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When I applied for medical school nearly twenty years ago, I remember having a discussion with my father about choosing a career that had meaning. He told me not to waste my life regretting the choices I make. He said in a fatherly way that I was too young to realise why a career in medicine was such a wonderful choice, and a vocation.
I was brought up in a Sri Lankan Catholic family which, although it had no doctors in it, viewed doctors and priests with great reverence. The medical world I joined was very different from the impressions of doctors that I had when I was growing up. It was better. It was a profession that was actively breaking down barriers and boundaries. Altering the hierarchy that was a barrier to a meritocracy. During my time in the profession, we have gone from a male dominated profession to one that reached parity and now refreshingly has a female majority.
Over that time, as the medical profession went through these internal changes, what we have also seen develop is a society that has sought to tear down the professionalism of individuals and belittle public service. We have some in a pervasive media and political class who believe the rest of society holds the same money-centered, callous, mercenary approach to life they do. They put the profit motive above all else, and hold the belief that monetization of every problem is the route to improvement.
The negotiations with the medical profession over pay have followed this approach. There is a staggering lack of understanding of the health service by those who claim responsibility for it. The form of tick-box, target-driven contracts that successive Labour and Tory governments have imposed on the health service and doctors has created perverse incentives in our health system.
My colleagues, our doctors, are people who have always wanted to excel. You set them an exam, they don’t just want to pass: they want to “smash it” (in the words of a neurosurgical colleague of mine). If you set them a target and say, “this is what you need to achieve to be a good doctor,” they will work tirelessly to achieve it. So when governments harnessed this by manipulating NHS targets for their own aims, and then found they had miscalculated, the right thing to have done would have been to congratulate the staff for reaching the goals you have set and pass on the credit and bask in the glory of success. However, having miscalculated and mismanaged, governments have simply resorted to accusations of fat cat GPs, or lazy work-shy consultants.
The fact is, successive governments have tried to claim credit for the hard work of frontline staff. The amazing work the NHS does is often in spite of the political meddling and mismanagement. Unfortunately professions such as journalism and politics, which attract such little trust and respect themselves, often hold others down to their low standards.
The context of the latest discussions about pay and conditions, seven day working, etc., is all smoke and mirrors. These are just attempts by a government hell-bent on undermining and denigrating a profession and a health service. They feel they need to tear down the edifice of the NHS that enjoys a greater credibility, respect and trust from the people we serve than they can ever hope to achieve.
If this government were serious about improving services and improving the lives of the people who access and pay for the health service, they would engage in rational adult discussions with the professionals who work day in day out, tirelessly to improve the lives of the patients and public.
I hope I never regret my decision of 20 years ago. Every time I go to work and deliver another baby and hand that baby to a gorgeous new family, I am reminded that our patients do understand what we do and why we love our jobs. If only that were true of the government, too.