What's life like as a junior doctor and what do current trainees wish they had known when they started?
By ITV News Content Producer Alex Binley
Thousands of junior doctors entered the NHS on Wednesday, and while first-day jitters at work are common for all, most people's jobs don't involve having someone else's life in your hands.
The day has previously earned the controversial nickname "Black Wednesday" in some sections of the media with reports implying an increased threat to health from the new intake, though this is dismissed by the British Medical Association and the British Medical Journal.
Nor are all junior doctors lacking experience.
In fact, it is the catch-all term for any doctor who is not yet a consultant or a qualified GP but who are also placed in new roles in early August.
So what is life as a junior doctor like on the first day, what do current trainees wish they had known before they started, and what are some of the more embarrassing - but thankfully not life threatening - mistakes they've made?
What is a day in the life of a junior doctor actually like?
A junior doctor in Wales who has just finished her first year of training to be an ear, nose and throat (ENT) surgeon explains what a day in the life of a Senior House Officer - a non-consultant or registrar hospital doctor who has completed their foundation years - on a surgical ward is like, from arriving at work early, to acting like a "guide dog".
6.40am - My alarm goes off, I want to kill myself.
7.15am - Leave home and head to work.
7.40am - I arrive at work. I don't officially start until 8am, but every single surgical job expects you to be in early to prepare list of patients and put out metaphorical fires before the ward round begins.
8am - I begin the ward round (seeing the patients on the ward and updating them on their care and assessing them) with a registrar. My job on the ward round is basically to be a guide dog to the registrar, guiding them around the hospital to see the most sick patients first.
8.15am - The registrar gives up on the ward round
8.15am-9am - I see the rest of the patients by myself. Most of them are healthy post-operation and can go home.
9am-10am - I write up discharge summaries for the patients I saw and sent home.
10am-12pm - I see patients in the emergency treatment room. These are patients that have been booked into a nurse-led clinic that the nurse needs help with. For example, a prescription needs to be written or they have some sort of worrying symptom that needs exploring by a doctor. I saw a patient with an outer ear infection and cleaned his ear out, put a wick in and gave him some antibiotics. I saw a lady with sudden hearing loss that I sent for a hearing test and gave some steroids to.
12pm-12.30pm - Lunch
12.30pm - I get called to resuscitation for a patient who is bleeding after having their tonsils taken out. A&E are particularly resistant to helping me as the patient is expected to go to the Ear, Nose and Throat ward.
1pm-2pm - I go into the theatre with the registrar and we try to stop the bleeding.
2pm-3.30pm - I carry out ward jobs like blood tests, write more discharge summaries, write referral letters to other specialties, and chase scan reports.
3.20pm-5pm - I go into the office and try to clear a backlog of discharge summaries from the past year, as well as doing some auditing.
While the day sounds intense, it is unlikely that a junior doctor's first day fresh out of medical school will carry this much responsibility.
Instead, on their first day, and each time they rotate into a new specialty, junior doctors are supposed to receive an induction.
"Rarely are inductions useful"
A junior doctor training to be a GP in Manchester, but who has just completed a stint in psychiatry recalls the different ways this has been interpreted during her four years working for the NHS.
"I have been to two-hour inductions which don't tell you much of the job, it's more of a 'hi, here's loads of paperwork for you to do', but I have also done three-day inductions which have you falling asleep in fire safety and information governance talks, which you've heard or done online a thousand times before," the doctor told ITV News.
"Rarely are inductions useful. Rarely do they tell you what your job role is in that particular job.
"What you want to know is where to be and when, how to use the computer systems, where the jobs list is kept, where to find request forms and how to contact your senior!
"The best induction tends to be when you meet someone already in the role or bump into someone who has done the job and can give you the inside tips."
Emma Coombe, a paediatric registrar in Somerset, warns trainees it will be a "very, very steep learning curve" and that they should prepare themselves for it.
She urges them to "ask lots of questions ... even if you think they're stupid questions".
"At first I was scared of annoying more senior colleagues, but medical school can't prepare you for everything."
So what do the junior doctors wished they'd asked now?
Ella Mi, a general surgery trainee in central London, said that when she first started as a junior doctor she thought she could only answer calls on a hospital phone and so "would often walk a long way to get to a phone".
She explained: "I later realised that there’s an app (Induction) which allows you to dial the number that bleeped you so you can take the call on your mobile – it meant a lot more uninterrupted lunch breaks!"
Another valuable lesson Dr Mi learnt came to the clothing.
"I eventually found out that there’s a machine which dispenses scrubs which you need to get access to with your card.
"I didn’t want to ask anyone in surgery as I thought it would look stupid so ended up asking a colleague in the intensive care unit!"
After almost a year in her job, the doctor from Wales learnt that she did not need to climb four flights of stairs to get to the toilets.
"It turned out there was one at the end of our corridor that we can all use, but unhelpfully it was labelled 'men's rest area'."
And it took several months into another post before her morning battle over parking eased.
"In my first job I arrived an hour early every day to get a parking spot because the car park was so busy.
"Three months in someone told me about an overflow car park that changed my life."
It seems sharing information is the key to getting new staff bedded in - and it works both ways.
The doctor from Manchester told ITV News: "At the end of my last job, after four months in it, I told my colleague that he could search for blood test results using a surname rather than a patient's NHS number because sometimes the results won't show on the system with an NHS number.
"It turns out he'd spent hours on the phone to the lab over the course of the placement asking for test results when all he needed to do was change the search parameters!"
When it comes to the life-saving part though, the doctors are confident that medical school is very good at preparing you to notice warning signs.
Harrison Carter, who has just finished his first year as a junior doctor, told ITV News he'd recommend to newcomers: "You've done lots of training at medical school to try and equip you for this."
He would also urge the new intake to "act on your gut instincts and if you feel something is not right, don't dismiss that feeling".
The ENT trainee though, adds that the reality of the first few years is "you use very little of your knowledge of human anatomy or physiology" on the ward.
"Instead you become the local expert on how to kick the printer in the perfect spot to make it start working again or how to successfully request a catheter from the secret room at the back of radiology."
She urges trainees to be prepared to adapt to the past.
"The NHS also uses 1980s technology - you need to learn how to use a fax machine and relinquish your phone to be replaced by a beeping plastic box that is cumbersome, often breaks and requires endless tape to hold it together."
And finally: "NHS England does not provide stationary and your pen is more valuable than gold."
So how do they cope with the stresses of the job?
The ENT doctor also offers tips for coping in such a stressful environment.
"We are all overworked. When a ward clerk snaps at you, make them a cup of tea. It helps to have as many people on your side as possible, and it is simply not your fault when people are stressed and consequently in a bad mood.
"You will feel like people are blaming you for failures that are much bigger than you and well beyond your control, remember that all you can do is keep doing what you're doing, do it well (carefully), keep smiling and document EVERYTHING."
A trainee in the north east who is one year away from qualifying as a GP says she would advise her new doctors to make time to unwind after a shift so that they don't take the stresses of an intense job home with them.
"Make sure you make time for yourself," the 28-year-old advises.
"You need to de-stress and detach yourself from your day when you go home - you can't spend all your time worrying about a patient.
"You need to be able to go home and find a way to relax, whether that be through sport, or reading, or any hobby."
Dr Coombe agrees.
"Make sure you look after yourself. You can't do everything yourself.
"Make sure you take breaks as you can't make good clinical decisions when you're exhausted.
"I've seen so many junior doctors take time off for stress or burnout, or have their hours reduced."
What keeps junior doctors doing the job?
The 28-year-old doctor from Wales sums up the motivating factor which kept her in the profession after such a tough start.
"As a junior doctor you will not be paid well, but that doesn't mean you won't be rewarded," she explained.
"Roughly every six months you will have a 'that's why' moment.
"For example in my very first year I had a patient with dementia who had undergone major surgery and was very unwell.
"She thought I was her granddaughter, and I held her hand when she died.
"She said it meant the world to her to have me (her granddaughter) with her and she was ready to go because she knew I was happy.
"Her granddaughter had moved to Australia and hadn't seen her for seven years.
"It is a privilege to be able to take care of other people's relatives and it reminds you how lucky we are to have NHS staff doing that for our own relatives wherever they are in the UK."