Modernising medical careers has done many awful things to surgical training, which has had little impact on me personally as I am a post Calmanisation trainee. However, the little impact it has had is of great importance; I have lost my wingman, I’m like Maverick without Goose.
Ward rounds, that are left to me to do, occur with 2 or 3 junior doctors (F1, maybe an F2 and maybe a core trainee which is meant to be like an SHO) instead of the old team of senior registrar, registrar, senior SHO, SHO, JHO. Almost all of whom, in a big a hospital like Bighospital would have been career general surgeons.
Now of the 2 to 3 of us, only I am a surgeon and the rest hate surgery. My core trainee is a GP trainee and the F1 and F2 are similarly psychiatrically or internal medically inclined. In the olden days on this professorial unit people (including me) fought with each other for the honour of being Prof’s JHO and it was a job that went to the keenest and most desperate wannabe surgeon.
Nowadays, a computer nationally allocates them to Bighospital and they rotate through each unit every month. Dreadful for them, dreadful for us.
Back to how this has meant I am Batman without Robin. Everybody needs a wingman, especially on a ward round.
Let’s pretend you are an emergency admission with right sided abdominal
pain. Your GP has sent you in as query appendicitis and so you also suspect that you have appendicitis. The male F1 examines you and says “yes probably it is appendicitis ” the male F2 is too busy to see you. The nurse reads the F1’s notes and discusses with you all about appendicitis and theatre and even starts getting you ready for theatre. They’ve fasted you for the 8 hours you’ve been in hospital.
I appear, a young(ish) girl, I spend 2 mins listening to the (appalling presentation) that the F1 gives. I ask a few questions, I look at X-rays and bloods and urinalysis results. I examine you, I conclude that as you are hungry, have normal obs, have no peritonism, normal bloods and haven’t done a shit for 4 days you are likely just constipated. My plan is: eat and drink, pain killers, something to move your bowels, observe and reassess in 8 hours. You will be feeling better by the next morning, when you will want to go home, and will be pleased with the outcome.
It is at this moment some patients look to the male junior for confirmation of this change of plan. Male junior is so inept and so inexperienced I wouldn’t let him decide what day of the week it is never mind anything else. He looks glum, chastened that he is wrong. It’s at this moment your wingman steps in, just nodding in agreement with what you’ve said. Some good nurses play wingman, they know the score. Some good F’s can play wingman but they can’t be relied on.
I miss that friend with a nodding head at my elbow. Maybe I should get a puppet to pull out of my pocket when necessary to nod in agreement.