Sunday, January 26, 2014

Healer or more?

The role of a doctor has always one which has fascinated many for ages- and continues to do so- perhaps never more so in such uncertain times as in the NHS. There are those who firmly believe doctors should and must have a responsibility towards society..more than just attempting to provide the best care to the patient in front of you, while there are some who feel their job is the latter and leave the idealogical debate for others. And a distinction is created..the problem I personally find is the level of intolerance demonstrated in different camps...a bit like that immortal Bush-ism.." You are either with us or against us".

I keep hearing of how privatisation of the NHS is all wrong, how it will provide poor care and I fully understand the logic behind that. That is also suggesting all countries who are not blessed with the level of socialism that the UK has incredibly poor care. Having worked in other countries, it is not the case...the debate over there is different...you get high quality of care and treatment based on your wealth and circumstances...the fortunate minority have the best healthcare available. That is a different social debate rather than saying the NHS will suffer,isn't it?
You want to solve inequality..come and see what happens in a rural village in India where the only drugs available are Septrin, aspirin and paracetamol compared to the high tech hospitals a few miles away in a city where wealth brings everything medical science has created...that's where you understand the importance of social equality or lack of it. If the NHS is privatised, the same staff will still provide the same quality of care...its not the care that is at stake, its the lack of universal coverage which will be.

I also hear how its all gone down the pan since the new Act came in place...I don't know what sort of utopia most of these commentators lived in but I recall doctors and nurses still struggling when I was an SpR..same pressures, same frustrations..the different media outlets, harsh politics, social media result in amplifying the problems even further. Factor in what was always inevitable..the steady realisation that unless funding was matched,we were going to run into trouble..and all the ingredients of a perfect storm have been beautifully crafted.The sadness is that lots have allowed their dislike of ideologies blur the adult debate one has always needed about the NHS. And don't please say it was all fine, or only "minor" changes were needed...if you prefer that, suggest speak to all the whistle-blowers..the Julie Baileys, the James Titcombes or the relatives who have suffered..or even go through the Francis report.

So to the initial question...what is the role of a doctor? Play within the system...irrespective of changes or political colour helming the changes, have the chutzpah to do what's necessary for patient care...or take a stand for social equality and take on a more political role? Some clearly have gone for the second role and my tip of the hat to them but I don't necessarily believe that will improve patient care..what will improve it is genuinely giving the front-line the power and responsibility to lead the change that is needed..and that, I am afraid, no political party will do..for fear of losing control.I have heard over the last 5 years plenty talk about it, show pretty presentations how they are doing it...at the level of the wards or clinics, that still is a rarity. Till then, irrespective of whatever changes happens, I can only promise to deliver a quality service for all those who walk into my department.

On the other hand, you want to start a genuine movement to put the frontline in charge...dissociate health from party politics...I will dust down those old boots from my college days when I used to live and breathe politics..and lead from the front. Till then, this doctor stays what his dad taught him to be..a healer first, everything else..later.Never forget what Hippocrates said..." A life so short, a craft so much to learn". Amen to that indeed.

Sunday, January 12, 2014

Respect..give it a try

Let's just say time had stood still and someone, some almighty powerful being...had asked us all for 1 thing...just 1 thing we need to get the NHS "back on track" or even functioning without browbeating, recrimination, angst etc etc...what would that be? 

Most people who I ask that question come back with mixtures of sarcasm, hope but in the majority people ask for finances, capacity, idealogical change and over the last few years, I have tended to agree but as chance would have it, the answer for that came from my dad. He is 73 years old, still going strong, working - and many moons ago, in the early to mid 70s was a doctor in the NHS before he decided to return to his roots. 
He had come over to visit me..(no better present than spending your 40th with all your loved ones)...and one evening, I sat down for a casual chat with him. He had been reading the newspapers, the BMA news, watching Sky, BBC..all the bits about the NHS...and I asked him what he thought had changed. He smiled and told me about his working day, the ward rounds with the juniors, the cup of tea with the ward sister, the sitting down and holding hands of the elderly patients, sharing a laugh..and after a pause said this.." You know what I think? You all seem to have lost respect for each other"...and went back to playing with his grandson..after all, Spiderman wouldn't allow the Green Goblin to rest anymore.

And you know what? The old fella had nailed it in a flash. It isn't the money, in fact, it doesn't matter how much money you pour into the NHS, there will still be a squabble about who "deserves it more". Everyone I meet within the doctor world thinks they work the hardest..which probably is true..but somehow there is also the assumption that others don't..a basic lack of respect for other specialities..its everywhere.. Walk outside the hospital..a perennial debate..do GPs work harder? Do specialists work harder? Maybe views are tainted by the small interactions made in the mists of time but the lack of respect...striking. The sniggers..all to visible..all too obvious. We talk a lot about integration, working together..and some places are doing so..where the money has been else of an issue..as something has clicked..not the pathway, not the leadership, but mostly the development of mutual respect.

And its the same everywhere unfortunately. Nurses, managers..everybody ..give or take afflicted by the same issue..that's what the pressures and erosion of values of the NHS have done..silos are formed when you don't respect others. Everybody seems a bit angry..a bit angsty...doctors giving opinions about nurses working without any idea of what their jobs involve, managers giving ideas about how doctors should work without the foggiest clue about job plans, doctors being rude to managers as they are "just about numbers, not clinical care"..cue angry responses, cue disgruntled employees, cue an NHS where a few are trying their utmost and many feel disrespected for the work they do.

So what does one do? Somehow get other specialities to spend a day with each other? Make a manager shadow a Consultant from start to finish, understand job plans better? Get a Consultant to understand why the nurse hasn't discharged the patient even though "they have said so"..the balancing of call-outs from patients, relatives, drug rounds, meal times and oh yes, ill patients? 

I don't have the answers to this- but this I will openly admit..I was among those who felt GPs didn't do that much hard work when I was a trainee..reason? My views tainted by the Consultants who dropped remarks on ward rounds about how "easy" it was..dinosaurs from the past who had never stepped out to general practice either. Things changed when I started my research and had to base myself in primary care recruiting patients, talking to GPs. Did they work harder than I saw my Consultants do? No, they worked EQUALLY hard- but with different pressures, different targets, different set of rules...and that view solidified when our model of care started to develop..I understood the business structure better, the importance of QoFs, the model of working GP surgeries had. No one's working harder or less so, in fact, there are actually no prizes for who works hardest...there's only a system up to its brim with capacity where everybody is working as hard as they possibly can..and the quicker we get out of this debate about who works hardest..the better for patients.

So tell you what? Try it - whoever reads this- to spend even half a day with a speciality or profession who you think are lazy, the profession for whom you have the most disdain. I bet you will learn something and also take this tip, when you turn around and perhaps say, "Yep that duty hospital manager/ward sister/orthopaedic doctor works bloody hard, sorry I was wrong in my opinion about him/her", that will not be seen as patronising but actually open up the gates to getting patient care just that bit easier..or at least that works for me. It will still be as hard as ever but at least with a colleague you respect, you can share a joke while working down to the bone.

In the words of Van Goethe " Being brilliant is no great feat..if you respect nothing". Go on. Give it a try.