Thursday, June 21, 2012

Good night..and Good Luck


By the time this is posted, the strike will be nearing it's end. The media will be pouring over whether it was a success or a damp squib, you will have both parties claiming "victory", few stories about how "patients have suffered", a few on how hospitals and GP surgeries have functioned on "skeletal staff" and as usual the truth will lie somewhere in between. In the middle of all this are caught countless doctors, not quite sure whether to twist or stick, caught between the ethical dilemma of refusing to see patients and the right to protest. And it's been fascinating to watch all this.
So far, I have broadly seen 4 groups: the "militants" who think this doesn't go far enough and we should down tools completely and bring the establishment to their knees; the "moralists" who believe we should never stop seeing patients as this is a vocation, the "careerists" who are using this opportunity to denigrate their fellow strikers and sidle up to the powers that be, mentioning how committed they are compared to their dastardly colleagues and then there is the "inbetweeners"- folks who are a mixture of the first 2 groups to varying degrees and who simply don't know what to do.

I rarely read the Daily Mail but today I thought it would be entertaining enough. True to style,it mentions the money the taxpayers will have to pay to bolster those greedy doctors, it dedicates a box to the BMA chair, Hamish Meldrum, showing how much of a wealthy person he is, what sort of house he lives in, he was even given the title of "architect of chaos"..you could nearly hear Aquaman from the  Spongebob Squarepants cartoon shouting in the background.."Eeevvvillll". Now I don't know Dr Meldrum but to me he has come across not as a money grabbing, scheming man but someone who has been extremely dignified in answering all the provocative questions thrown at him by the media.  I am pretty convinced that if someone pointed him out to me as my GP, I would feel more than reassured to see him.Maybe it’s the distinct Scottish accent..but he doesn’t come across as a tax-dodger..or a comedian for that matter…

Anyhow, a few personal stories over the last few days perhaps crystallises the problems doctors face. Recently one of my patients nominated me for an award in the local press. Tongue in cheek I forwarded it to my friends one of whom mentioned jocularly that it was the Kar self promotion at work...and it showcased what inherently we doctors are uncomfortable about..we are uncomfortable about telling others what we do. It's supposed to be a vocation, isn't it...so why tell others that we work hard, do a damn good job and be proud when patients turn around and say thank you? It's just part and parcel of what we do, isn't it? Actually, yes, it probably is...and for all those feeding the tabloids, we also do work darn hard to earn it too.  I get paid a 6 figure salary for a 46 hour week. In my last  week, I have spent in excess of 90 at work...that my friend is the vocational element, that is what we provide without cribbing about it. So the angst is understandable when the media labels doctors in a sweeping statement as a money grabbing, greedy bunch. We are not, and frankly, if we did become so, the NHS as we all know it, will cease to exist.
The second one was me going to a patient support group last evening,for the press folks, a voluntary exercise at 7 pm in the evening- after I had been at work since 730 am. It was an open forum..a meet the Consultant session...and the first question was.."Are you on strike tomorrow, doc?" Answer to the negative drew consenting nods and it was apparent that we doctors had lost the battle of perceptions. We hadn't been able to get across the level of angst that drives a profession built on caring and desire to help to take a drastic step such as refusing to work.  And if you don't have the public on your side, then the battle is lost.

So what could doctors have done...without splitting themselves into the aforementioned groups or giving that opportunity to the press to paint us as the heartless souls we have now become? Think of a scenario where all doctors, unanimously decide to stop answering any emails, phone calls or correspondence, apart from those directly related to the patient in front of you? If I did that today, refused to go to any management meetings, stopped all my emails apart from those directly related to patient care, then without harming a single patient, the powers that be will take notice- as without doctors indulging in paperwork, the supertanker called the NHS stalls. Would have made life easier if the BMA asked us to boycott all non-clinical work for 1 month…apart from making our lives so much better, it would cause enough sludge in the system for folks to take notice. Would we have had patients divided in their support for us? Unlikely. Would we have had the press on our back? Very unlikely.

Then there is the Health Bill, a situation which has created a strange chasm amongst professionals, those who want to use the opportunity to try and see whether the clinician being in charge can make a difference- to those who vehemently oppose it, believe that the NHS as we know it will be damaged beyond recognition. Look at the twittosphere, it's full of clashes between professionals of those 2 camps...we, as things stand, are a divided lot. If we as doctors wanted to make a stand and opted to show the powers that be, then all that may have been needed was a disengagement from the existing process for a month or two...and maybe, just maybe, we may have had both the public but also political will on our side. When doctors as a group fail to protest against the "dismantling of the NHS", as some like to call it and then choose to down tools for their pension, in times of austerity, then its a battle lost even before it began. Heck, we couldn't even get all the Royal Colleges to join forces go oppose the bill...what hope for pensions??

As regards promises that a strike won't harm patient care, unfortunately it does ring a bit hollow. Yes, emergency care continues to be provided, but even when electives are cancelled, harm is done. When the elderly lady who has been waiting for her hip operation patiently, struggling through pain killers, waiting for that day when the operation would give her some relief from the incessant daily struggle...only to find her operation has been postponed...folks...harm has been done…harm has been done to our reputation, harm has been done to that lady. So, as you see my friends, in this particular battle..we have conceded the moral high ground. Look at the deafening silence from any other professional organisations, lack of any public support from nursing unions, physiotherapists, pharmacists..i.e. folks we work with every day...and even on that front, we have been isolated. Lest we forget, the BMA was also the organisation which publicly opposed the formation of the NHS itself, so their track record of standing up for "just causes" isn't the best either! So..in chess parlance..the player at the other end of the table hasn't said "Check, your move"...they have actually said..."check mate" and walked away.

So what now for the disgruntled doctors? We live to fight another day? More strikes? I doubt it as I don't think the public, press or even the fraternity will have the appetite for it. It's likely most will shrug their shoulders and get on to do what they do best..trudge back to work, roll up their sleeves, apologise to their patient for the distress caused...and carry on with the daily grind.  As for me..it's always been pretty easy...contribute 14.5% of my salary in the hope of getting a pension after 68? You must be kidding me!

Have a think...here's scenario A. I am 38 now, perhaps work till mid 50s and then walk away from it all...I would rather at that stage someone younger, fresher took my job while I use my skills in poorer countries, perhaps do some charity work, try and repay back to society a bit of the debts owed...and travel the world at my own leisure and choice for holidays. All that on one side weighed up against Scenario B, where I am trudging to work at 67, in an unrecognisable NHS, but still secure in the belief that I will get a healthy pension at 68. Well, that may appeal to some...but it's one life guys...so no contest in my book at least. And how the heck do I anyway know I will make it to 68?? Do it all for the kids? Sorry...but I hope to educate them enough so they can stand on their own feet- not count the day till dad corks it to claim his pension. 

So, no strikes from me...While I am at this job, I will give 110%,maybe even more... but when I am done...I am done. As Edward Murrow would say with a flourish… "Good Night…and Good Luck”...one gets the feeling that the BMA has just been told that too by the government.

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