Friday, March 23, 2012

Consultants...time to cross that bridge?


NHS Consultants....maybe the problem lies in the title. it somehow implies the role is simply to consult, little else. Reality is its much much more than that...heck...I bought a sofa recently from a renowned store, and had to chat with a "Consultant"...and he certainly knew less about the intricacies about medical science than me!  Then there is the added burden whereby the title has somehow become intrinsically linked with being inside the shiny towers of a hospital..nope, no sir, a Consultant does NOT work anywhere else, heaven forbid. The few who don't do so..well..they "clearly" couldn't quite "cut it" within the cut throat business of a hospital.

Let's face it, Consultants don't necessarily do themselves much favours either. A few bad apples is all that it needs...a few who choose to spend more time doing their private work, the select minority who have adopted "Lancelot Spratt" as their prototype, the handful who turn their nose up at those inferior beings called GPs ("I tell you, Partha, they became Gps because they just couldn't hack it")..and you create a public perception of elitists sitting in ivory towers, sneering and shouting at nurses, GPs, patients, ducking out in work hours to play golf....thus making it high on the list of priorities of politicians to sort these impudent beasts out.

It certainly doesn't help when one looks at the pay-packets involved...now this may raise hackles of a lot..( ah well, who cares) but the reality is that we are paid from the public purse a significant salary, better than most in the public sector, with quite comfortable lives and a cracking pension too ( well, at least at the time this blog goes out).For those who argue with that, I can only say this..maybe start living within your means and stop thinking that you are related in some way to the Royal family. thus rightfully there is a significant amount of indignation when Consultants are not available, seen to be less accessible and sometimes just plain and simple, rude to colleagues or patients. For those who moan about working times, I would like to introduce you to my dad. He works in Kolkata, is nearly 70 and ever since I have been mature enough to understand what he did for his family ( nope, teenaged years were not included in this), he has always been available around the clock for his patients. Why? because under the system existent in India, there is no six figure set salary for government work, there is no set time of work, and patients always demand to be seen "now". So when you counterbalance that with what is present in this glorious healthcare taxed based system, ladies and gentlemen, there's only 2 words to say....Get Cracking.

The problem however is that such individuals although in the minority, have unfortunately become the public face of a Consultant. Listen to the lunatic mutterings of the Daily Mail advocate, Kevin Mackenzie, he would have you believe we all drive Porsches, spend most of our time on the golf course and saunter in when we want to. Now this may sound incredibly corny but a lot of Consultants I know have got an inherent goodness in them, a passion to make things better, a passion to help. That's my personal view, take it or leave it...but that's what I have seen so far. Yes indeed there are the ones for whom personal glories matter most, initiatives done only with an eye on Clinical Excellence Awards...but I reiterate..they are in the minority. And let's face it, say what one may, there is no question about the prestige and respect it carries in the eyes of the general populace.

But it's time to change. Time to develop a new way of being a Consultant, step away from the inherent arrogance. Part of me understands why Consultants from the generation before sneered at their GP colleagues...there wasn't any GP training scheme..you became a GP, in lots of cases, at least in the eyes of the Consultants, when you couldn't hack it. Cue a division where Consultants have more often than not treated GP colleagues with contempt, and now with the power shifting, those same GPs baying for blood. Just like a school ground when the school nerd is suddenly made the class monitor...the time of the bully is over. So to hell with the patient...let's slug it out, shall we...let's see who has the bigger balls.
But hey, times have changed folks. There is a GP training scheme, and our best trainees now choose this, of their own volition.They are a GP because they chose to be so, not because they couldn't "hack" it ergo the new age Consultants have as their GP colleagues their drinking buddies or mates, people who have mutual respect..thus the divide hopefully eases. Some of the best SHOs I have ever worked with (Shane, Chris,Howard,Penny) - they are all GPs and frankly if someone can show me a "more qualified" Consultant than them, then please do.

So we need to change, we need to grow up, we need to respect...respect what our primary care colleagues do, understand that our specialty area may only be a fraction of what they do and be there to support, to educate...not in a condescending way, but as a colleague, as a friend, with respect, with understanding of their issues. The good news? the signs are there...the new breed are getting there, slowly but surely. It maybe the politics, it maybe the changing times or it may just be an understanding but the divide will close, and as Consultants, it's up to us to adapt. 
If there is a bridge to cross, someone has to take the first step, someone has to extend that hand and it doesn't make us any smaller, any less for doing so- or at least in my view, it doesn't. We have achieved a lot locally as regards service reconfigurement -not due to the politics or negotiation skills...but due to the relations. 

My principle is simply this: Go back to why we went to medical school...and you will see that taking that first step will eventually help one group of people who we all want to help..the patients. So let's give it a try. From my personal experience? It's certainly worth it. 

Friday, March 16, 2012

An evening for Generation Next....

It's not very often you come away from a meeting with a warm fuzzy feeling...even less so when it has anything to do with work...but somehow this was different. Somehow it was not accompanied by the same jaded feeling of having been here before, somehow it wasn't just me trying to lace a talk with passion...for a change, it was my peers. This was an evening set up to try and inspire generation next, try and get the cream of the upcoming trainees to pick diabetes and endocrinology as a specialty....lo and behold, we were starting to grow up as a specialty, starting to understand the value of marketing our specialty, showcasing it to the impressionable minds that this was a profession which harked back to the reason why we/they joined medical school...the intention to help, the intention to care, the desire to be there for the ailing patient. This wasn't about labelling Orthopods as carpenters, taking potshots at others..no...this was about stating what diabetes and endocrinology was all about. This was about the joys of sugar and spice.

The attendance was good, the venue was classy and maybe it was the lure of the free food, but at least the workforce of the future was there. Bright young faces, impressionable minds came, sat and listened as Mike Masding breathed fire and passion about what traits one needs to have in their core if they want to join this specialty, that this wasn't for folks who thought about one part of the body, this wasn't for folks who felt uncomfortable when patients shared their personal turmoil...no...this was for people who believed in holistic medicine, believed in treating the patient as a person, not a commodity. I sat in the audience and listened to him saying the joy one feels when a woman with diabetes has a normal healthy baby, when the patient comes and says thank you and one felt goosebumps...I felt energised, I felt I was amongst kindred spirits.

Derek Sandeman explained bits of Endocrinology as only he can...simple, logical, scientific..and suddenly PCOS looked sexy, no longer was it only about "hairy women", it was about feedback mechanisms, intricacies of hormonal swings and manipulations; Chris Byrne spoke about research, made it sound exciting, made it sound something you wanted to do and then we had our local SpRs, Lina, Eveleigh and Rajesh talk about why they chose this...and I sat back and relaxed...I maybe only 4 years in as a Consultant, but the passion, the burning desire to "do something" had rubbed off...my job here was done.

One looked around and saw colleagues like Mayank Patel, Jimmy Chong, Victor Lawrence who had taken time out of their busy lives to just be there, just show support and one was proud to be in a region where colleagues were more than just that, they had responded to the clarion call...they were friends.One saw the Deanery representative and felt grateful for the official support, one saw representatives from Sanofi in the audience and felt appreciative of a brave new pharmaceutical world, hopefully heralding a more adult relationship between health care professionals and the industry, this wasn't just about their "wonder drug"...this was about trying to help diabetes care.

Mike Cummings stood up as Wessex Programme Director in Diabetes and went through the intricacies of application, questions faced, the training available locally and one turned around to see eager faces busy scribbling down notes...Mike alluded to the Young Diabetologists Forum, made a joke about one's former role.....and one let out a smile in deference to those heady days when one dared to take on anybody and everybody, made some friends, those days when raising the training issues of trainees came before anything...those early days of being the original maverick, and finding fellow rebels like Pratik..ahhh memories now lost in the mist of time for so many.

And then there was food...and over dessert, you could see junior doctors, medical students coming up to speak to the Consultants and SpRs in the room. Folks came to ask about research, took away emails while one chatted to bright young things, offering them options to come to the clinics where it all happens, explaining that ward work in diabetes was not a true reflection of what we do, no sir, come to the adolescent Type 1 clinic, the pituitary clinic, the pump clinic...and be amazed. It was not just about money, it was also about a work life balance, it was about the opportunities for flexible training. For the Orthopods you see driving a Porsche in his Saville Row suit, do bear in mind the hard hours they out in, the evenings they spend in private premises,the legal battles they entail. Bear in mind that on a public taxation system, a Consultant or GP salary put you in the top 4% of the country, gives you the opportunity to have a comfortable life,and in this specialty, you can choose to do exactly as much as you want, while being there for the patient, being part of their lives.

And then the night was over..as the folks drifted into the night, one kept ones fingers crossed that maybe, just maybe some had been inspired, some were taken in by the lure of the intricacies of this fascinating specialty....we shall wait and see. As one has dabbled in national politics, one comes more and more to one realisation...we cannot wait for organisations to do it for us, the responsibility is..ours. If we care about our specialty, if we want best for the patients, then we have to try and see whether we can get the best professionals to our specialty, the cream who will take diabetes care to the next level. We must not bow to negativity, we must not let ourselves be brow beaten to believe it can't be done...we must believe in the "Mourinho effect", no, not the desire to be "The Special One" but the unshakeable self-belief that " it can be done". And ladies and gentlemen?..it can be done.It HAS to be done.

Thursday, March 8, 2012

Please....let us fly

Glasgow...have forgotten how many times one has visited this city and all it has borne has been happy memories. Another conference of Diabetes UK, under new leadership, new energy, new passion..the "year of the foot"....buzz of people dedicated to making things better. For me, this has always been a venue to catch up with similar minded folks, learn from other areas, mistakes, novelties...anything to take back to one's working place to try and see whether an existing system can be made better.

But somehow there's just something missing...somewhere you get the feeling that a trick has been missed...where are the GP commissioners, where are the Trust executives, where are the folks who hold the purse strings, make the decisions? Where are the innovative GPs who stand up and say how they want to work with specialists and have commissioned services to improve diabetes care? unfortunately not much of that....but that's what we need...there wasn't any lack of folks who believe things need to be better...it feels like practicing to the preached. It's the same old faces, the same guard, looking tired, weary...but still there..still telling us all how to do.
The past is still insisting that they know the road to the future...while the present look on...hopping from one room to another, parched souls looking for that elixir which will breathe life into their ailing diabetes service.
Where are the Pratik Choudhurys, the Niru Goenkas, the Nic Olivers, the Pete Careys...the ones who are certainly to be the leading lights and buzz with ideas, innovations and understand the importance of working with primary care..why aren't they headlining these events...no..we stick to the age old belief...the wizened ones know best, the grey heads with their sagacious knowledge will lead the way, somehow they will be the Gandalfs showing us poor Frodos how to avoid the eye of Sauron.

But alas, such is not the case...somehow there continues to be the unbridled desire for the old guard to stay on, the desire to pat the young ones on their head and shake their heads in unison to say " not yet, little un, not yet". Well, I say enough!!...experience has it's role but needs to be mixed with the passion and energy of youth..the ones who are chomping at the bit to do something...different. Let the energy of youth come to the fore, let the ones who have trained with GPs, who understand what their primary care colleagues do come out...not the ones who still feel primary care are second class citizens, view managers with suspicion and commissioners with disdain.

Every sphere of life has now embraced the word "change"..the need to inject passion, drive and energy..be it politics, sports or movies. Experience certainly has it's role, it is to advise...certainly not to drive. Let the young brigade loose, let them pave their own path, the ones who don't dwell on experience to lament about the good old times, but take the leap in the knowledge that something better can be done..or at least be happy in the knowledge that they have been bold enough to try something new, something fresh..unrestricted by the fears of failure. This is not about organisations, this is not about holding on to have influence....this is about making diabetes care better for patients.

The young are ready, believe us, the wings are sturdy....please...let us fly.

Sunday, March 4, 2012

Comic book heroes...and life in the NHS

While growing up, comic books were an ever present companion and one of the characters which always attracted me was Batman. I was never a Superman fan..too much of a boyscout for me. Batman was the "man" and nope, it wasn't his flashy lifestyle- but more his anti-hero persona, the nonchalance to step into the dark side in a quest to deliver "justice". Something was inherently sexy about the general public labelling him a vigilante, but all the goons knowing he was to be feared and respected...the Dark Knight.

One may wonder how that is relevant to the NHS...and strangely it is. Comic books were always a more public-friendly way of depicting tortured personalities and as one engages more and more in NHS Management, one sees different personalities day in and day out. If one takes a step back, I went to medical school, not because my parents said it was that or nothing. but because I simply wanted to...help. Corny? Maybe. The Truth? 100%. As time progressed, one learnt that maybe the Superman way wouldn't always work, at least not for me. Being indignant about lack of patient quality care unfortunately doesn't always work or cut ice with some of the powers that be, thus the need to use all skills in one's armoury to one and one end only- help patient care. More of that later in future blogs...and some interesting stories to tell..as to why Batman has always been better than Superman, as regards the NHS!

Rebels have always been my idols, folks who dared to buck the trend, dared to stand up against the establishment...Steve Jobs, Mohammed Ali, Barack Obama..men who have shaped the world, men who have fought against adversities..and have come up trumps. Ever since I have been a trainee in my profession, I have heard nothing but negativity from the so-called great and the good. Its all doom and gloom, its all about how patient care is suffering, all about how about we are being undermined...very little about what one is planning to do about it...and one questions...why?? Some of such national meetings with "experts" are like having a cup of tea with a Dementor (from JK Rowling's collection)...by the time you finish your cuppa, you have lost your entire joy and inspiration in life.

So...you know what? Enough of that. Enough of "organisations" telling us what to do, enough of "experts" telling us what is right...locally, we are doing what we think is best, trying to forge something new, trying to build a new future, trying to step away from the turf-wars of primary and specialist care..and for sure will share with all concerned...not professing this to be the best, but even if there is something others can take tips from...and that helps improve patient care...fabulous.

We shall see where this takes us...and there is no one, absolutely no organisations who can stop a driven individual...and come hell or high water, I will certainly give it one heck of a good shot to try and improve diabetes care. I have very little time for organisations who are more interested in politics or their CEA points or even their own "standing"...and neither do I care much for "personal feelings".

The only folks I care about are the patients and their well-being...and if you are going to be in the way of that... then either move aside or get ready to take me on...ready or not, here I come.
The first 3 years have been a warm-up act...now for some fun...so where is my cowl again?