Wednesday, 27 June 2007

The crux of the matter

This 'dumbing down' debate is an interesting one, and it certainly has the potential to get pretty emotional and messy. I felt the need to clarify my position as some people feel the strange desire to distort things in a way that stifles a proper discussion.

The multi-disciplinary team is invariably a good thing, different members of the so called 'team' are trained for their differing roles and if all runs smoothly, then the patient is the one to benefit from the mixture of skills and expertise on offer.

I have an enormous amount of respect for the vast majority of staff I have worked with in the NHS whether they be nurses, doctors, physiotherapists, paramedics, OTs, phlebotomists, radiographers et al. We are all trained for different jobs and it is essential that we all respect one another's roles, while appreciating the particular expertise of one another. I realise that paramedics are far better at managing a trauma patient at the scene than I am, however there will be a few things in which I am more highly trained and proficient.

Modern health care is undoubtedly different to the old fashioned system, and some aspects of change have been essential. However the 'dumbing down' of which I speak is a change that I fear has the potential to have a detrimental effect on patient care. Why do I think this, I hear you ask?

Different health care staff have different roles, meaning that they are trained in very different ways to take this into account. Nursing training does not prepare one to be a doctor, and vice versa. I therefore have grave concerns when one form of worker is given jobs that were previously done by another differently trained form of worker, without having as adequate and thorough a training as the worker who previously did those jobs.

As a doctor I appreciate that I have not been trained to be a paramedic or nurse with my training, hence if I wanted to switch careers I would expect to do the same training that paramedics and nurses have had to do. The converse applies, if non-medically qualified workers want to have the significant responsibility of practising medicine in unsupervised roles then they should have to undergo the proper medical training that a doctor has to.

Some new roles provide a valuable and excellent service, for example when nurse specialists are used in their nursing area of expertise. There are many roles in the NHS that have recently appeared, in which less thoroughly trained workers are doing jobs that were previously done by more highly trained workers. One example is in ambulances where paramedic technicians are being used in roles which were previously manned by paramedics, despite a reduced level of training. There are some that would argue that this has its inevitable consequences. There are clearly some staff who agree that paramedic technicians are being used in roles in which they may find themselves out of their depth:

"it needs a paramedic on every truck. I've said it before and I'll say it again; techs are adequately trained to do their role as first aiders but it needs a paramedic to be able to provide the necessary advanced skills to ensure the highest chance of rescue.I'm afraid a tech with or without his lma is just not up to speed for most pre hospital work. "

The debate needs to be had in my opinion. It is important that proper standards of training are not eroded in a way that endangers patients. I do not think it arrogant to think that staff who do similar jobs should be trained to similar levels, as if one group is not trained to as high a level then it is unfair on patients. No group of workers is perfect, we all make mistakes and we are all fallible humans. However it runs against reason to suggest that a group of more highly trained workers will not do the job they have been trained for better than a group of less highly trained workers. I am sure some of you will be keen to say otherwise though.

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