So we can now all breathe a sigh of relief…Black Wednesday has come and gone…and phew! Aren’t we lucky another year has passed?! Damn those newbie doctors…killing all those hapless folks being admitted…shame on the NHS for once again failing the public!
Well, the papers have been all over it…no prizes for guessing that the Daily Mail is right in there, but so is the Telegraph and its interesting how few in the medical community has actually said anything in words of protestations or otherwise. So, is it true? Anecdotally, we all worry about that first week…but is it really true? Whenver we see statistics that criticises us, the first reaction is its either a cock-up or a conspiracy- a phrase I borrow from a speaker and good colleague..It can’t POSSIBLY be true, can it?
So..on to the evidence. It traces back to a study done by Researchers in Imperial College London in 2009 entitled: “Early In-Hospital Mortality following Trainee Doctors’ First Day at Work”. They reviewed NHS hospital statistics from 175 hospitals over the period 2000 to 2008; comparing admissions from last week of July and the 1st week of August.
All patients were followed up for a week- and taking all variations into account, there was a 6% increase in the first week of August compared to the last week of July. The 2009 study however did not include a breakdown of each patient death. As such, it gives no indication of the cause of each death and is impossible to see whether this was due to the error of a junior doctor.
The study also acknowledged that it could not ensure that the only difference between the two cohorts was the presence or absence of new medical graduates. There were other factors, such as the severity of the ailment or disease, which were not adjusted- and in fact the researchers themselves at no point blamed new junior doctors for the increase in death rates. But hey, has that stopped anyone from pointing the fingers at the newbies? Nope..not a jot.
The evidence is there- so let’s not rail against it…but could it be because the new folks lack the support?
“Killing season”- screamed a paper- and it made me wince. I have been a junior doctor and no, unlike some of my Consultants, who allegedly used to come in at 5 am every day morning to “clean the wards”, did a 1:1 shift, worked 140 hours / week etc etc (anyone ever heard the phrase “In my days?” )…I probably worked more hours than now per week- but with exactly the same intensity and passion as the present lot do. I have been a Consultant now for close to 4 years…and have I met junior doctors who are slackers or look on this work just as a “job”? Of course I have. Are they any more in numbers than what I had around me when I was a junior doctor? Not in the slightest. Do these guys have the same inclination to learn? Yes. It’s not their fault that the working hours prevent them from attending teaching. Here is an example. Our junior doctors are not allowed to stay after a night shift because it would breach European Working Time Directive. It used to be one of the best times that you learnt..how on earth are you supposed to know what you did in the middle of the night was right or wrong? But no,,,evidently the portals to Hell will be opened and the undead shall inherit the earth evidently (or something like that)..so they have to leave. Would the juniors love to stay back even for half an hour and learn? You betcha. Are they allowed? Don’t be silly.
When I started as a baby doctor, I met the most amazing guy ever. His name was Azman Ibrahim …he was only a Senior House Officer…just 1 grade above me…but boy, wasn’t he always there for his juniors. I still remember a particularly hard day- when every single time I had tried to draw blood, I had failed. It was busy, I felt like a failure…and this guy, in the middle of everything, brought me a cup of coffee, sat me down and said he would stand with me for the next set of bloods to be done. It took him 2 minutes…and I felt like a million bucks. And a lesson was drilled into me..never, ever abandon your juniors. Go that extra bit, they will give you much more than 100% when the crunch comes. These fresh faced folks need support- not start their career with the press labeling their start day as “Black Wednesday”. What a load of rubbish..and how demoralizing can it possibly be? An evidence base which could have been as much the fault of the seniors…but nope, its all the fault of the juniors, isn’t it? Well, no it isn’t. Its maybe our issue that we haven’t made the provision in our job plans for those initial weeks of those juniors lives to stand next to them, sometimes just put an arm around the shoulder and say “well done”..a little word of encouragement which can go such a long, long way. How many of us as Consultants have planned to make sure as a team we do something different to make sure there is extra support around at this time of the year? If we know mortality rate is worse, then the collective responsibility is ours to solve it, not shrug our shoulders and wonder how “junior doctor standards are dropping”.
I have had 2 junior doctors shadow our team over the last week or so, bright eyed, enthusiastic and if anyone tells me they are not scared, please, in McEnroe style, let me holler back..”You CANNOT be serious!”. Any evidence to the contrary, believe me, is just bravado. That is what we doctors do…if you don’t know something, put a brave face on…worries are for “wusses”…but no, its natural to be worried, natural to be afraid…I would be concerned if they weren’t. We have all been there, all walked those long corridors…and as Consultants, senior staff, folks who have spent those lonely nights fretting about the patient whose care I handled…sometimes you just want someone to say..It’s ok…you are doing fine. So for those who have started today in a new job, those who have just started…look ahead, take a deep breath and get back into the thick of things. It’s not a Black Wednesday. Its the day when you begin a life where you help others. It’s an amazing day..this day, should always be in your life known as the Wonderful Wednesday…or for those who started on
the 1st August 2012…it will always
be the Wonderful "Wiggins" Wednesday, a day of positivity and happiness.
Ladies and gentlemen, welcome to the NHS and may you all do fantastically well in a career you have chosen to help another human being. There is nothing, absolutely nothing negative about that. Amen.