Tuesday, 15 April 2008

Lame ethics

Medicine is dumbing down, the apprenticeship is being replaced by less shift work, as old fashioned learning methods are replaced by politically correct self directed methods. Everyone must be complimentary to everyone else, pointing out that something is just not good enough is no longer allowed. Students and juniors are cotton wool wrapped like never before, as it becomes harder and harder for those who really want to learn to get the valuable experience that they so badly want and need.

This story perfectly demonstrates the dumbing down and the abdication of responsibility that is happening far more often than it used to. A Foundation 1 doctor, this is the grade formerly known as house officer (PRHO), was asked by a nurse to pop a venflon in (to site an IV). This doctor then called her registrar because they could not do this task. The registrar went along and asked this F1 doctor if they had tried to do this simple task, the F1 replied that she had not. When asked why she had not, she tried to defend her lack of effort by saying that it would be ethically indefensible for her to put a patient through any pain when the registrar was more likely to be able to succeed with the task. The registrar replied by politely stating that ethically she should think of all the patients that she is going to treat in the rest of her career, they will be relying on her skills that she must develop during her training. She then grudgingly had a go, failed and burst into tears.

Of course I have a little sympathy for the aforementioned F1, however venflons should be bread and butter after a few months of house jobs, and even if the patient is particularly tricky then a junior should virtually always have a go before calling for senior help. Maybe I'm just biased, but I get a feeling that junior doctors are getting less and less experience than ever before. MMC was meant to remedy this, however it appears to do the very opposite, the combination of MMC and EWTD have led to most junior doctors working full shift rotas these days. This means that the continuity of care is affected which impacts upon training and patient care, while juniors are often busier with menial administrative tasks which means that they have less time to experience the useful bits of their job than in days gone by.

I have more experience of the surgical specialties and the current environment is most definitely shafting surgical training. I have to also say that I do come across many more trainees who are incredibly committed and motivated to learn, as opposed to the work shy clock-on-and-off shift workers. The new system does unfortunately encourage the latter's approach, and I must add that GP trainees are somewhat more likely to be part of the latter group as they have no interest in proving themselves to hospital consultants as they their path to GP-land is assured.

What's the solution to all this woe? Well a 48 hour week is certainly not the way to go. I like the idea behind Remedy's Barbados plan, as trainees must take the initiative if we are not to become a cohort of deskilled shift workers. MMC and the competency based lunacy that goes with does nothing to deal with these grave problems with training. Two things can be modified, either the service can be lowered in quality or the way the service is delivered must be changed. The empowerment of a whole raft of health care practitioners (HCPs) is changing service delivery but also reducing the quality of the service, while also having grave implications for the sustainability of the service, as if the consultants of the future are massively deskilled then this could have dire implications in the long term. I do reckon though that trainees must push to work longer hours otherwise not only will patients suffer the effects in both the short and long term, but we will not become as good a doctors as we once hoped we would.


Hospital Wallpaper said...

I'm flabbergasted at the attitude of this Doctor, unless the patient was a young child who was unlikely to let anyone near them if the first attempt failed, or in a patient who only had one viable site left, there is no excuse for her behaviour. Even as a student, I'll have a go (two at the maximum if the patient is willing) before asking the F1 to take over. As for bursting into tears because the venflon failed? Perhaps this was the straw that broke the back of a really bad day, but otherwise she needs to toughen up. She's going to have many more failed venflon in her career.

Anonymous said...

And hey, if worries about inflicting pain are what's slowing her down, then freeze the site. It works.

From a fellow R1.

DrJD said...

venflons aside-this is a load of crap! Push to work longer hours? Is this a Government sponsored website? WTF???
Why aren't we pushing to have shorter hours AND more training? Are you really all so brainwashed into thinking the old days where you worked until you collapsed from fatigue and never saw your families/friends and sacrificed your lives and health all for your oh so glorious career were good?
What on earth is wrong with you?

Maybe you have what we call SDS, or "Senior Doc Syndrome". You know, where it's not you having to go through any of this hell so you don't give a fuck? And it's much nicer for you to have your own Reg and SHO in house all the time, day and night so you don't have to come in, just be "on call" over the phone? Very nice.
Way to look after your juniors.
How can you condone the unsafe work practices in times gone by? Are they so distant for you that you can't remember how awful they were?