Wednesday, August 28, 2013

Chance and focus

So there comes a time when you take a fresh guard. And school holidays are always a good time to take a break and reassess. 4 years as Clinical director in the Portsmouth Diabetes centre has been a rewarding time..but thats now all in the past. Maybe its just the circumstances, maybe its just the season- but I spent some time, forgetting the politics for a bit,as to what could be done for patients with diabetes either locally or even on a broader scale- what works, what doesnt?

For starters, there's the emergency admission side of things- we feel we have a 5 day service in the NHS but stories abound where the diabetes team haven't even been involved on weekdays, let alone anywhere else. Huge amount of variabilty about what diabetes teams deliver around the country. Why don't we look at models that work, learn from each other, borrow each others business cases...I don't know..but its an enigma that has forever baffled me. Is it ego? Is it the reluctance to believe that someone "else" could have come up with a good idea? Either way, thats certainly an area of debate but one that doesn't need necessarily investment but better coordination, better sharing of ideas, better understanding in the ethos that we are in the ever shrinking economy together.

And then there's "7 day working" ever increasing clamour - quite rightly - to provide better care over weekends. We know care is poor over weekends- and I can assure you that as swashbuckling I would like to portray our department as, we fail our patients on the weekends. I have some thoughts and ideas to resolve this- and in all fairness to the national organisations, they have given the opportunity for organisations to "earn" revenue which in turn would support the building of teams to deleiver 7 day cover. Best Practice Tariff for diabetes patients admitted is a great innovation...the question is how many are building business cases around that? And is it always about investment? Or is it about specialists working more smartly? So many little answers.

There's also the area of more people being more on pumps..knowledge at the front door about what to with such patients? Not good at all...partly it is about education, partly its what the specialist team have done to improve the knowledge about pumps to their colleagues...but the challenge with education is also about sustainability. Does it work in an environment with such fast turnover? Again, questions with variablity of answers.
So the targets for me is to throw myself into those areas of challenge...can't tell the world what to do if I can't get it sorted in my own backyard. I have some ideas which i think will be able to crack the nut....lets see whether it can be done or not.

Finally, a break also gives you a moment to take pause and see whats also so close to you. Too many evenings spent socialising, trying to "crack a deal", negotiate the next innovation, spend time on thing seemed to be losing I will take on the above challenges but also want to do so with an eye on whats dear. So, more time for the family..more time to see the kids, hug them a bit harder..and perhaps more focussed areas as above to concentrate on for folks with diabetes. I hope I can always have the opportunity to do that.

Sunday, August 18, 2013

First Five

"Where do you see yourself in 5 years time?" A standard question in Consultant interviews- and I honestly can't remember my answer. Beyond the external fa├žade of being cool and collected, the adrenaline was pumping, the heart was racing...I so desperately wanted to work in the diabetes department at Portsmouth...the whole interview, to this date, has continued to be a blur. But whatever I may have said, today, standing where I am, about to embark on the next 5 years of my Consultant life, I can guarantee you that I wouldn't have been able to predict I would be where I am. It has been a spectacular 5 years, a roller-coaster ride with more highs than lows...and I couldn't possibly have scripted it any better. Awards, fame,notoriety, recognition, accolades...everything have come along the way and I wouldn't change any single bit of it. So many have contributed to it..made me grow..understand the joy of achievement..moments you couldn't appreciate without the pangs of loss. People who have become a part of my life, people I have lost...all a part of the growing up process.

5 years can be a lifetime and perhaps its my inherently positive nature, but I have genuinely enjoyed my time. I don't have time to sit and moan- that has never appealed to me- and spending the last 3 weeks in India has given me a more deep seated realisation as to what kind of amazing opportunity I have been given in life. I have taken my hat off and bowed respectfully to colleagues in South India whose work ethics have made me look simply..ordinary. Yes, there is corruption, yes, there is the base drive towards money which corrupts most peoples morals...but the overwhelming majority work day in, day out, battle against the system and still have time to smile. As I have said before, I am a Consultant in Diabetes in England- earning well, having free weekends mostly, a good social life..everything I could hope for...and in return, I have one shot, just one shot at hopefully making a difference in the lives of those who have diabetes.

I keep reading in social media, media outlets about those lazy GPs and Consultants, heartless nurses, managers who are simply target driven, clinical commissioners who don't understand anything...the problem is that unless I live in utopia, I don't find those individuals in a majority. You sit down with any of those groups, smile, have a coffee, spend some time...and inwardly burns bright a deep seated desire to do some good. 5 years has taught me many things...but most importantly to place trust in that inherent goodness. If you can't do that and simply mistrust everything and anything, look for a conspiracy in everything, you will sink in your own negativity. Conspiracy theories are good- but in the main, people within the NHS are trying their hardest to improve care. 

I set out 5 years determined to make a mark- and fame or notoriety, I suspect I have...I am human- have my faults as anyone else- but am trying to bring the smile out more rather than the one who needs to fight the system all the way. This holidays and time spent with family has made me appreciate many things...appreciate the strength of a family,appreciate the support they provide, appreciate that in the eyes of your parents you are still just the son who they have never stopped loving..not some trailblazing Consultant..but simply their...son.

Nothing would be complete without acknowledging the folks I work with who tolerate my darker moments with a smile, let the lighter side flourish...folks in whom I place complete trust to deliver and in return, watch with awe their unshakable faith in my vision. And finally, my patients...who continue to teach me every day, more than anything my training period taught me...I make mistakes, I learn...and each day my resolve to make things a bit better grows stronger.

So to all those who have made my last 5 years such an family, my colleagues and my patients, I humbly and respectfully say..thank you. All I can say is that I promise to do what all have placed faith in me to do...but perhaps with more humility and a bit more smile. 
I have always loved the comic book analogy..Batman..the dark character who is a loner has always appealed to me. 5 years on...a simple realisation...It's time to hang up that cape ...I don't need an alter ego to do what I need to do. With so many people's blessings and good wishes, why would I? Here's looking to the next 5 years.