This morning I woke up and realised, I should just draw up a list of all the things I said I would never do, and just do them.
Firstly, there was the research…
Then there was the hill-walking…
And the camping…
I have a terrible confession to make: I think I’m becoming a management person.
I’m not entirely sure how this happened. I think my inability to keep quiet in front of seniors probably has something to do with it, along with sticking my nose into things, and having an impatient streak that doesn’t see why we can’t just find a solution to things. (One of my A&E friends used to say “see a problem, fix a problem”, except that half the solution is being able to “see” the problem in the first place).
And I’ve ended up doing things I told myself I would never do. I’m talking to seniors about getting more junior doctor representation; I’m taking part in the BMA; I feed juniors cake and try and sort out their rotations (not very successfully so far, but it’s a start). There are things that no-one else is doing, and I’m not sure why I’ve taken them on. I just have because they needed doing.
What happened to the girl who was going to be a “pure” clinician? Who was just going to put 120% into her firm, and patients, and team? Who wasn’t going to “waste her time” on all the paperwork, and re-organising things?
When I was younger, I wanted to change the world. I thought the only way of doing that was to be a big chief somewhere (I thought I was going to run the WHO, because that’s what paediatricians do! I do not have delusions of grandeur. I just get a bit carried away sometimes…)
Then I met my first patient, and I realised I didn’t need to stand on some podium to change the world. (*sentimentality alert*) I could make a difference by talking to them; listening to them; remembering what their job was. If I was the best doctor I could be, then I would be making that difference.
But more and more, I’m realising that I can’t be the best doctor I can be, because it isn’t about how much work I put in, or how many hours I spend staying late after work (not that I would ever do that, and I faithfully promise that I have completed a breach form for every single minute I am delayed leaving work…). Eventually, something in the system stops my patients getting the best.
Sometimes it’s me: because I’m looking after three new admissions at once, and I can’t explain to families the way I want to; because I have bad times when I’m tired and grumpy and I need rescuing by amazing people; because I make mistakes when I’m dealing with those three things at once; because I don’t make contemporaneous notes (for the simple reason that I’m doing the things I’m supposed to be recording); because I’m human. (*should probably tell myself that more often*).
Human beings don’t set out to make mistakes, snap at parents and nurses, & forget to write things in the notes. We don’t aim to go out and generate incident forms about ourselves. We don’t wake up in the mornings and think “today, I’m going to give someone sub-optimal care. I’m going to put them at risk because I can’t be bothered to do it better”. This is not the kind of job that you can survive in unless you care.
But we don’t work in isolation. We’re part of a system. And when things go wrong; when there are repeated and consistent mistakes and omissions; when patients and families and your colleagues don’t get the best from you that you can deliver, that’s not about individuals. That’s about the systems that we work in.
So, if I want to be the best doctor I can be; if my patients are to get the best care they can get; if my amazing, fantastic team are going to get the best team member they can get, then something has to get better. Things have to change.
I can’t just change myself. I have to change the systems I work with. It’s never going to be perfect. It can’t ever be perfect. But we have to keep trying to make it better.
Just being a “pure” clinician isn’t going to do that for me. Getting involved in systems change and joining the dark side of management might be the way forward. Dealing with teams and structures means being trained to do that, so I’m going to a conference. I’m getting some training from my LETB (because I’m a trainee. I’m entitled to be trained to do this, just as much as my clinical work. Plus, they’ve already top-sliced the study budget to provide the course, so I’d be crazy not to take it up. But then I still think I’m crazy to be doing it…).
I have friends who are so disheartened by the systems we work in that they tell me it’s a waste of time & energy; that we’ll never change anything. And maybe they’re right. Maybe there’s one little tweak that won’t make any difference to the NHS. Maybe I won’t run the WHO.
But trying to get enough otoscopes on the wards would be a start…