Dr Beth Durrell recalls her first days as a consultant and shares the hard lessons she learnt.

Why are they all looking at me? Realisation dawns – I’m the consultant, and I have to make the decision. The feeling of being responsible for more than just my own work suddenly hit me.

It was my first week as a consultant psychiatrist, and I had finally achieved what I had spent my entire adult life working towards. Years of training, studying, audits, exams and ARCPs were done – surely it was now time to relax a little. No. In the same way as you only really learn to drive after passing your test, starting as a consultant is a steep learning curve.

Those first months passed in a blur of patients, meetings, decisions, policies and emails. I got through them, and so will you.

You are a team leader

I preferred a fairly flat hierarchy, and listened to the views of the junior doctors and nursing staff at every ward round. Despite this, I was acutely aware that the final decision rested with me, and where there was disagreement within the team in relation to the care of a particular patient, this could be challenging. I recommend that you avoid an ‘I know best’ attitude, and be prepared to politely and clearly explain your decisions. Listening to the views of others can sometimes open your mind to a better solution. Don’t dismiss their knowledge and experience simply because they do not hold a CCT.

Everybody wants your time.

Learn to say no

Everybody wants your time. The patients and their relatives want to speak to the consultant. So do the nurses, and the junior doctors, and doctors from various other specialties. You will receive more emails than you thought possible. You will be invited to meetings on all manner of subjects, some of which you know something about. Could you review this policy by tomorrow? Would you take responsibility for audit within the department? Can you teach the FY doctors this morning? You cannot do it all.

Your secretary can help you manage this flood of requests. Consider checking your emails only at specific times of the day and selecting only the meetings you actually need to attend. A lunch break each day will help maintain your sanity. Don’t give up your interests and social life and make sure you take your annual leave.

Be nice

Being polite, respectful and approachable to all your colleagues, not just the medical director, will reap dividends. The nursing staff, secretaries and cleaners can make a big difference to the quality of your working life. And you can make a big difference to theirs – please and thank you cost nothing. You will work with some difficult people. Just make sure the difficult colleague is not you.

Photo credit: Getty Images

You are a manager

As a consultant, you have line management responsibility for your junior doctors. Most are excellent and a pleasure to work with. Even the best junior doctors need to be supervised, observed, given feedback, supported and signed off. A struggling trainee will need a lot of additional input in terms of providing teaching and additional supervision, and extra support. You may also find yourself on the receiving end of complaints about your junior, and have to provide the doctor with negative feedback. Although this is difficult, failing to do so risks your patients’ safety, and will not resolve the problem.

You don’t know everything

Discuss challenging cases with your peers, always bearing in mind patient confidentiality, of course. Keep up to date with developments in your field. Attend the teaching programme, grand rounds and conferences. Being aware of your limitations is important. Identifying your learning needs, and working towards meeting them, is a crucial part of your annual appraisal, and your revalidation. It’s always advisable not to leave it to the last minute.

How will you prove your worth?

Find out from an early stage how your performance will be judged. Data may be kept on length of inpatient stay, number of admissions, readmission rates and so on. Quality and quantity are both likely to be important. This knowledge can help you keep an eye on your own performance. Review the data held by the trust to see how you compare to your peers. If you audit your own work, it will be easier to deal with any concerns as they arise.


I hope that these thoughts help those first few months go smoothly.

  • Be receptive
  • Learn to say no
  • Maintain your work-life balance
  • Respect your colleagues
  • Take your role as line manager seriously
  • Keep up to date
  • Monitor your performance

This page was correct at publication on 12/08/2015. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.