I know there is always a risk of viewing the past with rose tinted glasses but I genuinely believe my experience of training in Medicine 11 years ago was very different to how we treat our young doctors these days.
My first Foundation Year 1 post was on a general medical ward with around 30 beds. There were 2 consultants, 2 registrars, 2 SHOs and 2 FY1s on the firm. Yes we still called it a firm back then. On any particular weekday you could expect 1 registrar, 1 SHO and 1 FY1 to be around. There were enough of us to do other activities – we had time to go to clinic, to do audit work, to start studying for Royal College exams and to get involved in teaching.
We did all our on calls with one of the registrars from the firm. I was paired with Hermione. She was a proper superstar and if I’m honest was probably one of my main inspirations for pursuing general medical training. She was like a swan. Having now been a medical registrar myself I’m sure her legs were kicking furiously under the water, but she was so serenely calm on the surface. She was also an exceptional teacher and taught me how to apply my knowledge to real clinical situations. I always felt supported and we developed a real sense of team during some extremely harrowing experiences.
After our night shifts we would present all the patients we had clerked to the on call consultant. This would give time for invaluable feedback from a variety of seniors on how we had managed our patients.
I’ll always remember getting myself into some trouble with a terminally ill patient on the respiratory ward. I won’t go into details here but my Consultant was so supportive. He couldn’t have been more so.
Towards the end of our rotation our boss invited us all to his house, together with our partners, for dinner. He had checked the rota to find a date when none of us were on call. We were all so touched by the thoughtful invitation and the effort that both he and his wife put into the evening.
What have I described? Adequate staffing, time to train, strong team culture, meaningful feedback and excellent pastoral support. All these factors spurred me on to pursue a career in medicine.
I fear that in 10 years we have destroyed all that for our junior doctors. Very rarely do they ever get to present the patients they have clerked on the AMU to a consultant. They are never on call with the same colleagues. They are stretched so thinly on the wards during normal working days that all the ‘extra’ stuff has been pushed in their own time.
Yes things have had to change given increased demand on health services, but I think if we do not look to the recent past and change how we treat our trainee doctors then we are never going to inspire them, value them, encourage them and build them into the senior doctors of the future.
Kate – I feel the same. I trained about 15 years ago when we were still Pre-Registration House Officers and we were working the tail-end of patterns that phased out as the European Working Time Directive came in. People were just coming round to the idea that routinely working >100 hours a week or a full weekend on call with literally no break from Friday morning to Monday afternoon was a little unsafe and perhaps should be discouraged. There was camaraderie in the mess and a Dunkirk spirit in the face of covering gaps in the rota. It wasn’t perfect and plenty of unsafe practices still occurred but we had the sense that the worst was over and that safe staffing and appropriate hours was tantalisingly close. Now we seemed to have returned to the dark ages and I don’t understand why: the vilification of doctors in the press, the erosion of respect, increasing pressures, the slow chipping away at salaries and now the lunacy of a unilaterally imposed contract – if someone was writing a guide to destroying a perfectly workable system it would look like this.
You are so right. I have said the same many times.We worked together as a team on the “front line” but someone always had our backs. Now, there is no team spirit, no camaraderie , no pastoral support and the world is a very lonely place as a JHD. How do we help to make it better – surely it is down to us to start making change for the better. Politicians will never understand, but the Colleges and the `BMA should.
As a user rather than a medical person, I agree wholeheartedly with your comments Cathy, change always has to come from within. Politicians, of whatever colour don’t know the reality of life on the shop floor, nor do strikers shouting with placards, the only people to hurt are themselves and us patients.
Send this to Jeremy Hunt Kate. Cx
For those currently still working in our stressful hospitals, please don’t forget the chaplains, who are there for staff as well as patients. You don’t have to be religious in any way – we are here for all. A quick chat in a corridor can make all the difference between being supported or not. Chaplains can’t change the system (any more than anyone can individually) but we CAN be there for you – a familiar and friendly face (hopefully!) – and someone interested in the person underneath the stethoscope.
My young daughter and I greatly valued the input of the hospital chaplain when we had to leave friends and family in N. Ireland and spend 14 weeks in Bristol Children’s Hospital where Leah received intense treatment for a rare haematological malignancy. Unfortunately, due to staffing shortages on the chaplaincy team we received much fewer chaplaincy visits than we would have chosen:
Thankfully, during the 2.5 weeks that Leah subsequently spent in Belfast City Hospital before she died we had almost daily chaplaincy, which is what we wanted and needed.
The comfort we got from our hospital chaplain when my father-in-law passed away was invaluable. I’m not religious but the feeling I had after meeting her (she also did follow up home visits) can only be described as extremely comforting and I can’t even explain why.This was far more meaningful than anything else offered at the time and I can’t thank her enough.
That is most worrying to hear how times have changing as regards the training of junior doctors.
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Just heard the news of kates death – Kate was an inspiration and although we only met through the RSM End of Life film We felt priveledge to have spent time with you both,
Our thoughts are with you and your family at this sad time
Theresa and Jeshni xxxx
Thanks so much
I had been following Kate’s blog for a while and for the last few months when I received a post I was dreading the bad news… Sorry to hear of her death and I wish you the best for the future.
I came back to the blog today because a close friend and boss has started palliative care today after three months of cancer treatment. I thought how can I help her, what can I do for her? I know her family will take care of her so I felt quite useless. Then I decided to get her something that it will be helpful in her final journey. I just bought The Bright Side. x