Thursday, 27 August 2009

The NHS in the media

For a while now, there’s been something that’s been baffling me about NHS stories in the media. People I meet think that the NHS is awful and slag it off and it routinely gets a pasting in the media about how bad it is and about how low the standards of care are etc… etc… On the front page of today’s Telegraph, they were at it again.

'Cruel and neglectful' care of one million NHS patients exposed
One million NHS patients have been the victims of appalling care in hospitals across
Britain, according to a major report released today

However, this doesn’t tally with my experience from the “inside.” Just about every single day, my patients and their relatives thank me and tell me I’m doing a good job. I have a growing collection of thank-you letters from patients and their relatives. The vast majority of patients on the ward seem very happy and very grateful for the care that they are getting. This isn’t just my experience either.

The Care Quality Commission’s patient survey says that 93% of patients thought that their care was “good” or “excellent” and just 2% though it was poor. Put another way, a massive 98% or out patients were satisfied with their treatment. What other organisation, public or private, can boast 98% satisfaction from it’s customers? Your bank? Your electricity company? Your plumber? Your mechanic? Your restaurant? Your hairdresser?

When the Yellow Pages found that a mere 84% of its customers were satisfied, they used it to front a huge advertising campaign. When you put it into context and realise that hospitals do far more difficult and complex things than say a builder or and water company, you start to realise that the NHS is truly amazing. Admittedly, it’s not perfect. 2% is 2% too much and there are definitely improvements still to be made, but, looking at the big picture, it’s pretty damn good.

So why do the media keep running these stories that say the opposite? Why have The Patients Association come out with this “report” of theirs?

I’ve done a little investigating and it’s been very revealing indeed. A look at the list of The Patients Association’s backers proves very interesting.

BMI Healthcare. MediRest. Cardinal Health, The Harley Medical Group, Virgin Healthcare etc… etc… Basically, it's a list of private healthcare companies and pharmaceutical companies.

Now, I’m not saying that The Patients Association is merely a front for private healthcare companies. Nor am I saying that private healthcare companies are using The Patients Association as their mouthpiece to the media in order to slag off the NHS. All I’m saying is now I know where these anti-NHS stories are really coming from, and why the media do not reflect the experience of the overwhelming majority of our patients.

Tuesday, 18 August 2009

Finding my groove

After nearly two weeks at my new hospital, I’m starting to bed down a bit and find my groove now. I’m working as an intensive care registrar and, as you can probably imagine, the responsibility that my new job involves is huge. Out of hours, I am effectively the most senior person in charge of looking after the sickest people in the hospital, which effectively means that responsibility for the lives of the sickest people in the whole city rests on my shoulders.

On my first day, one of the consultants walked all the new doctors around the intensive care unit (ICU) in order to give us a bit of a flavour of the sort of patients we’ll have to look after. At first, I was just a bit overwhelmed by the sheer size of the ICU. There are about 40 or so critical care beds and the variety of illnesses that the patients have is also huge. There are the usual patients with sepsis, multi-organ failure etc, but there are also patients who are post-transplant surgery, and there are those with head injuries, conditions I’d never looked after before.

Starting a new job is always daunting, but I think I’ve settled into it surprisingly quickly. For the first few days, my main emotion was “Oh shit, I don’t know what to do,” but I’m getting over that. I’m realising that actually, the majority of the time, I do know what to do and on the occasions when I genuinely have no idea, there are always people around who can help me out.

As a result, I’m actually starting to enjoy working in intensive care. I admit that I was dubious about it at first, but I’m finding that I like dealing with sick people, I like making an intervention, starting a treatment and seeing people respond to it, and (hopefully) start to get better. It also gives me the feeling that I’m actually being really useful, that I’m able to help out and to make an immediate difference to the patients. I will confess that once the patients are stabilised on the ICU, I still find the slow progression of their treatment really frustrating, but like all jobs, you have to take the rough with the smooth.

All in all, while the step up from anaesthetic SHO to anaesthetic registrar is undoubtedly a huge one, I think I’m coping with the transition quite well. Maybe, just maybe I was ready for the step after all, despite my previous doubts.

Tuesday, 4 August 2009

Best of luck!

To all the doctors changing jobs tomorrow, to everyone starting work in a new place with new people, to the FY1s starting for the first time, I wish you all the very best of luck.

Stepping Up

Tomorrow, I start work as a registrar. A registrar in Anaesthetics and Intensive Care, to give me my new job title. I'm about to make the step up from the ranks of "the junior doctors" to "the middle grades"

I’m starting a new job, in a new hospital (in fact, at TheBigTeachingHospitalDownTheRoad) with a greatly increased level of responsibility. I’ve now completed the transition from being “the doctor who knows when to get help” to being “the help.” Previously, I’ve known that if I found myself in a situation that could get out of control; that I could call on the anaesthetic registrar to come and bail me out. Now, I’m the bail out person and there’ll be no one around to bail me out if things go wrong. That thought is pretty scary.

It feels like I’ve come a hell of a long way in what seems like a vanishingly short period of time. Two years ago, I gave my first simple anaesthetic to a patient. From tomorrow, I’m going to be expected to look after the intensive care unit out of hours. I’m going to be expected to know what to do with all the life-support machines that the patients are on. I’m going to be expected to manage all the various inotropic infusions, the ventilators, the haemofilters and dialysis machines. I’m going to be expected to know what to do with intra-cranial pressure bolts, jet oscillators and all manner of complicated things. To be honest with you, I’m a bit worried.

I’ve got a slightly empty feeling in the pit of my stomach, like I’m standing on the top of a very high building, leaning over the edge. I’ve had this feeling before, I recognise it well. I had it when my Dad was driving me down for my first day of university. I had it the first time I stepped into a hospital as a medical student. I certainly had it on my first day of work as a doctor. I had it the first time I was fast-bleeped to A&E resus as a medical SHO. I had it the first time I was on-call for anaesthetics, and tonight, I’ve got it again.

It’s partly the fear of the unknown, but it’s mostly the fear of what can go wrong. It’s the fear of hurting people, of doing the wrong thing, of not being able to help someone who needs my help.

Perhaps I’m being a bit dramatic, I don’t feel anywhere near as scared as I did on my first day as a doctor. I actually feel that things are going to be OK for me and for my patients. I know that the consultants and the nurses will know that I’m new and that they won’t be expecting miracles from me. I know that I need to ask about things that I don’t understand, and I have a feeling that I’ll be asking a hell of a lot of questions initially. Given a choice, I would have preferred to have another six months as an anaesthetic SHO, but our training is not set up that way and I’ve got to make the step up now.

So here I am, swotting up on the Surviving Sepsis Bundles and wondering how I’m going to cope tomorrow when I walk on to the intensive care unit as “the new reg.”

Work is about to get a hell of a lot more interesting…

Monday, 3 August 2009

The European Working Time Directive (again)

So, the European Working Time Directive has finally come into force for doctors in training, and it’s in the news again. Last year I wrote about what I felt about the EWTD and why I think, overall it’s probably a good thing. I haven't really changed my opinion in the intervening time.

Basically, if you’re organised and the system is on your side, there’s an awful lot that can be achieved in 48 hours.