Sarah Al Saad, an F1 (foundation year 1) doctor now:

Dear past F1,

I tend to start my mornings with the same naïve optimism every new doctor seems to carry: that perhaps today will be the day the NHS runs smoothly.

Once dressed and caffeinated, I open the Lime bike hire app. My mornings are timed carefully and there isn’t much room for error. In theory, the nearest bike is only a couple of minutes away.

In practice, that optimism is frequently misplaced. It’s surprisingly common to arrive and find a flat tyre, or to walk five minutes to the next one only to discover a pedal missing entirely. I sometimes think ARCP competencies should include ‘problem-solving under transport duress’.

Anisur Rahman, an F1 in 1989:

Dear future F1,

Your transport issues sound taxing. I have no similar problems because, like the vast majority of F1 doctors, I live in the hospital. As I am on call one night and one weekend in every three, so much of my waking life is spent here that it is hardly worth having a home elsewhere. I have my own room and share kitchen and bathroom facilities with six others. I do not have to pay but I sometimes do not leave the hospital environs for days on end. But I can be on the ward five minutes after getting out of bed if necessary.

Sarah:

You don’t pay for accommodation. You wouldn’t believe the rent prices these days …

When I eventually reach the ward, there are usually 15 minutes until morning huddle. Five patients. Three minutes each. Entirely achievable, in theory.

I triage quickly.

1. Ongoing thrombocytopenia, otherwise stable
2. MFFD
   So far, so efficient
3. AKI, anaemia, hallucinations, new swellings and more antibodies than I knew existed.

Momentum slows.

There’s a particular sensation that comes with realising time is evaporating. Peripheral movement increases. The clock reads 08:59. Huddle begins.

Three out of five patients reviewed isn’t perfect but it’s 60 per cent. A solid 2:1. I take small victories where I can.

Anisur: 

I have no idea what some of those words mean. We certainly never huddle (except perhaps for warmth if your ward is a Second World War-era prefabricated hut). What is MFFD anyway? Actually, my first task on most mornings is to take blood samples from my patients as there is no ward phlebotomy service. In fact, it often seems that many routine tasks are my job; taking blood, siting cannulas, performing ECGs, giving intravenous drugs. In my first week, the nurses persuaded me that it was also my job to shave a patient’s groin for hernia surgery. It wasn’t but it was eminently believable that it might be.

Sarah:

Nurses and other healthcare professionals do many of those routine tasks now. But I’m amazed that you don’t have a morning huddle. Where do you plan discharges or liaise with the occupational, physio and pharmacy teams?

Huddle can feel less like a meeting and more like a strategic negotiation.

Each day brings a version of Black Alert. Beds are needed. Flow must be maintained. Discharges are currency.

I’ll often volunteer one straightforward discharge, only to be pressed for another. There’s a subtle art to these conversations; agreeing, deferring, promising an update after consultant ward round.

Estimating a discharge date for a complex patient can feel slightly theatrical, as though I’m consulting a crystal ball with limited reception.

It can feel high pressure but never hostile; it’s everyone trying within a system that cannot stretch any further.

Anisur: 

Life is not like that for me. I think we have a lot more beds than you do. Planning discharges is done on routine ward rounds and we do not have these daily negotiations. Something must have happened between my time and yours to cause this situation. Perhaps patients became older and more ill. Perhaps successive governments reduced the number of hospital beds in the name of efficiency.

Sarah:

You’re not far off with those thoughts.

Only after huddle do I enter the ward.

All our records are electronic, which means very little can happen without access to a computer. Securing a COW (computer on wheels) has become a ritual of its own.

A lay person might reasonably assume hospitals provide enough computers for staff. This is naïve and optimistic.

An abandoned COW with loose wires is usually terminally broken. One with a water bottle and pencil case perched on top is claimed territory. The fully functional ones are rare and guarded.

This is where alliances come in handy. A nurse I once shared a cup of tea with might catch my futile efforts and come to my rescue. These small acts I never forget.

Anisur: 

In my time there are no portable computers at all, anywhere in the hospital. So, I have pens and notebooks and random pieces of paper. Fortunately, all of these plus my stethoscope and Oxford Handbook of Medicine can fit in the voluminous pockets of my white coat.

I have to wear a tie and white coat every day. It is expected. There are rumours that infection control specialists will one day move to ban white coats altogether. But how will patients tell who the doctors are? And where will the doctors keep all their paraphernalia?

Sarah:

White coats are a thing of the past. We are now ‘bare below the elbows’ … No coats, no ties, no wristwatches. Instead, we wear large yellow badges, scrubs and the stethoscope – which tends to be the occupational giveaway. Much less paraphernalia to carry and many more passwords to remember.

Consultant ward rounds are a choreography of typing whilst walking, scrambling to check the right bed number, and yanking curtains that are as stiff as a board.

Not yet published in the GMC’s Good Medical Practice (surely the day is coming) is my categorisation of typical cases encountered on rounds:

ICC – Ill with Clear Cause: straightforward medicine.

Appreciated on a busy day.

IUC – Ill with Unclear Cause: the potential investigations seem infinite.

Clinical reasoning has reached its limits.

TT – the Ticking Time-Bombs: a new symptom every day.

Plot twists that would make a thrilling seven-part film franchise.

SS – Social Situations: medically fine, socially impossible.

Daily interactions with occupational therapy and social services to achieve a reasonable discharge arrangement.

CH – Challenging Historians: forgetful until the consultant appears.

What do you mean you’ve had one month of haemoptysis and 10 kg weight loss? I’ve seen you five times this week and nothing mentioned.

Anisur: 

Ah yes, the consultant ward round. Sounds familiar. Instead of a computer on wheels, I get to wheel the ‘notes trolley’. This contains a number of sections, in each of which resides the medical records file of a different patient. Except that the notes for the patient you want are often missing, or in the wrong slot, or in the wrong ward. Nightmare.

Your patient categories are very familiar to me. ICCs are certainly appreciated. Our range of investigations for IUC is less plentiful than yours. We have no MRI or PET scans and very little in the way of interventional radiology. As for CH, my consultant turns up on ward rounds in a bow tie and somehow elicits details of the history that have eluded me for days. I try to persuade myself that this is something that will come with experience. Maybe I will be like him one day. I will never pull off a bow tie though.

Sarah:

No MRI, no PET and minimal IR – I applaud you, but in equal measure envy the lack of vetting that comes with it.

Afternoons in the hospital tend to feel like a high-stakes chess game. A radiology vetted-and-booked scan is like making checkmate in three moves. An accepted referral is a diplomatic triumph. A completed discharge summary feels like finishing a short novel.

Anisur: 

You are talking about administrative challenges here aren’t you? I agree – completing these gives a huge sense of achievement. There certainly is a lot of diplomacy involved in getting other teams to give an opinion or even take over the care of patients.

You probably type discharge summaries on those new-fangled computers that you mention. As for me, I write everything by pen including all the medications. Carbon paper enables discharge summaries to be produced in triplicate – one for the patient, one for the GP, one for the hospital notes.

Sarah:

Everything by hand. I can’t imagine! The writer’s cramp you get must be bad …

I’m not sure if you relate, but by 5 pm I tend to wonder where the time went. The tasks all blur together but despite this I usually leave with a small, quiet sense of achievement.

Because between the bleeps, the chaos, and the search for a functioning COW, there are moments that carry real weight.

• A patient saying thank you
• A consultant noticing you’ve worked hard
• A colleague cheering you up on a rough day.

There is an indescribable effect in these micro-interactions.

Being an F1 in 2025 is hectic and the NHS may not always run smoothly, but the human parts of it, the people, the humour, the resilience – those still do.

Anisur: 

All those things are exactly the same in 1989. Despite the stress and the challenges, being a doctor is a privilege. We can make a real difference in people's lives. And there are days when you see a patient walk out of the hospital with their family and you know that this was only possible because of something that you did. There is no feeling quite like that. The friendship and fellowship of our fellow professionals are things that you never forget.

Good luck for the future. I hope we meet some day.