Self-care, working within competence and the MDT

Why this matters on day one

A tired, unsupported doctor is a patient safety issue, which is why the GMC frames self-care as a professional obligation rather than a personal luxury. And most of what you need to do on a ward, you cannot do alone.

The sequence

1. 1Working within competence. Know what you can do unsupervised, what needs supervision, and what you should decline. Saying "I haven't done this before, can you supervise me?" is a demonstration of competence, not a lack of it.
2. 2Make a referral well. Have the notes and results in front of you. Use SBAR. State clearly what you are asking: advice, review, or acceptance of care. Record the name of the person and what was agreed. If you are declined and remain concerned, escalate rather than accept it.
3. 3Use the MDT. Nurses know your patients better than you do — ask them. Pharmacists prevent your prescribing errors. Physiotherapists, occupational therapists and social workers determine whether discharge is safe. Specialist nurses are often the fastest route to expert advice.
4. 4Basic self-maintenance. Take your breaks. Eat and drink on nights. Exception-report hours you actually worked — that is how rota gaps get fixed. Register with a GP who is not you, and do not self-prescribe.
5. 5When it is not going well. Talk to your educational supervisor, the foundation programme director, occupational health, the BMA, or the Practitioner Health Programme. After a difficult event, attend the debrief and take the offer of support. Serious incidents and complaints affect doctors profoundly; that is normal, and support exists specifically for it.

What goes wrong

• Doing something unfamiliar unsupervised because asking feels embarrassing.
• Not exception-reporting, so the rota gap persists.
• Skipping breaks and working through nights unfed — error rates rise measurably.
• Self-prescribing or informal treatment from colleagues.
• Accepting a refused referral you are still worried about.