Monthly Archives: January 2014

Hello, is anybody there? Talk to me………

If we can’t communicate with each other, what hope have we?

This week, a junior colleague approached me in a very distressed state, because she had received a complaint.

Now, complaints are an unpleasant reality of working in medicine.  We all strive to avoid them and, hopefully, they are infrequent, but most healthcare professionals will have to deal with a complaint at some stage in their working lives. They are a distressing experience for all concerned and I include the patients in that comment, as well as for the healthcare professional and often the wider healthcare team, causing cognitive, physical, emotional and behavioural illness to a greater or lesser degree, depending on the severity of the complaint and the processes surrounding its resolution.

We all have systems in place for dealing with complaints, from the practical responses to the reflective requirements to make sure that issues don’t recur and, indeed, appropriate management of complaints is a vital aspect of clinical care.

A complaint from a patient is usually based on a lack of communication, misinformation or misunderstanding. Sometimes it is about poor care. Whatever the cause of the complaint, it reflects a breakdown in the consultation process and, more often than not,  discussion between the doctor and the patient results in successful resolution of the problem. In those instances, where adequate resolution does not occur, there are alternative avenues for pursuing the complaint, such as the CCG or the GMC.

A complaint from a medical colleague is a whole different ball game. Knowing the emotional trauma that complaints cause, when a medical colleague complains, casting doubt on your medical ability or expertise, it must be serious; it bites into the very heart of your medical professionalism.

This complaint was from a local consultant. It took the form of a courtesy letter (or should I say cursory) letter advising the doctor that a formal complaint had been made to the GMC and NHS England because of medical concerns. No discussion had been had with the doctor, nor the senior partner at the practice. It hadn’t been raised with the CCG, nor with the hospital administrative or clinical board.

The foundation of the complaint was that a prescription had been issued without a face to face consultation. The patient concerned had not been unhappy with this process, but the consultant had felt that it was an absolute failing in medical process and procedure and had felt it necessary to go straight to the GMC.

Since the Mid Staffs scandal, identifying poor medical care has quite rightly been high on the medical and public agenda. It is essential that poor care is challenged, but processes need to be followed. If this particular consultant had followed normal procedures, the situation that led to a prescription being generated could have been discussed and better understood. Moreover, what this incident highlighted to me was the lack of understanding that we have of each other’s work environments.

A huge proportion of General Practice consultations now take place over the phone and prescriptions are often generated accordingly. This particular situation certainly was not a one-off, but a regular everyday occurrence. When a Primary Care clinician generates a prescription without a face-to-face appointment, it is done in a number of clinical situations and for a number of reasons, including patient choice and convenience and in order to deal with increasing demand – it is simply not possible for all consultations to be in the surgery setting. Of course I’m not advocating telephone prescribing without appropriate and due consideration, but in many situations – such as this – it is useful and entirely justifiable.

If you are a follower of my Twitter stream, you will see that I am a great advocate of inter-colleague communication. I am convinced that if we have a better understanding of each other’s workloads and systems, then we can improve patient pathways. We need to work together, not in isolation, to enhance and redesign patient services and for that we need to talk to each other.

This complaint was generated by a lack of understanding of the current way that much of primary care is delivered and, with inter-colleague communication, could have been avoided.

So come on General Practice and Secondary Care, stop being ‘islands’, let’s put the holier than thou attitudes to bed. Can we get off our backsides and start communicating?

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Bloody Women

It’s not often that I’m speechless, but credit where credit’s due, the esteemed Professor Meirion Thomas managed to silence this gobby female this week (for a few minutes anyway). The aforementioned, brave, though some might say, foolhardy soul, was standing up, courtesy of that paragon of English journalism, the DM (like Voldemort, I dare not say its name) and was waging war on female doctors, female GPs in particular.

I won’t dignify the piece by linking it, but a few of its pertinent quotes include:

“By 2017, for the first time, there will be more female than male doctors in the United Kingdom.”

“I fear this gender imbalance is already having a negative effect on the NHS. The reason is that most female doctors end up working part-time — usually in general practice — and then retire early.”

“Given that the cost of training a doctor is at least £500,000, are taxpayers getting the best return on their investment?”

“In truth, general practice is organised for the convenience of doctors — particularly, I suspect, for female GPs — and not their patients.
No wonder many people, faced with a medical problem, ignore their local surgery and go straight to A&E — one reason why emergency medical services are at breaking point.
The problems with A&E are very much in the public eye. Not so the issue of part-time working — but it certainly should be, as it is linked.”

You can’t argue with the statistics; there are more women than men who work part-time and yes there are more women than men in General Practice, but it is for the time being a reality that women bear the children and in the main, when it comes to choice, are the ones that take a career ‘backseat’ to look after the little rug rats. Sometimes it is the woman’s choice, often I think, it is the couple’s choice and frequently it is because the woman earns less than her partner. Whatever the reason, it most certainly is a choice, perpetuated by the society we live in and thank goodness we are lucky enough, in the main, to have that choice.

What I actually took exception to, was that there are obviously still bigots in the medical profession who differentiate between male and female doctors. Doctors of both sexes work part-time. Indeed, the definition of ‘full-time’ working in medicine is one of conjecture. I would hazard a guess, that Professor Thomas’s ‘full-time’ working week has involved rather a lot of successful private practice. However, one’s achievement in the medical world shouldn’t be about gender. I consider myself a successful doctor, not a successful female doctor.

I had a rather unconventional start in medicine. I was married when I was 21 & had my first child when I was at medical school. Ok, it wasn’t a planned pregnancy, but it was no less wonderful an event for all that.
I had to take a complete year out of Medical School and on my return, first firm, Monday morning, my consultant said, “so which one of you idiot women has just had a baby?”. Let’s just say he didn’t make a similar comment again and I still got an A!

I passed finals with an eighteen month old in tow and did house jobs, working a full 1:3 rota with my young child. My husband was my rock and still is. We celebrate our 25th wedding anniversary this year. I have always worked full-time and am a mother of three; our choice, our joint effort.

I am no feminist heroine. Check out my avatar. I embrace being a woman & my sexuality, but it plays no part in me being a doctor. My ‘female characteristics’ may make me more caring and empathetic, who knows, but more importantly who cares.

At some stage, we may have to look at work force planning, taking into account likely working patterns, but I hope any discussions will be based on the reality that, for the time being women will not pop children out into vast incubating areas and immediately be forced to return to work, but rather be a considered evaluation of the needs of the NHS and patients coupled with the needs of 50% of its workforce. After all, being ‘a good doctor’ is multifaceted, but what it certainly isn’t is gender dictated………

(Perhaps the illustrious Professor should retire early….)