Fantasy Football Medical Politics 

5000 new GP’s are going to be in surgeries near us, really soon apparently. The clever government have decided and pronounced and thus it will be so. 

What utter rubbish, nobody believes this is possible. There was one GP covering Bighospitalburgh this weekend and none in neighbouring DGHville. Apparently this is likely to continue for most of the summer as people take annual leave. Where are these 5000 GP’s? You can’t conjur them up at will or manufacture them. 

Seeing as the government are allowed to make silly wish lists that are pure fantasy, here is my wish list for the NHS. 

1. Thousands of new nurses. 

2. Fair pay for all staff. 

3. Scrap 18 week targets because all operations are not equal. Let us decide on priorities for urgent and non urgent operations. 

4. A management cull. If you have an NHS iPad you are out. 

5. Invest heavily in decent IT services to save money on doing wasteful tests and wasting time. 

6. Improved meals for patients. You eat better on a plane. 

7. Streamline the referral process  from hospital to social work and remove the delay in getting nursing home places. 

8. Do something to motivate and invigorate most of the staff in the NHS. Most of them are bored and lethargic and need to find their inner medical or nursing student again, that young, hopeful person who was desperate to be where we all are now. 

9. For government to realise that emergency care (not the length of wait in A&E) is more important than elective waiting times and prioritise it’s delivery. 

10. Give general practice a break, 7 day working is not the answer to what is wrong with the NHS. 

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Dear Health Secretary 

Dear Health Secretary 

Dear Jeremy, 

Can I call you Jezza, Jez? I just wanted to write to you, really so you can get a feel for what goes on in the NHS. Let me tell you about my day, it began when I got up at 6.15am, I arrived into work at 7.30am, not 8am when I actually start because it is Thursday today. Thursday means that my unit is running three operating lists, this causes chaos as there will not be beds for half of them when they arrive at 8am. I will have to see and consent any day case patients and make sure they are ready for theatre.

On top of that and that I have to see all of our in-patients on the 8am ward round. There is only me about today as my colleagues are on call, on holiday and on study leave respectively. The junior doctors essential to my ward round start at 8am, they arrive on the ward at 8am with a coffee, looking bad tempered. 

The junior doctors change weekly being moved around different units and even hospitals within our trust. There is no continuity of care. No wonder they are annoyed and learning nothing, I don’t even know their names half the time. 

The nursing staff are looking after 8 patients each, they are doing the drug round when I begin the ward round and so can’t join me when I eventually get started. I have 30 ward patients, 6 boarders, 2 in HDU and 1 in ICU. I have to see them all by 9.30 when I will rush to theatre and begin an operation that will take about 7 hours. I have no time for a coffee or a drink of water prior to starting this case, there is no lunch break, no opportunity to go to the bathroom. 

The operation finishes and I am off and out again, I have an ill person to review urgently on the other side of the hospital, I arrange a CT scan for them and then head up to the ward to do the round. The junior has gone home, like me she finishes at 5pm, unlike me she has left. 

I do the round alone, I see all my patients most of whom have relatives in with them who all want to talk to me. It takes a long time to get round them all, then I go to the CT scanner to see my sick lady, she needs a drain inserted which I have to arrange. 

She has not had her clotting checked though and first I have to find someone to do that, after 20 minutes I give up trying to find an F1 doctor and take the blood myself. 

The on call radiologist is at home and isn’t sure if he wants to come in and do the drain, he wants to know how sick she is and if she can wait. I tell him that she can’t and an argument ensues. 

I feel bruised by this encounter and stop at the shop to buy some chocolate and a can of coke, my first food or drink since breakfast. This is swiftly followed by the need to urinate, again for the first time since I got up. I ponder the cost of toilet paper, you have pointed out how much money we waste on not getting the best deal on toilet paper. I can assure you Jeremy, I rarely get the time to pee and feel I am a low user of toilet paper. 

I’m a fan of multi tasking so I use the opportunity to check my emails. Management are banging on about the 18 week wait breachers, we have a list of anal skin tags and other crap to do tomorrow to prevent them exceeding 18 weeks. I can think of other patients who more urgently need surgery but they aren’t breaching so there is less rush in management’s view. 

The on call registrar is running about looking stressed, he has had 36 admissions so far and not enough beds are free. He’s too busy to sort out my lady with the drain, so I wait and get the clotting study back and then phone the radiologist to reiterate that she remains septic and needs a drain. He agrees to come in and do it. 

I head to the changing rooms, it is 2145. I know that my best friend from uni, an inner city GP will be available for a chat and I ring her from the car, she is still at work attending to mountains of paperwork that she can’t get to during the day, she’s a part timer too. 

Safe care costs less you say? Indeed it does, but it’s only safe because most of us are working hours far beyond what we are paid to do. 

I get home and kiss my sleeping children, look out their uniforms and speak to Mr KBW. I am worried about the lady with the drain so phone and check she is well, I eat and try and drink a litre of water before bed as I am so dehydrated.  I’ll be back in tomorrow to start it all over again. 

Then I see that you Jermey are wanting to make the NHS safer, for less money, which is curious. I see you are also worried about the babies killed every year during childbirth. This wakes me up as crikey, so am I! That’s completely terrifying, some satanic psychopaths perhaps? What could you mean? You can’t mean the babies that die during childbirth? Can you? 

Lights out at casa KBW and I dream of clinics that aren’t over booked, operating lists based on need not targets, managers that are free to manage departments not meet targets. 

The alarm goes off and it starts again as it does for most of us, you see I am not some disorganised muppet who can’t organise herself, this is the daily grind for us all. We are the NHS, we live it every day and will continue to do so when you are foreign minister or PM or (ideally) in the opposition. 

Best wishes and good luck finding those baby murders! I’m in your team for that one. 

KBW. 

Being a bad senior

I met someone recently at a meeting who was my SHO when I was a JHO (an F1 in new terms). He was a complete shit, I hated him and despised being on call with him. He didn’t answer his bleep, went to bed on nights and wouldn’t get out of it other than for theatre, lied on ward rounds that he had seen patients when he hadn’t and terrorised us little newly qualified doctors. 

Hard to imagine now, but I was too scared and intimidated to ever confront him or tell a more senior doctor of his misdemeanours. I hadn’t seen him for 15 years until we met again at this meeting. He was very chatty initially, he asked after everyone in Bighospital and was keen to brag about how great he was. 

I told him that I had learnt a lot from him, “Really? That’s so great” he said. 15 years is a long time to regret not speaking up for yourself “Yes” I said, smiling at him “I learnt about how not to be an SHO. You were awful to us. Good to see you!”. 

Being a good senior means different things to different people, take my Bighosptial bestie this week, she gave a junior colleague a row for failing to do bloods on our sickest patients, failing to write in the blood results in the blood folder and failing to repeat a sample that was clotted. 

The little shit listened whilst she asked him to do his job more carefully, he grunted. Five minutes later he took her aside and told her off for daring to speak to him on the ward, in future she was to take him off the ward to speak about such matters. 

What these F1’s don’t understand yet is that they are trainees, they are baby doctors who know almost nothing. I am also a trainee, as are all my consultant colleagues in a way. We are all constantly learning and developing. 

An operation that I am doing under supervision will involve frequent “no, use your hook here”, “I don’t like that”, “I think you should reposition”, “you shouldn’t be so rough”, “stop fucking about and put a stitch in that” and that’s from the good guys. 

Bad guys tell you “that was a serious error” or  “oh fuck, get out of the way”. One trainee was even told he was going to be killed after an operation. 

It’s the nature of my job that I am constantly criticised and I welcome it because it makes me better. Nobody has time to politely and politically correctly tell you that I am dissecting around the portal vein in a terrifying fashion, they say “you’re a bit rough there, careful” and that doesn’t make me want to cry. 

Medical school is not preparing students for the realities of surgical training and feedback. There is no other way of doing it, it is instantaneous and instinctive and there is a live patient that one person is responsible for at the heart of it all. If I cause a 2 litre haemorrhage from the IVC because I am careless someone might die, and my boss is responsible for that. If they are letting me do the operation, then they get to endlessly comment on what I am doing, be it good or bad. 

One of my bosses raps us on the knuckles when we make an error, it doesn’t bother me. All of us surgical trainees are constantly and endlessly criticised and refined and so we improve. There is no other way. 

This little oik, that my pal gave a row to, wants to be a surgeon, a general surgeon no less. If he wants to get even 6 months down the line he is going to have to learn to take some criticism and not see it as a personal failure but an opportunity to improve. 

Learning to take criticism is easier than learning to give it. I am a fan of the so called shit sandwich; good thing, the bad thing, another good thing. “F1, you managed to request most of the bloods and that was good, but you missed the three sickest people on the ward which was bad, you remembered to hand over that they were sick to your night shift colleague that was good.”  

It is harder than parenting to be honest. I’m going on a course soon to learn more about this dark art, I’m hoping to have a whole picnic of techniques for criticising people!  

 

In praise of women

In praise of women

Whilst comforting a friend recently, one who feels her husband doesn’t understand, love or support her I was struck by how often I have heard the same thing from so many of my girlfriends. My response to this scenario is always the same “he is doing his best, he can’t show that he loves you the way you do.”

Men are great, but they aren’t women. Women notice you have lost 5lbs, bought a new scarf, that you are wearing a different eyeshadow. They text you to tell you that you are in their thoughts in good times and bad, they remember birthdays and buy thoughtful and personal gifts.

We cook and bake for each other, send each other little gifts via Amazon, buy and send funny and cute cards, we tell each other how loved we are and never judge or criticize. I love seeing my friends and will make an effort when we go out, choosing an outfit and making an effort with getting ready. It is exactly the way you behave when you are dating.

Since I have stopped expecting my husband to behave like a woman, my life has improved significantly. Yesterday I came home having bought an expensive jacket, he was watching tv, the tennis was on. Previously I would have become annoyed that he was not interested in the new jacket, put off the tv and started an argument. This time I asked “is this an important match?” Apparently it was desperately important, so I waited and showed him it later. He doesn’t like the neckline, but otherwise thinks it is fine.

Four hours previously my friend and I were at the shops, we had spent an hour or more discussing jackets, her holiday wardrobe and the difficult question of “is a white jacket insanity with 3 kids?”. Then we spent an hour looking for a top for her, traipsing round the shops together and chatting and having fun. We went back to the white jacket shop three times in total before I bought it. Afterwards she texted to say how much fun it had been, that she loved her top, and that her husband had said “it’s nice”. Men aren’t women, a top is a top, it has sleeves or not, a collar or not, buttons or not.

If we stopped expecting men to behave like women (or like men do when they are trying to get in your pants) the world would be a happier place. Be thankful that someone noticed your new lipstick, that someone wrote you a poem for your birthday, that someone sent you a text after they saw you looking tired to say “hope all ok, anything I can do?”, don’t be cross that it wasn’t your husband.
Anyway, the purpose of this is not to berate men, it is to praise the general fabulousness of women. I am grateful for the women who make my life a better place, they make me feel normal and understood, they do this whilst juggling work, kids, husbands, hobbies, families and homes.