Things I said I’d never do…

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…

And now…

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…

 

Being marmite…

Most of my thoughts about academia seem to come out of random phrases that float into my brain at odd phases.  “Being marmite” is one of those phrases that I’ve heard several times at leadership & management conferences.  I have to say, it didn’t mean a lot to me, because I’d never tried marmite (I know, I’m 31 years old, and I’d never tried marmite.  This is on the list of other things that I’d never done, like camping, but that I might have to catch up with during my 30s!)

During the discussions, it turned out that what they meant was marmite is a love/hate relationship.  Everyone (apart from me, clearly) knows whether or not they love or hate marmite.  Everyone remembers marmite; they recognise the brand; they recognise the taste instantly. Nobody is going to forget about marmite.

I’ve needed some time to think about this.  I don’t really want to be hated, but nor do I want to be forgettable.  Would I rather be liked and not taken seriously? Or not liked and remembered?

That’s a really difficult thing to think about, and I can’t see it working in a clinical setting: we’re a team, and that’s what makes things work. Why would deliberately creating a love/hate impression just so that you’re easily remembered work in academia? or management?

Things like this are why I never wanted to get involved in management; why I just want to sit in my little box, and let the world of work trundle past… until I get so annoyed about something that I have to get involved!

Two things happened in the past few weeks to make me change my mind.  Firstly, I had a talk on leadership and management from one of the best (OK, probably the best) consultants  I have ever had the privilege to work with.  And yes, that is a deliberate work with and not work for.  (Anyone who’s worked with Andy Currie will know that’s true).  It made me think about why he’s such a brilliant leader: it’s not that he deliberately sets out to make himself memorable by generating this love/hate scenario I keep hearing about (the marmite effect).  It’s because compared to getting the job done, and done well, personal things become irrelevant.  The team works better when we all get along; because it delivers good care.  That’s what we feel is important.  It’s not that we need to be memorable to be good leaders; it’s that leading the team to get the best possible outcome over-rides all those personal considerations.

The second thing that happened, is that last week, I had my first taste of marmite.  And, it was OK.  It was nice. It would work really well with cheese on toast; I can see me putting a bit into a tomato sauce or a chilli; it would probably give a really nice dimension to some bread (of course it would, it’s yeast!).  But it isn’t this yes/no, love/hate phenomenon I was told it would be.  Actually, it’s a really nice flavour enhancer that helps everything else sing a little bit more; work a little bit better…

Maybe being a good leader is about being marmite after all: but it’s my kind of marmite