together,
14:12which I can then present to the registrar or the consultant,
14:15the senior doctors and say, hey, look,
14:17this is what's going on.
14:18This is the deal with the patient.
14:19These are the blood results.
14:20This is the scan.
14:21This is what I think is going on.
14:22And this is what I think we should do.
14:24In the early days, I was always very hesitant
14:25about suggesting some kind of plan
14:27because I didn't really know what I was doing.
14:29But now, especially having done it for the last eight months,
14:31I'm now relatively comfortable with suggesting plans.
14:33And most of the time, the senior doctor is like,
14:35yeah, sounds good, go for it.
14:37And they appreciate the fact that I've suggested a plan
14:39and it's a reasonable plan.
14:40Occasionally, like happened last week
14:42and actually earlier today as well,
14:44I made a plan, which is I think we should bring this lady
14:45back for a serum HCG level next week.
14:47And the senior doctor was like,
14:50I don't think that's a good idea.
14:50I think instead we should not do that
14:52because the serum HCG is not gonna tell us anything.
14:54I think we should bring her back
14:56for a scan in two weeks time.
14:57I'm like, oh, okay, cool.
14:58Why is that?
14:59And then they say, okay, because of this, this and this.
15:00I'm like, oh, okay, that makes sense.
15:01Thank you for letting me know.
15:02And so I get a lot of fulfillment
15:05out of kind of packaging it up,
15:06figuring out and proposing a plan.
15:08But I also have to take basically none of the risk on myself
15:11because it's always the senior doctor
15:12who is kind of approving most of the decisions that I make.
15:16It's nice when you get into that flow state almost.
15:19And this is what everyone says
15:20about what brings fulfillment in anything that we do.
15:23And part of the reason why I love making YouTube videos
15:25and editing and kind of doing website stuff
15:27is it really gets me into this flow state
15:29where it's just me and the task at hand.
15:31And I kind of lose track of the time.
15:33And so sometimes when I'm getting into the flow state
15:35with conditions that I'm familiar enough with
15:37that I know what's going on, that feels kind of nice.
15:40So there's sort of the good aspect of medicine.
15:41People asking about what are the bad things.
15:43So, I mean, there's the bad things
15:45that are associated with having any kind of full-time job,
15:47which is that you become a slave to your roto almost.
15:50And if I wanna take time off,
15:51I have to negotiate it with the roto coordinator.
15:53I have to figure out no one else is off sick that day
15:56or no one else has got annual leave.
15:57Because obviously we always have to have
15:59a certain number of doctors on at any given time.
16:01And so in a way, it becomes our responsibility
16:02to manage the roto and figure out,
16:05okay, on the 21st of August,
16:07there are three people on the wards and we only need two.
16:10So I can take annual leave that day and stuff like that.
16:12And especially with the whole coronavirus thing,
16:14when we switched to an emergency roto,
16:16that became quite tricky
16:16because suddenly we needed three doctors on
16:18at any given day.
16:19And there are only four of us in the whole,
16:21essentially on the placement
16:22in terms of the senior house offices.
16:24And so we all had a real issue with getting annual leave
16:27and kind of getting time off when we wanted it.
16:29So that's just kind of a general aspect
16:31of having any kind of full-time job.
16:32The other things that I don't like about it,
16:34I mean, there's a lot more admin and logistical paperwork
16:37than I would have guessed.
16:39A lot of the time, I'd say maybe kind of 10% of my time
16:43is spent actually seeing a patient
16:45and 90% of the time is spent typing notes
16:47up on the computer, arranging a scan,
16:50labeling the bloods, handwriting some blood labels
16:52because they have to be handwritten,
16:53sending that down to the lab,
16:54trying to find my senior doctors who are in theater
16:57because they're busy with an emergency
16:58and being like, okay, you know,
16:59I've got this list of eight things to ask them.
17:01What order should I do it in?
17:02A huge chunk of it is logistical
17:03rather than patient sort of sitting in front of a patient
17:06and patient focused.
17:07And obviously all those logistics are really important
17:09because it's the system that cures the patient.
17:11It's not the individual,
17:13but still it's a somewhat frustrating part of it
17:15where I'm like, yeah, I've just taken some blood
17:18and this is fun.
17:18And I'm like, oh, well now I have to spend 10 minutes
17:20printing the blood labels and oh, the printer's not working.
17:22Okay, cool.
17:23Got to go around, find another printer
17:24or oh, they're not registered on the system yet.
17:25Therefore I have to go to another computer and log in.
17:27And it's those inefficiencies within the system
17:31that are one of the annoying things about it.
17:33But hey, it's just something that you gotta do.
17:35The other bad thing that I, well,
17:37somewhat bad thing is like when I make a mistake
17:40and I know that I've made a mistake.
17:42This has happened a few times, like in the last few months
17:46on each of my placements,
17:47I've made certain kind of classes of mistake.
17:50Thankfully, very few times sort of actual harm.
17:53So like something really bad has happened to a patient.
17:55On obstetrics and gynecology,
17:56it's one of those things where often a lady will come in
17:58with early pregnancy bleeding and a little bit of pain.
18:01One of the things that that could be is an ectopic pregnancy
18:03and an ectopic pregnancy is a pregnancy
18:05that's not growing in the womb.
18:06It's growing in one of the fallopian tubes or usually.
18:09The problem with an ectopic pregnancy
18:10is that if it grows to a certain size, it can burst.
18:13And then the lady bleeds into her abdomen and pelvis
18:15and that can be life-threatening.
18:16But the problem is that most of these ladies
18:18are young, fit and healthy.
18:19And so if they do have an ectopic pregnancy
18:21and they are bleeding into the pelvis,
18:22you might not know it from just looking at them
18:24because all of their vitals are stable.
18:27Their heart rate is fine.
18:27Their blood pressure is fine.
18:28They don't look particularly unwell
18:29because they're young and fit and healthy.
18:31So they can compensate for that problem
18:33because their body does a good job of compensating for it.
18:35And they will sort of drop off the cliff very quickly.
18:38And so especially seeing someone at nighttime
18:40where we don't have a scan available until the next morning
18:42and they look completely fine
18:44and their observations, their vital signs
18:46are completely fine
18:47and their blood tests are completely fine.
18:48They could still have an ectopic pregnancy.
18:50And so it's always scary sending these people home
18:53for the scan the following day,
18:54because most of the time the scan shows
18:56it's either an ectopic pregnancy or most likely it isn't.
18:58But very occasionally,
18:59they will rupture that ectopic pregnancy overnight
19:01and there'll be rushed into theater
19:02in the morning via ambulance.
19:03Then you find out in the morning,
19:04oh, we've got an ectopic pregnancy in theater.
19:06It was a ruptured ectopic.
19:07And at least for me, I have that sinking feeling.
19:09I was like, oh God, is this a lady that I saw yesterday?
19:11Is this a lady that I sent home
19:12because I thought it was fine?
19:14Is there anything I could have done differently
19:15to prevent this life-threatening emergency?
19:17The risk-taking aspect of it is,
19:20I wouldn't say it's a bad part,
19:21but it's obviously not a nice feeling
19:23when you have that kind of sinking in the stomach.
19:25You're like, oh crap.
19:27Is this someone that I sent home
19:28that I shouldn't have sent home?
19:29Is there anything I could have done differently?
19:30And you find your mind warring through the possibilities
19:31and thinking, no,
19:32like even knowing that it's a ruptured ectopic,
19:34the picture that I got last night
19:37would not have made me act any differently, which is fine.
19:39Or it's a case of discussing it with a senior
19:41and thinking, okay,
19:42is there another sign I should be on the lookout for?
19:44So the nice thing, again, about medicine
19:45is that it's a very kind of learning experience,
19:48and especially when you're a young
19:49and junior doctor and stuff.
19:50And even as you get older
19:51and progress through the training,
19:52there isn't really a culture of the blame game
19:54that, oh, it's your fault that the patient,
19:56something bad happened to the patient.
19:57It's more like thinking, okay, why did that happen?
19:59What can we learn from it?
20:00And what can we do to avoid doing it next time?
20:02People ask expectations versus reality.
20:04Honestly, I think the main expectation
20:05versus reality issue was the fact of
20:08just there being just a large amount of logistical admin
20:11having to deal with,
20:12and that's the stuff that medical school
20:13does absolutely not prepare you for.
20:15The other thing as well is that I kind of thought
20:17it would be more a case of having to think
20:19and having to do like Dr. House
20:22and diagnosing people magically and stuff.
20:24This is the idea that I had before going into med school,
20:26but actually so much of it is based on guidelines
20:29and sound principles.
20:30And by the time you've seen
20:31early pregnancy bleeding a few times,
20:33for 95% of the cases,
20:34they fall neatly into one of the guidelines.
20:36And so you don't really have to think
20:37when managing them.
20:38It's only in the 5% of edge cases
20:40that you need to think a little bit harder
20:41or ask a senior and be like,
20:42hey, this is a bit weird.
20:43This is not what we're expecting.
20:45But the whole research and stuff within medicine
20:47has gotten to a point where,
20:48like me and a lot of my colleagues feel that
20:50we're not really doing a lot of thinking on the job.
20:52We're just plugging numbers into a guideline,
20:54plugging numbers into a scoring system,
20:55and then it's telling us what to do,
20:58which is exactly how evidence-based medicine should be.
20:59Like it should not,
21:00like a well-designed system
21:02should absolutely not be based on
21:04the competence of individuals.
21:05It should be based on
21:06the kind of tightness of the system as a whole.
21:08But that's just an aspect of it
21:10that I didn't really appreciate
21:11before I started doing it.
21:12Got a question here about regrets.
21:13What are your regrets in the last two years?
21:15Regret, I don't think I have any real regrets.
21:18There've been a few cases where I've done something
21:20which I shouldn't have done
21:21for not knowing any better
21:22or because I was blindsided by detail
21:23or various reasons where harm,
21:26in certain ways, harm came to a patient.
21:28Like obviously I'd rather those things
21:30wouldn't have happened,
21:32but also they were part of the learning experience.
21:34And essentially it's impossible
21:36for all the patients to be seen
21:37by the most senior consultant every time, right?
21:39And the system is designed for training,
21:41like it's a training system.
21:42Inevitably, when you have any kind of training system,
21:44you are gonna get mistakes happening
21:46because that's just what happens
21:47when you're training people
21:48and when juniors are seeing patients.
21:50And it's a necessary part
21:52of building a healthcare system
21:53because you need some way of training up the juniors,
21:55but it does inevitably mean
21:57that some people are gonna get shortchanged.
21:58That's something that's hard to come to terms with.
22:00I think in Paul Calanthini,
22:02whatever his name is, his book,
22:03When Breath Becomes Air,
22:04he talks about this idea of kind of
22:07whether the operation is being done by a junior
22:09or being done by a senior.
22:10Because we all kind of know
22:11that sometimes less experienced people
22:13have to do the operation
22:14because if they don't,
22:16then they'll never get the experience needed
22:17to actually become competent.
22:18But we also know that if a less experienced person
22:20is doing the operation,
22:21there is a slightly increased risk
22:23that harm is gonna come to the patient
22:24because it's a less experienced person doing it.
22:26And we can mitigate against that by supervision
22:28and sort of making sure a senior is with them
22:30at all times and stuff.
22:31But inevitably when you have less experienced people
22:34doing stuff, you're gonna get mistakes happening.
22:34And that's tricky, right?
22:35Because let's say, you know,
22:37I'm a doctor in the system.
22:38I understand what's going on.
22:40If my mom needed surgery,
22:41I would appreciate that the registrar,
22:43that the junior doctor needs training in the operation,
22:46but I would still want that operation
22:47to be done by a consultant
22:48because this is my mom we're talking about.
22:49But that only works on the individual level.
22:51Like that is not the sort of thing
22:53that is really feasible with the entire system
22:56because it's not feasible for every single operation
22:58to be done by the most experienced consultant.
23:00So that's a tricky part of it.
23:01And so like when it comes to regrets,
23:03yeah, I've made a few mistakes that I wish I hadn't made,
23:06but I know that making those mistakes
23:07as part of the learning process,
23:08I know that mistakes across the system are inevitable.
23:11And so it's hard for me to say that it's a regret as such,
23:15just because that is kind of how the system works.
23:17We learn from making mistakes.
23:19And unfortunately, in the field of healthcare,
23:21sometimes when people make mistakes,
23:22you know, harm is gonna come to a patient
23:24in one way or another.
23:24And I don't really think there's any real way
23:26of avoiding that other than doing what we can
23:28to mitigate against the risks.
23:30Most rewarding moments.
23:31We have a question.
23:31What are the most rewarding moments?
23:33I think it's those times when a patient says, thank you.
23:35And I feel like I've had some kind of personal input
23:37into their care in a way that I haven't with other patients.
23:39Because again, this comes back to how it's the system
23:41that saves the patient rather than the individual.
23:43Like most of the time, the patients who are on my ward
23:46and are leaving and saying, thank you everyone.
23:47It's been a pleasure, you know, take care, blah, blah, blah.
23:49I don't really feel anything specific for those patients
23:52because I don't know them that well.
23:53I maybe saw them once or twice.
23:55I probably wasn't the person who saw them
23:56when they first came in.
23:57I probably wasn't the person who assisted
23:58during their operation
24:00just because it's, you know, the other people
24:01in the system that are doing those bits.
24:02And so when they say goodbye, thank you,
24:04you've really helped me or give a thank you card and stuff,
24:06it doesn't feel that personally rewarding.
24:08But when it comes to patients who, for example,
24:10if I was the first one to see them
24:12when they came into the emergency department
24:13and I was the one who said that they should be admitted
24:15into hospital and, you know,
24:16arranged the logistics of their operation
24:18and then potentially even assisted in their operation.
24:21And then they go to a recovery,
24:22then that feels a lot nicer because it feels like,
24:24oh, you know, I feel like I know the patient.
24:26I know this lady, I know what the story is.
24:28And I feel like, yeah, you know, this is a good day's work.
24:30So that's probably kind of the rewarding aspect of it.
24:33It's also like annoyingly rewarding
24:35to get praise from seniors.
24:37And I never thought I'd be that guy because,
24:39but like, you know, a few weeks ago,
24:41I got a compliment from one of the consultants
24:43and then a couple of weeks ago,
24:44I got a compliment from one of the registrars,
24:46one of the other seniors.
24:46And it just feels really nice when like a senior doctor
24:50or one of the nurses like acknowledge
24:52that you're good at your job
24:53and that you did something right
24:55and that you did something well.
24:56It'd be like, you know, even on our medic bleep,
24:59essentially kind of secure WhatsApp type system.
25:00Occasionally I'll kind of write a long thing
25:02and suggest a plan and the response will be,
25:04oh, that's a great idea, thanks.
25:06Feel free to send me a sort of feedback request or something.
25:08And that's the doctor saying that,
25:09oh, wow, you've done a good job.
25:10I'm happy to write up something for your portfolio.
25:12It's just kind of comments like that,
25:14that just feel like disproportionately good.
25:16It's kind of annoying, right?
25:17Because I certainly don't want my own self-esteem
25:20and my own self-worth to be tied
25:21to what other people think of me
25:22because that's not a good way to live life.
25:24And yet when a senior compliments you,
25:26there's just something nice about it.
25:27So that's another kind of really rewarding part of it
25:29that I wouldn't have expected.
25:30And that kind of makes me think
25:31that like when I'm a senior doctor,
25:33I want to be the sort of person
25:35who compliments people on doing a good job
25:37because I know how much of a difference it can make.
25:39And like, you know, there were a few doctors on my team
25:41who are sort of a less,
25:43like you'd like present a case to them
25:45and they would give you the answer
25:46and you might've done the right things,
25:47but they wouldn't even give you a well done.
25:48That's the right answer.
25:49They would just be like, cool, yeah, go for it.
25:50And it just feels less nice working for those people,
25:53even though they're just as good
25:54and you know, they help you learn and stuff.
25:56But just a little compliment goes a long way.
25:57And that's something that I will definitely keep in mind.
26:01And I remember when I was a medical student as well,
26:02like anytime a doctor were to go out of their way
26:05to help me learn something,
26:06I'd feel like, oh, wow, this is amazing.
26:07And it takes so little effort for like a doctor like me
26:11to take an interest in the medical students
26:12and be like, hey, what's going on?
26:13Do you want to help with this?
26:14It's so little effort on my part,
26:15but it makes such a big difference to their day.
26:17And so it's the sort of thing that I really want to keep up
26:19as I go through training and become more senior.
26:21And I don't want to forget what it feels like
26:23to be complimented.
26:24If that makes sense.
26:25We've got a few questions as well
26:26about kind of what you've learned
26:27since starting the channel and your side businesses.
26:29And I'm going to sort of try and relate that
26:30to medicine in a way,
26:31but this is stuff that I've talked about at length before,
26:34you know, this idea that I think like for me personally,
26:37I don't want to live a life where my full-time job,
26:41the thing that I do for a living is kind of making a living.
26:44Like I don't want my job to be the thing
26:46that I need to actively do to make money.
26:48I want to have the option to do what I want.
26:50And obviously money is a part of that
26:51because we all need some amount of money to live.
26:53And for most of us,
26:54that amount of money is directly coupled
26:56to the thing that we spend our time doing.
26:58And I've long thought that I don't want that
27:00to be the case for me.
27:01I want to have a job like, you know,
27:03I want to stay in medicine because medicine's fun,
27:05but I don't want to have to stay in medicine
27:07because I need to pay the bills.
27:09And so over the last couple of years,
27:10as the YouTube channel has really taken off,
27:12thank you everyone who watches these videos,
27:13especially if you're watching this far,
27:15as the YouTube channel has taken off,
27:16as I started making more courses and classes on Skillshare
27:18and affiliate products
27:19and these different streams of income,
27:21I feel I've gotten to a point where
27:23I really don't need to rely on medicine to make money.
27:27And that feels like a really good position
27:28because it means that now when I'm doing medicine,
27:30I'm doing it for fun rather than because I have to.
27:34And again, you know, this isn't like a dichotomy thing.
27:36It's obviously like a spectrum.
27:38There are some people who absolutely love it
27:39and do it for fun.
27:40And it also happens to make money,
27:41which is absolutely fantastic.
27:43But for me, like I think if given the choice,
27:46the way that I've spent the last two years
27:47is not how I would choose to spend the rest of my life.
27:50Like I would not actively choose
27:51that on average five days a week
27:53and for 48 hours a week,
27:54I'm gonna drive an hour to work,
27:56drive an hour back and spend time in a hospital.
27:58I don't think that's the way,
27:59like if I could design my lifestyle and my life from scratch,
28:02that's not what I would actively choose to do with it.
28:04I think what I would choose is that two or three days a week
28:07I'd wanna do medicine cause it's fun,
28:08but I wouldn't wanna do it much more than that.
28:10At least that's what I'm currently thinking.
28:11You know, obviously this is subject to change.
28:13We all change our mind at various different times.
28:14I've changed my mind and what sort of specialty
28:16I want to do a hundred different times is fine.
28:18We don't need to have all the answers.
28:19And we've got a question kind of,
28:20what are your worries, concerns
28:21about the next year slash future?
28:23Yeah, all right.
28:23Let's, I mean, shed my worries to the camera.
28:26So what am I worried about?
28:28Worry is a strong word, right?
28:29Because I tend not to worry about things in general,
28:31but I have some level of concern about the following.
28:33So firstly, you know, as I mentioned,
28:35I'm kind of worried that I'll wake up in the mornings
28:37and not really know what to do with myself.
28:39I'm kind of worried that when I do decide
28:41to go into a specialty, I actually won't like it.
28:43And I'd wanna leave the specialty.
28:45And I'm worried about, you know,
28:47if that happens in the future,
28:48to what extent that is just a function of the specialty.
28:50Maybe it just didn't gel with me, the specific specialty.
28:53But I think more likely, if it comes to that position,
28:55it's more a case of, I'm not doing enough
28:57to enjoy this thing.
28:58Because I think that a lot of the time,
29:00we are the ones who can choose to enjoy
29:02the things that we're doing.
29:03Like I could study for my exams,
29:05absolutely hating every minute of it.
29:06Or I could choose to study for my exams,
29:08enjoying the subject and enjoying learning new stuff.
29:10And it's just that mindset shift
29:11that really makes a big difference
29:13between hating your life and loving your life.
29:14And I'm worried that if I end up not enjoying medicine,
29:17it won't be because of the medicine itself.
29:18It'll be because I am choosing not to enjoy it.
29:21And I'm kind of worried that because,
29:22in a way, because I've got the option to not do it,
29:24that I will choose to exercise that option
29:26and that I'll end up quitting medicine completely.
29:28I can't see it happening, but I, you know,
29:30in the back of my mind, it's that question of,
29:32well, I kind of decided I wanted to be a doctor
29:34when I was 16.
29:35What did I know about it?
29:36Absolutely nothing.
29:36You know, is this really the right thing for me?
29:38If I had my time again when I do medicine,
29:39absolutely, in a heartbeat.
29:40But I think that is building towards this idea
29:43of working part-time as a doctor
29:44rather than working full-time as a doctor.
29:46So that's another thing that I worry about.
29:47The other thing I worry about is that,
29:48well, you know, people are only following me on YouTube
29:50because I'm a doctor and I went to Cambridge and stuff.
29:52And, you know, what value are my productivity tips
29:54or study tips if I'm not walking the talk,
29:57I think is the phrase.
29:58And so I'm, and some, and I'm also kind of worried
30:01that if I choose to make the decision
30:02to not do medicine at all,
30:04because I found something else to do,
30:05then to what extent am I hamstringing
30:07my other streams of income?
30:09Because in a way, I feel like I have the security blanket
30:11of multiple streams of income,
30:12why this YouTube channel and other things,
30:14to not have to do medicine.
30:15But if I wasn't a doctor,
30:16would my YouTube channel be as successful?
30:17Probably not.
30:18If I didn't have the Cambridge thing behind me,
30:19would it have got momentum initially?
30:21Possibly not.
30:22You know, if I'm not a doctor working full-time
30:24and I'm making videos about productivity,
30:26do they have as much value?
30:27Possibly not.
30:28It's all these kinds of things.
30:29And so what I, what I worry about is that
30:30if I do decide to leave medicine,
30:32suddenly everything else unravels as well,
30:34because all of it was somehow tied to this fact
30:37that I'm a doctor and that was the thing
30:38that ties everything together.
30:40And again, like, I can't see myself leaving.
30:41I can see myself going very part-time,
30:43but that's another thing I worry about.
30:45The other thing I worry about now is even now,
30:46kind of with the size of this YouTube channel
30:48and the streams of income, lol,
30:50it still feels like a house of cards
30:51that could come crumbling down at any moment.
30:53And I still kind of feel a sense of every time
30:55we put out a video and it does badly on the analytics,
30:57I think, oh, you know, it's the beginning of the end now.
30:59People have realised that I'm a fraud
31:00and my YouTube channel's not worth anything
31:02and it's going to unravel.
31:03And it's a, it's a nice problem to have,
31:07but it's still a, it's sort of a,
31:09an existential sort of thing of,
31:11is this business really going to survive?
31:13And kind of from reading stuff
31:15that people have written online
31:15about what it's like to run a startup,
31:17to have your own business,
31:18the stresses of running your own business
31:19are the existential stresses,
31:21the worries of, okay,
31:22is our business going to be alive two years from now?
31:24The stresses of having a normal job is like,
31:26what does my boss say, think of me,
31:27and am I going to get that promotion?
31:29So it's, it's a different sort of stress,
31:31kind of doing this sort of entrepreneur,
31:32self-employed business lifestyle type thing
31:34that I'm dabbling with.
31:35That's kind of what it feels like on the inside.
31:38And so every time we do get a video
31:39that doesn't perform well,
31:40maybe this is going to be one of those,
31:41but it's just like a case of having to do
31:43a lot of mental shenanigans to think,
31:45no, you know, my self-worth is not tied to the analytics.
31:49And just because a video performed,
31:50it didn't perform very well,
31:51it doesn't mean it didn't resonate with people.
31:53And you know, 50,000 people watched that video.
31:54That's still quite a lot of people.
31:55Maybe it's not 500,000,
31:56but 50,000 is still a hell of a lot of people.
31:58And they've written comments saying this video helped them.
32:00And you know, all of these mental shenanigans
32:03that I have to do to not feel bad
32:04about the fact that videos are performing less well.
32:06So those are the sort of worries
32:07that go through my mind about this year and the future.
32:10Yeah, I just kind of wanted to end
32:11by thanking everyone who has followed the journey
32:13over the last three years.
32:15I think it was June, 2017
32:16that I first started this YouTube channel.
32:18And obviously when I started it,
32:19I had absolutely no idea what level it would get to.
32:21And you know, every day when I kind of look at the stats
32:25and see the comments from people
32:26and get the DMs on Instagram and stuff,
32:27I almost can't believe that it's real.
32:29And I think that's partly where the fear comes from,
32:32that all of this could come crumbling down at any moment.
32:34But I want to extend a huge heartfelt,
32:37for whatever that's worth,
32:37thank you to everyone who's watching this,
32:39especially if you've watched this far, watched my ramble.
32:41Those were just some general reflections.
32:43And thank you so much for watching.
32:44If you liked this video,
32:45smash that like button for the YouTube algorithm,
32:47as they say.
32:48Although apparently these days,
32:49the YouTube algorithm doesn't even take likes into account,
32:51but hey, smash that like button anyway.
32:53Do please leave a comment down below.
32:54I'd love to have a chat with people
32:56to see what you think about the journey.
32:57You know, where are you on your journey?
32:58What is it like?
33:01What kind of decisions, kind of crossroads are you at?
33:04I'll be curious to hear your guys' views on the topic.
33:08So thank you very much for watching.
33:10I'm going to get a drink of water
33:10because I can't speak anymore.
33:11And I'll see you in the next video.
33:12Bye-bye.