Tuesday, 6 September 2016

Timeline melancholy

My Twitter time line is a forlorn place right now. The dominant theme is the Junior Doctor's strike, and there are three prevalent themes:


  1. Junior doctors are striking because of their concerns about patient safety
  2. Junior doctors are striking and are threatening patient safety.
  3. This person says Junior Doctors shouldn't strike, and this is why they are wrong. 
In the last couple of weeks, David Oliver (@mancunianmedic) has been asking doctors close to CCT how they will behave when they are consultants (#whenimaconsultant), and he sparked my current train of thought. 

I struggled emotionally through registrar training, and my overall synopsis of those 5 years could be presented in the motif  'I was a happy geriatrics registrar and miserable med reg.' Too much of my time was spent worrying about why I was finding the role difficult. I spent way too little time articulating to myself and others what made the role unnecessarily hard, and what could be done to improve it. I spent a lot of time feeling bad about feeling bad. I felt guilty that it mattered to me that I felt unsupported, over-worked and stressed. 

I would go to talks about leadership and hear platitudes about embracing the leadership potential of junior doctors, and about improving training. In the end, there were two things that made all the difference to me. The first was taking a year out to do a leadership programme that taught me all about reflective practice, and the habits of personal sustainability. The second was working for a consultant who offered all of his registrars the opportunity to help him develop his service and develop beyond the delivery of clinical services. He was fun, energetic, kind and restored my faith. 

A great many consultants I worked with over my junior doctor career were guided by the ethos of 'telling not asking', and 'bollocking not understanding,' and for them it was easy pickings: the entire focus of my junior doctor training, until I wrestled some control back, was entirely focused on clinical skills. None of the other essential skills of stress management, team working, team building, reflection, or understanding behaviours featured on my curriculum. 


Junior doctors now, as then, find out their rotas the day they start a job. Contracts never appear, pay not confirmed until you are actually paid. I once presented myself at induction, only to be told to go home as I was starting nights that evening. One hospital tried to be organised, and demanded that I take a day off work before I started there to visit their HR department. I refused. The consultant I was working for told me not to make trouble and to go along. 

There is something very akin to bad schooling about how we treat junior doctors. Publicly, we encourage them to question, to enquire, to be open about mistakes and feedback, but in private, our behaviours scream the exact opposite: we expect them to do as instructed, to mask their independence and intelligence until they are consultants, because until then, they are someone else's responsibility, and cannot be trusted to use all of their clinical skills, common sense and social skills effectively. I found it infuriating then - it still is now. 

Too little trust and autonomy is placed in these capable, effective men and women who staff our wards and clinics. Too little time is spent on helping them develop the habits and skills that will help them navigate stressful and demanding jobs with happiness and satisfaction. 

Twitter is currently reminding me of how toxic this kind of culture can be. The GMC has escalated the rhetoric about the risks junior doctors run by striking; the Association of Medical Royal Colleges has decided to discount the value judgement behind the decision to strike. Everyone seems to have an opinion about the justification of strike action, or the risk to patients, but with each comment we mark ourselves as dissociated and out of touch with the very doctors we are supposed to be mentoring. The debate around the strikes has turned into conversations with them, advice given to them, instruction given to them. No one would know we are all part of the same professional family. 

Imagine you are part of a rugby team, and you are planning a foreign tour somewhere, but your forwards don't want to go because of the poor human rights record of the country you are planning to visit. Do you tell them not to be silly, that they are putting in jeopardy the whole tour, upsetting the sponsors, and anyway, all the tickets have been booked? Would you go without them and try to beat a 15 man team with your 7 man team? Or would you listen to them?

In Bowling for Columbine, Marilyn Manson was asked what he would say to the children from the school, and marking himself out as something of a sage for our times, he replied 'I wouldn't say a word to them. I would listen to them.' Who knew that occasionally you need to consult a Shock Rocker to get any sense of a situation? What he realised about Columbine is that rock music wasn't the problem, it was a symptom, and that when kids feel like they're shouting and no one is listening, the shout louder, and more violently. 

Our junior doctors are shouting loudly, and instead of listening to them, we keep bollocking them. They are shouting loudly because no one seems to be listening properly, and those that do come up with childish put-downs which clearly misunderstand the point being made. Junior doctors are people who articulate complex problems for a living. They interpret a raft of symptoms into neat, precise sentences. They have analytical skills, deductive and inductive insights, and they have the verbal fluency. They are telling us there is a problem. That means there is a problem. 

Remember, junior doctors all learn when to ask for help. Good ones take the problem they are dealing with as far as they can, then call their consultant. These juniors have called their consultants, and now it our job to help them find a solution. It is our duty because they are part of our professional family, because they are crying out for support, and because they clearly recognise that they cannot fix this current impasse by themselves. They are doing all the things we have taught them to do. 

Perhaps with this round of industrial action we can do more than either support them or criticise them. Perhaps we can engage with the discussion both at our own trusts and more broadly about how we move forwards. Perhaps we can demonstrate to our junior colleagues that times have changed, and not only do we trust them, but we also believe them, and we value them. 

That was what I promised to do when I became a consultant. 


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