Quietly, and without fanfare, ambulance crews have started wearing body armour. I stand in the casualty department, staring at them, having a Daily-Mail-reader moment all on my own. Things in the NHS just aren't what they used to be when I was a fresh-faced new doctor. Two whole years ago.

I've been out in those little vans, prowling the territory, in the dark, in the middle of the night, in those lonely cabs, driving a little bit of hospital around what I now unthinkingly and unpretentiously call "the community". And I wet myself even without knowing that there was some rat child out there waiting to stab me.

Now I ask you: who the hell stabs an ambulance man? Who sticks a knife into an ambulance woman? Is it when they're on their way into the building to find the patient, or do you wait until they're on their way out, back to the van? What exactly are you lot all playing at out there? It's a wonder we don't drink ourselves to death.

And so to another dinner with the drug reps, another grumpy hangover free of charge. Because there are only about two-and-a-half psychiatrists on the rota here, and I'm the only one who doesn't commute from London, they don't even bother peddling their evil psychiatric drugs on their sinister free nights out. This dinner has been arranged to flog some weird new inhaler to the medics, so they are spared my usual drug-baiting antics.

I wander down to the mess. "I can't believe you were so rude to that drug rep." I casually aim some boiling water at the discount-priced coffee granules and hit a layer of sugar on the work surface as the polystyrene cup flies away. I cough, suavely, as if that was exactly what I meant to do. The two women in the room are rather attractive, if you go for that haggard-house-officer look. And I'm an SHO (senior house officer) now. This is relevant because, as every boy in medicine knows, female doctors only ever snog upwards.

"I mean, I can't believe you were so rude to that drug rep." I look up innocently, trying to piece together the string of accusations being flung at me by two bionic posh girls watching the football on what is, even by the standards of mess sofas, a very stinky sofa. I breathe my nausea down deeply and cough up some more stale fags. Drug reps are there to be baited. Secretly, I explain, they like to be kept on their toes. What could I possibly have had to say about an inhaler? I've been a psychiatrist for five months. I can hardly remember any of that stuff.

"Well, you were doing all right until you told him his flagship antipsychotic was 'genius' because the side effects were as bad as all the others but just didn't kick in until three months later, by which time you'd already managed to convince the punters to take them." Sounds perfectly reasonable to me. Actually it sounds rather astute. Make the best of a bad lot and all that.

"And then you started telling him proudly about how you never listen to a word that drug reps say on principle, just after me and Katy convinced him to fund our leaving party." If this is true I may well be an arse. "And then you tried to chat up his trainee. Who is also his girlfriend. It was so tragic."

You see? I don't know what's happened to junior doctors. When I was a house officer we used to take bets on which consultant could make the drug reps cry at lunchtime meetings. Now they pander to them. Where's the ruggedness gone?

I carry my hangover to outpatients for the alcohol clinic - my monthly event where I stick all the biggest boozers in one morning, so that none of my middle-aged depressed housewives complain about the smell - to see Julio, a nurse who has been suspended on full pay in disgrace for six months, with no inquiry, after a sexual-assault allegation was made by a patient who has since retracted all charges. Rather sensibly, he has been drinking three bottles of wine a day since his wife left him. I can't offer him anything that strong.

"What can I do for you, Julio?" I think it's a good question, and I might as well ask him, instead of thinking it over myself. "Bus pass." He's on full pay. It's a meaningless gesture. I fill out the form and lie my tits off, like we always do on DSS forms, or they get nothing. "I'm going to give you post-traumatic stress disorder, with a prominent depressive overlay." He smiles. It's the least I can do.