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It’s been a vintage year for blogs on the BMA website, and we’ve been looking at the most popular posts. The range of topics covered by our contributors – most of them working doctors with little previous writing experience – has been huge.
We’ve had life, death, and a rather memorable piece on the many euphemistic ways patients used to describe ‘private parts’.
The blogs found stress and humour in topics such as changing jobs, patients with deeply unusual presentations, and working overseas. You can see them all on the ‘Connecting Doctors’ area of the BMA website.
There have, however, been some stand-out themes from the blogs which attracted the most hits.
The ‘little things’ aren’t that little
Teabags are very cheap. Replacing a doctor is not. That was the practical argument put forward by junior doctor Miranda Barry who noted with sadness her employer’s decision to start charging for tea.
She wrote: ‘This is not a moral issue – there’s no human right to free teabags at work. Nor is it a question of management being ‘mean’: it’s the nation’s money they’re disbursing, intended for the care of the sick. No, my objection to the withdrawal of free tea, coffee and washing-up liquid is a practical one.
‘Sickness absence rates in the NHS are about 4 per cent. The rate of vacant nursing posts is 10 per cent – in London 17 per cent. Junior doctor morale – well, let’s not go there. I’m not suggesting that these problems could be solved overnight with strategically deployed free teabags, but surely cheap, simple steps to make staff feel valued would help.
‘The vast majority of managers are doing the best they can in increasingly trying circumstances. But when employers save a few pennies by taking away teabags, they reinforce the impression of themselves as distant, heartless bureaucrats: people with no recollection of how it feels to be on your fourth consecutive night, taking your first break somewhere around 5am. They lose a little bit of institutional loyalty, a little bit of commitment, a little bit of willingness.’
One doctor commenting on the blog wrote that: ‘Staff are given the impression that they are not valued in any way, they are just there to function. This works well with robots but not with highly skilled staff in a very challenging environment.’
Kind words cost even less than a teabag, and the Secret Doctor wrote that it’s the supportive words of colleagues that ‘balance the books’ after a traumatic day: ‘I walk past a senior nurse and she stops and asks if I am OK and when I am leaving work the consultant tells me, I was great today.
‘I work in a job where there can be so much sadness and I am at first incredulous that this patient can look at me and think I am “just so happy”. Jumping to the memories of human tragedy that peppered that week I realise that they are also memories of kindness.’
Sometimes, it’s 2016 only in date
Most medical students are female, most junior doctors are female, and it is only a matter of time before the profession reaches gender parity – in numbers at least.
Female doctors still have to contend with the kind of newspaper article earlier this year which attributed the workforce crisis in the NHS not to chronic underfunding or poor morale, but to the number of women who had the temerity to become doctors.
It was like watching a really bad film – almost worth enduring in the knowledge that a gloriously scathing review would be close on its heels.
Enter, junior doctor Rachel Clarke: ‘No branch of medicine is safe. Operations are known to have been halted – with the patient actually on the table – when the female surgeon breaks a nail. Chest compressions are being terminated mid-cardiac arrest when the junior doctor thinks her brow has started to glisten unbecomingly.
‘And, perhaps most alarmingly of all, every Boxing Day for the last 10 years, in-hospital mortality rates have soared by 11 per cent as female doctors desert their patients in droves, in pursuit of cheap shoes in the January sales.’
The pressures already faced by women doctors, aside from poorly informed media coverage, were underlined by a very moving and thoughtful piece by consultant gastroenterologist Helen Fidler. She has returned from maternity leave five times, and experienced ‘impostor syndrome’, a lack of confidence in readapting to the working environment.
She wrote: ‘I’m a pretty confident and assertive person, but there is something about the loss of status that you feel as a non-working parent that disempowers you. The days of shouting “let endoscopy know we’re on our way” seem far removed from “can anyone give me a spare *** pad?” And that first week … oh dear. I continually expected someone to catch me out and ask what on earth Michael’s mummy was doing putting in a central line.
‘This phenomenon is well documented – it’s called “impostor syndrome” and it is particularly common in women. I certainly felt, in those first few days, that I didn’t belong back in the macho and invulnerable group of junior doctors and consultants I joined after my time off.’
Of the many comments that the blog attracted, one read: ‘It’s a privilege to understand how doctors and consultants such as yourself cope with it to give me an ounce of insight which will hopefully help me when I get to that stage. Thank you for emphasising that a family and career is do-able and not at the expense of your own ambition.’
Do you ‘stay off’ the politics, even when the politics affects everything you do?
The blogs are an ideal place to share frustrations and put forward solutions about an under-funded, under-staffed health service.
But some doctors maintain a strict ‘not in front of the patients’ rule when it come to discussing the shortcomings of the health service.
Dr Barry remembered the moment in the emergency department when she decided to stop holding back.
A man was complaining about his son’s long wait.
‘I was sitting at the desk writing up the notes for my last patient. So far I’d kept my head down and out of the line of fire, but I could hear voices rising and tempers starting to fray. The department was full, and the nurse had already dealt with a few irate parents, in between rushing to triage children, give nebulisers and check observations.
‘No, sir,’ I said. ‘Of course we don’t think it’s acceptable. Unfortunately, we just do not have enough staff to see everyone in a timely fashion. May I suggest you write to your MP?’
With medical students, there can be almost the opposite problem. They’ve spoken to enough doctors, and visited enough hospitals, to have picked up on the stress, workload and poor morale. But is that the whole story? And do doctors have a responsibility to pep them up?
When a medical student asked Emily Claire Vincent ‘is it as bad as they say’, it gave her cause to reflect: ‘For these students only half way through their medical studies with many more exams ahead, mounting student debt and a constant barrage of depressing news, the end goal no longer held the appeal it once did – they were feeling demoralised and desperate.
‘But the truth is that, old contract or new, medicine is still the best profession in the world. I have friends in other sectors; law, accountancy, finance, but even despite the recent turbulence, I love my job more than any of them ever have done or will do.’
That was a piece that attracted some very different responses from ‘yes, it is as bad as they say’ to ‘medical students – be excited’. There are probably days when both of those statements are true.
Why aren’t you all writing blogs?
Rose was a patient who would sometimes sing, sometimes shout, but, as the Secret Doctor put it: ‘Every single interaction fell between us on the floor.’
She was unresponsive to any efforts at conversation, and it was thought she may have advanced dementia.
Then one day, something extraordinary happened: ‘One day it was close to 5pm and I was leaving her room. “See you tomorrow Rose,” I said as I left, but then I then stopped. I had heard my name (she knew my name?) followed by two words, “I’m lonely”.
‘I could hardly believe my ears, rushing to her bedside. “I’m sorry, would you like to talk?” She didn’t. We could read a book or the newspaper perhaps? She asked me for a crossword.
‘I bolted out of that room like I was looking for the crash trolley. “I need a crossword,” I called, out loud, as I darted in to the activities room to rifle through the magazines.
‘The nurses gathered and peered through the little side-room window in awe. This was awakenings, the closest thing you get to a miracle in care of the elderly.
‘Rose knew every answer of that crossword, I did the writing and stayed for almost two hours. We spoke like nothing strange had ever gone before us.
Now, this kind of thing doesn’t happen every day, but many of the most successful blogs have in contrast dealt with the commonplace – think teabags.
The thing about commonplace experiences is that everyone has them, and so everyone can share and sympathise with them.
Most of our contributors, regular and occasional, had no background in writing, and have discovered a cathartic and validating way of sharing their ordinary and extraordinary moments.
If you’d like to write a blog, email [email protected] – we’re always happy to discuss ideas and help with editing, or you can leave a comment on any of the several hundred or so already published. Please do have a go.
Neil Hallows is content editor at the BMA
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