Sunday, November 27, 2016

Heart of hearts

I don't know how many of you do ward rounds but I swear you should. Just for the heck of it. Just to experience what Bill Murray went through in Ground Hog Day. Beyond my niched world of diabetes, I do what is colloquially called "Unselected work". In simple definition, its known as seeing anyone who comes to the ward- none of the "No Sir, its not quite the level of heart failure needing Cardiology opinion"..nor the "Ooh, old but not quite old-as it doesn't fit the latest criteria". Nope- anyone- heck, even the fractures. I jest of course but you get the drift..its all a world of specialism while we dance around on egg shells trying to fit round pegs into square holes.

Then there is the fascination of this ethereal thing called 4 hour target. How in the blinking blue hell is a target for which the acute Trust only is liable when the problem is with the system of ANY use…beats me- but hey, what would I know? Evidently its a marker of system pressure- well if thats the case, then open the newspapers- plenty of indicators there- don't need a target to drive everyone up the wall when no one in their right mind actually believes this is achievable without adequate social care.

When discharge targets and achievements take precedence over all else, the world of healthcare has taken a turn into another arena where teaching, healing, pastoral roles- are all footnotes of history. An assumption that professionals keep patients back on hospital beds, or refer them just for the lark drives us into unknown realms of mutual mistrust and finger pointing. The facts never bear out- its all about anecdotes, its all about that stray incident. Sensible plans would be to focus on the biggest area which could unblock the log jam (yet to understand why everything in hospital is so focussed on toilet analogies!) but nope, its about the small things. Someone obviously took the tagline of ASDA a bit too seriously (Every little bit helps)..the amount of time we theorise what quicker discharge summaries would do…and we wonder why our junior doctor colleagues wonder what exactly their role is on ward rounds anymore.

I said this about 3 years ago- and I will say this again. The 4 hour target is irreparable- its no longer about the process-its now about capacity. We can spend as much time as we wish blaming each other (ah if only we all did GIM / ah if only we had more radiology scans / ah if only patients didn't turn up) they are all- bar none- tinkering with the small margins. Every little bit helps- but when you are rejoicing at scoring one, but already eight down, even the most optimistic Liverpool supporters from Istanbul will tell you- there is a limit to ones dreams. At some point, they roll into fantasy.

In the middle of all this, I admire the dedication of all those who do this day in, day out- whether they be nurses, physios or there "flow"-managers…I have no idea how you do it- and keep sanity. What I would ask however is perhaps all to realise that there really isn't anyone who's working less than you. When a radiologist says 'don't send unnecessary requests"- I can promise you- I don't. I do so when its needed. I don't get paid more for an extra scan, neither do I like to irradiate people just because I like the Incredible Hulk storyline.

The system needs to understand mutual shots do so little- and if you haven't done someone else's job, you really have absolutely no right to criticise another, Junior doctors do jobs nowadays I would simply hate to do- ticking boxes has never been my thing, you see. 

By all means, rail against the system, rail against the lack of social care which is buckling hospitals, the lack of community beds, the lack of adequate primary care provision….but go easy on each other. The 4 hour target is a relic from an age- which doesn't exist anymore. Maybe its time for one across the system- I don't know what it is- but this much I do know, without social care funding, the emergency stream is all about how pretty you can make your powerpoint slides. 

In your heart of hearts, you know that too. Don't you? 



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