Thursday, July 12, 2012

With great power....


It's always nice to get an invite to prestigious conferences ,especially when there's an email from Jonathan Levy and Steve Gough asking you to "contribute to the event". To boot,the programme looked good and the speakers, present company excepted, looked to be of high calibre, and it was in Oxford too, that place which evokes imagery of high knowledge and august reputations.  I was asked to chair a workshop on Integrated care pathway, possibly because of our local work and although I am no expert on said topic, was happy to contribute and if not anything else, to also find out what exactly were other views, what else was happening etc. Backed by Big Pharma, it didn't look like a product placement event, though cynics would suggest that it's the subliminal message which is getting drilled into all of us....ahh those dastardly folks with mind melting skills...someday you shall have your place in the pantheons of Doctor Who villains.

So I travelled. All up the way the A34, scorching the roads as was late coming out of a job planning meeting, which all things considered was a reasonably pleasant affair. Usual challenges from management which to be honest, is relished, if not for anything else, to showcase to all and sundry the work the diabetologists do...yep, same argument,same repartee...but say it enough times, perhaps finally it's sinking in that we are there to get diabetes care sorted, not backfill other departments. Sorry, I digress but suggestions that we are medicines poor cousin does make my blood boil...Anyhow, a few friendly faces around the table, few jokes, few serious debates and boom! A bit late, but a bit more pressure on the accelerator and I was on my way to Oxford.

Now Oxford is a lovely town, but certainly not built for parking...so arrived about 5 minutes before my start time...was greeted by Jiten Vora in his inimitable style and then walked into a room. And I couldn't help let loose a wry smile. Anyway I turned there was folks I have looked up to, listened to in meetings and here I was chairing a workshop with them as delegates! There was Charles Fox, there was Cliff Bailey, the was Roland Guy, Dan Flanagan...either I had arrived in life or the organisers had run out of speakers...whichever it maybe, butterflies seemed to develop very quickly within the stomach. Hiding behind the veneer of nonchalance and playing it uber cool, I started off trying to engage the folks in the workshop. There was a mixture of folks in the room, some from the old guard, some from the new lot, some who have settled into their new roles..and it was fascinating to hear the interchange of views.

There were the hard boiled folks who have seen this before, but never come across such financial challenges but still happy and eager to put in ideas, guide the youthful upstarts such as their workshop Chair, there were the new guys who were trying something new and were keen to share, bravely going where no diabetologist has gone before.. and then there was the third group which were...I don't know..just cynical. There wasn't any evidence for any of the things suggested, so why try? One could sense an unwillingness to change the status quo or was it because of their local experiences? They were unhappy with what was happening, unhappy with changes suggested ( it wouldn't work) , unhappy at lack of engagement from patients, disenchantment at politicians for not being bold enough to say the obvious or tackle the food industry...crossed arms, pursed lips...and don't get me wrong, this isn't a criticism at them but simply a thought at why motivated individuals had become reduced to such. You wanted to go all Bugs Bunny on them and shout "whatsup doc?" I know people say to someone like me..."you will learn, let the hard knocks come"...but I work with 3 other guys with me, who have been in the NHS for about 10-15 years who are always brimming with enthusiasm, ready to try something new...so what is it that creates such despair? Maybe it IS the local experience, maybe it's the incessant headlines which says we all provide inadequate diabetes care, maybe it's the system....but whatever it is, that level of cynicism can only create a degree of inertia which sludges everything up. Anyone who thinks all of my plans work, must be kidding themselves..as with anyone else, you have your share of triumphs and falls... But when you fall, you dust yourself up and go another round, don't you?

Anyhow, end of workshop, we had to summarise our findings and again from the audience, a similar mixture and then someone who asked where the patient was involved in the care pathways we were talking about. He wanted to take some notes away as learning points. Here was an audience for whom working beyond the confines of an acute Trust was blasphemy...so I had to ask a few reverse questions back. What do you do if your Trust doesn't get the contract or hasn't bid for the community work, hasn't got any foothold in the Out of Hours work? Do you step outside your Trust work and engage with GPs, paramedics, think of working differently to help your patient OR do you hold to your contract, do something else to make up your 12 PA contract (please sir, can I do some umm acute medicine, a bit more general medicine, anything?)? Who is responsible for the ill being of that patient in the community? and how is it right to criticise your GP colleagues for "poor care" when you haven't shown the chutzpah to work with the community to help your GP colleagues, and have decided to stay within your bastion and not come out? Does your patient actually care who you work for..and finally who do you owe your allegiance to...the Trust, the NHS ( of which the community is a part of) or your patients...with the view that I will work for anyone, anywhere, any place to help the patient? Answer.... A deafening silence...associated with some gentle nodding of the heads (maybe in approval, maybe not)

2 weeks later, I am in Warwick at a New Consultants meeting organised by ABCD... This meeting held a degree of poignance for me, an issue over which I had a bitter dispute with a few I had trusted previously. For me, once you lose my trust, I don't have much time or interest in you. Bottom line, once that trust was lost with those individuals, I wanted this meeting to be under ABCD as the specialist organisation, not anyone else....and as with most things, if I put my mind to it...well...you know the rest. So to the meeting I arrived and I am thinking "here we go again". Another meeting where I am about to meet some more cynical folks.

But then what a pleasant surprise it turned out to be. Dev Singh gave an inspiring talk about mentorship, the passion burnt through...he was someone who still believed, someone who wanted to help! The workshops were engaging and the delegates were bubbling with energy. I had Dipesh Patel, Tristan Richardson with me as energetic speakers, sharing the vision, staying away from the doom and gloom.... and then there was Yohan, there was Rajeev, there was Abd...and they were keen to look at opportunities to change, opportunities to grasp the nettle...and I felt once again enthused. Mike Baxter was there, a man with amazing management and clinical credentials and perhaps one of the coolest dudes around..with his love for fast cars...and it was fabulous listening to him, learning. It was a pleasure to listen to Chris Walton...very much like Yoda, watching all the Young Paduans scrap it out, itching to be let loose. 

Forget those arms crossed few in Oxford, here was the ones who were the future, the ones who would stand side by side as we battle the politics, battle the naysayers ...and who were the ones who would lead diabetes care in the future! They will be there as we redefine the future, redefine what a Consultants role should be. Not just as a specialist, but also as an educator, also as the person who would take responsibility for the patients with diabetes in the area they work in, not be afraid to challenge colleagues either in primary or specialist care if they weren't up to the mark. These guys had got the message...being a Consultant wasn't about just turning up, doing your expert thing and going home. With due respect, a good staff grade can do that. 

A Consultant gets those big bucks to show leadership, take responsibility for his patients....and the delegates at this meeting knew it....and you know what, after a long time, I went back home with a smile. This wasn't a lone battle any more. The troops are definitely in place, change is coming and there is now enough of us to wrest the initiative away from the doom mongers, the naysayers.With great power. comes great responsibility..so said Uncle Ben...and those words are as poignant for Spider Man as it is for those who are given the mantle of being a Consultant...so do, please, accept it with humility and broaden your shoulders...remember those days we griped about Consultants not showing the way? Well..we are "it" now...and we are the ones we have been waiting for.So let's make a difference, shall we?

1 comment:

  1. Since hearing you speak, I have found renewed vigour in trying to make a difference. you are very inspiring.

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