Saturday, May 6, 2017

Wards and being Special

7 days on the trot. On the wards- seeing any patients that were on the ward. One of those things called "unselected" medicine. A great bunch of junior doctors helped- and it was fun, enjoyable- and most importantly, educational for me too. The 7 days spanned a weekend and a bank holiday apart from normal working days- and thought it gave a perfect opportunity to put down some personal observations.

No change: Overall, nothing much has changed as regards attitude of junior doctors- it was the same level of enthusiasm, eagerness to learn and a desire to improve care as when I was one. I grow tired of the "in my days" nonsense. We don't draw comparisons between Chuck Berry and David Bowie- different eras, different styles, the sheer genius is indisputable- lets leave it at that. They are still the same eager folks- appreciative of good support from their seniors

Process: This has changed a lot- it had a feel of being more automated. Somewhere doctors seem to have lost their flair for independent thinking- it was more process driven, more protocol-based….board rounds at X, ward rounds at Y, standing on 1 leg at Z. Does it take the joy out of doing medicine- is it more about the workforce being the "same"? I don't know- but it certainly jarred. Maybe its just me- but if i was a junior doctor nowadays, I would question the point of doing some of the banal things they are asked to do. Where's the learning when you are seen by many as just someone to do discharge summaries?

Weekends and Bank Holiday: Lets get this factoid nailed. Without changing ways of working of support staff to deliver Sunday just like a Tuesday, tinkering with doctors work for weekend work is a bit silly. You can dance around that one as much as you want but the only constant I saw compared to a Tuesday were the nurses and the doctors- everyone else was a bit variable at best. Its not a uniform thing across the NHS. If YOUR hospital is doing it- shamazing…but it aint a universal thing. Period. 

Campaigns: 2 new campaigns have hit the floor- as with many social media ones, for many on the ground who stay away from social media they came as a surprise. #Red2Green and #EndPJparalysis are the new ones. The first one makes me smile-as why a campaign to lessen the alert level of a hospital based on arbitrary criteria should make doctors (generally folks who believe in evidence base, NICE sort of thing) engage is beyond me- you may as well call it #Improve4hrperformance
Campaigns miss the point about the degree of cynicism doctors hold about such campaigns when they struggle to make one understand the clinical benefit of it….having said that, the #EndPjparalysis is one which has got legs- if its handled properly. 
The reasoning is sound, the clinical benefit seems good- but it must not slip into evangelism. Someone said that most of my patients would be on the golf course if they were not dressed in their PJs. Nope- if you know my style of doing ward work, they would be home wearing whatever they want- not be relaxing on an acute bed. The key is convince clinicians its a patient benefit initiative- not yet another hashtag designed to get people quicker to help a 4 hour target

Special: The "olden days" used to have general medicine clinics, general physicians..the ones who use to "specialise" in having the bigger picture, the ones who could join the dots, the ones who could come up with the clever diagnosis.
And then specialism happened..properly. We all became specialists..doing only a little niche, little else. The Cardiologists left general medicine, no longer were they dual accredited..they only looked at the heart. The dealt with heart failure but if it was due to a pulmonary embolism, it now had to be the Respiratory physicians issue. If by chance, the patient had a minor bleed secondary to the warfarin, they had to be seen by the Gastroenterologists, if, heaven forbid, their blood sugars were high, call the diabetologists....and if they had anything resembling silver hair, it would be a travesty if the elderly physicians weren't looking after them.So what the heck happened to us as physicians? I take my hats off to Medical Assessment Unit colleagues who still do and understand general medicine but are being reduced to triage doctors due to the incessant pressure of either discharging them or moving them to another speciality. But medicine isn't that easy...not everyone fits nicely into a category, a pre defined speciality, do they? 

So there you are- a 7 day trip of medicine- away from the specialty work. Its also a fact that perhaps I enjoy it as its not incessant- and comes at a frequency which is easy to manage- and keeps my interest levels high on both quarters. Perhaps also why everyone doing their bit would mean a lot- not create artificial categories of X being a specialty more special than Y. 
Maybe Chuck Palahniuk, author of novel Fight Club had the right idea..."We are not special. We are not crap or trash, either. We just are. We just are, and what happens just happens". 

Perhaps thats what we need- the ability to stop taking ourselves too seriously :-)

1 comment:

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