The ethics (and economics) of paying doctors

If you have friends who are doctors (or keep a close eye on the national news) you will have heard of the recent bust up over a contract for junior doctors. The very short summary is the Department of health wanted to reform existing contracts for doctors, and started negotiations with the BMA. These broke down, but the government threatened to impose the contract anyway, junior doctors, in turn have threatened to strike. [ref] For much, much more detail, consider reading NHS Employers, the BMA, and the DDRB (renumeration board) proposals.[/ref]

I am much more ambivalent about the contract than most of my peers, who are varying shades of outraged. I’m not sure why. Continue reading

Dying in hospital

“Good morning, it’s Gregory the surgical SHO. You bleeped – how can I help?”

To contact a doctor overnight, you generally paged them, and I had a well-rehearsed patter when replying. The delivery was slightly too jaunty for 2AM on a Saturday morning, but there were worse images to project than eccentric enthusiasm.

“Hello, it’s Sabine the sister on ward eight. Can you review Mr. Amir? I think his breathing has gotten worse.”

My heart sank. I was on call, and although Mr. Amir wasn’t under my team when I was working normal shifts, I knew him by reputation. Metastatic colorectal carcinoma, resection was unsuccessful, leaving him with both a poor prognosis and a major operation to try and recover from. I had heard his team talking about him with little hope – the best case scenario would be he would recover from our forlorn attempts to help him and could go home with palliative treatment. The worst case would be that he would die in hospital. I knew he wasn’t doing well: recurrent chest infections, multiple courses of antibiotics – ineffective, poor wound healing, bedbound.

“Of course. Is there a purple form?” Continue reading

Saving the World, and Healing the Sick

When I applied to medical school, I had to write a personal statement: selling how exceptional my achievements were, what wonderful personal qualities I had, and my noble motivations for wanting to be a doctor. The last of these is the most embarrassing in retrospect:

I want to study medicine because of a desire I have to help others, and so the chance of spending a career doing something worthwhile I cannot resist. Of course, Doctors [sic] don’t have a monopoly on altruism, but I believe the attributes I have lend themselves best to medicine, as opposed to all the work I could do instead.

These “I like science and I want to help people” sentiments are common in budding doctors: when I recite this bit of my personal statement in a talk (generally as a self-flagellating opening gambit) I get a mix of laughs and groans of recognition – most wrote something similar. The impression I get from those who have to read this juvenalia is the “I like science and I want to help people” wannabe doctor is regarded akin to a child zooming around on their bike with stabilizers – an endearing work in progress. As they became seasoned in the blood sweat and tears of clinical practice, the vainglorious naivete will transform into a more grizzled, realistic, humane compassion. Less dying nobly, more living humbly; less JD, and more Perry Cox.

I still have a long way to go. Continue reading

I’m sorry sir, but you’re fucking annoying

Some patients can be extraordinarily irritating. Some are easier to tolerate than others: it’s easy to put up your professional barriers towards a patient swearing at you or who regards you as an irritation. Far harder are those that aren’t trying to annoy you – the garrulous but well-meaning patient wastes you oh-so-valuable time.

A recent case:

GP placement, late morning. I’ve been observing another student try and take a history from the same man for forty-five minutes. I doubt I would have done any better at fighting through the free-associating detours and distractions. He varied from lecture, to anecdotes, to slideshow (he brought photographs of his various collections of computers and cars to show to us). Continue reading