From the President

Who cares wins

Bob Handley

I quite like being a doctor. In your late teens in some interview or statement you may well have said that “I am good at science, play the piano and have a gold Duke of Edinburgh award” and then with an air of inevitability added “I like helping people”.

Corny as this last statement may sound, I do believe that most of us have this motive, but it may become concealed by events or fade with career weariness. In Oxford we now have a system of COTW (consultant of the week), which involves seven days of mainly not operating; doing ward rounds, clinics, call etc. I did anticipate that this would be a chore, but providing continuity for patients, juniors and ward staff is appreciated by them and pleasingly satisfying to me. It seems that I did not mislead the sub-dean in my medical school interview too much.

As part of our craft speciality we do of course help people as we complete our technical work, but there are other opportunities to find if we are not too blinkered. Currently, there is an increasing number of patients in the limbo between primary and secondary care. GP’s are using about 30% of their consultation time with patients who are already on a waiting list. Surgeons have the prospect of operating above baseline activity to catch-up. So who has time to venture into the limbo land to assist the patients circling there? It is a conundrum that was explored in the recent Coping with Covid webinar focused on supporting patients; Joe Dias showed what could be achieved, but then not all of us are Joe. There is no panacea, but the active management of the waiting list and at least giving patients reason to believe that both in primary and secondary will live up to the second part of our labels and ‘care’.

The blinkers may also shield us from the worries of trainees. Rob Gregory has explored the consequences of the curtailment of normal surgical activity on training. There looms the prospect of some extensions to training becoming necessary with the consequent disruption of fellowships, job plans and life in general. Even if not in our gift to change the landscape exactly as trainees would wish, an appreciation and accommodation of their problems is another way to fulfil the ambition we once expressed to the sub-dean. We should at least remember that every case is a training opportunity.

The burnout survey involving the BOA was not designed to compare ourselves to others but to be more aware of our own problems. Unsurprisingly, many who completed it displayed signs of burnout, and it was a reminder for each of us to be alert to the problems our colleagues may have. However, what I found salutary was the much higher incidence of burnout in the juniors. Particularly in the last year the consultants amongst us are more likely to have had a variety of advantages in this regard; stability in our surroundings, being with family, having a garden, perhaps a dog and no doubt more besides. The juniors may well have been isolated from many of these advantages. In the earlier Coping with Covid webinar with a theme of supporting surgeons Tony Clayson would definitely have impressed his sub-dean having forged and then assumed a position with the Trust to look after the wellbeing of colleagues of all specialities.

The recovery will have much bureaucracy, many acronyms, new initiatives, finance, irritation, zooms and more besides and we will do our best to participate, but in amongst all this we should take off the blinkers, look around, be true to our interview and care.