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Wilkommen to my blog - my name is Karin Purshouse, and I'm a doctor in the UK. If you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I'm currently a doctor/research trainee in oncology after spending a year doing research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Tuesday, 2 April 2013

Get up, Stand up! Why Junior Doctors must lead from the front

Trainee doctors are an often forgotten entity, although we occasionally get some air time as per the Dispatches programme shown last week.  There has also been a recent wave of discussions about daily Consultant reviews and same-standard care 7 days a week, and GMC guidance for doctors about raising concerns.  

Fact is, when you arrive in hospital, you see a nurse, and then you see me.  You may see only me for a while, depending on how unwell you are.  Then you will see a series of other, but more senior, doctors in training.  You will see a consultant within 24 hours, but until then, it's doctors in training of a range of seniority levels who will manage and guide your care unless you happen to be extremely unwell.  Junior doctors look after patients on the ward, with senior input daily and as required.  If someone becomes unwell, junior doctors will often be first at the scene unless it's a cardiac arrest.  Getting your scans, blood tests, referrals etc done will generally be the responsibility of the junior doctor. 

So I'd say junior doctors like myself are fairly 'front line'.  One consultant I worked for described us as their 'eyes and ears' while they juggled their other commitments like clinics and teaching.  Junior doctors are leaders from the moment they do their first ward round (jogging behind the consultant juggling three different folders trying to write, listen and pull the curtain round all at the same time). 

I went to a national leadership conference in Bolton recently - I was one of only three foundation doctors there, and I knew the other two, which perhaps suggests that there exists only a small world of leadership-minded junior doctors.  
Hurrah!  Excellent conference, but where were the juniors?!
And it was very interesting! Because when we sat down and did a group project about solving clinical problems, or clinical governance, or patient safety, or resource management, or human capital, or the work environment, or CCGs..... etc etc..... who provided stories, anecdotes, evidence for what the issues are, and what might be done to solve them?  Ah - enter the junior doctor!  

I'm not trying to suggest there is no role for Consultants or other clinical staff, but if it helps to paint the picture, one of the Consultants there commented towards the end of one discussion that we needed to get juniors involved in these leadership issues because we still believe that change can come, and we're the ones on the ground with the ability to make these changes happen.  

But what changes?  I would describe these as twofold - attitude/cultural, and practical.
1) Attitude/culture - 
We are a new generation of doctor.  We do shift work.  We're expected to be able to do more - there's incredible medicine and surgery out there.  If someone spikes a temperature, or has a heart attack, or has complete renal shut down, there's actually something we can do about it.  We're expected to show our teamwork/publication/presentation-ing skills around a 60 hours working week. But yet we still live in some bizarre shadow of yesteryear that it was 'tougher back then', you should practically fear your consultant and seniors, and any weakness/emotion/personal life issues are almost an question of professionalism.  
Let's show a little love, people!  Yes, it was tough then, but it's tough now, just for different reasons.  Let's support each other and look after each other and, leadership evidence says, we'll be a happier, more efficient, more effective and safer clinical machine.  

2) Practical - 
There are so many on-the-ground practical challenges that remain - the way a 'Take' list is constructed.  The organisation of the blood cupboard.  The sorts of jobs you get bleeped about that might be better placed in a jobs book.  The appearance of the clerking proforma.  We use them every day - if it doesn't work, or it's impractical, let's change it!  

So junior doctor compadres - let us lead from the front, not shirk our duty and hold our heads high - for we are the medical leaders of right here, right now, and not just tomorrow.  We must engage for the sake of improved clinical care and efficiency, and be the leaders we know we are already.  

In the interests of GMC new guidance relating to social media (although I think it's pretty obvious from the side bar): my name is Karin Purshouse.  I am a Foundation year 1 Doctor.