Tuesday, November 6, 2012

Pride and Prejudice

We live in interesting times. Times of cynicism, times of mistrust, times of suspicion. Times when it's all about having polarised opinions. Simple example? read about the furore unleashed about the Liverpool Care Pathway. Something which was designed to help patients die with dignity is now labelled as the "Death Pathway" by the Daily Mail. It's now like a frenzy. A junior doctor trying to raise the issue, trying to get a petition signed..is now facing abuse from trolls on social media sites, threatened with personal harm. We are the society we have chosen to be.

In between all that, it was an absolute pleasure to be in Warwick this weekend...being part of a 2 day meeting aimed at new Consultants and senior SpRs in diabetes. This was generation next...and they wanted to do something...different. Yes, there was frustration, yes, the was a level of angst aimed at primary care, but there was the desire to try something different. Members of the faculty consisted of Jiten Vora, Melanie Davies,Tony Barnett and Cliff Bailey...figureheads in diabetes care who have made their reputation based on years of contribution to improving diabetes care. and then the were the guest speakers..Kathy McLean and Azhar Farooqui...giving examples of how primary and specialist care are trying to work together etc.

At some point..as Professor Farooqui was outlining the process of changing diabetes care in Leicester, the words "Super Six" came up...it was part of the Leicester redesign...and I had to sit back and smile. I heard the faculty acknowledging at various points the work we were doing down on the South Coast...and I felt so proud..not because of what had been done, but because of the distance we had travelled. The Super Six wasn't some magical concept I had dreamt of, people had talked about it, written about areas where specialists needed to be involved..I had simply been in the right place at the right time. Right set of commissioners, right set of colleagues..and voila, we had our model of care in place. So..a lot of pride...a significant lot.Couple that with colleagues you have trained with raising a glass to you at the bar or senior SpRs coming up and thanking you for "fighting for the specialty"...and yep, a lot of pride Awards mean a lot but when senior peers, folks you have grown up respecting acknowledge the work you do..it means a lot more than anything else. Just behind the accolade of being recognised by a patient...but not too far!

But then where there is pride...how could prejudice be far behind?  

I have given up being surprised or being caught off guard by comments passed about our local amputation rates or questioning our model. However it is only with a sense of irony you read emails from said detractors CCGs about advise as the "specialists won't engage"... you can only let loose a wry smile. "Too big for his boots" has been a refrain too from some quarters...but hey, I wasn't aware this was a popularity contest. If I wanted to be in one, I could perhaps just have taught a dog to dance...

But then again, prejudice can be of different forms, you see..so the latest one which questioned whether I actually should be doing this as I wasn't "indigenous" did make me grit my teeth. Having dedicated myself to improving healthcare in the UK, having paid all my dues by training right from the basics...a question about whether I am "local enough" is always...interesting. And it did bother me for a day..till I suppose it sunk in that it's probably one of the last cards for detractors to play. As I said...we live in interesting times, don't we? 

Prejudice is about others feeling obliged to make comments..and boy I have faced a few..."how's the spin going?"..."didn't know you had trucks with that organisation too"..."your Consultant group or should I say mercenaries"..."it's not really that good, is it?"....all very interesting, all very spiteful...all very...negative. Time and positive outcomes, not to mention recognition via awards have dimmed the barbs, but It has made me wonder "why"? Is it because it's something new, is it because people don't like change..or is it something a bit more base..something else which has never reared it's head in my career?

Life has a funny way of hardening you up..and thankfully the positive vibes from friends and well-wishers  do outweigh the negativity.  I have an unquenched zeal to make things better....and it will clearly be an interesting battle of the opposites which is likely to be an everlasting feature. 
Penning a document on the role of Consultant Diabetologists in the new NHS....one thought crosses my mind. Am I just a glutton for attracting controversy....or is it an irresistible desire to amend the status quo which isn't benefitting patients?

Time, I suppose, will pass that verdict..."indigenous"...or not. Till then...there is a battle to fight.On a day when President Obama gets re-elected past all the Republican vitriol, playing on prejudice..there has to be...there must be hope.

Thus, to look ahead to the challenge ahead...lets simply quote Dwayne "The Rock" Johnson..."Bring...It...On". Indeed.

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