The World Health Organization defines health as ‘a state of complete physical, mental and social well-being’.[1] Often in medicine we consider physical well-being, but neglect the mental and social aspects of health. We can think of house jobs in the same way and fail to consider the emotional, social and spiritual challenges that we will face.

Many difficulties confront us as house officers: we may have had better training than our predecessors in communication and a broader education, but we often start work with less clinical experience. Our rota may require us to work unsociable hours in an irregular pattern. Supervision of our work may sometimes be lacking. Our network of Christian contacts, instrumental in strengthening our faith during medical school, may seem to vanish overnight.

We have to confront problems in the NHS, and cope with the challenge of a career commonly associated with higher than average rates of divorce, suicide and alcoholism. Is it surprising that whilst over 300 students attend CMF’s national student conference, the equivalent conference for junior doctors only draws eighty or so?

Almost everyone survives medically during house jobs, learning a great deal. However, many suffer spiritually. We must aim to thrive as believers, not simply survive. From my recent experience of house jobs, here are some thoughts and ideas to enable you to thrive wherever God should place you.

Choose your job wisely

Location is important. A hospital near to where you studied will enable you to stay at the same church, perhaps live in the same accommodation and be near to friends; all of this will make the transition from medical student life to being a doctor easier. Others may want a complete change and choose to move to the other end of the country. The ‘clean slate’ offered by moving may benefit some, but is not without its costs.

Consider the type of hospital in which you will work. A large teaching hospital will bring academic activity and patients with rare conditions. It will also usually be busier than somewhere smaller, making it difficult to take advantage of the opportunities on offer. In some specialities a small career advantage may be gained by taking a teaching hospital job, but this is becoming less important. District General Hospitals (DGHs) often provide a friendlier atmosphere and quieter pace of life, but there may be fewer doctors, leading to a busier on-call rota and less comprehensive senior cover.

The General Medical Council (GMC) proposes to implement its ‘Modernising Medical Careers’ scheme in the UK during 2005. With this, house jobs will take two years to complete instead of one, but there should be more choice and variety than the soon-to-be replaced six month medicine and surgery posts. New schemes will probably allow early exposure not only to these areas, but also to general practice, academic medicine and other specialties. Choose specialties that you have enjoyed as a student, and if you have a clear career goal, consider your choice in that light.

Investigate the on-call rota for a given job before applying. Many house jobs are now organised on a shift system rather than an on-call system, which will lead to working fewer hours, but may be more disruptive to leading a life outside medicine. On-call rotas are simpler for swapping duties to fit in other activities, but may mean more hours in total, and often include covering the on-calls of colleagues on annual leave, which can increase hours markedly.

Consider where you will live before you start work. As a house officer you will be entitled to free accommodation on site (the only cost being loss of London weighting if you work within London). This is convenient, but is sometimes of poor quality: bed bugs infested the rooms at one trust where I worked, which will remain nameless(!) and may lead to a feeling of being trapped in the hospital. Living out allows more freedom from medical life, but can lead to long journeys to work - not ideal at the end of a long on-call.

So, you have a job, and the first week of August has arrived. How will you cope? Here are some biblical pointers.

Stay close to God

Maintain your devotional life

The author of Psalm 1 seeks his delight in God’s law, rather than the counsel of those around him.[2] It is easy as a house officer to draw values from those around you, even though these are the values of this world, not those of heaven. Maintenance of our devotional life is essential if we are to know and follow the Lord’s way.

Don’t neglect some formal Bible study and reading of Christian books. If you are living somewhere new, you may have more time for this than you did as a student. Even when busy, there are spare moments of time to be with the Lord, but patterns may have to change from those of student life. Some time with God is possible during even the busiest day. There are many opportunities for brief one-off prayers as we wait for a bleep to be answered, or as we walk down a long corridor. A pocket size Bible allows you to read at any spare moment. There are times of the day when you will rarely get bleeped (such as nursing handover periods). Take advantage of these so that you can give time to God.

Time spent travelling should be used. I sometimes prayed through my list of patients whilst commuting, which was both effective for them, and also a good way of reminding myself which patient was in which bed, and what was wrong with them!

Maintain Christian fellowship

The writer of Hebrews exhorts readers to continue to meet together to encourage one another.[3] Many of us will have been richly blessed with Christian fellowship as students, much of which may suddenly disappear when starting work (especially if moving to a new area). It is important to seek out believers quickly.

Finding a church is important. Look for one that mirrors the early church - meeting for teaching, fellowship and prayer.[4] If you are only in a town for six months, find a church quickly and stay there. Primarily you need teaching and fellowship, so don’t worry too much about denominational issues. Your involvement in church may alter; if you have been involved with groups on several nights of the week as a student you may have to do less. Conversely if you were heavily involved in CU and CMF activities as a student, with much less dependence on church, you will need to increase your church involvement.

CMF can also help! There is a pastoral care scheme that links junior doctors to a local CMF member who can provide fellowship, friendship and maybe recommend a church. A junior doctors’ conference is run each autumn, and there are junior doctors’ ‘open house’ groups operating in an increasing number of cities (listed on the back of CMF News). If there isn’t one near you, why not start one? There is a starter pack available from the CMF office. The most successful groups have started when enthusiastic final years carried on meeting after graduating. Encouraging other Christian colleagues is rewarding. I had a long conversation at a party with an SHO, who turned out to have previously been a very active Christian, but had fallen away somewhat. She was very encouraged to hear that it was possible to keep up Christian activity and faith whilst working, and seemed much more willing to continue with the Lord after we had spoken.

Keep in touch with some non-medical Christian friends as well - I was greatly supported by believers who knew me well but had nothing to do with medicine and could give a wider perspective.

Take evangelistic opportunities

The great commission still applies during house jobs![5] Sharing our faith is vital if we are to grow in our knowledge of God.[6] Christians who do not evangelise will rapidly fossilise! Be known as a believer from day one, perhaps by talking about church activities if asked how you spent last weekend. This means that a godly life will be associated with Christianity, rather than you just ‘being a good person’.

There are some unique opportunities as a house officer, particularly with the colleagues with whom you share your rota. It is permissible according to the GMC to share faith with patients.[7] Opportunities are often few, with limited time and lack of privacy, but must be prayed for. Even a few words may have a profound effect.

Watch your lifestyle

The Ephesians were reminded to be ‘imitators of God’, and to live a life of love.[8] Those around us rarely share our values, and we may think that we can get away with things, especially if there are no other believers around. Gossip is a constant issue, especially in smaller hospitals. Avoid getting involved from the outset. Alcohol can also create difficulties, especially as you can now afford it! Know where your own limits lie and stick to them.

Sex is also a problem, especially in hospitals with an active social life. If lonely you may be more susceptible to temptation in this area than you have been as a student. Even if you feel this way, God has not forsaken you.[9] There may be lonely times during house jobs, for example when on-call alone at night. Use the time to draw closer to God, and be wary of entering into relationships that you would normally not consider.

I found that cynicism was a problem. There is little dispute that there are problems within the NHS. Take action over problems (via local committees or the BMA) rather than moaning in silence. Problems are best brought to light early so that they can be dealt with whilst you are still in your job – otherwise they may be allowed to drop when your cohort of juniors moves on, leaving your successors to fight the same battle.

Do the job well

Be of good report

It is imperative that we do our job to the best of our ability. Not only will our Christian witness be worthless if we are perceived as bad doctors, but there will be fewer obstacles to our walk with God if we work efficiently and quickly - for example, it will be easier then to leave on time to get to house group.

Maintaining integrity and a gentle manner are vital. It is so easy to exaggerate the severity of a patient’s condition to get a scan done faster, or to say that you have done something when you have not. It important to be truthful as God himself is, and medically far safer to tell the truth at all times, however difficult. At the same time, shouting down a telephone will rarely help when our tempers are frayed. Integrity will pay dividends, particularly in smaller hospitals. People will come to trust you, and will be more helpful when a test genuinely is urgent. Keeping good records is of the utmost importance: both to aid the practice of good medicine, and to protect yourself and your consultant in the event of a complaint.

This does not mean that all Christians should be ‘doormats’ and say yes to every request. You may need to be firm with nurses if asked to do inappropriate tasks, or if repeatedly bleeped over trivial issues. You may need to be firm with managers about rotas that do not comply with New Deal guidelines (the rules governing what hours a doctor can work), or about poor accommodation. Isaiah spoke out about injustice,[10] and failing to do so will blunt your Christian witness and leave unresolved issues for your successor.

Many other things relating to work are common sense - being careful about timekeeping, answering your bleep promptly and knowing the names of the staff you work with. We will not do everything perfectly - especially in the first few weeks. Be prepared to admit error, and learn from mistakes.[11]

Ask for help

Know where your competency ends, and call for help if that point is reached. Go initially to your own seniors, rather than going to other departments over their head. Even if a senior is initially unhelpful, they usually appreciate that you asked for their opinion. Record that you sought advice, and what action you took as a result.

Build relationships

Most relationships built at work will be short-term - although they may be intense at the time. Try to learn the names of non-medical staff on your ward. A Christian attitude to work does get noticed. I was very encouraged during my second job when after about a month, I was talking about my future plans with a nurse, and mentioned my intention to work with CMF. She immediately responded, ‘are you a Christian then?’ When I said ‘yes’, she replied, ‘I could see that a mile off.’ It was heartening to know that in small ways, a different attitude on the wards is noticed by some. Help students: even as a house officer you can teach simple practical skills, or subjects such as fluid management that are best learnt at the patient’s bedside.

It is not possible to have a deep and meaningful relationship with every patient, but with a few you can go beyond simple physical medicine (particularly with long-staying or seriously ill patients). This is not only part of good medical care, but may lead to opportunities to share your faith as well.

Manage time well

Not only house officers are short of time. Even Jesus had more demands on his time than he could immediately meet. He managed this by setting his own priorities, rather than pandering to those of others, and prioritising people.[12] God first, people second, work third is a good model for us to use.

In the work environment, the key is to prioritise. Is it important for you to do? If so, do it now if it is urgent (run to a crash bleep), or schedule it if it is not (decide that at about 4pm, you will write out tomorrow’s blood forms). If it is not important for you to do, try to delegate it if it is urgent (a porter can usually take urgent blood to the lab for you). If it is neither important nor urgent, question whether anyone needs to do it at all! Know what things are your responsibilities, and don’t do things that are someone else’s job unless things are very quiet.

Look after yourself

Get adequate rest

Even Jesus rested and prayed.[13] There are few situations that will be made worse by a 20 minute delay for you to eat lunch. Try to take advantage of natural breaks in the day. Your performance suffers when you are tired, affecting patient care.

With the other house officers on your rota, you can plan during the normal working day to make on-calls less tiring. Don’t leave a drug chart that you know will run out on Saturday, but rewrite it on Friday afternoon. If you see a patient at 4:30pm and their cannula is obviously nearing the end of its useful life, change it. Give a clear handover when you leave; tell the person on-call about any outstanding jobs, and any particularly sick patients who may deteriorate or need review. It can be very hard when on-call to do even a relatively simple task for a patient about whom you know nothing. If everyone works this way on-calls become a lot quieter and you can enjoy your rest better, secure in the knowledge that your patients will be well looked after.

You will get 14 days holiday in each six month job, as well as a day in lieu of any public holiday that you work. Some may be used for Christian service, but save at least half to get genuine rest! Try to keep up some recreational activity outside work - I was able to sing in a choir and do some musical accompanying. This keeps your contacts amongst non-Christians, and is often more relaxing than just watching the television.

House jobs can be a considerable strain on romantic relationships, even if rotas are reasonable. Write time for each other into your diaries, and make it inviolable, in just the same way that an on-call would be. A godly relationship can be a great source of strength - I started going out with my now fiancée during house jobs, and she supported me a great deal.

Manage your money well

After having little real income as a student, you will have a substantially above average income after you qualify. There is more money, but less time to spend it. Some of your living costs will increase - you may need a car to get to work, and you will be liable for council tax (a large and often forgotten cost).

Aim to give, spend and save in that order. When you give, make use of Gift Aid to recover the tax paid. Giving should be joyful and of free will, and is most effective when planned ahead.[14] Make good records of all income and expenses. Debt that is tying you down (overdrafts, credit cards) should be cleared as soon as possible. Try to avoid borrowing unless very clearly thought through. Financial advisors may be able to help you in planning, but their agenda may be quite different to yours.

Know your ethics

You may be surprised that this has been left until last in a CMF article! Although ethics is important, it seldom causes the downfall of Christian house officers. It is rare that you will make the final decision, but you will be expected to give input - so know where you stand, and stand there firmly. The most common issues on the ward are usually ‘not for resuscitation’ orders, palliative care, and withholding and withdrawal of treatment. Beginning of life issues may loom larger for those doing general practice jobs.

Remember that God is with you

I hope that this article has inspired some of you, and enthused you anew for house jobs. Others may be wondering, ‘how will I cope?’ There can be some fun as a house officer as well. On a cold, January on-call night, I was bleeped to see a patient who was complaining of being too cold. I arrived at his side room to find that following recent building work, there was a gap of about two inches between the window frame and the wall! My treatment for this was to get up on a chair and place masking tape over the hole to insulate the room. Although I hadn’t been taught this at medical school, the patient seemed especially pleased with my management plan.

Even despite times of enjoyment, we will sometimes suffer during house jobs. Paul, amongst others in the Bible, described severe suffering yet maintained that he drew closer to God as a result.[15] Ultimately, we know that ‘in all things God works for the good of those who love him’,[16] and must trust him in that as we follow his calling to work in medicine.