Friday, March 23, 2012

Consultants...time to cross that bridge?


NHS Consultants....maybe the problem lies in the title. it somehow implies the role is simply to consult, little else. Reality is its much much more than that...heck...I bought a sofa recently from a renowned store, and had to chat with a "Consultant"...and he certainly knew less about the intricacies about medical science than me!  Then there is the added burden whereby the title has somehow become intrinsically linked with being inside the shiny towers of a hospital..nope, no sir, a Consultant does NOT work anywhere else, heaven forbid. The few who don't do so..well..they "clearly" couldn't quite "cut it" within the cut throat business of a hospital.

Let's face it, Consultants don't necessarily do themselves much favours either. A few bad apples is all that it needs...a few who choose to spend more time doing their private work, the select minority who have adopted "Lancelot Spratt" as their prototype, the handful who turn their nose up at those inferior beings called GPs ("I tell you, Partha, they became Gps because they just couldn't hack it")..and you create a public perception of elitists sitting in ivory towers, sneering and shouting at nurses, GPs, patients, ducking out in work hours to play golf....thus making it high on the list of priorities of politicians to sort these impudent beasts out.

It certainly doesn't help when one looks at the pay-packets involved...now this may raise hackles of a lot..( ah well, who cares) but the reality is that we are paid from the public purse a significant salary, better than most in the public sector, with quite comfortable lives and a cracking pension too ( well, at least at the time this blog goes out).For those who argue with that, I can only say this..maybe start living within your means and stop thinking that you are related in some way to the Royal family. thus rightfully there is a significant amount of indignation when Consultants are not available, seen to be less accessible and sometimes just plain and simple, rude to colleagues or patients. For those who moan about working times, I would like to introduce you to my dad. He works in Kolkata, is nearly 70 and ever since I have been mature enough to understand what he did for his family ( nope, teenaged years were not included in this), he has always been available around the clock for his patients. Why? because under the system existent in India, there is no six figure set salary for government work, there is no set time of work, and patients always demand to be seen "now". So when you counterbalance that with what is present in this glorious healthcare taxed based system, ladies and gentlemen, there's only 2 words to say....Get Cracking.

The problem however is that such individuals although in the minority, have unfortunately become the public face of a Consultant. Listen to the lunatic mutterings of the Daily Mail advocate, Kevin Mackenzie, he would have you believe we all drive Porsches, spend most of our time on the golf course and saunter in when we want to. Now this may sound incredibly corny but a lot of Consultants I know have got an inherent goodness in them, a passion to make things better, a passion to help. That's my personal view, take it or leave it...but that's what I have seen so far. Yes indeed there are the ones for whom personal glories matter most, initiatives done only with an eye on Clinical Excellence Awards...but I reiterate..they are in the minority. And let's face it, say what one may, there is no question about the prestige and respect it carries in the eyes of the general populace.

But it's time to change. Time to develop a new way of being a Consultant, step away from the inherent arrogance. Part of me understands why Consultants from the generation before sneered at their GP colleagues...there wasn't any GP training scheme..you became a GP, in lots of cases, at least in the eyes of the Consultants, when you couldn't hack it. Cue a division where Consultants have more often than not treated GP colleagues with contempt, and now with the power shifting, those same GPs baying for blood. Just like a school ground when the school nerd is suddenly made the class monitor...the time of the bully is over. So to hell with the patient...let's slug it out, shall we...let's see who has the bigger balls.
But hey, times have changed folks. There is a GP training scheme, and our best trainees now choose this, of their own volition.They are a GP because they chose to be so, not because they couldn't "hack" it ergo the new age Consultants have as their GP colleagues their drinking buddies or mates, people who have mutual respect..thus the divide hopefully eases. Some of the best SHOs I have ever worked with (Shane, Chris,Howard,Penny) - they are all GPs and frankly if someone can show me a "more qualified" Consultant than them, then please do.

So we need to change, we need to grow up, we need to respect...respect what our primary care colleagues do, understand that our specialty area may only be a fraction of what they do and be there to support, to educate...not in a condescending way, but as a colleague, as a friend, with respect, with understanding of their issues. The good news? the signs are there...the new breed are getting there, slowly but surely. It maybe the politics, it maybe the changing times or it may just be an understanding but the divide will close, and as Consultants, it's up to us to adapt. 
If there is a bridge to cross, someone has to take the first step, someone has to extend that hand and it doesn't make us any smaller, any less for doing so- or at least in my view, it doesn't. We have achieved a lot locally as regards service reconfigurement -not due to the politics or negotiation skills...but due to the relations. 

My principle is simply this: Go back to why we went to medical school...and you will see that taking that first step will eventually help one group of people who we all want to help..the patients. So let's give it a try. From my personal experience? It's certainly worth it. 

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