My theatre list finished early today and I was lucky enough to leave work by about 4pm. I got changed, picked up my bag, my coat and my books and headed outside. As soon as I stepped out of the door, I almost took a step back. It took me a couple of seconds to realise what had startled me, but then it became obvious.
It was the twilight. In that moment I realised that I hadn’t actually seen any daylight at all since Sunday afternoon. I wake up in the darkness and it’s still dark by the time I get to work. I spend the day in the operating theatre where there are no windows and by the time I’ve woken up the last patient of the day, it’s dark again, so I don’t get to see the sun he I go to see my post-op patients on the ward.
I’ve become a creature of the night and I don’t really like it. Is it too early to start looking forward to summer?
Last week, New Town anaesthetics department had its “Junior Doctors Forum.” This is basically a place where we juniors get to say what I working well and what is not working well within the department.
Unsurprisingly, straight out of the gate was the state of the on-call rota. Basically, there aren’t enough junior doctors to fully staff the rota. This means that we are constantly being asked by medical staffing to do extra shifts. The consultants frequently have to carry the on-call and cardiac arrest bleeps and the hospital trust is having to fork out huge sums of cash to pay for locums (it costs the hospital £3185 to pay for a locum anaesthetic registrar to cover a week of night shifts). The problem is going to be even worse in the new year, when a couple of the more senior SHOs leave to take up registrar position elsewhere in the country.
In the meeting someone asked if there were any plans to employ more juniors and the reply I got was something like this.
“We’re trying. We’ve had a couple of adverts out for a while now, but we only had one applicant and that person pulled out of the interview last week.”
I was flabbergasted. When I applied my job as a Medical SHO, human resources told me they received nearly 900 applications for 2 positions. Now, a couple of years later, they can’t even attract a single applicant? It begs the question – where have all the junior doctors gone?
The answer is obvious isn’t? It’s another legacy of MMC and the MTAS fiasco.
On the face of it, you’d have thought that a shortage of junior doctors was never going to be a problem. In January of this year, there were 33 000 doctors simultaneously applying for only 21 000 jobs and we junior doctors were fretting about unemployment - indeed I came within nine days of the dole queue.
It seems that what’s actually happened is that the suits at the Department of Health and the MMC have seriously overestimated how much shit junior doctors are willing to put up with.
What is now becoming apparent is that thousands of us have “Just Said No.” This has led to a mass exodus of junior doctors from the NHS. I personally know of 13 doctors of a similar experience level to myself that have left the NHS this year. Multiply that across the nation and you’re talking of a huge number of doctors who were simply unwilling to be treated in such an unfair and callous way. I think Dr Rant hit the nail on the head with this post.
The funny thing is, not one of my friends who have left the NHS regrets their decision. Whether they’ve gone to work abroad, or just given up being a doctor completely to do something else, it seems that they’ve found working conditions far better outside the NHS and, as things stand, none of them have any intention of coming back.
Yesterday, I was on call for anaesthetic emergencies with Jim, one of the slightly more senior anaesthetic trainees. The surgeons wanted to operate on a man in his eighties who had come into hospital with bowel obstruction. When we went to see him, it was obvious that this man had so many other medical problems that if he would need to go to intensive care after the operation to give him the best chance of surviving the surgery. Jim, myself and the ward sister were in the process of organising this man’s post-operative care. Despite obviously having lots to do, this nurse was doing the best she could to help us set things up so our patient could have his operation with the minimum delay possible.
I turned to Jim and said, “Do you not find that the ward sisters (senior nurses) are generally much more helpful that the staff nurses (junior nurses)?”
“Yeah, I think there’s something in that. I think that the senior nurses see more easily that you’re trying to sort stuff out for the patients. If you’re being polite and ask reasonable stuff, then they do their best to try and help you out. I think that the more junior nurses have a tendency to lump all doctors together. If they’ve had a bad experience in the past, they get the “all doctors are arseholes” syndrome and it’s really difficult to get them to do anything at all.”
As you can imagine, being a junior doctor in the modern NHS I spent a hell of a lot of my working time on “documentation” AKA paperwork. Writing in the patient’s notes, copying out drug charts, writing the request forms for referrals, writing out the discharge summaries for patients to take back to their GPs, writing requests for consultations, the list goes on and on…
Unsurprisingly, this all took its toll on my fingertips and over the past few years I have developed impressive calluses on the first three digits of my right hand.
In contrast, in anaesthetics, I spend much more of my time doing hands-on stuff with my patients and much less of my time on paperwork. As a result, four months after leaving General Medicine, my calluses are slowly shrinking.
Before starting deciding to change my career path and become a trainee anaesthetist, I used to be a junior doctor working in General Medicine. This is the same job that Zach Braff’s character in Scrubs does, but I have to say I’m less inclined to have surreal lapses of reality.
I think whenever you decide to change an aspect of your life, you always wonder whether or not the decision is the right one. It’s now been several months since I made the switch and, looking back, I have no regrets.
Here’s the first of the reasons why I don’t miss general medicine.
The ward-round octopus
Ward round days were when the consultant in charge of the overall care of the patients on the ward would go round and see each patient, catch up with what we juniors have been doing and make decisions about their future care.
As a junior, it was my job to know what was going on, and to have all the relevant information to hand that allows decisions to be made. It was also my job to document conversations between the consultant and the patient in the medical notes and write down what the management plan is.
On a practical level, this was often a bit of a headache, especially because I was often the only junior on the ward round. It meant that I had to find the patient’s observation chart and make a note of their most recent blood pressure etc…, get the blood results folder (that I had previously prepared) and open it at the right page to see their most recent lab results, get the patient’s medical notes and find where to write the day’s entry (often not as easy as it sounds), all the while I’d be listening to the conversation between the patient and the consultant and writing down the relevant points as legibly as possible, whilst being ready to interject with any relevant scan/histology results and I’d also be trying to write down any tasks that needed doing over the next day or so… and I’d have to do this ALL AT THE SAME TIME.
Seriously, even with judicious use of all available flat surfaces (the notes trolley/bedside cabinet/patient’s bed/patient’s footstool), I felt like I needed an extra couple of limbs just so I could relay all the available information and write everything down so things didn’t get forgotten about.
This process would have to be repeated for every patient on the ward so I had to be quick with my octopus arms because after deciding on his plan, the consultant would move onto the next patient whether I was ready or not.