Multiple ways to F@*k up in the virtual world

My usual response to Twitter goes something like this:

1. See interesting point/comment
2. Get involved in interesting discussion (usually medical; sometimes political; occasionally cat-related)
3. Trundle along quite happily
4. Get completely thrown by comment (usually re: doctors or the NHS)
5. Realise that I have (yet again) fallen into the trap of believing that I’m a half-way decent person who is open-minded and doesn’t live in the bubble… except that I do
6. Slink away to try and re-set my brain and process the new information
7. Reconnect with social media
8. Start the cycle from #1 all over again.  And repeat.  And repeat

The comments that I struggle with are always ones that attack (?) something that I think is important.  I’m getting better at dealing with the ones that are political (although I cannot comprehend the logic that says that some children are more deserving of food, warmth, and life than others because they happen to be born in a particular part of the world.  Still struggling with that one. Not going to get my head around that any time soon. Or the thought process that states that the more guns are available, the less likely you are to get shot.  I’m shaking a little just trying to fathom exactly how that one works).

The comments that make me turn and hide are the ones that are personal; the ones that challenge my values.  The discussions about “you lot” as though by being a doctor I’ve made a choice to detach myself from the rest of humanity  (Why  is it considered socially acceptable to refer to healthcare professionals as “you people”? It happens to lots of groups… but I hadn’t realised that it was acceptable to do so.)  The comments that don’t let me pontificate in my head about how it’s all about patient care; how healthcare professionals always work for the best for their patients; how “we” do things differently…

Oh yeah… “we”

I struggle with social media because it’s challenging.

And it’s a lot easier to rationalise in my head that:

1. The real world isn’t like that (“Of course I don’t see myself as different”)
2. I/we would never act like that (“I don’t talk about patients like that”  Except of course, I’ve just referred to “patients” as a single homogenous group who can be “talked about”…)

Every so often, usually when I’m engrossed in some Twitter discussion or fuming about a particular comment my partner will suggest that I block or mute people.  It’s tempting. And sometimes I do delete my apps and sign-out of all my social media stuff (apart from Instagram – because that’s mainly cats and pole-dancers) and sit in my own head for a bit.

And then I start to wonder how far in my bubble I’m living… So I come back

I don’t have any neat profundities to sum this up.  Except that I’ll keep running through the social media cycle.  I’ll take Twitter-holidays when I need to, but I’ll be back when I have the resilience to be challenged again.  And I’ll keep f@*king it up.

Bear with me?

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I am worth more than (just) my salary

I know that this is going to get me a lot of criticism from my peers, but I don’t think that my “value” is determined by the amount of my salary.

I know this is an unpopular view because over the past 48 hours I’ve been told that I am sanctimonious and have poor self-esteem for saying that money is not what determines my self-worth.

Why does it matter how doctors measure their self-worth? Why does it matter if we feel valued at work?

It matters because a sense of value is related to burnout; burnout is related to patient care.  And whatever comes up about salaries, most healthcare workers do care about their work.

It’s a self-perpetuating cycle:

1. Don’t value your workforce
2. Increase burnout in your staff
3. Diminish the care given to patients
4. Reduce staff self-worth and increase burnout…
5. Repeat. Again.   And again.   And again…

As I’ve said before, what junior doctors are contracted to do and what we deliver in practice differs quite a lot.

When that extra isn’t recognised, then yes, I feel unvalued.  Sometimes, it’s as simple as being part of my team.  A phone call from the administrator or consultant to ask if I can work the extra shift? An agreement with my consultant that I will come in to cover during my leave, but that she will make sure that I can get to that conference I really need to get to?

The problem is that the money makes things easier (obviously).  My worry is that the salary was used to replace the other ways that a responsible employer would value their staff.

Junior doctors can rotate between different hospital Trusts every 4 – 6 months: we are supposed to get 6 weeks notice of this.  In my area, that can mean that in July you work in Leicester city centre and in August you work in Boston.  These hospitals are 70 miles apart: a 90 minute commute if you drive, or 3 1/2 hours by public transport.  What do you do? Uproot your home every 6 months at a few weeks notice? Try and find somewhere to stay after a 12 hour shift? Rent somewhere else for that six months, and hope that you’re closer for the 6 months after that?

When do you see your partner or family? Especially if you’ve been allocated to different areas (the choice is usually between accepting a post in the speciality that you want for 8 years – and whatever part of the country – or not having a job.)  You can apply for a transfer between different Deaneries, but only if you fit certain criteria and only if Deaneries agree.  Colleagues with young babies live at opposite ends of the country to their families because their requests for transfer were refused. Having the money to travel to see your partner? Kind of important for your wellbeing.

We’re supposed to get a rota for that six months.  Again, this is supposed to be 6 weeks in advance.  How do you arrange childcare at that notice? (Bear in mind, this could be in a completely different city) How do you get night cover, or cover for a shift that can finish at 10pm or midnight or 2am?  In practice of course, we often get our rota a few days before the rotation starts: family trips? time with your partner?*

We pay for most of our own training courses – last year, I spent £7000 on training.  I get a study budget of £600.  Some of the money I spend includes mandatory training (fairly important stuff like life support), but it’s not provided in house.    The courses get booked up months in advance… which is a problem if you don’t have a rota…because you can only use certain days. So, you book a course that’s further away (but on a date that you can make). You take the extra financial hit of accommodation and transport as a result.

My value is not just about my salary.  But there’s precious little else to show us that we are valued.

* My ex-partner was a junior doctor as well.  We lived in different parts of the country.  Every July and every January turned into a waiting game for our rotas to be published.  Once we knew what we were working for the next 6 months, it would take hours on the phone trying to work out when we could see each other; if we could combine a weekend together with seeing friends as well; how tired we would be (invariably, one of us was always post-nights and so would turn up having not slept for 24 hours +).  It doesn’t make for great quality time together; it really doesn’t help your relationship

Why should you care?

As a patient; as a relative; as a carer; as a member of the public who might need the NHS, why should you care about the new junior doctor contract?

Because it will damage the care that you receive as a patient.

The irony of a Health Secretary who declares that he wants healthcare to be “more human” whilst simultaneously imposing a junior contract that dehumanises front-line staff is impressive.  The argument is that the “evidence” shows that patient care will be improved by our working longer shifts, by designating longer hours as “plain time”, and by removing the obligation for employers to monitor our hours.  Leaving aside the soundbite that isn’t based in fact (for a clearer review of the often mis-quoted seven day services paper, I suggest reading this excellent summary) there is a wealth of evidence that a happy, well-cared for workforce is more efficient.

Does this apply to healthcare?

Yes

We know that tired doctors make mistakes.

We know that repeatedly being in stressful situations without the chance to off-load and regroup leads to compassion fatigue and loss of empathy.

And we know that emotional competence has a direct impact on clinical care

I always thought that part of being a professional, a doctor, was the ability to separate work from my personal life; to live in the bubble and block myself off.  It doesn’t work like that.

A few years ago, I hit a particularly low patch.  I was adamant that it wasn’t going to affect my work – if anything, I worked harder and harder to make sure that I was available for my patients.  I smiled at work (all the time); I said “yes, of course” to every task; I convinced myself that I could separate work and “out-of-work”.

And then one of my patients told me I looked sad all the time and gave me a hug.  Don’t work with children if you’re trying to hide anything – they see through everything.  She was seven and she was dying, and she had time to see what none of my colleagues (or I) wanted to see – I was not being “her” doctor.

I see so many conversations on social media about mistakes made when we didn’t listen; when we didn’t take the time to pay attention; when we lost the ability to care as professionals. When we stopped being human.

We should all care about #juniorcontract. Because we deserve healthcare that treats us all like human beings