Tag Archives: team

What does a Junior Doctor Do Exactly?

A letter written to Jeremy Hunt by a consultant currently working in England.
An excellent illustration of how indispensible ‘junior’ doctors are to the NHS and the public as a whole. I couldn’t have put it better myself so I haven’t tried to 😀

…………………………..

Dear Mr Hunt,

My name is Philip, and I am a consultant physician. Not so long ago, I was a junior doctor and like many others I am outraged and angry about what you propose to do with ‪#‎juniordoctors‬ and their ‪#‎juniorcontracts‬.

I thought that maybe, given you have not worked in healthcare, you might not understand what it is that doctors do (much like if I was made, say, head of Network Rail) so I thought maybe I can help you by shining a light on what I used to a few years ago as a medical registrar.

The medical registrar is the most senior medical doctor in the hospital out of hours. In explaining to my friends what we do, I tell them everyone who doesn’t need an operation right away, or doesn’t have a baby falling out of them, above the age of 16, is our business (and often we have to look after those too). We were the ubiquitous shirehorses that carried the hospitals medical workload day and night. And here’s a typical night shift I did at a general hospital. (all details changed and adapted from real cases to protect patient confidentiality).

I arrive at 8:50 PM for a 9:00 PM handover. It’s been a busy day and the emergency department is full. The outgoing medical registrar tells me there are no beds in the hospital. There are 10 patients waiting in A&E for the medical team, and a lot of patients need reviewing on the wards. He’s already admitted 36 patients during the day, and the consultant is still there seeing some of them with the daytime doctors. I wave hello at her as I head into the fray. I know the consultant and she’s not seen her kids since her on call week started. She waves back wearily.

My first patient for review was a young man with abdominal pain. My first thought as I walked into his cubicle, he looks sick. This is a skill you develop after years of training, when you look at someone and know that they are minutes from death. He’s grey, clammy and shocked. I immediately set about treating his shock and assessing why this has happened. Does he have a bad infection? Is he bleeding? Does he have a blood clot on his lungs? A quick bedside test confirms he’s bleeding badly, likely internally, and my surgical colleague (another junior doctor) and I urgently arrange for an operation. He hurriedly talks to his parents and completes a inacapacitated patient consent form as his condition deteriorates. I leave him in theatres with the anesthetists and surgeons as I have other patients to see.

The next patient was an elderly woman who has fallen. Although she has no hip fracture, she’s unable to walk and needs admission for painkillers and rehabilitation. I reassure her as best I can and stop many of her medicines potentially making her fall. There are no beds for her on the assessment unit or the elderly care ward, so the A&E sister arranges for a pressure support mattress and bed for her in the department overnight. She was lonely and depressed, and I spend some time talking to her about her worries and fears but after a while I needed to move on. She squeezes my hand and smiles, thanks me and settles for the night.

Next is a resus patient with an asthma attack. He is drunk and abusive verbally, though he’s too breathless to be too abusive. A blood test show his attack is life threatening and he he fights off attempts to treat him by myself and the A&E team, pulling off his nebuliser mask and oxygen. As I read out the blood test result to the intensive care registrar (another junior doctor) the man goes blue in the face, gasps and stops breathing. I drop the phone, run over and take over his breathing with a manual ventilator. He has had a respiratory arrest. Alarms blare, help comes running, we inject him with various medicines to help relax his airways and the intensive care doctor slips a tube into his windpipe to help him breathe. The consultant physician, still there, helps with what she could, running blood tests and helping to scribe in the notes. After a nervous period, he stabilises and we take him to intensive care.

It’s now midnight.

In the meantime I have reviewed five more patients, seen by the twilight team, and also my night SHO has discussed some patients with me. The consultant finally got home around 11PM. I’m now on the wards, a liver patient with severe cirrhosis is unrousable. I read through the notes. He has cirrhosis and is not suitable for a transplant. The team has tried everything. I sit and talk with his family, telling them I’m very sorry but there’s nothing more to be done. They cry, one of them screams at me that I’ve killed him, but I accept this as part of my job. With more assurance they’re calmer and I reassure them he’ll be kept comfortable.

My bleep goes off as I write in the notes. Is that the medical reg? The hospital is now totally full, can you please choose some patients to send to our sister hospital down the road? I groan, although I understand the necessity patients understandably hate it. I pick four stable patients and liaise with the registrar down the road.

2AM. I send my SHO off for a quick break as I review some more patients. A confused elderly man who might have a urine infection, a young man with severe headache, a diabetic patient with a very high blood sugar, a lady withdrawing from alcohol and hallucinating. The A&E sister makes me a coffee, lots of milk, lots of sugar.

3AM. I’m with a man in resus again, he is vomiting bright red blood in large volumes. He is jaundiced and looks unwell, very unwell. As the A&E team arranges for a massive transfusion to be set up, I ring the intensive care doctors and the gastroenterology consultant. He listens and says “I’ll be coming in”. I then slip a line into his neck under local anaesthetic, a practiced skill that’s hard at 3AM when you’re tired, but fortunately successful. We pour blood, clotting products, medications and antibiotics into him to halt the bleeding. The gastro consultant arrives at 3:40 and he’s taken to theatres where he performs a life saving procedure. The patient goes to ITU.

4AM. A brief moment to sit down for a quick break. I have reviewed three more of the SHO’s patients. This is the first time we’ve had a chance to sit down together, a quick chat and a cup of tea was interrupted by a cardiac arrest bleep. We run to the cardiac ward. A 54 year old gentleman admitted with chest pain by the day team has had a sudden cardiac arrest. The excellent CCU nurses are doing CPR and attaching a monitor. I ask them to stop as it’s attached, the rhythm is ventricular fibrillation.

“Back on the chest please, charge defib to 150, charging. OK, off the chest, stand clear, top middle bottom myself, oxygen away, SHOCKING.” The patient jolts. “Back on the chest please.” I heard myself say.

Two minutes later he has a pulse. We repeat an ECG, he’s had a full heart attack. I call the cardiologist at the heart attack centre 10 miles away. He’s accepted and an ambulance crew transfers him for an emergency angioplasty. I send my SHO back to A&E as I write a transfer note.

5AM. The resus doors burst open. Another patient, an elderly woman with breathlessness. The A&E F2 listens to the chest, pulmonary oedema. She’s given the emergency treatment but it’s not working. I decide to start her on positive pressure oxygen. Strapped to her face was a tight mask blowing oxygen to inflate her lungs, buying time for the medicines to work. The plan works and pints of dilute urine fills her catheter bag, her breathing improves and she says thank you through the mask. Despite the fatigue I smile and give the F2 a fist bump for a job well done.

7AM. Four more reviews. a patient with kidney failure due to medications, a depressed young man who took an overdose, an elderly nursing home resident with pneumonia, and an elderly man with a broken hip whom I assess with the orthopaedic surgeon. I start to round up the patients for the ward round. 18 patients overnight, five transfers out, one death. A relatively quiet night. I check with the clinical site manager and SHO that we’ve not missed anyone and click save on the list. No one is waiting to be seen, a good feeling.

8AM. The consultant from last night arrives, she looks tired but asks us how we’re doing. OK we said. We start in A&E as most of our patients are still there, the site manager is worried as some of the patients from last night are coming up to 12 hours in A&E. We review each patient’s story and tests, and talk to them about their condition. We visit ITU for the two new transfers there.

11AM. The ward round of the night patients are done, and I have completed a death certificate for a patient overnight. I climb into my car and listen to the breakfast show as I drive home, an hour away. I’ll be in bed by 1PM , and back for the night shift after 6 hours sleep. A relative luxury from a relatively quiet night.

This would be a relatively quiet night for a junior doctor and I am sure many registrars would laugh at how easy I’ve had it! But the people doing this work are junior doctors, who show dedication, commitment and goodwill beyond belief. They do lifesaving work up and down the country, working hard without complaining and sacrificing time with their families.

Please, I beseech you, treat them fairly and with the compassion they treat others daily. The new contract is not fair, and the extended hours it’ll cause is not safe. ‪#‎notfairnotsafe‬

I hope this little story will give you some insight into the vital work junior doctors and the NHS do. If you like, please come and spend a night at our hospital, I’ll come in with you and show you around. Please talk to my junior colleagues and listen to them, you may be surprised what you’ll learn.

Best wishes,

Dr Philip Lee

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Save Our NHS!

Sharing this from a doctor’s facebook wall with permission because she says it better than I could express through the mounting frustration and despair I feel.

“I would like to tell you what the NHS means to me. It means that as a doctor. I get to think about what my patients need, and what is best for them. I get to think about that, above all else. Because my patients are someone’s daughter, someone’s wife, someone’s mother, someone’s mentor, someone’s shoulder to cry on, someone’s friend. I get to value their life over all else.

I love that. I love that when I’m driving down a busy street at rush hour, and an ambulance with blue lights and sirens wailing, presents itself to this mass of people on the road – people with jobs to get to, meetings to attend, events to arrive at, exams to sit – not one of them stops in the middle of the road and refuses to let the ambulance pass.
Not one of them thinks their schedule is more important than the stranger in the back of the ambulance, fighting for their life. They, the general public, the person on the street, the people of Britain, value a stranger’s life above everything else at that moment. I love that. I love the humanity.

Jeremy Hunt says, he wants us to provide a 24 hour NHS. I think thats fantastic. I am pretty sure I have already worked every hour of every conceivable day to make up the 24/7 ideal. I work bank holidays and public holidays and religious holidays. I work often right up until I need to leave to catch a train to a graduation or a wedding. Sometimes I have an Emergnecy and I work past that. And I send my apologies and I lose my tickets. Because the person I am working on matters. Because I value their life over all else at that moment in time.

I think a 24/7 service is wonderful. It’s the dream. It’s like dubai at night. Or New York always. The service that never sleeps. I mean. I never sleep. Not on call. But, yes, sure, things can be delayed. It takes longer for one doctor to see 80 patients at night, than it does for a team of 4 to see them during the day. It takes longer for one lab technician to process 80 blood samples vs a team of 5 during the day. It takes longer for one radiographer to image 80 patients overnight than a team of 3 during the day.

The hospital is not just made up of doctors. We cannot work without our colleagues. Nurses, phlebotomists, pharmacists, radiographers, porters, health care assistants, scrub nurses, physicians assistants, and anaesthetics techs.
We all work together as a team. At all hours of the day and night. Because we value the life of the person we are seeing.
We would love a 24/7 service. But you cannot achieve it by taking the same doctor, spreading him or her thinner to cover the gaps they are already covering regularly – and then tell them that’s what they ought to have been doing all along so let’s slash your meagre pay by 1/3 for good measure.

To achieve the sort of dreamlike 24/7 service Mr hunt is selling and we all want to buy. The answer is simple. Create more training posts. Hire more doctors. Twice the current amount. Hire more nurses. I’m tired just watching them scramble night after night, running between rooms taking care of double their normal case load. Hire more ancillary workers. If you really wanted a fully functioning service, where 3am on a Sunday looks the same as 10am on a Tuesday, that’s the solution.
Don’t fillet and tenderise your already overstretched team to plug the gaps. And don’t turn the public against them because they have said that it’s not right.

What happens to our value as human beings? As care givers? As people who place others first? Where is the logic, in destroying one of the greatest legacies of modern history? In order to reappropriate the money as bonuses for management consultants who “told us what was wrong”.

I never finished my story about what the NHS means to me. When I’m done with my job. And that isn’t dictated by the clock but by when my patients are all stable. When I’m done I go home to my mother, who is terminally ill. Sometimes she is very unwell. And at those times I return to the hospital. This time not as a doctor, but as patient and family. I cannot begin to explain the relief in knowing that our arrival isn’t heralded by piles of paperwork to determine how much money we have to pay for treatment. They wouldn’t find much. I’m always overdrawn. I once laughed when I lost my wallet, because there wasn’t any point in cancelling my bank cards. They would find nothing in the account. I am 34 years old and a “junior” doctor that has been working for 10 years. But I have nothing worth stealing. That’s because I usually just get paid enough to cover my rent and bills. And when I need to do exams or get a wedding gift or live without relying on a credit card I would pick up extra shifts, working even more weekends and holidays than I normally would, which was already a lot.

Then, like a lot of my colleagues. I volunteer. I volunteer my services to local communities. I voluntarily sit on charitable boards where I help develop plans to help the most vulnerable in society. I travel to refugee camps to help those that unlike me, cannot make ends meet, have been forced out of their homes through no fault of their own, and now have no one to care for them. Very few people value them at all, these proud, resilient, insightful people in camps and on journeys – let alone above all else.

So I am grateful for the NHS. Because as a terminal cancer patient. My mum and I show up at our A&e a lot. And often at the most inconvenient times. 3am. 7pm. Weeknight. Weekday. The tumor doesn’t care. But you know who does? NHS staff. They care. They value her life over all else when she walks through the door – even if she may not have very much life left to live. They always smile. They always listen. They are always patient and kind. They are cheerful most of the time, even as their pagers bleep mercilessly through every conversation they have, alerting them to another patient in need of being valued.

They trundle away regardless of the time, tucking my mum into bed, helping her to the bathroom, taking her blood despite the fact that her veins disappeared under the influence of chemotherapy long ago. Patiently searching for those life giving green threads in her hands and arms. Listening to her chest. Poring over her substantial medical history to make sure they understand everything. Discussing the minutiae that may unveil what the cancer is doing this time and how they can best hold it at bay. There are no shortcuts even at 3am. They value their patients and the families above all else. And I love them for that.

That’s what the NHS means to me. Service that comes full circle.

I treated someone’s mum like they were the only person in the world that mattered right then. And later on that night, some other kindly fatigued uniformed intelligent gentle soul did the same for my mum. And sometime during those 24 hours someone was late to pick their kids up from school or collect their dry cleaning – because an ambulance with the most valuable person to someone else, closed off the road they were on as it whizzed past.
That. is Healthcare delivered as a right, not a privilege. That is humanity. So the only question, Mr. Hunt. (And anyone else who backs the sham of making an understaffed workforce doing the best it can to work twice as long for two thirds of the pay, and ensuring that women who have families and researchers who seek to cure terminal conditions like my mother’s can’t do their job, which is what they value – ) the only question is – What do you value above all else? Money? The bottom line? The shareholders? Your mates who run companies that want private contracts? A shot at being PM?

None of that will matter to you when you are ill, Mr. Hunt. I promise you. At that moment in time. You will value your health above all else.

More than that, you will want a team of dedicated well trained NHS employees to value you above all else.
Value.your.health.service.”

Top 10 Lists

You know those lists that rank the top 10 in whatever category you can make think off. Generally, I take it all with a pinch of salt because these lists tend to pander to stereotypes. But a couple of years ago, I found this one (I think it was in a forwarded email) and edited it ever-so-slightly to make it a perfect fit for me and posted it on Facebook for my George. I was surprised and pleased to find a list that seemed to be reflective of me. I have pasted that list of 20 ‘things girls want guys to know’.

  1. I love when you cuddle with me
  2. A kiss on the cheek is a definite yes
  3. I want you to put your arm around me at the movies
  4. I don’t care if you are the strongest guy in the world
  5. Size doesn’t always matter so don’t stress
  6. I don’t always look my best so get over it
  7. I shouldn’t have to plan everything
  8. I’m always ready to talk so call/text or talk to me
  9. I’m not perfect and I never claimed I was
  10. I love surprises
  11. The little things you do mean the most
  12. I like boy stuff too (you know it too!)
  13. Cursing & fighting doesn’t impress me (in fact the complete opposite)
  14. Don’t be mean to me to get my attention
  15. I can tell when you’re not listening so fix up and listen to my pearls of wisdom (let’s face it, I’m always right!)
  16. When I say I’m cold, that’s your cue to come closer
  17. Hugs mean more sometimes (or should that be most times?)
  18. I need your advice sometimes so don’t be afraid to offer it to me
  19. I will take good care of you if you treat me right
  20. I will love you more 😀

 

All 20 items are absolutely applicable to me especially how much I appreciate a hug, a cuddle and a kiss on the cheek. For a relationship to work, I totally believe in items nos 8 and 9. 11 is so true and I keep reminding my dear husband of that fact. George, my hubby, insists that he is not romantic in the slightest. That is a huge untruth because George will swear blind that no 6 doesn’t apply to me. He claims I look perfect all the time which to me qualifies him easily as the most romantic man I have ever had the pleasure of knowing. I know that of course it is not true but psychologically, it really doesn’t matter because at the end of the day, I know he sees perfection in me because he looks at me through love-tinted glasses. When he looks at me, he looks at me with such appreciation and I can tell you, it is great for my self-confidence and body image. Since meeting George, I find that when I look in the mirror and all I can see are my flaws, I am able to say to myself it really isn’t that bad and not sink into depression as I used to on rare occasions in my younger days.

No 20 is rather funny because in the early days of our relationship, I would say that to my husband and he would get upset because he thought I was questioning his love for me. As he knows now, that is not the point of that statement. Despite my competitive nature, when it comes to love for me it is the opposite of competition. It is the ultimate team pursuit where the strength in the individuals promotes strength in the team greater than the sum of the individual strengths. So when I say no 20, I mean to say I love you more than you realise. I do not mean that my love for you is greater than your love for me. I mean to say that every day I love you more. And I mean to say that I pray to love you even more every time I say those words. So who says women are complicated? I genuinely believe that if my husband could apply these items to our everyday life, he would make me the happiest wife in the world. Simples!