“After careful consideration, it has been deemed that you have not made sufficient progress with your Foundation training and are not yet ready to progress to the next level of your learning.”
Pretty strong words. When people imagine life as a junior doctor they think long hours, on-calls, stressful life-or-death situations. ‘Training’ conjures the image of the wise old professor decanting his yoda-like pearls to a new generation. Or perhaps a Rocky montage of blood taking, chest compressions and stethoscope wielding would be more appropriate. Lifting textbooks in the doctors mess to the tune of eye of the tiger etc.
So it might or might not surprise you to know that our yoda is a square box, that glows with bland light and plastic keys. Faceless doctors we have never met fill out online forms about our ‘performance’ so far removed from the day-to-day activity any outsider would view as a reasonable reflection of a doctors skills it boggles the mind. Catch-22 themed measures of performance such as pointless form filling (uploading a scan of a paper version of an electronic form already filled out on the same system), and sending out simplified tick box assessment forms to disparate team members with varying levels of qualification- from senior consultants to ward clerks to the man that runs the coffee shop. And there’s reams and reams of this stuff- the average electronic portfolio for junior doctor progression takes around 40-60 hours of work. So sorry Mrs Smith I can’t sort out your pulmonary oedema I have to chase up the newspaper delivery man to fill in a TAB form.
I may give off the impression of a man with an axe to grind, so in the truest principles of the general medical council let me be completely open and let you judge for yourselves. I failed to pass my first year as a doctor, with the potential to have to repeat without correction, for the following, devastating, infractions- 1) one set (out of twenty) forms lacks a consultants signature and 2) one section of one form doesn’t have the posts I worked on- despite this information being available in literally thirty other places on the portfolio (including on top of that Same form).
I am sorry o great Hippocrates, for I have failed you.
Oh and super sorry but everybody else failed as well.
But what does this mean? Is your NHS flailing in the hands of an entire generation of incompetent and dangerous junior doctors? It might be. It probably isn’t though. But this system has no way of knowing if that is the case- or at least levels every facet of performance to have exactly the same value, rendering the entire exercise pointless.
I labour the point but we are supposed to be working in an objective, enlightened medical profession. Despite Mr Twains protestations statistical evaluation of medical outcomes has saved more lives in the twentieth century than penicillin. I’m not talking about “4 hour” wait times. If there is any evidence that seeing every patient within four hours is safer than seeing them in a safe, prioritised order it is kept extraordinarily quiet. I’m talking about outcomes that mean something- patient mortality, maternal complication rates, reoperation rates. Where is the academic rigour here? Where is the evidence to create such a convuluted bureaucratic assessment system and enforce it so vigorously- turfing out the doctor who didn’t upload her scanned form because she was doing a sixty hour week on-call. It doesn’t serve the patients, it doesn’t serve the teams who want competent juniors, and it certainly doesn’t serve the junior doctors themselves.
But this takes me on to a bigger theme.
Where did this system come from? Who decided that this would be a good idea and how did this come about? The problem I see it is our profession as a whole. Doctors don’t care about doctors anymore. The NHS has gone from paper driven target to paper driven target with each successive government. Politically it is in the best interests of Westminster to always have the NHS percieved as a problem to fix- its something to campaign about, to committee about, to reorganise and then to apologise about- before stepping down about. As Doctors we are supposed to hold to a different code- the GMC endeavours to maintain the public Trust in doctors and as such mandates a strict ideal to adhere to, lest your license to practise be taken away. The concerns of managers and targets are not supposed to be ours – the patient is our first concern. Each time, every time. But the attitude in recent times has not been to reject or challenge the paper targets of our hospitals but instead to join in.
In some brightly lit, Feng-Shui office a group of people, some perhaps doctors, some not, decided that objectivity could only be achieved without people, that assessments could only function in the abstract, that electronic meant ‘better’. And filling in a form is as important as safely handling an unconscious patient, crossing the ‘t’s more important than being an actual, practising doctor. We have blurred what is important with what isn’t.
We don’t respect each other. The seniors know the system is a farce but they go along with it because they are pushed for time as it is- the training of a new generation is out of their hands and just another endless tickbox. The juniors don’t respect the system, the seniors who enforce it or even the profession anymore. Ironically as we try to remain open to any outside suggestion in the name Of greater public trust we lose it. The public lose their respect for doctors who seem to disrespect themselves.
I feel like we are all like Nemo – swimming alone in the dark, wondering where the shoal went. The system alienates us, we alienate each other, we just ‘get through it’- continue ad nauseaum or ad retire-um. Or ad go-and-work-in-the-City-um.
There must be a way to fix this, to restore our professional pride without inviting professional arrogance, to protect our profession from attack while keeping ourselves completely open to public scrutiny, to make the phrase ‘Trust me, I’m a doctor’ really mean something again.
Rant over. Now, would someone mind filling in this TAB form for me?