R-UK
The magazine from RemedyUK
Issue 2 - August 2008 www.rukmag.org
Unfinished business Time to hold the architects of MMC to account
Also inside: Darzi under the microscope : Morris Brown, Phil Hammond & Dr Rant Max Pemberton - Amateur Transplants - Maureen Mull - Dr Grumble
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EDITORIAL
R-UK ISSUE 2
Welcome to the second issue of R-UK magazine
I
’m very proud to be editing this issue of R-UK. Not only are we bigger – 24 pages of diverse news, views, opinion and humour – but we’re the launch pad for one of Remedy’s most important campaigns of 2008, Unfinished Business.
Contents
It is extraordinary that despite a High Court Judge, two august review bodies and the Commons’ Health Select Committee branding MMC/MTAS 2007 a disaster, its architects have not been held to account. A generation of junior doctors has seen their careers torn to shreds by arrogance and incompetence. We hope to right that wrong, with your help – in the cause of justice, not revenge. You can read the text of our letter, published in The Lancet on 26th July, on page 5 and add your name online.
4
RemedyUK on Darzi
5
Unfinished Business – The Trial(s) of Sir Liam,
Dumbing down and deprofessionalisation
6
Professor Morris Brown deconstructs Darzi
8
The Choice Agenda: decoding the mantra
9
Tim Jones from the Department of Health gives
his side of the story
10
Rob Finch: Jonathan Fielden on the August
changeover
11
Falling from Grace: Respect for doctors?
12
Give GPs a break, by Julia Manning
15
Leadership Skills for Doctors by Matt Green
16
What makes a doctor change career?
17
Taking care of yourself in medicine
18
Backstage with the Amateur Transplants,
Resident medico-musicologist Dr Beat
21
Mulled Whine: The bottle-necked Lost Tribe
22
Phil Hammond on Darzi: Groundhog Day?
23
Dr Grumble on predicting disasters
24
Max Pemberton on Newspeak in the NHS; Diary
of an HSMP
25
Dr Rant spews forth
26
House Doctor: The outer limits of news
27
Anaesthetists’ Corner: Crossword, Competition
and Remedy Detectives
The ‘big news’ since Issue 1 is, of course, the Darzi Report. Both Professor Morris Brown of Fidelio and Phil Hammond – Private Eye’s Medicine Balls – share their take on it on pages 6 and 22 respectively. Remedy’s offered a cautious welcome in principle to the education and training components – but we want your views before commenting in detail. Be sure to take our online survey and encourage your friends and colleagues to do so too. And then settle back and enjoy this issue. We’ve got something for everyone (we hope) with ‘Trust Me, I’m a Junior Doctor’ Max Pemberton; Liz Miller on the importance of taking care of yourself; a response from the RCS to Ben Dean’s ‘The Dumbing Down of Surgical Training’ in Issue 1; an interview with the Amateur Transplants and a fascinating insight into the nature of ‘choice’ by cultural dynamicist Pat Dade – plus columnists Maureen Mull and Dr Rant, House Doctor and Dr Beat AND Dr. Grumble! And lots more. R-UK is a magazine for doctors, by doctors. Please tell us what you think – good, bad or indifferent. And please tell your friends and colleagues about us. And if you’re about to remove this copy from the mess – put it down now! You can now get your own copy for just £12 a year. Find out how on page 13.
With every good wish Lindsay Cooke
Contact R-UK at R-UK magazine, The RemedyUK Office, 1 Coach House Mews, 217 Long Lane, London SE1 4PP Tel: 0845 643 1821 Advertising enquiries : 0845 680 5627 Email Editor@rukmag.org Website www.rukmag.org R-UK magazine is the magazine of RemedyUK. This issue of R-UK and all of its contents are fully protected by copyright © 2008 and no part of this magazine may be reproduced without express permission of the editor. The views expressed in R-UK magazine, in print and online, are those of the authors specifically and are not necessarily those of RemedyUK.
www.rukmag.org
Issue 2 - August 2008
Editorial team Lindsay Cooke Ben Dean Idris Harding Matt Jameson Evans Stephen O’Hanlon ‘House Doctor’ Line editor, Issue 2: Lindsay Cooke Layout editor, Issue 2: Stephen O’Hanlon
3
REMEDYUK NEWS
R-UK ISSUE 2
Grant award to support e-democracy & growth
The Darzi Report – what do YOU think?
R
training and education components of the report and its implications
emedyUK has been awarded a grant of £25,000 by the Joseph Rowntree Reform Trust Ltd to develop its e-democracy agenda.
Please be sure to make your voice heard by taking our survey on the for deprofessionalisation and the privatization of the NHS. The survey is short – around 25 questions – but comprehensive, and there’s also space for your personal views. Our ‘white boxes’ allow
An unconditional award of £15,000 will enable Remedy to better research grassroots doctors’ attitudes to participation and the development of sophisticated and user-friendly online methods of engagement. A further award of £10,000 is available for ‘matching’ by new subscribers to its Remedy+ paid membership. In June, Remedy
you more than 150 words, too … You can take the survey on the R-UK website. Please encourage your friends and colleagues to participate too. Remedy policy will be based on your responses.
NEVER MIND THE POLYCLINICS....
P
introduced a new free membership, Remedy Basic, ‘because we couldn’t think of a good reason why you should have to pay to be heard’ and renamed its paid membership Remedy+.
olyclinics have unsurprisingly hogged the media limelight in the weeks following Lord
Darzi’s report. What the chatterati You can sign up for Remedy+ on our website. You’ll receive
passed over were the big changes
personal contract, rota and/or banding advice if you need it, your own
to medical education set out in a
copy of R-UK, a RemedyUK lanyard and key fob – as well as discounts
sister report entitled “A High Quality
on books and courses. And every pound will be matched by the
Workforce”. And – despite all the
Joseph Rowntree Reform Trust Ltd.
familiar truisims (“all members of a team are valued” blah blah) - we might allow ourselves a cautious
The Remedy Team – an update
frisson of optimism out of some of the report’s meat.
W
A few months ago the Parliamentary Health Committee enquiry
e’re
having
our
own
August
appeared to put the kibosh on Medical Education for England
changeover. Chris McCullough, who
(MEE), a (hopefully) independent-minded body designed to oversee
was appointed Remedy CEO last
education and turn around abysmal manpower planning. Thankfully
autumn to oversee our transition from ad hoc
Darzi has blown a big raspberry at this nonsense. If MEE avoids the
pressure group to organisation, has completed
usual cabal of medical educationalists and gains the support of the
that task ahead of schedule and is stepping
profession (a big IF) it can achieve a great deal.
down. There aren’t the words to thank him for the invaluable work he has done, not just
Darzi also gains credibility with what appear to be some intelligent
in making us lean, mean and fighting fit, but
approaches to the problem of trusts failing trainees. With funding
also in expanding our network of influence
to strictly follow the trainee it will be easier to hold trusts and
among decision-makers. Chris is staying on as
departments financially to account if they fall below standard – a
Remedy’s ‘Special Counsel’ and will continue to
must in the current culture where training comes bottom in most
help Remedy+ members with their contractual,
departments’ service priorities.
rota and banding issues. Buried away in the report is a section with a hilarious Nu-speak “It’s been a privilege to work with such
title: ‘Modular Credentialing’. Difficult to decipher it appears to be
a dedicated and talented team at RemedyUK.” said Chris. “The
a form of revalidation with fangs, and our initial reading is that this
committee have, and continue to, work tirelessly to fight for doctors
will apply to all doctors throughout their career. One to watch with
of all grades. RemedyUK is now well placed to drive representation
rather less hilarity wethinks...
of doctors into the 21st century. We have an exciting and challenging year ahead.”
Perhaps the most encouraging aspect of the report is Sir John Tooke’s response in which he praises its strong adherence to the challenges
Other changes include: Mat Shaw is on sabbatical, working in
he set out in the MMC Inquiry. If Sir John could be encouraged to
Australia for a year. Matt Jameson Evans becomes Co-Chair of the
keep his watchful eye over the implementation of the reforms we
Committee. Richard Marks adds Policy to his Legal and Medico-
might further be encouraged.
Political remit. Lindsay Cooke becomes Co-Chair of the Committee and communications lead. Stephen O’Hanlon becomes webmaster and Managing Editor of the web edition of R-UK. Ben Dean joins the committee to work on outreach and e-democracy.
www.rukmag.org
Step forward the new Chairman of MEE?
Richard Marks Political Spokesman, RemedyUK
4
REMEDYUK NEWS
R-UK ISSUE 2
Dumbing down and deprofessionalisation
As part of Modernising Medical Careers, the MRCS exam is being changed. In R-UK Issue 1, Ben Dean argued that this represented a ‘dumbing down’. His argument has been challenged by the RCS. Stephen O’Hanlon takes the debate forward.
T
he Membership of the Royal College of Surgeons of England exam (MRCS) is changing. Historically, it consisted of two written papers, followed by a viva, and finished with a clinical
exam. The College has recently announced that the viva and clinical will be replaced by a combined OSCE format. David Ward, Chair of examinations and assessment for the College maintains that steps have been taken to ensure that the new exam maintains the standards of the old MRCS.
the MRCS will still be a great achievement and will be essential to progress from ST2 to ST3.
M
MC/MTAS 2007 has been called the greatest crisis to hit the NHS since its founding.
Its effects on the future and quality of the service and on patient care are currently impossible to calculate, but will become all too clear over time. Its
effects
on
a
generation of doctors of our most experienced junior doctors have seen their careers brought to an arbitrary end. Many
“OSCE does not mean that the exam becomes a tick-box exercise, and there will be face to face examining in most of the stations. The total examining time in the OSCE examination will be similar to the time for the same components in the present MRCS. A minimum mark will be required for each area as well as achievement of the overall pass mark.
have left or are leaving the profession or the country. Even those who were ‘lucky’ in the MTAS lottery have been forced through an unjust and abusive process. Highly trained, committed professionals have been shipped around the country like so many widgets; families torn apart; partners forced to choose between career progression and their relationship. It is the unforgivable inhumanity of the process that has, in many
“All the stations will be examined by fully-trained examiners. In the communications skills area, one of the examiners may be a trained lay examiner, paired with a surgeon examiner. Only in the surgical skills and patient safety area may one examiner be a trained healthcare professional such as theatre nurse. “The changes have been made by surgeons for surgeons. PMETB has the statutory duty for approval of the changes, but the changes were made by the Royal Surgical Colleges. PMETB approved the changes without alteration.”
instances, been responsible for what Ben Dean, writing elsewhere in this issue, calls ‘the death of hope’. There are those who argue that the profession must ‘move on’. We have always believed that moving on is not possible until this issue is resolved. Many of those responsible for the events of last year are still in positions of power and influence: many of them have been charged to put right what they got so very wrong. This is unacceptable. Many individual attempts have been made over the last 18 months to hold the architects of this preventable disaster to account. All have,
Many surgical trainees still have concerns about the exam. They are not happy that lay-examiners and theatre nurses will be enlisted; believing that the minimum requirement for an examiner would be to have passed the exam him- or herself. Questions have also been raised about anticipated pass rates. We are told that it is expected that many of the applicants to the OSCE stage will pass the exam. But typically, currently, only about one third of applicants passed the MRCS viva at any one sitting, with roughly a third of those passing the subsequent clinical exam. Logically, this would seem to indicate that only one applicant in nine will pass the new OSCE stage.
thus far, fallen on deaf ears, perhaps because individuals are easy to ignore. Numbers are not. That’s why we’re asking you to join us. On 26th July 2008 a letter calling for accountability, signed by Richard Marks, Matt Jameson Evans and Chris McCullough on behalf of RemedyUK, junior doctors’ champion Dr Gordon Caldwell, and BMA Council member and outspoken critic of government policy Dr Clive Peedell, was published in The Lancet. It is reproduced, by kind permission of The Lancet, on our website, www.rukmag.org Please add your name to ours, by using the form on the website. When we have 500 signatures, we will present the letter to the GMC in person with a formal request for an investigation.
If pass rates are significantly higher, will this mean that training has become significantly better? R-UK, trainees and patients everywhere
www.rukmag.org
Holding the architects of MTAS and MMC to account
are all too clear. Many
“The examination is not being dumbed down”, he tells us. “Passing
can only hope.
Unfinished Business
Further information can be found at www.intercollegiatemrcs.org.uk/new
Resolving this issue is not about revenge, but about natural justice. The sooner you sign, the sooner the journey towards that goal can begin. Thank you.
The RemedyUK Team
5
FEATURE
R-UK ISSUE 2
Thoughts on Lord Darzi’s ‘A High Quality Workforce’
Professor Morris Brown, founder of Fidelio, tells R-UK his view on the Darzi Report
F
or those whose careers have been wrecked by the catastrophe
on this occasion the extensive post-mortems pointed the finger at one
of MMC and MTAS, the offerings in the Darzi review must seem
person, who despite being architect of the disaster was almost alone
too little too late. When, however, we compare Darzi to the initial
in failing to acknowledge the disaster or his responsibility. Medicine
underwhelming DH response to Tooke, there is some relief that the
deserves leaders who come out of the shadows, with integrity to
Tooke report seems likely now to have substantial impact. I am also
admit their mistakes, compassion for those they have harmed, and
reassured that this victory (over the long-grass approach to Tooke)
the honour to resign after withering criticism by a Select Committee
reflects a rising star for the real medics recently imported by the DH
of MPs. Until it becomes clear whether he has been side-lined, or
– Mary Armitage from Medicine and Sir Bruce Keogh from Surgery –
continues to pull strings in his fantasy kingdom, it is impossible to
and the way out for the disgraced architects of MMC/MTAS.
have complete confidence in the fate of any new plans in which he continues to be mentioned.
The
most
feature
of
positive the
Darzi
The
report
does
not
recommendations is his
appear
acceptance in principle
even acknowledge, the
of
medical manpower mess
Tooke’s
proposed
to
tackle,
or
independent body to run
and
medical training – NHS
House of Lords ruling.
MEE. We have had some
It has seemed to me
months to ponder the
that a fundamental gulf
merits of this proposal,
between
and
predecessors has been
its
to
appreciate
superiority
MMC
of
and
the
its
the
the assumption that it is
counter-proposal in Alan
possible to buck, rather
Johnson’s initial response
than simply guide, the
to
namely
market. MMC was a rigid
keeping the current MMC
parallel ladder, with the
Board as a substitute.
same
While the Board has made
and leaving – once a
a better fist than the
year. Yet it was never
Tooke
–
to
aftermath
Douglas Review of finding
stated,
number
entering
probably
never
common sense solutions at short notice, and being responsive to real
appreciated, whether the driving number was the one at the top or
doctors, it is not an independent body and offered no guarantees
bottom of the ladder, and where this number was plucked from. Some
against a repeat of 2007. The Board is now relegated to implementing
have accused the DH of a conspiracy to drive down the cost of doctors
the strategy of NHS MEE. Its role remains important, because it was
by flooding the labour market. The post-mortems, however, revealed
the implementation of MMC/MTAS as much as the conception which
a DH systemically incapable of planning a conspiracy, and it hardly
led to disaster.
made sense to limit the number of doctors entering training, if the long-term goal were to produce a cheap-and-cheerful labour-force.
The rest of Lord Darzi’s proposals are harder to assess. Worthy-
One of the clearest signs and consequences of the attempt to beat the
sounding in principle, they strike me as uncomfortably resonant of
market has been this year’s combination of unemployed doctors and
the untried motherhood and apple-pie of Tomorrow’s Doctors, and
unfilled posts. For all the supposed concern of NHS managers about
ominously lacking in any assurance that (a) no change will be made
filling posts that was used to justify the 1st August deadline of last year,
for change’s sake, and (b) any necessary change will be piloted and
never has the NHS seen so much strain on its workforce caused by
validated before innocent victims are once again sacrificed on the
the predictable disappearance of locums during subsequent months.
altar of ideology. Despite – or perhaps because of – the complicated
The long-term damage to trust and morale is even more serious.
table at the end of his report seeking to align sections of the report
Meanwhile, Darzi is unenlightening on the thinking (presumably there
with recommendations in Tooke’s, I could not understand why Tooke’s
is some?) behind the desirable and expected numbers of trained and
generally more considered and detailed proposals could not simply be
training doctors, and the fate of those in limbo: the FTSTAs who are
accepted as they stood.
neither training nor trained. Given the swathes of unfilled posts, including hundreds of previously sought-after clinical lectureships,
The problem with the civil service is that it is often hard to identify
why does the DH resist its sister departments – Home and Foreign
the individuals responsible for day-to-day implementation – or indeed
Office – who wish, respectively, to encourage skilled migrants to come
the ideas to which Ministers put their names – and these individuals
here, and to increase UK influence by exporting our skills around the
are not expected to put up their hand when mistakes are made, or
globe?
acknowledge their failings before being let loose to try again. However,
www.rukmag.org
6
FEATURE
R-UK ISSUE 2
Yet, between the lines I sense the kernel of something more radical
with those we identify as allies in the DH. We should be thankful for
than Tooke, which may work to the benefit of doctors now in training
the acceptance of Tooke’s proposal of MEE. But it is now imperative
– if their confidence is won. Modular credentialing. One should read
that – unlike the run-up to MMC/MTAS – the Royal Colleges play an
such jargon with a dose of antihistamines. But is Darzi suggesting that
active role from the front in ensuring that only those changes are
jobs currently performed by non-career grades will be used instead to
implemented which are rigorously shown to improve medical training.
provide further training as CCT holders progress through ST and even
To me it is bizarre that, whereas College Tutors – even Presidents,
the Consultant grade? I would rather see a spectrum from training to
bless them – combine their administration with patient care, the
trained, with all doctors being somewhere in the spectrum, than the
people who now hold the juniors’ careers in their hands are full-time
current system of first and second-class doctors. Fear of post-training
Health Authority employees – the Deans and their army of ‘rules-
unemployment or a sub-consultant grade has, ironically, rendered
are-rules’ non-medical recruiters. This balance must change, and the
junior doctors among the most vehement champions of limited
profession must once again take our destiny into our own hands.
training numbers. It would be better if non-automatic progression through post-specialisation (Consultant-level) grades can be as nonstigmatic as in the parallel academic track, where Chairs come much later than lectureships, and not to all. Darzi wishes the workforce of coming decades to be more adaptable to change, and the challenge to us is how to benefit from, rather than be threatened by, an era of greater change. Medicine is on the crest of a transformation in how we understand and quite probably treat most common disorders, and
Morris Brown Professor of Clinical Pharmacology, University of Cambridge Founder member of Fidelio, www.fidelio.org.uk
traditional barriers are likely to move. Maybe ‘modular credentialing’ will be a passing buzz word. Or maybe it will be no more than a training option or CME. But maybe it will describe what we all have to do when our everyday practice has disappeared, or is performed better or cheaper by someone else. Things could be worse, and the medical profession needs to work
www.rukmag.org
7
ARTICLE
R-UK ISSUE 2
Choice - Decoding the Mantra
Pat Dade, director of Cultural Dynamics, Strategy & Marketing Ltd, writes about what ‘choice’ really means
T
here is nothing new about the notion of ‘choice’ as the panacea
are more inquisitive, concerned with justice, are more caring for
for all ills. Successive governments for the last 30-odd years
others and the environment, have broad horizons and are happy
have believed that offering us ‘choice’ would guarantee our
with their life at the moment. To these people choice is expected
satisfaction with ‘this’ service or ‘that’ Department of State.
and they will play merry hell if they don’t get it. Because they are natural seekers of information they are more likely than all others to
Choice isn’t, at core, good or bad. It is a concept filtered in different
know, or know where to find, data and information to provide them
ways by different people. The same thing can be good for one person
with real choice. These are the people most likely to be on boards
and bad for another; or even good for the same person at one time
of organizations – where policy is set. They want choice and they
and not so good at another, depending on their dominant motivation.
assume everyone else does as well. Unfortunately for their policies,
There’s more about this in the second part of this article, which you’ll
only about 35% to 40% of the population agree with them.
find in R-UK online (www.rukmag.org). The segment on the left hand side of the map (OD or Outer Directed) I’ve been studying why people make one choice and not another
represents people who have a different values set. These people
for almost 40 years. Today, I head a team of people collecting and
want to be seen and heard, to stand out in a crowd, to be successful,
interpreting data on the values, beliefs and motivations of the British
to be the life of the party, to be the one with the best, to have more.
population. We advise corporations, government departments, NGOs
Their approach to choice is not quite as simple as the first group.
and other organisations on the implications of the changing values
They like choice in that it gives them an idea of what and where the
sets of individuals - and by extension the culture they create and
best is, where they can get most, how they can stand out from their
use - on their future policies, procedures, programmes and projects.
peers. They will not usually know where data and information about
Over the last 35 years, we have identified and now work with 92
choices are to be found, unless the choice satisfies the dominant
different aspects of values systems in people living in the UK.
needs they have – the ones I’ve listed.
Choice, and the way we
Both these very different
perceive it, is one of the
groups
defining
high on ‘Self Assured’ –
of
our
characteristics individual
score
relatively
values
meaning they believe they
systems – the subconscious
can handle most things
lens
coming
through
which
we
their
way,
they
filter the phenomena we
can handle them better
encounter into attitudes, or
than most, and that things
orientations towards ‘good’
usually turn out the way
or ‘bad’.
they expected them to. Choice is a concept they
To
examine
‘choice’
and
can handle.
our responses to it, we begin by looking at three
The third segment (SD or
broad groups within the
Sustenance Driven) rejects
population:-
this approach to life – for
-those who are likely to
them, choice is and always
expect or demand choice
will be a con. It may look
-those
choice
like choice - but ‘people
is nice to have, but not
like me never really know
necessary, and
what THEY are DOING TO
for
whom
-those for whom choice is positively unwelcome.
US’. Things never seem to get better – in fact they were always better in the past. They want ‘authority’ to provide them with services and products that are safe
Take a look at the above map (go to www.cultdyn.co.uk for background
– the one ‘they’ think is the best, not a range of options that they
to the data and method). You can see that two out of the three
can’t judge between anyway. Shrewd and always on the lookout for
segments of the map are more likely to agree with the cluster of
what is wrong in an offering, they are unlikely to embrace options
questions that measure ‘Self Assured’ – the values attribute related
that are ‘new’.
to ‘choice’ - than the other sector. The bottom (ID or Inner Directed) segment represents people who
www.rukmag.org
Part 2 of this article is on the R-UK magazine website. Contact Pat Dade at www.cultdyn.co.uk
8
ARTICLE
R-UK ISSUE 2
The other side of the hill
Tim Jones, Head of Communication on the MMC team, talks to R-UK about selection and cynicism
Y
ears ago when I worked in a London teaching hospital, one
Now and then there’s a weird sense of déjà vu when someone
of the SpRs asked me to give a talk to his colleagues about
suggests that it would be a big help if there was a national application
communications in the NHS. Notwithstanding the usual jokes
form, perhaps with a web-based application process (and that’s
about what the initials ‘PR’ mean to different audiences, it was an
happened more than once over the past three months). I can’t say if
interesting afternoon. I was slightly shocked by just how cynical
we’ll be able to think about doing that again soon – and certainly not
the assembled SpRs were. They thought management, the NHS in
without a huge amount of preparatory testing and consultation. But I
general, and the Department of Health in particular, were all out to
can promise that we want to make practical changes to improve the
get them in some way.
process from the applicant’s practical point of view.
So it was a bit ironic that I was asked to take charge of communications
We’re in the middle of holding four events around the country to
in May last year for a reform programme that seemed to confirm all
listen to everyone’s views about this. I know how easy it is to be
those suspicions.
cynical about these events and in general about the idea that people in Government or in the NHS are ‘listening’. In this case it’s too easy
Last year was incredibly tough and extremely stressful for a lot of
– because we really are in listening mode.
doctors and for a lot of families. I feel enormous regret about that, and so do my colleagues, because we have friends and family members
We’ve already heard about some problems that I didn’t realise were
who are trainees too. It’s our responsibility to try to make sure that
problems – such as the bureaucracy involved for consultants in
nothing like that happens again.
providing references. Some of the really difficult issues are the ones we need the most help on – such as the balance between local and
One of the silver linings of the past year has been working with doctors
national processes, or whether we need some kind of preferencing.
and others to produce a way of recruiting and training doctors that, while far from perfect, doesn’t repeat the mistakes of last year. We
At the end of my discussion with the SpRs all those years ago I
don’t always agree about everything, but there is enough goodwill
remember thinking that we seemed pretty bad at talking and listening
and pragmatism to get by.
to junior doctors, and that this might cause problems in years to come. Unfortunately I was right. Fortunately we’re determined to do
My impression is that two of the main problems from applicants’ point
something about it.
of view in 2008 have been the difficulty of finding vacancy adverts (although Remedy has done a sterling piece of work in trying to help with that), and of the sheer hassle of filling in many different application forms, all broadly similar, but each containing subtle, crucial differences.
The views expressed in this article are those of the author alone and do not represent those of the Department of Health or any other authority
Give yourself a treat For just £12 a year, you can now subscribe to R-UK. Every other month for six issues, your personal copy will thud onto your doormat. To sign up via PayPal, visit our website. R-UK is currently mailed free to Remedy+ members.
www.rukmag.org
9
OPINION
R-UK ISSUE 2 BMA consultants committee chairman Dr Jonathan Fielden tells Rob Finch about the August changeover
T
he
sunshine
downpours
that
and
heavy
accompany
can have a knee-jerk, simple but ineffective way of doing things - or you can plan it - which stretches people but delivers.
Wimbledon, Glastonbury and
Royal Ascot are what makes British
‘Last year a lot of organisations did make contingencies, and yes
Summer great. Summer just wouldn’t
there was a degree of run down of services, but the vast majority
be summer without them.
maintained services to capacity, largely using career grade doctors, but also with consultants stepping up to the mark.
But once the major events of the
ROB FINCH
summer are out of the way and the
‘But some trusts took the short-sighted step of cancelling leave.
newspaper editors jet off on their
That is desperation, but partly it is almost a marker that you haven’t
holiday, we enter what is commonly
planned adequately. Leave is discretionary but it is also part of health
known in newspaper circles as the
and safety and part of having a good quality workforce.
‘silly season’. This is the time when any
remotely eye-catching story can get whipped up out of all proportion,
‘You need to plan for what would be ideal and what desirable. Above
especially if it includes a celebrity or a skateboarding puppy.
all patient safety has to be maintained - that’s the line in the sand. With my consultants committee and my director of medical education
And for us hard-working journalists there are always the ‘old faithful’
hat on you must not drop quality of training. That may mean a
stories, the good old ones we religiously mark in our diaries for the
morning not spent on the wards, but that will ultimately speed up
coming year so that we can dash them out without having to think too
their performance. That also needs consultation with consultants so
hard. A current favourite is the one which says ‘Don’t go to hospital
that they can understand it and adapt their timetable.
in August because it’ll be staffed by cack-handed six-year-olds and Corporal Jones from Dad’s Army’.
‘This year, yes there will be tensions, we know there are many gaps in the specialty training process that aren’t filled yet. Trusts need to
Obviously there is more to it than that, so rather than trot out the
be intelligent, that is made difficulties because of lack of information
usual guff on the August changeover, I spoke to someone who’s been
and artificial political targets. It may mean slightly longer waits for
through it a few times, and might have a bit of insight to share. That
patients in order to maintain quality and safety.
somebody is Dr Jonathan Fielden, chairman of the BMA’s consultants committee, who also happens to be a director of medical education.
‘One of the fundamental things about doctors is that they will put
Here’s what he said.
patients first and deliver for them. We must make sure trusts don’t exploit that and harness it in an effective way.’
‘There are two broad ways you can look at any problem like this, you
Rob Finch is the former editor of Hospital Doctor
The future of medicine
Neel Burton discusses how changes in training might affect the future of the medical profession.
R
ecent changes to medical education and training are having
a more recent development, asked to sit extra exams such as UKCAT
a significant impact on all levels of the medical profession:
and BMAT. The impetus behind all this is a desire for greater fairness,
those coming in, those moving up, and those at the top.
but the net effect is paradoxically to discourage talented but socially disadvantaged young people from applying in the first place.
Today more than at any other time, people are being discouraged from applying to medicine by the rising costs of a medical degree
This desire for greater ‘fairness’ also underlies many of the recent
combined with the falling take-home pay of junior doctors who
changes in specialist training. Progress up the career ladder seems
are currently losing both banding payment and subsidised hospital
to be almost completely arbitrary, based more on gamesmanship
accommodation.
As a result, many medical students are leaving
than on any objective and validated measure of achievement. Many
medical school with debts in excess of £20,000 and no immediate
dedicated junior doctors are frustrated by the vacuity of current
prospect of paying them off.
selection and training methods. They are left with little choice but to leave the country or the profession, and are doing so in ever
If prospective applicants are not put off by this, they might be put off
increasing numbers.
by the increasing demands and complexity of the application process. They are not only required to submit their UCAS form early, but also
A friend of mine, a former SHO in general medicine in London,
expected to gain extensive experience in the healthcare sector and, in
recently took up a job at a prominent City firm. When I spoke to her
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10
ARTICLE
R-UK ISSUE 2
about why she had decided to leave medicine, she told me, ‘I really
professional, not an anonymous, dehumanised and under-trained
very much loved medicine, and had always believed that I would
‘service provider’. I expected to spend my time with patients and
practice medicine my whole life. Ultimately, I left because I looked
with books and journals, not playing meaningless games for my
at my senior colleagues and realised that I didn’t want to be any
survival and advancement, nor sitting in endless meetings to discuss
single one of them. I was so angry with MMC – I felt that if things
the latest half-baked policy.
were this bad now, they would only get worse.’
Another friend, a
former SHO in plastic surgery in London, left for a job in industry. He
The recent changes to medical education and training are having a
had dedicated 15 years of his life to medical training and amongst
significant impact on all levels of the medical profession. Their net
his many achievements were a PhD, several patents, and the co-
effect is not only to discourage talent from rising up the ranks, but
authorship of a best-selling book. He said, ‘Leaving was the hardest
also to prevent it from being expressed at the top. This should set
thing I have ever had to do.
alarm bells echoing in the heads of those responsible, whoever they
But I absolutely don’t regret it and
my life is so much better now.’ Despite still being in love with my specialty of psychiatry, I too have jumped off the bandwagon. I am currently studying for a Masters in philosophy and have no immediate plans to return to the NHS.
When I went into medicine 12 years
ago, I expected to become an independent, respected and valued
might be.
Neel Burton is author of ‘Living with Schizophrenia’, ‘Clinical Skills for OSCEs’, and ‘Psychiatry’, which recently won the Richard Asher Prize for ‘best undergraduate textbook’.
Falling from grace
Respect for doctors? In the media? Welcome to the 21st century
T
he medical profession is in the grips of an identity crisis.
Doctors must take some responsibility for the uncertain position we
Unprecedented levels of service and management restructuring
now find ourselves in. The decades of quiet reverence we have enjoyed
have bled away doctors’ status in the workplace as respected,
from virtually every section of society has had a corrupting effect
valued professionals. There are those, particularly among the media
on our professional relationships, cultivating a patriarchal ‘doctor
and political classes, who now openly vilify the profession as greedy
knows best’ mentality both in us and in our patients. Resting on these
self-serving elitists who stand in the way of progress. Murmurs of
laurels, we have essentially watched in a state of bemused denial as
dissent have been met with loud accusations of arrogance and a
the NHS has been twisted and reshaped around us, mangling us in
reluctance to adapt. The self-doubt that ensued has cost us dearly.
the process.
With our representatives having all but capsized in the wake of disasters such as Shipman, doctors were ultimately given an outright
This month has seen a flood of articles, debate and analysis marking
mauling in the jaws of MMC and MTAS. But why should a group
the 60th anniversary of the NHS. Despite its capitalist dissenters,
historically lauded for its stoic professionalism now be treated with
it is clear that there is still broad public support for the institution
such contempt?
as a whole and nobody in government is looking to sign its death certificate just yet. It is also clear that the radical transformations
It has to do with respect. Respect has always been important to
initiated under Tony Blair are far from over. Lord Darzi’s recently
doctors, helping to offset the stress and poorly remunerated long
published vision for the NHS paints an optimistic picture and makes
hours the work traditionally entailed. Unfortunately however, there
sweeping recommendations for the future. His report categorically
has been a creeping confusion in the practice of respect over the last
states the need for greater clinician involvement in designing and
few years, in that treating someone with manners has now become
implementing service reforms, a tacit acknowledgement perhaps that
tantamount to declaring ‘you’re better than me’. This does not sit
overly centralised control is no longer the way forward (if it ever
well in a society encouraged to adopt a consumer-like mentality
was).
towards healthcare, where the customer is always right. In their eagerness to avoid letting doctors think themselves ‘superior’, people
The twenty-first century promises to be a defining one for the medical
tend to overcompensate and become actively disrespectful instead.
profession, which is now faced with an historic choice. Either we accept
Regrettably, this has led to a culture both within and outside the NHS
that others can indeed do a better job and leave the running of the
of ‘putting doctors in their place’ and knocking them down from their
NHS in their hands, or we re-discover our voice and play a key role in
irritatingly exalted status.
shaping the NHS of the future. Whatever our decision, it is likely that the traditional image of doctors working tirelessly in the service of
The drive to flatten the NHS has in many cases blurred the boundaries
their patients will continue to fade into memory. Improved pay-scales
between its professions, leaving managers, doctors and nurses
and work conditions are a poor substitute for the loss of the nobility of
jostling for position. Having traditionally been at the top doctors are
our profession, and we are increasingly going to have to look beyond
inevitably having to compromise the most, but the re-structuring has
our careers to give ourselves more balanced and emotionally fulfilling
been presented more as lateral growth rather than as the demotion it
lives.
actually is. This has resulted in an uncomfortable erosion of identity - death by a thousand cuts - rather than the clear redefinition that
Saj is a psychiatry SpR in London
was needed.
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R-UK ISSUE 2
Hope - a victim of Modernising Medical Careers
I
t
case
to crumble. Going that extra mile does not happen as frequently as
that everyone got the medical
has
never
been
the
it used to, and who can blame those who are now the routine victims
career they wanted; far from it.
of the stick, as the carrot has been whipped away from them without
However at least it could be said that
any warning? Clock watching has replaced diligence and apathy has
most people felt that they had had a
replaced the great motivation of hope.
decent crack of the whip. Medicine
BEN DEAN
has always been competitive and
No-one knows exactly what will happen this August. The signs are
doctors have never been averse to
that some SHO posts may not be filled at all; so when this is combined
fair competition. That said, Liam
with the current shortage of locum cover and the new 48 hour week
Donaldson’s ‘lost tribe’ tag was always
it has the potential to be a recipe for disaster. The MMC promises of
an unfair one, and ironically it is MMC
‘better training’ appear naïve in this context, as many trainees will
that has created a tribe of doctors
be spending a lot of their time covering large gaps in rotas and thus
who are more lost and devoid of hope
missing out on training. Again, the devastating effects of lowered
than the ‘lost tribe’ ever was. The conventional ‘lost tribe’ were a
staff morale upon service provision have been ignored by a bullying
motivated group who spent a few years gaining a valuable broad base
authoritarian regime; the use of sticks without carrots is also the
of experience which would stand in them in good stead whether they
strategy of choice currently used by the government in trying to push
ended up in their dream speciality or not. Although many would not
through the sub consultant grade.
gain access to their dreams, there was a sense that everyone had a chance, an opportunity along the way.
The saddest thing is that these problems were so very preventable. The balloons that were once buoyed with hope have now been brashly
The old days were never perfect. There have always been those who
popped.
have missed out and those who end up bitter and twisted. Life can be cruel and unfair at the best of times, but that does not justify the great
It is the NHS’ 60th birthday year and the excessive state control
mistakes that have been made in forcing such negligent government
of our profession in recent years has not been good for us or our
reform upon a generation of unsuspecting doctors. With MMC’s
patients.
arrival came the death of hope for a generation, and consequently the high quality NHS service that was fuelled by this hope has began
Ben Dean is a member of the RemedyUK Committee
Give GPs a Break!
A vision of primary care by Julia Manning, director of 2020health.org
I
remember his words like they were yesterday: “I’m quitting the
marketed authoritarian consolidation as multiple consultations, they
NHS”. Last year, this GP who had given 30 years of his life to
now send others to deliver their orders – sorry – ideas.
caring for patients looked at me with tears in his eyes but a
wry smile on his lips. Pain from the resignation and disappointment;
The best known clinical messengers come in the form of Lord Darzi
relief from the burden and battle. “I’m an effective doctor because
and Dr Colin-Thomé, now masters of double speak. “No Polyclinics
I know my patients, their history, their families, their jobs and their
will be imposed” – but PCTS are already having to go ahead and
neighbourhoods,” he went on. “Up until now I’ve adapted and changed
chose the location for them! “No GP will have to work in one” – but
to the Government’s whim, but no more. They behave like we cannot
don’t complain to us when you refuse to work in the polyclinic we are
be trusted – I can’t work for a boss that doesn’t trust me”.
building in the same road as your surgery! “Don’t keep your patients waiting” but can you just fit in a few extra thousand healthy bods so
You may have noticed, barely a day goes by when GPs are not being
the Government will be reassured that they aren’t ill?
criticised and maligned, or pushed and shoved. No matter how much the Government messed up the GP contract, is this the way our
Over at 2020health we are hosting a petition for GPs to sign to
health ambassadors should be treated? Our confidant in sickness?
demonstrate their commitment to the core values of the NHS:
The professional who we trust with our most intimate care?
Valuing the patient practitioner relationship, free from Government interference and bureaucracy, able to respond to patient needs, and
The Government’s vision couldn’t be more blurred if it put on a pair
delivering excellence in healthcare. PLEASE get your GP and Doctor
of bottle top spectacles with vaseline smeared over the lenses. They
friends to visit us and encourage them to sign - they deserve a break
talk about easier access then plan more remote mega-surgeries.
and after all our coughing, reeking, discharging and whining I think
They talk about patient-centred care then prescribe an overdose of
they’d like our support.
targets that deliver computer-centred consultations. They champion ‘evidence based medicine’ thinking it can disguise greater state control of treatment. So having talked at clinicians for 10 years, and
www.rukmag.org
2020health.org is an online think tank for Health and Social care
12
REMEDYUK NEWS
R-UK ISSUE 2
Rotas: mind (and record) the gaps
Bacongate warrents and apology from its instigator
I
I
n response to a suggestion from Dr Gordon Caldwell, director of Medical Education and Worthing hospital, and aware and
n the latest pitched battle between the medical profession and the consumerists, few have been as loaded with vitriol as the
concerned about anecdotal evidence of bullying and undue
Iwantgreatcare.org saga. The blogosphere went crazy, the country’s
pressure on juniors to fill rota gaps, RemedyUK will launch its own
pre-eminent libel lawyers were hired, and porcine mock-ups of the
diary monitoring exercise in early August.
site’s founder became de rigeur. All this ads up to a seismic turnaround in reputation for the founder of DNUK. His groundbreaking service
Diary cards will be downloadable from our website, www.rukmag.org,
that started ten years ago changed the way doctors communicate.
and chapter and verse on what needs to be done and how you should
It is ironic and indicative of a cannibalistic fervour that the forums of
do it will be available.
his own creation sowed the seeds of the backlash.
Inevitably, this raises the question of putting your head above the
Despite this, he should be congratulated for his entrepreneurial drive
parapet. If you – collectively – don’t, very little will change. If you
and vision in setting up DNUK. Which makes iwantgreatcare.org such
– collectively – do, you’ll have mutual support and the safety of
a puzzling and unedifying cock-up. For a start the website is clunky,
numbers. But it has to start with your individual decision to do what
has inaccurate information on its principal targets, and a rather glib
you believe is right.
justification for its existence in the blurb. And this is not even the main problem. How can someone who rode out the dotcom crash
Over to you.
Now you can subscribe to R-UK …
and was so ahead of his time put his name to such a half-baked catalogue of nonsense? The vacuum surrounding Bacon’s motives is drawing inwards. Altruism is out, financial gain lacks credibility. Perhaps this is a means of ingratiating himself with the commercial
For just £12 a year, you can now subscribe to R-UK. Every other
directorate of the DH with a view to grander projects. Who knows,
month for six issues, your personal copy will thud onto your doormat.
but whatever his motives, his current position appears riddled with
To sign up via PayPal, visit our website.
intellectual dishonesty and hubris.
R-UK is currently mailed to Remedy+ members.
We have all witnessed the at times intolerable pressure that clinicians
… or deliver it!
find themselves under. We have all been grumpy, irritable, and on occasion, curt with patients. How will this website help? There is little to add to the already voluminous criticism meted out by NHS
Six copies of R-UK are available
Blog Doctor and others, so Remedy
FREE to be placed in doctors’
will comment no more. Except
messes. They are posted to the
to say, by not apologising,
home addresses of distributors
by failing to acknowledge its
who currently cover around 120
unassailable
of the country’s 350+ hospitals.
people will draw their own
Yes, it’s that simple. You pick up the post and take it to work!
deficiencies
–
conclusions.
If you think you’d like to plug a gap, get first sight of the next issue – and go into the draw for an iPod Nano – please email us at editor@ remedyuk.org
www.rukmag.org
13
ARTICLE
R-UK ISSUE 2
Essential Leadership and Team Working Skills for Junior Doctors
Matt Green from Apply2Medicine, who deliver Leadership and Management courses for junior doctors, shares some important points regarding effective leadership and team working skills for junior doctors
B
elieve it or not, no matter what stage you are at in your medical
◊ A coaching leader should find things to praise, lead with their own
career, you are likely to have varying degrees of leadership
ideas (making sure to explain their thinking) and consult and listen
and management responsibilities. Whether this is leading a
before arriving at a final decision.
crash team or chairing a committee tasked with a particular remit it
◊ A delegating leader should allow others to take the lead, ask to be
is important that you understand the key elements of being a good
kept informed and challenge those working under them to excel.
leader and how to work effectively as part of a team.
◊ The leadership approach you choose to adopt should be tailored towards the particular situation, individual or goal in question.
According to the GMC, management within a healthcare context can
Effective leaders use all four styles to ensure the competence and
be defined as:
commitment of the people they work with.
‘Getting things done well through and with people, creating an
Effective Teamworking
environment in which people can perform as individuals and yet co-operate towards achieving group goals, and removing
Working effectively as part of a team within a clinical setting is vital
obstacles to such performance.’
to delivering high quality treatment to patients. All doctors must demonstrate an appreciation of what makes a good team and why
All doctors have an obligation to be aware of the principles of effective
they are a good team player. The key points to working effectively
management and to work cohesively with nurses, specialists and
within a team are:
non-medical professionals in multidisciplinary teams. A doctor must
• Clear understanding of the overall goals of the team.
be able to draw upon a variety of resources, play a role in evaluating
• Clear understanding of your own individual responsibilities within
and setting priorities and make other leadership decisions to improve
the team.
the provision of healthcare within a given clinical setting. The seven
• Ability to clearly communicate with your team members.
principles of effective management for doctors are:
• Ability to listen to the views of others.
• Selflessness • Integrity • Objectivity
Conclusion
• Accountability • Openness
Whether you are a FY1 doctor fresh out of medical school or a Specialty
• Honesty
Trainee with a number of management responsibilities, effective
• Leadership
team working and leadership are central to the goal of delivering
Leadership Styles
first-rate patient care. In order to ensure effective teamwork, leaders and managers must balance the demands of the task, the team as a whole and the individuals within the team. The most effective leaders
As a doctor there are several approaches to leadership you can adopt.
understand the importance of motivating team members and adapt
Leadership styles can be broadly grouped into four categories:
their management style to suit differing situations and individuals.
◊ A directive leader should find aspects to positively acknowledge and give direction, ensuring to check that those under their
Apply2Medicine provide a range of medical development courses
management understand what is expected of them.
including an ‘Introduction to Leadership and Management Course’
◊ A supportive leader should coax ideas from those working under them, listen and encourage and keep the decision-making process collaborative by asking open questions.
which is ideal for Junior Doctors wishing to broaden their knowledge on this topic.
Visit www.apply2medicine.co.uk for information.
RemedyUK have teamed up with Apply2Medicine, the UK’s leading provider of medical career support and advice, to offer an exclusive 20% discount to RemedyUK users. Visit www. rukmag.org and click on the Apply2medicine advert to take advantage of this offer, and get advice on management skills, interview preparation, communication skills, and much more.
www.rukmag.org
15
ARTICLE
R-UK ISSUE 2
What makes a doctor change career?
Sonia Hutton-Taylor was an ophthalmologist until 1990 when she set up Medical Forum - a career management facility for doctors. In the first of an ongoing series, she provides advice for doctors thinking of doing something different.
I
conferences over the past year is anything to go by - an alarming
In fact lack of career plan can emanate from any situation where a
number of doctors are pondering the “do I don’t I?” $64,000
person can’t see clear options or a future that is attractive to them.
dollar question at the moment. Even more surprisingly delegates
Sometimes they are right not to have a plan within their existing
were not only disillusioned juniors but consultants and GPs too.
career—for example if their personality and skills are fundamentally
But what is it that finally makes a person let go of the medical mantle
unsuited to medicine (it happens!). No degree of career planning
and leap into the blue yonder “outside”.
will foster a satisfactory medical career in such a situation. However,
f the numbers of delegates attending the three Medical Success
many of the other reasons that push someone towards thinking “get There are reasons that pull (to be covered in next issue) and those
out” can be addressed such that the person does start to see ways
that tend more to push someone into thinking a radical change is
forwards to a more motivating career within medicine.
needed. The latter fall into quite a wide range of categories It is also worth mentioning that in a recession , the security of •
Ill health caused by work
medicine as a career takes on a whole new meaning. An opposing and
•
Unsuited to medicine
just as valid view is that change of any sort in society always means
•
Work exacerbating ill health
opportunities and chance favours the prepared!
•
Conflict with colleagues
•
Performance issues
So sometimes the “presenting complaint” of “I’ve had enough” can be
•
Application hurdles
reinterpreted (after investigation and history taking!) as “I have no
•
Boredom Exam/study/research hurdles
vision of the future that fires me up”. That may be partly the fault of
•
Frustration with the NHS
the NHS but the individual themselves has to take some responsibility
•
Lack of career plan
for this. And sometimes it becomes ever more clear that something is going to have to be done!
One might think that the lions share would be held by “frustration with the NHS” but surprisingly this leads the field in tandem with “lack
Next issue: “The Career Happiness Equation”
of career plan”. What are the things that “pull” a person forwards in their careers and Lack of career plan is common in those frustrated with the systems and procedures, career structure and unfairness within the health services. And who can blame them. Feeling down or hopeless about an unsatisfactory career situation certainly quashes creative or forward
bring fulfillment in medicine or beyond.
Visit the Medical Success forum website, www.medicalforum.com for more information
thinking (as in mild depression).
Visit the R-UK website for much, much more! Did you know that this magazine is fully interactive? As well as most of the content of this magazine, there is much more on the website. You will be able to find longer versions of many of the articles, as well as contributions from readers that we couldn’t cram into the magazine. Plus you’ll find the following: • • • •
Cartoons Videos Music downloads Forums and comments
Go to www.rukmag.org for more www.rukmag.org
16
ARTICLE
R-UK ISSUE 2
And how are you feeling today, doctor?
Liz Miller is a co-founder of the Doctors Support Network, Mind Mental Health Champion 2008 and currently works in Occupational Health. In this article, she encourages doctors to take better care of themselves.
Y
our greatest asset is your health, physical and mental. As long
Personal Strategies – taken from a recent Doctors Support Net-
as you are physically and mentally fit and healthy, you can
work Survey.
always earn a living whether as a doctor, prime minister or in a
Flexible working; career breaks; choose jobs with fewer unsocial
call centre. This article is about looking after your greatest asset.
hours; career counselling; keep your friends; take time off when necessary; healthy lifestyle; hobbies; meditation; a life outside medi-
All too often, because of “stress”, lack of time, low self-esteem we
cine; psychotherapy including CBT
think those simple rules don’t apply to us. We act as though we were superhuman and diseases are only for patients. If only! As someone
Phone a Friend – Where you can discuss what is happening with
who has been through the mill (several mills, several times) and has
friends, including non-medical friends, colleagues, and your seniors.
just about recovered from the grinding life has given me, here is
It helps to know if your problem applies to you only or if everyone
some advice.
feels the same way.
You need to look after you, so you can look after other people. First,
Web based
take your own advice –
There are many web based resources, including the Doctors support
-Eat a healthy diet
line and the Doctors support network, and of course, RemedyUK. Visit
-Exercise regularly
the online version of this article for a list of organisations and links.
-Get good sleep -Have good friends
Phone based – It’s good to talk Cruse – Bereavement 0844 477 9400
The Yes Questions Do you sleep well and deeply? Do you eat healthy food when you can? Do you open your bowels regularly and easily? Do you exercise at least twice a week? Do you have either have an intimate partner, spouse, one or two close friends, and/or family whom you speak to and confide in at least once or twice a week? Do you have at least two possible career plans, ideally three or more? Do you know who to go to if you have a problem with your work and health? Do you relax and enjoy yourself regularly?
The No Questions Do you think you are immortal, infallible and can do anything
Doctors Support Line – independent confidential phone line evenings and Sundays 0870 7650001 Samaritans – 24 hours helpline 08457 90 90 90, you can also e-mail and see someone personally Sick Doctors Trust 24-hour helpline for doctors with addiction 0870 444 5163 Person-to-Person Your GP – a friendly GP can be your best friend and advocate. On the dark side, the GMC does not look favourably on doctors who do not have access to a General Practitioner. Occupational Health – more later Human Resources – yes they are Human, they do have Resources and they can help Mentor – formal or informal – they help Your consultant - yes most of them are humans too
you set your mind to?
A word about Occupational Health
Do you think, “This will never happen to me?”
If you need time off for medical or mental health reasons reasons,
Is being a doctor the major part of your identity and your
Occy Health can help. The Disability Discrimination Act 2006 applies
reason for being alive?
to everyone, including doctors. You are entitled to full patient confi-
Do you feel you isolated?
dentiality and your employer, boss, manager, HR only need enough
Do you drink too much?
to ensure you can do your job safely and effectively. If you need
Do you take drugs?
therapy, counselling or physio, you need it as much as any other pa-
Do you get angry with people?
tient, and you need the time to attend your appointment!
Do you feel panicky or stressed? Answer the following questions: If you have more than a couple of “No”s to the “Yes Questions” or
Visit the Doctors support network, www.dsn.org.uk for more information
“Yes” s to the “No Questions”, the rest of the article is for you. For those who can truthfully say your “Yes” is “Yes” and your “No” is “No”, can I be your patient please? Happy healthy doctors have happy healthy patients.
www.rukmag.org
17
INTERVIEW
R-UK ISSUE 2
Interview - Amateur Transplants
Adam Kay and Suman Biswas released their ‘Fitness to Practice’ album in 2004. Since then, they’ve played the Edinburgh fringe and brought out the ‘Black and White Menstrual Show’ DVD. R-UK talks exclusively to Adam Kay. How did the two of you meet, and what led to you writing and
How do you draw up the inspiration to write your lyrics?
performing songs together? There’s a bimodal distribution to our lyrics. Firstly, the smart-arse, We met at Med School in 1998. Imperial was a very bitter place at the
word-salad, dictionary-corner patter songs. These take fucking days
time, deeply riven into two factions - Shark Island and Tiger Island.
to write, and are a thoroughly miserable experience. The second type
I was leader of the Sharks and Suman was leader of the Tigers. The
are the sweary songs. We think of a quick nob-gag and stretch it
two tribes were sworn rivals and would only meet once a week, at
within a minim of its life until it’s two minutes long. We can effectively
the regular beach party. One such week, myself and Suman found
write those ones in real-time.
ourselves together on a stage - and we discovered our common love of the comedy song. Amateur Transplants was born, and Imperial
I expect that some people get offended. Any memorable
was as one again. I’m pretty sure that’s what happened. Then again,
complaints?
I was extremely drunk. Virtually no complaints as it happens, with one exception. We sing How did the two of you go about recording and releasing the
ourselves hoarse for four years about the diseased and deceased and
album, Fitness to Practice?
no-one bats an eyelid. One song about Northern girls being ugly and easy, and suddenly our inboxes are stuffed full of ire from angry (and
Fitness to Practice was thrown together as a RAG week endeavour -
presumably also ugly and easy) Northern girls.
unrehearsed and recorded in a single take (using a keyboard intended for children and a sound desk we had negligible control over). We had
You are both practising doctors. What are your current jobs
intended to flog a couple of hundred copies for RAG, but the public
and career directions?
appetite for swearing seemed to far outweigh this - and it has sold tens of thousands of copies. Somehow.
We’re both working in London. I’m an O&G reg and Suman’s an Anaesthetic reg.
www.rukmag.org
18
INTERVIEW
R-UK ISSUE 2 Sorry, I’m getting off-topic. No, clearly MTAS wasn’t a particularly
Name : Adam Kay Favourite colour : Blue Favourite band : Blue Fancies : Duncan (from Blue)
great plan and it was implemented by a collective of idiots. We were badly let down by the BMA by their prolonged inaction. Remedy will I’m sure get bigger and stronger, and could quite conceivably become a viable alternative doctors’ union within the decade. Go comrades. If you were Gordon Brown, how would you improve the health service? How would you improve junior doctors training? Shit, I’m not very good at the political stuff. We tend to deliberately
Has your music influenced your medical careers at all?
avoid it in the songs. I haven’t been particularly impressed with Labour’s health moves since Brown got in - they were off to a bad
Not quite sure how to answer that. We try to keep our two separate
start with me from the moment they made Ara Darzi grand high
careers quite, well, separate. Like Clark Kent, or Peter Parker. Or
wizard, or whatever the hell he is. (I met him at a party about four
Harold Shipman.
years ago and thought he was an incredible dick. Next thing I know he’s in charge of the health service. My views on him seem to be
Were either of you affected by MTAS? Were any of your friends
quite widely held though now.) They’re never going to ask me to go
or colleagues affected? Did this inspire any of your songs?
on Question Time are they?
We were both lucky with MTAS and managed to slip through the net.
Lastly, any advice for junior doctors who want to become pop-
I quite enjoyed some aspects of the process in fact - particularly the
legends?
‘bran tub’ part of it. I quite wanted to still be a Gynae trainee, but there was a very real chance I could have been randomly allocated
My advice for junior doctors who want to break into comedy music
as an F1 in Tropical Medicine. You don’t normally get that sort of
has always been the same. For the love of God don’t do it - it’s a
excitement at work.
small enough niche as it is, the last thing we need are more people muscling in on the action. Does this count as a journal - can I pop it
The other part I enjoyed was my voyage of discovery about Wessex.
on my CV?
I’d previously only associated Wessex with Thomas Hardy, and an almost-certainly-gay member of the Royal Family. Suddenly I had an interview there. I informed my mother: “It doesn’t exist dear you’re thinking of Essex”. I might as well have told her I was going to work in Narnia. Or Ambridge. When it came to interview day I was unable to find the building I was meant to be in, so went back home uninterviewed and still uncertain whether Wessex existed.
The Am Trans are playing the Edinburgh Fringe 9th to 16th August. Visit their website at www.amateurtransplants.com for more details. They also play a set monthly at the Bedford in Balham
Deserted Dono’s Island Nightmare Department of Health insiders have informed RUK of an alleged rift between
supremos
Lord
Darzi of Denham and CMO
Sir
Liam Junior
medical
Donaldson. Health
After
Minister’s
the
new
moving
performance on Radio 4’s Desert Island Discs, muffled expletives were apparently heard emanating from behind a certain Departmental door.
DR BEAT
Our sources tell us that not only has every junior doctor’s favourite CMO been angling for a spot on the hallowed sandy couch for years – to
no avail - but Darzi’s choice of the Nenah Cherry/Youssou N’Dour classic ‘Seven Seconds’ is Sir Liam’s all-time favourite – a fact surely known to the Nu-Labour Peer.
We’re told that the indefatigable
doctor-cum-bureaucrat has responded to the perceived snub by a brand new targeted campaign to become Kirsty Young’s next castaway. Civil servants are, apparently, hard at work preparing his selection.
www.rukmag.org
Their shortlist so far : I am telling you I’m not going - Jennifer Hudson If you don’t like me, don’t look at me - Morrissey Even Machines make mistakes - Union of Knives If I could turn back time - Cher No one left to blame - The Proclaimers Unfinished Business - the Blackbyrds I will survive - Gloria Gaynor
Dr Beat recommends : Man with the red face - Mark Knight Clinging on for dear life - Boy Omega Head in the sand - Dylan Young Got it all (Wrong) - The Loose Cannons Teflon Don - Badlandz Legion Don’t go away mad, just go away - Motley Crue I hate you so much right now - Kelis
19
MULLED WHINE
R-UK ISSUE 2
The bottle-necked lost tribe
I
n 1992 Elizabeth Paice, Associate Dean of the North West Thames Regional Health Authority, found 303 SHOs in 16 hospitals and asked them how they felt about their jobs; their workload, level of supervision, education and living conditions.
They agreed about one thing only. The
accommodation
particularly
the
and
lost and flogged to death hitched to a plough. However, the NHS had always been an interesting, if disinterested employer. It was about to become more so. Apparently 50% of Junior Doctors were still SHOs and it still wasn’t precisely known what the buggers were getting up to. Closer inspection suggested all sorts of totally unregulated activity. The tribe undertook the majority of direct
food,
patient care. They also indulged
cockroaches,
in
were rubbish. Nobody is recorded as actually saying, “I’m a Junior
fact-finding
questionable), volunteered in the Third World, careered in the States.
mission
They were changing crafts and
formed the basis of a conference
countries like pairs of socks!
attended by 300 people, 200 of them SHOs, entitled, “SHOs: The
People, they were being ‘left to
Lost Tribe”. A fuse had been lit.
decide on and to implement their own career pathways’! It was rumoured,
During the rest of the Nineties
and I struggle not to be sexist here,
the world, and presumably the
that some of them were even having
303 SHOs, moved on. Other more
babies. Yes, as Elizabeth Paice had
colourful lost tribes were discovered
discovered ten years earlier, this
in Peru and Brazil. Those who
was a determinedly, and probably
survived these discoveries bore
unavoidably, heterogeneous group
poignant witness to the results
of highly-educated adults making
of blundering, if well-intentioned,
their own decisions and getting on
intervention in fragile ecosystems. “When the loggers made contact with us, we came out of the rain forest. That was when the disease began. The disease killed us. Half of us died.” Jorge, Murunahua man, contacted in the mid 90s, Peru. Organisations
such
as
Survival
International developed to protect those who came to be known as
‘uncontacted’
tribes,
tacit
recognition that the term ‘lost’ probably
said
more
about
the
seekers than the sought. It fell into disuse.
with their lives as they were able
Maureen Mull is a GP. For the last 25 years she has chosen to practice remotely. Patients are rarely allowed in the same building let alone the same room. She is on-call all of the time. This gives her much too much time to brood. She has a husband, three grown children, one of whom is a graduate medical student, an Art Gallery and decided opinions - lots of opinions. It is only the last of these she actively wants to share with you...
Undeterred, or possibly unaware, in 2002 Professor Sir Liam Donaldson, CMO, BSc, MBChB, MD, FFPHM, FRCP, F Med Sci, FRCA, or scone-face as he was sometimes called, though never by me, finally turned his mind to ‘Unfinished Business’. Not as you might expect a treatise on toilet training, though parallels could be and would be drawn, but a malignant analysis of the vexing problem of the SHO grade that was proving so ‘difficult to manage’. In the introduction to this frankly scary document, Liam referred to SHOs as both the ‘lost tribe’ and the ‘work horses’ of the NHS. There is a dichotomy here. It’s difficult to see how anyone could be both
www.rukmag.org
unpaid,
variable pass rates so patently
In 1993, the anecdotal evidence this
sometimes
unaccredited externally and with
Doctor. Get me out of here!”
from
research,
PhDs, post-graduate exams (totally
and as they saw fit. Obviously this had to stop. Previously,
a
bunch
of
control
freaks posing as a government had committed themselves to a Health Service,
‘delivered
by
trained
doctors not trainees’. They didn’t have much money so cheaper units were needed, and more of them, fast. Scone-face had his orders and ‘Unfinished Business’ certainly had the tools; five Key Principles later to become Seven Pillars of Wisdom -
time-capped
training,
robust
structural frameworks, seamless progression through the training continuum, competency-based assessment, working in teams, with the right attitude, across professional boundaries... Reluctantly I quote. “It will not be acceptable for individual trainees to spend significant periods as SHOs beyond that necessary to complete this stage of training. Trainees will be expected ... to move on. Following completion of Basic Training those trainees unable to progress directly to Higher Specialist or GP training should be allowed a ‘period of grace’ before LEAVING TRAINING”. The capitals are slightly stunned and are mine.
20
MULLED WHINE
R-UK ISSUE 2
MMC was in the room. There was some mild The next few years were
hysteria
taken
end.
up
in
allowing
A
towards few
the
people
Junior Doctors sufficient
realised what they had
rope to hang themselves.
done, what was going
They
repeatedly
to happen. Still, in early
asked what they wanted.
2007, the last lost tribe
They were encouraged to
was, against its will,
write it down. Eventually,
pressured
as chance would dictate
surreal selection process
and fatally, they got the
and spat out randomly
answers right.
the other side. The ‘lost
were
through
a
tribe’ became thousands Meanwhile,
in
of truly lost individuals,
another
part of the forest, the first
many
underpowered F1s had
period, though not a
of
them
in
a
been born in captivity.
state, of ‘grace’.
They didn’t breed (that was
happening
In
further
2008
the
only
question on the block
down the chain in Medical
is, “What now?” No-
Schools), but they did need to grow up and become F2s. They were inexorably applying
one has the answer. It seems to revolve around differing opinion
upward population pressure on the poor bottled and bottling SHOs.
concerning the correct placement of the next bottleneck. Or which
Faced with the spectre of entering the training continuum or leaving
group will be shafted next. I hear the accommodation problem has
forever they were being pushed relentlessly towards the bottleneck
been largely solved. It is difficult to complain about the standard of
that was MTAS.
something that you no longer have.
Bottlenecks don’t just happen; they are made. They are someone,
And the SHOs themselves?
or something, that retards or halts free movement or progress. Interestingly, in Mendelian terms, they are a dramatic reduction in the
Well, I used to keep bees. In the last few years global agriculture
size of a population or species that results in a decrease in variation.
and food production have been threatened by the ‘Marie-Celeste Syndrome’ or ‘Colony Collapse Disorder’. It is thought a hostile virus
Anyone who still thinks MMC and MTAS were just big mistakes, cock-
causes worker bees to mysteriously disappear without trace leaving
ups not conspiracies, stop it now.
hives empty. And they never return.
Book Reviews by Maureen Mull
Their attractive thesis is that the beknighted Health Service has a
“The Hospital Revolution”, John Riddington Young et al, Metro 2008
J
ohn Riddington Young(JRY)is the Senior Consultant at the North Devon District Hospital, “where he has worked (when not suspended) since 1981”. His co-author is also a consultant
surgeon in an NHS hospital, but unlike JRY he “has not yet been suspended and would therefore like to keep his name undisclosed as he realises what a traumatic process this can be”. Their co-conspirator, Dr Peter Tomlin, “has no such qualms because he undoubtedly knows more about the suspension of doctors in the NHS than anyone else in the world and anyway, he is retired.” This tells you our protaganists are mischievous. It doesn’t tell you that, given their subject matter, this is a wittily erudite, joyfully discursive and totally irreverent analysis of what they see as the sickness threatening the life and soul of the NHS and the morale of
“huge cancerous growth inside sapping all its strength. This malignant mass is the management system”, or, as it is inevitably called, The Stasi. And my don’t they have some admirably scurrilous fun with the notion. The only trick they miss is to notice that the Stasi have taken over General Practice as well. If you’re feeling down and troubled, and let’s face it this is a sine qua non for the average “modern” doctor, read this book, put your head in your hands and weep with laughter. It beats the alternative. When you’ve composed yourself, consider their arguments and the convincing body of narrative evidence they’ve collected to support it. Then, if you love it, let it go. Straight into the internal mail to the admindroid you love best would be good, or to Westminster and an opposition MP. I’m sending mine to Polly Toynbee.
all who sail in her.
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21
OPINION
R-UK ISSUE 2 Phil Hammond—GP, Private Eye columnist and author of Medicine Balls— writes for R-UK on what he thinks of the Darzi report
Y
ou’ve got to hand in to Darzi.
every chapter heading (Setting Quality Standards, Delivering Quality
There aren’t many Iraqi born,
Standards, Monitoring Quality Standards and Action for Quality.) So
Jewish
the claim that the Darzi review is radically different for its focus on
schooled
sons
of
Russian Orthodox Armenian parents who
PHIL HAMMOND
qualify
in
Ireland,
quality is clearly bollocks.
become
internationally renowned academics,
Dobson put his paper out for consultation but Darzi has already
robot assisted laproscopic surgeons
consulted over two thousand doctors and the fact that so many put
and peer of the realm health ministers
variation in quality at the top of their agenda a decade after Labour
who get a chance to save the NHS.
promised to abolish it tells just how successful the last decade has
And he’s a nice bloke. But will his ideas
been. There are lots of other similarities – promises to put patients
succeed any better than the offerings
at the centre of care, gather their opinions and give them outcome
of Dobson, Milburn, Reid and Hewitt?
figures – but two key differences. Dobson’s log made not a single mention of the word ‘choice’. Darzi gives us 62 to choose from. Dobson
When Gordon Brown took over a year
is old Labour, believes in co-operation and collaboration in healthcare
ago, a friend of mine working at the Department of Health (yes, I do
(along with the Scottish and Welsh assemblies and the BMA) and
have one) was staggered that Gordon, having waited impatiently in
that people don’t want to shop around for treatment when they’re
the wings for so long, had so few ideas about how to improve the
ill. Blair quickly got rid of him and brought in Milburn to feed the
NHS other than appoint Darzi to tell him what to do. In October 2007,
NHS to the market. Lots of money, duplication and job insecurity has
with the Summer to think about it, the good Lord produced an interim
indeed got waiting lists down but because the publication of clinical
report containing the immortal line ‘we need to change the way we
outcomes promised by Dobson and Milburn has never materialised,
lead change.’ As I asked in Private Eye; ‘Has Lord Darzi’s brain been
we still don’t know if the onslaught on waiting lists will come at a price
removed and replaced with ‘new’ Labour arse gravy?’
of failed cataracts and joint replacements later on. Quicker does not always mean better.
A few weeks later, I was summoned to Whitehall to find out. My Lord was gracious, engaging, slightly infected with jargon but with no
Dobson also believed that the healthy competition of professionalism
visible signs of arse gravy brain. He is clearly very driven and eager
would raise standards but Darzi has swallowed the Blair belief that staff
to succeed. And most people seem to have embraced his review
need financial incentives to practice good care. So as well as reminding
with some degree of enthusiasm. He’s taken on board many of the
them to treat patients with dignity and respect (doh!), they will be
Tooke recommendations and insisted on reforms that are clinically
paid extra for providing a ‘new’ quality service based on outcomes.
led and based on evidence, which should please most doctors (until
Could this be an extension of the quality and outcomes framework
they realise they have to publish their outcomes). But then he – and
that ‘incentivized’ GPs so well? Incentives work by undermining the
Gordon Brown – spoiled it by pretending that the first ten years of
neutrality of professional judgement and encouraging self interested
‘new’ Labour was all about building capacity (i.e. embracing private
decision making. Doctors are human. We follow the money.
competition) and this was a ‘new’ focus on quality. This time around, I suspect the government mean business on Let’s rewind to the 50th Anniversary of the
publishing clinical outcomes. ‘New’ Labour
NHS and Frank Dobson’s bestseller ‘A First
are probably a fag end administration
Class Service – Quality in the new NHS.’
and they’ve got nothing to lose which
Dobson’s foreword starts ‘All patients in
almost certainly means they’ll cock it up,
the National Health Service are entitled
rushing out figures that haven’t been risk
to high quality care’ and promises that
adjusted just to wind up the doctors. You
‘unacceptable variations that have grown
can see the look on Ben Bradshaw’s face
up in recent years must end.’ Just ten years
now as he fingers the worst trust/ heart
later, Darzi promises ‘high quality care for
surgeon/ single-handed GP in the country.
all’ and stresses that tackling significant
I’m a believer in the principle of published
variations in the quality of care will be his
outcomes – they keep competition healthy,
first priority.
rather than tainting it with money – but I doubt politicians have the intelligence and
Dobson’s reforms should have ensured ‘high
sensitivity to do it properly. If the last 60
quality care becomes the norm everywhere.’
years has taught us anything about the
Darzi, in contrast, will deliver ‘high quality
NHS, its that – Nye Bevan aside - politicians
for users of services in all aspects, not just
can’t deliver the hard stuff.
some.’ Dobson manages 191 mentions of ‘quality’ in his document compared to Darzi’s 359. But Dobson put quality in
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22
OPINION
R-UK ISSUE 2
I
n
Dr
concerned? The answer is privatisation. Many in medicine can see this
Grumble is a blogger. He likes to
case
you
don’t
know
happening though, curiously, not all. The writing is on the wall as far
call himself a top medical blogger.
as the NHS as we know it is concerned. It’s happening in a strange
It’s not really true but you can call
piecemeal fashion. There’s been no public discussion about it. It’s
yourself what you like on your blog.
just happening. There’s no overt policy on it. But clear signals are
How many of you read medical blogs?
being sent out. Where did this policy come from? Who made it? And
Dr Grumble is addicted to them. He
why? Dr Grumble has no idea. None whatsoever. If anybody out there
reads them avidly. The bloggers are
knows please tell us all.
often ahead of the game. Some of
DR GRUMBLE
you may remember Dr Grumble
The early morning news is on as Dr Grumble writes this. It seems the
frantically trying to alert the world to
media are catching up. Because one of the main news items is about
the impending catastrophe of MMC/
outsourcing. There’s been some committee advising the government
MTAS. For a while nobody listened.
on this. And who do you think was on the committee? You can guess.
Dr Grumble was incredulous as he
It was full of the representatives of Big Business. These are the
watched the disaster unfold. Others
people who make money from outsourcing. So what do you think the
knew there were problems ahead.
committee has recommended? Dr Grumble will leave you to guess.
But nobody did anything. All Dr Grumble could do was blog about it and try to alert everybody. It did no good. But it was a safety valve.
Outsourcing of public services has doubled in not much more than a
Dr Grumble was able to vent his wrath. Eventually the house of cards
decade. The value of the business is now close to £80 billion. That’s a
collapsed and the issue hit newspaper headlines. But the bloggers
lot of money. Somebody is making lots of money. That somebody is in
were first. By a long way.
favour of outsourcing. That somebody is advising government. Who is losing from this? If money is going to profiteers, is anybody losing?
You won’t find Dr Grumble commenting much now on MMC/MTAS. The
Perhaps. Perhaps not. It depends. What upsets Dr Grumble is that he
problem has been recognised. The great and the good are now on the
sees no debate. No discussion on the pros and cons. He doesn’t think
case and sensible people have been empowered to try and sort it all
the government wants discussion. The government mind is made up.
out. It’s time for Dr Grumble to alert you to something that you may
They ask advice from people who give the answer they want. Clever
not be aware of. More mistakes are on their way. Human beings, you
that.
see, make wrong decisions. It happens all the time. It has happened throughout history. Why it happens is perplexing. Especially when the
What has all this got to do with the NHS? The outsourcing market now
decisions are obviously wrong.
employs as many people as the NHS. In another decade, if outsourcing doubles again, will the NHS as we know it be gone? There are those
It’s a curious thing that the older you get the more history matters
that think that is exactly what lies ahead. Does it matter? Perhaps.
to you. After you have lived 50 years, a century doesn’t seem that
Perhaps not. Are we debating the pro and cons of this covert policy?
long. And, curiously, when you can see the past it enables you to
No. We can’t. Because the policy is not explicit. There are still a few
see the future. Another odd thing is that as the sands run out and
of Dr Grumble’s colleagues who cannot see what is happening. And
your own future shortens you become more interested in what lies
his younger colleagues are the worst of all. Yet for them it will matter
ahead. Yet the future matters most to the young. So why aren’t they
most. Remedy has woken up to the immediate future. Remedy and
concerned about it? Well, if the future is close they are. Remedy itself
its youthful membership now need to wake up to the more distant
is testament to that. But anything much further ahead may be of less
future. Ten years is not far ahead. It will matter to you. Dr Grumble
concern. For the young it’s too distant. It seems irrelevant. You don’t
will be out to grass.
worry about your pension on your first day at work. So what does Dr Grumble see in the future as far as UK medicine is
Visit Dr Grumble at his website, drgrumble.blogspot.com
Join Remedy+ now Take out a Remedy+ membership for just £15 per month - and every pound will be matched by the Joseph Rowntree Reform Trust Ltd. Help us deliver maximum bang for your buck - and grow - on 0.06% of the BMA’s income. -
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You can sign up at our main website, www.remedyUK.org
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23
OPINION
R-UK ISSUE 2 The ‘Trust me, I’m a Junior Doctor author’, writes for R-UK about Big Brother, George Orwell, and the NHS
I MAX PEMBERTON
sit in the lecture hall while the
that this is what patients want. Departments will close and lives will
lecturer drones on. Photographs
be saved. Increasingly the language used about, and within, the NHS
of smiley faces are projected
appears to be designed to obscure what’s really going on. Jobs aren’t
onto the screen and they look down
lost, instead services are streamlined and restructured. Resources are
at me, benignly. Key words are
redistributed and modernised rather than reduced; valuable services
flashed up in bright colours. The man
are improved by being axed. Bad things are renamed and re-branded
in front of me is explaining how there
as being good, in the hope that in someway we will begin to believe
will be fewer doctors employed by the
it. The parallels with Orwell’s novel continue in our ever-increasingly
Trust next year. He smiles. This, he
monitored and surveyed society as it infiltrates the NHS. It seems
concludes, is going to be beneficial
amazing that only a few years after leaving a century that saw some
to patients and help improve patient
of the worst examples of state-control and totalitarianism, we are
care. He’s saying something about
giving up our liberty so liberally.
delivering a modernised and focused career
structure.
Streamlining.
I have very real concerns about the ‘NHS Spine’. This is already
patent
being rolled out and will form a huge national database of patient
choice. But none of this really means anything, I want to scream.
records including personal details such as private telephone numbers,
There is talk of doctor’s competence, while we’re treated as though
accessible to potentially thousands of NHS workers and government
we’re all incompetent. Of responsibility, while responsibility is taken
officials with no opt-out mechanism for patients. But it seems that
away from us. Of choice, where there is none. As my mind wonders
while Big Brother may already be with us, we don’t love him yet. Polls
there’s a niggling feeling that this is all horribly reminiscent.
conducted by YouGov have suggested that hundreds of thousands,
Flagships.
Supporting
real
maybe even millions, would refuse to register on the proposed It wasn’t until the following day when I read the headline ‘Hospital
database that will underpin the ID cards scheme. Maybe we’ll wake
closures will save lives, says health minister’ that it fell into place.
up from the Orwellian nightmare before it fully begins. And perhaps
Suddenly I was 15 years old again and sitting in an English class.
we’ll cease to be fooled by Nu-Labour Newspeak. Wittgenstein stated
‘War is Peace. Freedom is Slavery. Ignorance is Strength’ I remember
that ‘The limits of my language are the limits of my world’ and in this
reading as we ploughed our way through George Orwell’s Nineteen
way, the new lexicon adopted by those implementing policy within the
Eighty Four. Increasingly, medicine is being infiltrated with the Nu-
NHS isn’t just jargon, it’s a new way of viewing the world. Theirs is a
Labour equivalent of Newspeak. In the novel, Newspeak is the official
shiny, happy world of smiling faces, looking down benignly while the
language of the totalitarian state of Oceania and its purpose was
NHS is slowly destroyed.
to provide a medium of expression for a world-view consistent with that of Big Brother which would make all other modes of thought impossible. Orwell could never have guessed quite how pertinent his novel would be to the current political climate. While people protest at the planned closures, we have our Government telling us, earnestly,
Max Pemberton is a doctor and columnist for the Daily Telegraph. The second edition of his book, ‘Trust Me, I’m a Junior Doctor’ is published by Hodder on the 7th of August 2008, priced £7.99
Secret diary of an HSMP, by Mei Bo (Mabel) Hwa Smith - age 33 and ¾
I
was walking along Queen’s Road East on the way to the Hong Kong Medical council head quarters to pay my annual subscription fee, when I spotted an advert in a small corner of Sing Tao Daily News. ‘’Come to Britain and work as a general medical SHO in a major teaching hospital’’ the advert said. I was gob smacked and nearly dropped my lunch of wife cake and pearl tea on the floor. The advert promised that I would have excellent training and the promise of a better life away from the pollution and terrible working hours which would have given the architects of the EWTD a month off work with stress if not an excuse for early retirement. So I told my family about this advert and they were very happy for me. After all the UK ruled Hong Kong for over 100 years and gave us Marks and Spencer, our modern medical system as well as our Kumar and Clarke textbooks. I applied for the job and got it after a short telephone interview during which they asked me probing questions such as ‘how soon could I
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start’ and ‘could I run a medical take with no senior cover as well as looking after 50 inpatients, while everyone else is in a teaching session?’ I found those questions surprising as I was expecting to be asked about clinical governance which my British friend told me was extremely important to all doctors. I then had to take an exam which tested my English skills. As I had studied medicine entirely in English and used all the excellent English text books, this proved to be no problem at all. Two months after starting my excellent trust SHO job in the highly regarded Lewisham University teaching hospital, I was allowed to have a weekend off. I went to the excellent local Primark to buy some £2.00 dresses made my fellow countrymen and bumped into a fellow SHO called Smith Smith who was buying £1.00 socks (also made by my compatriots). Our eyes met across the crowded racks of cheap clothing and we fell in love instantly. After a few dates in the local ‘all you can eat restaurant’, we decided to move in together.
24
OPINION
R-UK ISSUE 2
As well as our shared love of cheap clothing, we also shared a desire to be cardiologists, specifically cardiologists looking after adults with congenital heart disease.
but only because the person who was doing it was having a baby and no one else in Europe wanted this job. After two weeks, I realised why no one else in Europe wanted this job. But still, it was a job and allowed me to pay half the rent for a small flat in the grounds of the hospital.
So in the winter of 2006, we both applied for a medical rotation in the same hospital. By then, as I was a young and highly skilled migrant, I managed to get HSMP status. Smith Smith and I had both worked the same number of years as SHOs and both worked in the same University teaching hospital. We even showed each other our application forms and agreed that they were pretty similar.
Meanwhile my brother, who was also a highly skilled migrant, got a £500,000 bonus in the city.
Next month’s installment: Mei Bo (Mabel) Hwa Smith applies for a job through MTAS, is not short listed again and rings AskBMA.
He was short listed and I was not. This upset me somewhat and I asked my bosses why. They muttered something about the department of health, changed rules, not being allowed to have a job unless every single person from the UK had a job. Only then they might shortlist me, but only if there really was no one else from Europe who was unemployed either. So Smith Smith got the rotation and I stayed as a clinical fellow in rehabilitation medicine,
A
nd, so, Lord Darzi has spoken.
that staffing ‘hospital at night’ is both ****ing dangerous and leads
The NHS needs reforming,
to generations of junior doctors being under-trained in dealing with
and Nu Labour have chosen
emergencies. But Dr Rant doesn’t blame him for any of that. He is
the Baron of Denham for the job. And
still perfect.
is he the right man for the job? Hell, yeah. Dr Rant thinks he is perfect. He
He may even want to introduce even more changes to medical training.
would like to warmly shake his hand,
He may feel that creating new quangos such as NHS:MEE, and filling
give him a manly hug, and nibble on
them with his unelected chums is slightly better than keeping the
his shell-like ears. And why should
old quangos. He may feel that medical training needs a whole new
that be?
array of untried and untested ways to ensure it runs as smoothly as MTAS. And he may feel that he can chop and choose the best bits of
DR RANT
Well, it isn’t for his vision of primary
the Tooke report, while failing to implement it fully. No, there is no
care. He may have spent his formative
problem with any of that. He is still perfect.
years in Iraq, and trained as a surgeon in Ireland, and never worked as a GP
And there are two very good reasons for that.
in the UK, but that shouldn’t affect his
ability to reform primary care. He may be obsessed with polyclinics
First of all, on Desert Island Discs, he chose a pencil as his luxury
/ non-polyclinics, or whatever they are called. He may be oblivious
item. He must be very special. Lesser mortals, like yours truly, would
to the fact that there is neither enough money nor manpower to
have opted for an Angelina Jolie inflatable love-doll. But he chooses
run both existing GP surgeries and the new clinics. He may choose
something he can write with. Okay, it may be with something that
to ignore the fact that they are neither wanted by the public, nor
anyone can erase at any time. But it shows that he is a man with a
NHS staff. He may even want to “separate that fantastic relationship
purpose.
between GPs and their patients”. And he may choose to ignore the warnings from the BMA-organised million-strong signature petition.
And secondly, he has built his career on sending robots up people’s
But Dr Rant won’t hold any of that against him. He is still perfect.
arseholes. Indeed, he has sent so many robots up so many people’s arseholes, that became a professor in it, and was knighted for it.
He may even have a few unusual ideas about the roles of nurses. He
And that, dear reader, is why Dr Rant believes he is the man for the
may feel that noctors can be trained to do anything. He may not have
job; someone who can deal with both the head of the Department
experienced, as a junior, the nurse who is ‘just not happy’ to give 1g
of Health and the Nu Labour Government. He is an expert on both
of paracetamol to a patient without a prescription. He may think that
robots and arseholes.
the very same nurse can now be trained to do brain surgery with a six-week conversion course. He may not be too fussed about the fact
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Visit Dr Rant at his website - www.drrant.net 25
LAST RITES
R-UK ISSUE 2
T
HOUSE DOCTOR
his is our tribute to the most important people. Let’s not forget that despite the relentless smearing, counter-briefing, distortion, mindless propagandising, subterfuge, spineless insinuation, cash-splurging, pointless reconfigurations, bullying, media manipulation, and remorseless dismantling of a proud institution – the people that need and use the NHS are there to be looked after and recognised. Let’s not forget them.
Quango and cash
R
eassuring news from the nation’s least safe independent arbiter: the Postgraduate Medical Education and Training Board (PMETB). Arch quangocrat Peter Rubin, head of the soon to be decommissioned body, has announced that anybody, including medical students, halftrained surgeons, and driving instructors will soon be able to operate independently on the general public. Rubin, a herb enthusiast by trade, denied that he was taking his revenge at his fate by exposing the British people to DIY merchants: “the safety of the public is our paramount concern,” he said. When asked to justify his track record in differentiating bunglers from the surgical maestros of the future, greenfingers Rubin replied: “my background in horticultural taxonomy and accomplished trough technique make me the ideal candidate to safeguard the nation’s health.” PMETB staff will be handing out free scalpels and diathermy kits on 15th August at their London HQ.
Shit & Run - A National Health IT system in meltdown
I
f you were wondering where your training budget, accommodation, on-call access to food, office space, parking discount, ward equipment, study leave funding, and mess have gone, some clues may emerge in the following information.
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The DH has recently advertised for two Chief Information Officers for the NHS IT programme, instead of the one who ran the show before. The recent appointee left his post after only 3 months, allegedly unable to cope. Richard Granger, the former incumbent, reportedly squandered £20 billion in what is politely termed in the IT consulting trade as a “shit and run”. Granger, who coined the phrase “privacy fascist” to describe individuals who dare to question whether the “Spine” may be at risk of leaking sensitive personal data, left his £290, 000 a year post at the DH last December. The vernacularly talented Granger - who is also thought to be testing out other catching aphorisms such as “dignity mercenary” and “confidentiality iconoclast” – is back in the private sector scoping out his retirement fund. Thanks Richard. He has been joined at the mercenary Hall of Shame by Fujitsu, who have just left the whole of the NHS in southern England without a viable system and snuck off back to Japan licking their wounds. Meanwhile, the £20 billion virtual turd is thought to be festering somewhere in Whitehall. Turd turnaround specialists are hard to come by these days; hence the testicle-mincing salary on offer. That has not stopped the DH from hiring two turd turnaround specialists at thrice the original cost. Just wonderful.
Old skool, innit?
L
egend has it that a distinguished senior surgeon on the operating circuit of North London takes a lengthy nap during his weekly NHS clinic. Worn down by the relentless clipboard mania and waiting list micromanagement, our old skool hero from this edition, takes off his shoes and kips down for a few delicious moments to keep the madness at bay. Rather more illicitly, he is known to block out the smoke detector in the scrubs room and sneaks in a cheeky fag and a flick through the Sun before donning his gown. Sir, we salute you.
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ANAESTHETISTS’ CORNER
R-UK ISSUE 2
R-UK Crossword #1
Clues Across 1) A proper way to get to sleep (8) 5) Surgeons in the lost tribe (8) 9) Top person’s todger (3) 10) Satiated (4) 11) Twist keen joint (4)
12) 13) 15) 17) 20) 23) 25) 27) 28) 29) 30) 32) 34) 36) 37)
26) 30) 31) 33) 34)
See 7 down To arrange a pacer once again (5) Leech supper (5) Parts of which I stun bus (8) Could assemble a motor and a pinna (8) Only sixth? What a nerve! (8) When acne treatment makes a tidy job (8) Does anyone want to do it? (1,1,1) Racer who could always go (5) Right hypochondriac (5) Health Secretaries old job (7) The leader at the top of a boil (4) It’s worse that that, Jim! (4) Their contents can be found in latrines (8) Ergs torn with more power (8)
Clues Down 1) Perms for someone who does well (8) 2) Swallow the logo? (4) 3) Achievements for podiatrists (5) 4) Madmen observe oceans on the moon (8) 5) Drowning in beer mug (8) 6) A blacksmith needs this to hear (5) 7) They get oropharyngeal papillomatosis (4,7) 8) Back who makes the end freed (8) 14) A cure, even for trachoma tissue and otalgia (7) 15) Looking for lost rib near Avon (8) 18) Shoot, 21 down can happen to this (3) 19) A hundred (3) 21) Plastic surgeon does half a teat (3) 22) Gateway to the soul (3) 23) A proctoscope has one at either end (8) 24) New Labour stops sot (8) 25) Fake testicles; MTAS (8) No 10 department where petitions are sent (8) Bit of a dish (5) Chances of getting a cardiothoracics ST3 (5) An open and shut clue (4) A curse to stop the flow (4)
Win a year’s subscription to R-UK magazine
Send your completed crosswords answers by text or image to editor@rukmag.org and the first correct one we receieve will win a year’s free subscription to R-UK magazine. The same prize will go to the winner of this issue’s competition below. If you are already a Remedy+ member, you will win a special prize instead.
Competition
The Remedy Detectives need you!
This issue’s competition is to find the best/worst official excuse. Have you been given five day’s notice on the location of your job because of ‘unforeseen workforce planning issues’? Or do you have to tell you mortgage company that your job has suddenly become unbanded due to ‘mergers in the hospital at night’ structure? Or has the job that you have been promised suddenly vanished due to ‘human error’? Send your entries to editor@rukmag.org and we will send a prize to the shoddiest, silliest or most ridiculous entry we receive.
In the dimly-lit corridors of many a hospital, swept into a corner and ignored, lie Hidden Truths – of bureaucracy gone mad, the triumph of process over substance, and the junior doctor at the end of his or her resources.
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The Remedy Detectives want to hear your Hidden Truths, your untold stories. If you ask for anonymity they will respect it. Write to them at Detectives@ RemedyUK.org
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