You and Your Bleep. A Love / Hate relationship?

Having a bleep is a great accolade and is loved by all junior doctors. How important we feel when it goes off! Somebody wants us, no, somebody needs us, no-one else will do. ‘What do they want now?‘ We sigh and feel quite indispensable. 

All too soon though, reality bites and the bleep becomes a nuisance. It interrupts. Its piercing tone reminds you that you are at the beck and call of others confirming that there is no such thing as privacy in hospitals.

We are subject to on call rooms that don’t lock, grill fronted lockers where contents lie visible in the changing rooms and at least one bleep to ensure a variety of people know exactly where you are and perhaps what you are doing at any given moment.

On my intensive care unit, the staff toilet is housed within a wooden pillar structure close to the entrance of the unit. Everything could be heard through the paper thin walls which I found fairly inhibitory to the smooth emptying of my bladder. I avoided using this toilet when I realised the sound travelled equally in both directions but one day had no choice. 

I had not stopped for a drink or a loo break all day. As I entered and locked the toilet door, I heard a patient’s relatives at the nurses desk asking if they could speak with the doctor on duty. That was me. I could sense the nurse scanning the unit before saying ‘she was here a moment ago, I’m not sure where she has gone, but she won’t be far away’.

As she shouted to a colleague regarding my whereabouts I stood still. I really needed to go. Should I go and speak to the relatives and come back later? Talking with relatives is never a quick job, nor can it be rushed. I might not last. Should I go quickly, aware that they may hear me emptying my bladder from the short distance between us? Why was I embarrassed by this thought? I am a doctor for heaven’s sake and it is a normal bodily function! I had to go, so go I did. 

Just as I sat down and began to relax, my pager went off. 

Transiently I felt relieved; the sound of my bleeper would drown out the sounds of toileting. My relief quickly evaporated however, when I heard the same nurse tell the relatives ‘Oh, I can hear her pager go off, she’s just in the toilet. Shouldn’t be too long’.

No matter how comfortable you are about bodily functions, it does not feel right to have relatives of critically unwell patients, waiting for you to emerge from the loo.

Fame at Last!

This month I have made it into the Royal College of Anaesthetists Bulletin with an article explaining the frustrations that led me to write 'Adventures in Anaesthesia'. Hopefully this will help to spread the word far and wide that the 'jab in the back of the hand' is only the beginning.

You can download a copy of the Bulletin here. It is free and you will find me on page 44. Enjoy!

What’s the Open got to do with Labour ward?

In case you have failed to notice, The Open Golf tournament is taking place in St Andrews this weekend. This means almost all of the menfolk (and some of the fairer sex) will be glued to the television, present in body only. Any attempt at conversation being rewarded with a distracted ‘Mmm’ or ‘Uh-huh’ and a complete absence of eye contact.

St Andrews is well known for many things: the golf of course, being the University attended by Prince William and Kate Middleton and its ‘micro-climate’ . The latter means that even on a day where the temperature is reportedly 20 oC, it is freezing and blowing a gale in St Andrews. Hence those who actually go to the golf tournament, watch the action (action?) on a large screen in the sheltered confines of the beer tent. So they say. (A friend in finance even claimed he was ‘working' there.)

Rory McIlroy pulled out of the tournament due to an ankle injury sustained whilst playing football with friends. This was big news in my house and it did cross my mind that his sponsors must be fuming that their logos are missing out on four days of televised promotion despite the large fees they would have paid Rory to wear their products.

A similar occurrence happened in my department this week and, while the sponsors were not fuming, the rota consultant was pulling out what remains of his hair. You see, this is the prime fortnight of summer holidays in Scotland and only a skeleton staff remain. The workplace is very quiet and there is little slack in the system. 

When the news was received that not one, but two of our trainees had injured themselves during extreme sports and would be off sick for the foreseeable future, sympathy was way down the list of reactions. At the top was ‘who is going to cover maternity this weekend?’.

As ever the shortfall is made up by Consultants (see, we already work 7 days a week) and this costs the employer either time or money.

It makes me wonder whether we should enquire about leisure activities more closely during the appointments process. Do we really want an adrenaline junkie as a colleague? Should alarm bells ring when hobbies such as sky diving, white water rafting and off piste skiing are listed? Such diverse pursuits outwith medicine have to date been considered a bonus to one’s CV. Perhaps we should only admit to ‘reading and films’ to avoid hobby discrimination? That’s a good one for the equality and diversity trainers. 

Instead of inserting a ban on high risk activities into the contract, another solution would be for all anaesthetists to insure their left arm, in the way that piano players insure their hands and actresses do their faces, legs or whatever. That way when doctors are unable to work through injury, their insurance will pay for cost of covering 72 hours on the labour ward. Or we could ask Jeremy Hunt how he plans to pay for it. Time or money?

Anyway, now the rain’s off, I’m back to the yawn fest known as golf. 

10 resolutions the NHS should make Now.

1. Streamline equipment. Ten surgeons in a department should not mean ten varieties of hip prostheses are stocked. A choice of two alternatives of expensive clinical equipment is sufficient and guards against supply problems with either one. 
2. Remember, just because an operation can be done, doesn’t mean it should be. Obese diabetics aged 80 confined to wheel chairs due to breathing difficulties are not ‘entitled’ to knee replacements. Same applies to plastic surgery for ‘psychological distress’ caused by body parts being too large or too small. 
3. Standardise non clinical supplies across entire  Trusts, Local Authorities and Health Boards. In fact, even buying the same paper and envelopes throughout all departments in the same hospital would be a good place to start for economies of scale.
4. Remember that cost and value are very different entities whose relationship may not always be obvious, immediate or temporally related. Supporting Professional Activities (SPAs) are seen as a waste of money due to failure to recognise time for teaching, research and quality improvement projects means trainees score the hospital highly on GMC surveys. Universities listen to this and send more medical students to ‘good’ hospitals where high quality teaching is valued. These students bring money.  
5. Re-introduce prescription charges in Scotland, Northern Ireland and Wales where prescription medication has been free since 2011, 2010 and 2007 respectively.  Here in England, actual payment is made for only 10% of prescriptions. The other 90% consists of medicines for children and those entitled to free prescriptions. While ‘free for all’ is politically popular, there should remain a means tested rate of payment for those of us in the top 10% who can afford to pay. We should use, but not abuse the system.
6. Stop wondering why operating theatres are so ‘inefficient’. They are not. Instead acknowledge that adopting the latest in safety and best practice, (performing huddles, repeatedly checking name bands, having surgical pauses and post procedural debriefs) takes time. I’m not against these; check listing improves patient safety and helps prevent human error, but it takes time. And time has both financial and opportunity costs. This is not inefficiency but reality. 
7. Medium term employment contracts. It is very difficult to get fired from the NHS. You can be sick as often as you like and receive various levels of warning, reprimand, additional support and phased returns. Employment contracts reviewed every five years would allow the chronically sick and dis-interested slackers to be relieved from continually hampering the organisation. We all know who they are yet their managers seem powerless to fire them.
8. Redress the balance of non-clinical to clinical staff. An organisation whose sole purpose is to treat the sick should have more than 50% of its employees engaged in doing so. The contracts mentioned above could be useful here.
9. Decisions around healthcare provision must be based on clinical need and not on arbitrary vote winning declarations of speedy delivery. Cut your coat according to your cloth and stop wasting money chasing meaningless targets.
10. Start to value and incentivise staff to work smarter. Acknowledge and praise challenging work and excellent outcomes and your investigation of complaints and poor outcomes will be better tolerated.  Borrow from business with ‘Employee of the month’ rewarded with a parking spot or an early finish one Friday. Finished all your work half an hour early because the team worked fast and efficiently? Go home half an hour early instead of being redeployed to a late running team to help mop the floor. This will help reverse the drain of goodwill. There is no incentive to work harder if the reward is to be given more work. 

Midwives are driving me MAD...

If the requests were not in fact true, they would be hilarious. Back in real life, the rude demand of 'EPIDURAL ROOM 2!' being bellowed down the phone the second I get my toothbrush out, (which is only about three seconds after I have left the labour ward) is barely civil, never mind professional.

The phone is hung up before I can say 'Do you know anything about the lady?' (it's always nice to have some idea of the carnage you are about the walk into), but no, they've gone. Sometimes, if I'm feeling petulant I do not respond to their summons. When they page me again and again and again, innocently  I say we must have got cut off because I was asking them some details about the patient before meeting her- heaven forbid.

Now I know why it's called labour yard (and its nothing to do with the patients!

Anyway, I could go on and on as I'm sure many of us could.
If you want to share your mad midwife story please do in the comments box below.

Let us begin

It has been a long time coming but today I have finally managed to start my blog. My aim is to inform, clarify, explain all that happens after you have counted down from 10 and lose consciousness.
I will bring you highlights of my life as a doctor trained and working in the NHS and a variety of true tales, some happy, some not so.

I'd love to hear from anyone about their personal experience of anaesthesia whether good or bad. You can e-mail me on drelliemay@gail.com