Friday, 27 November 2015

NHS Survival Tips for Junior Doctors on the Eve of a Historic Strike for a Fair Contract

I am writing these tips to help guide junior doctors so they may survive the NHS. I and many of my colleagues have been deeply struck by the recent suicide of a NHS GP trainee Dr James Halcrow who was named the 'Top GP Trainee in the Country' , only a year following the suicide of a NHS GP partner who had received a gold medal for the highest MRCGP exam result in his Deanery as a mature GP registrar.

Dr James Halcrow was described... 'Nov 2015 a post on the resilient GP facebook group from a GP.

"I knew James. I worked with him for 6 months during my GP rotation in medicine. The article is not exaggerating in any way. He was a fantastic doctor, and I was fortunate to consider him a friend. When I heard he went into GP training, I was pleased because he would have made a truly top GP.

I remember one time, we did a ward round and we were running late. He spent 40 mins with an elderly lady patient because something was bothering her and the nurses and the rest of us never got to the bottom of why. James managed to actually coax out that she had urge incontinence and had some accidents. He asked me for advice and I suggested some oxybutynin. The next day I arrived at work and James had already conducted his own follow up, pleased that the symptoms were better.

This was a particularly poignant reminder of what a dedicated, conscientious and responsible doctor he was.

I heard from a mutual friend who attended the coroner's inquest. Whilst no fingers were pointed directly, in my own heart I know full well the GMC had a lot to answer for. I am not only disgusted, but extremely sad that the system that sets out to regulate us can do so much harm.

sorry for the long post. I felt it was important to give an idea of just what kind of doctor we have lost."

I cannot bear to see our finest doctors end their lives in utter despair. Here are my surival tips for junior doctors, and I hope this saves you and teaches you how to survive the NHS.

1. Find a mentor, a supportive trainer, programme director, associate dean, or even dean, you may ask for advice. In each programme, there are many personalities and you may find you gel with one more than the other. This is important if you run into conflicts at work with hospital managers trying to force you to work longer than the EWTD (European Working Time Directive). You can then confide in your mentor and they can have a quiet word and intervene discreetly to ensure both your safety and that of your patients. Remember you are a trainee doctor in an educational training programme. There is a duty to both educate and train you and for you to provide a safe service to patients. Tired doctors make mistakes.

Real-life scenarios:
A junior doctor confided in me that he tried to stick up for colleagues and raised concerns about managers scheduling a series of hospital shifts that breached the EWTD and he ended up allegedly being bullied by his trust. This creates an atmosphere of intense fear, and management may then exploit junior hospital doctors without any redress. Training programmes may deal with 'troublemakers' by never allowing them to complete training and may offer excuses such as we cannot find a GP training surgery for you ( leaving you unemployed for months) or we suggest transferring you to another area (which may be 100s of miles from where your family lives).

My advice would be to ask that a senior BMA industrial officer steps in, and if necessary meets with the hospital trustees to ensure EWTD is not breached and that junior doctors who raise concerns of patient safety from unfair working practices are not bullied, blacklisted or labelled as whistleblowers. Or you may need to pay for a private employment lawyer to fight your case.

A female mature junior doctor felt bullied at work and took time off sick. The trust allegedly accused her of breaching her contract when she took considerable time off for stress and she was allegedly referred to the GMC on lack of probity for contract breach.

My advice is to keep track of how many days you take off sick while training as if you take too many days off, you may not be able to obtain your CCT at the end of training or you may be asked to work extra weeks before you will be given your certificate of completion of training. It is no wonder some junior doctors may go in to work when ill because they may fear retribution for taking too much time out.

2. If you are a working mother or father with children, you may wish to consider flexible training. In my time Professor Liz Paice was Dean of London Deanery and she ensured flexible junior doctors were protected and treated as supernumerary doctors, ie an extra pair of hands. Her background was Canadian medicine! This was vital to ensure flexible junior doctors were not abused or overworked when they were effectively part-timers. This meant that on call in hospital for me was often a mere 3-hour shift from 5 pm to 8 pm, and not a 12-hour shift that junior doctors are now scheduled to work. Bear in mind that parents are never 'off duty' when you come home and take over from the childminder, or pick up children from after school care. Ask your training programme if there is any possibility that you can train part-time.

Remember tired doctors are more likely to make mistakes and now NHS doctors may be charged with criminal involuntary manslaughter if they make a mistake at work and a patient dies as a result. If convicted, this may come with a jail sentence.

Real case:
Lawyer Thomas said: "Is it symptomatic of your behaviour that day that you rushed to a decision without checking?" The junior doctor mother of 2 replied: "It's not that. It's a reflection of how long I had been working without a break." She had made a mistake into her 13th hour of work, was tired and now faces a jail sentence as the patient died.

3. If you drink socially, please be aware that a caution for drunk and disorderly in public or a drink driving conviction are GMC referrals. If a policeman suggests offering you a caution for say disturbing the peace, please consider refusing and instead fighting your case in court, as you may win and no GMC referral is then needed.

Real scenario: a doctor was allegedly asked to abstain from alcohol for 4 years by the GMC to have restrictions lifted. And inability to abstain from social drinking may have been the reason the GMC did not remove the restrictions on the junior doctor who hung himself. Until the GMC reforms its strict almost Draconian rules for NHS doctors, please take a time out, seek help and counselling and return to work when well. Programmes like PHP based in London offers confidential counselling for doctors with depression, drink and/or drug problems and gives you a pseudonym for 100% confidentiality. I would not advise you voluntarily self refer yourself to the GMC unless it is mandatory, ie you have been convicted of a drink driving offence.

4. Do I become a grey person to survive my NHS training?

A grey person is someone who keeps his or her head down, does not complain or raise concerns, and just gets on and does the job, ignoring all employment breaches, system failures and patient safety concerns. This is where it becomes difficult if you are a doctor with high moral fibre and cannot abide wrongdoing, especially if you witness harm to patients. Not surprisingly, many top doctors are the ones who cannot keep quiet but speak out and are often labelled as whistleblowers or controversial, ie Professor Edwin Jesudason (Oxford graduate and paediatric heart surgeon), Dr Raj Mattu (consultant cardiologist), Dr Kim Holt (Great Ormond Street consultant paediatrician), Dr David Drew (consultant paediatrician), etc. What do you do if you are a mere junior doctor and your career and livelihood depend on you acquiring your CCT (certificate of completion of training). This is where your choice of training programme is vital. Talk to colleagues and ask for recommendations of where in the country they would or would not like to train. Do your due diligence. Some trusts are better funded and resourced than others which may be struggling to keep afloat. Trusts strapped for funding may be more likely to take short cuts, overwork junior doctors and may have more patient mortality and morbidity than neighbouring trusts with healthier books.

5. There is another alternative to spending years of training in what may be an oppressive bureaucratic atmosphere run by managers. You may wish to continue training in Australia, Canada or America. Or you may wish to seek training in the private sector through old fashioned apprenticeships, ie learn on the job. GPs may be called a private GP after completing 2 years of foundation year training post medical school.

I hope this prevents a junior doctor suicide or junior doctor conviction for involuntary manslaughter.