Thursday, 21 April 2011

Tell me your name



Having just returned to clinical medicine from a year out on a clinical leadership programme, I have been interested to know what impact, if any, it would have on my experiences and effectiveness as a clinician.

For me the test I have been waiting for has been the acute medical take. As many of you will know, being the medical registrar on call can be a hateful job. Traditionally, I have opined that all routes to disaster arrive at the feet of the medical registrar. The NHS is bad at using the resource of the medical Spr effectively, and at times, I have found myself simultaneously sorting out problems on the obstetric and gynaecology ward, surgical and orthopaedic wards, while all the time trying to run the acute medical take, and providing telephone advice to local GPs. An on call shift in a DGH is one of the most testing experiences one can have, and for the 3 years I have been a registrar, this has been my life for 1 in 6 days and weekends.

At times, the pressure has been huge, and frequently, I have found myself tearing apart at the seams, wondering how I could feel so qualified, and yet at the same time feel so neglected and abused. Such pressure inevitably tells, and although with experience I have been able to identify my triggers better, and manage the pressures more effectively, I have often wondered how we could have arrived at a situation where a doctor is given so much responsibility, and yet offered so little support and guidance. That in itself tells a whole story about the NHS.

One of the unexpected benefits of the Darzi Fellowship was the amount of time spent exploring ourselves. Now I know how that sounds. But imagine being given the chance to understand better how you operate, and how that impacts on other people. Imagine being given the tools to understand issues about yourself that impact on your abilities as a professional and as a person, and imagine being shown how simple it can be to wrestle control over your experiences at work. This is what happened to me, and I never quite believed it could be that simple until I tried it out on call.

This learning is now tried and tested, and what I have learned is blindingly simple. So simple in fact that I am a little embarrassed I didn’t learn it before; but no matter, I am happy to share it with you here.

One of the things I have learned this year is the importance of personal connections, and one of the things I have always loathed about being a medical registrar is that people are happy to overload you with clinical problems (sometimes of their own making) but they are rarely happy to introduce themselves by name, and they are never keen to know yours, unless it is to document in a patient’s notes that you have told them something that they do not agree with.

On my first couple of on call shifts, I did something very simple: every time I dealt with someone new, I introduced myself and asked them what their name was. By lunch time, I was on first name terms with virtually everyone in A and E, and by supper time, we were riffing our way through the medical take.

It is a sad thing when one realises that an impersonal way of working has become the norm. But it is really simple to counter, and it takes no time to sort out. I really enjoyed pausing for a moment to connect with all of these new people that I met, and I think that it made us work better together. It doesn’t really matter what the protocol says, or how the policy is written, it is personal connections that make the world go round, and we ignore that at our peril.

So don’t be upset if you need some clinical advice from me next time I am on call, and I interupt you to find out what your name is. I think that it will help us in the long run.

3 comments:

  1. Gosh! I'm a gp. I'd never think of not starting a conversation with a colleague without giving my name. But yes I have noticed that I do usually have to ask the person I'm put through to for theirs... And their position. Mote civility please! Hope the word spreads!

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  2. Fully agree with this post, Riaz. The pace and stress of hospital medicine often means that basic communication skills are lost. We often hear, "Are you the surgical reg?", "Where is that FY1?" and "Is that the renal on call?".

    By going back to basics and addressing people by their name, we could improve organisational safety and productivity and team camaraderie.

    Fiona

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  3. I've been lecturing final year medical students about becoming a 'real doctor' for a few years and tell them the importance of telling everyone your name and asking people their names (and then writing them down so you can check just before you go back to ask the radiology receptionist for some xrays just before the ward round)
    In the last 10years of general practice I've called the hospital about once or twice a week for advice. The standard response is a neanderthal, 'yugh?' If I call to speak to someone for professional advice, I need to know who they are so that I know they are qualified and so that I know who to go back to if I'm stuck with the same problem, or, if they are particularly helpful, who I can call again.
    Sadly my GP colleagues daid they often answered the phone with an 'urgh'. Thanks for raising a vital point.
    More generally and in relation to the NHS reforms, I depend on knowing who my hospital colleagues are. The Any willing/ qualified provider model will be a disaster, as instead of my patients being under the care of (for example) the local renal unit, they could be anywhere.

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