Thursday, 28 April 2011

Nurture in the NHS

Last weekend, prompted by the news that graduate medical students would not be eligible for student loans,  I got involved in an interesting Twitter discussion about the relative merits of entering medicine as a postgraduate.

Some people found that having done a first degree, they were better equipped to deal with the pressures and challenges of being a doctor. Maturity was certainly one of the prevailing themes, and there were suggestions that people with more life experience than your average 24 year old make better doctors. This in itself is contentious, and I’m sure that we have all met both ends of the spectrum: children wise beyond their years, and grown ups for whom maturity is what happens to cheese and wine.

This is not what I really want to discuss today. Instead, I would like to focus on what this discussion made me think about the way we nurture our junior doctors in the NHS today.  

The first realisation I had, was that even though I was just 24 when I qualified, having gone straight to medical school, foregoing the opportunity to teach in Africa, I have always enjoyed dealing with graduate medical students and junior doctors. My standard line has always been that with graduate students and doctors, one can focus on the technical aspects of being doctor without having to instill in them the fundamentals of responsibility and professionalism. It has always been my working assumption that having the right attitude at work is something that everyone should just have. In fact, my views have sometimes been as polarised as stating that you either have it or you don’t - it can’t be taught. Nonsense.

Have you ever had a moment when you looked at yourself and thought that you must be someone else? Well that’s what I had. It struck me that among this debate on Twitter, and the attitudes that I took to work with me everyday, was the in-built assumption that when you turned up for work as a doctor, you were expected to be a polished product; that we don’t nurture our young doctors in the way that we should, but rather expect them to be as ‘grown up’ as we are, and to have the insights and maturity that we have.

What made this realisation so personal for me was the memory of a year I spent at one hospital that almost persuaded me to leave medicine completely. Everyday at that hospital was a grind against mediocrity - I was frequently embarrassed to be working there, given the quality of care on offer to patients. Needless to say, I initially tried to change things, but was soon worn down. One of the important lessons for me during that year, was the understanding that there were massive limitations to my approach to medicine and working in a hospital, but I entered that place with ideas, and energy, and all I needed was a little guidance, and a little bit of encouragement. What I got was confrontation and belittlement. Now I know that a lot of that was me, but what I needed at that time was for someone to understand that I was still a work in progress, but that I had potential, and with the right nudging, I would be able to do some good. I’m glad I stuck it out, because in the two years since then, I have received exactly that type of help.

So it has been important for me to realise that my stated preference for working with older junior doctors means that I sometimes forget an important lesson that I should have learned well by now: becoming a doctor can be challenging and stressful, and we only really know what we are going to be like when we start doing it. No one is perfect when they start out, and no one is perfect when they finish, but the challenge for all of us is to help each other get better and better. It doesn’t matter if your house officer has never seen a dead body, or doesn’t have much life experience, because if they work on a firm that allows them to grow and to reflect meaningfully on their experiences, then they will learn from both their failures and their successes. However, this kind of growth is really hard for anyone to go through if they are always having to pretend to be experienced and in control.  

I still think that it is a shame that graduate students will find it harder to study medicine, but what this whole discussion has made me realise is that the culture of the NHS that I know does not recognise that we have a responsibility to nurture our younger colleagues. I hope you will join me in challenging this, by giving junior doctors the space to air their concerns and thoughts, and the support they need to address their strengths and shortcomings with honesty.

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