How Could a Doctor Think of Going on Strike?

Best job in the world, thinks Geoff, at least when he’s not inspecting verrucas.

While Geoff is a fictional GP, he’s uncannily similar to a lot of real family doctors.

Right now he’s unwrapping a cheese sandwich and feeling grateful he’s not a hospital doctor facing life or death decisions.

Because any minute now BMA ballots will be plopping through their doors, asking whether they’d take industrial action.

Litmann type stethoscope

He’s not fond of strikes and instinct tells him doctors shouldn’t have them. If striking makes a perceptible impact, people get hurt. If it makes no impact, the strikers look stupid. Lose-lose, in Geoff’s book.

But what else can junior hospital doctors do?

By anyone’s clock, 7am to 10pm six days a week can’t be a standard working day. Geoff’s not sure how it squares with the European Working Time Directive which requires 11 hours rest a day. About 10 years ago the EWTD began to include junior hospital doctors. He recalls that opt-outs have to be voluntary. Is Jeremy Hunt aware of this?

It’s not about the money, say junior doctors. They’re not “trainee doctors”, by the way, despite the way the press describes them. They’re fully qualified members of the medical profession, ready, willing and (most of all) able, to resuscitate the dying or resect metres of gangrenous bowel as appropriate. 

Jeremy Hunt doesn’t look a bad guy.

Health Secretary Jeremy Hunt

He’s just wrong, thinks Geoff. That mortality paper in the BMJ has a lot to answer for. It showed that being admitted to hospital at weekends was linked with a significantly increased risk of in-hospital death. Lots more of them would be acutely ill, so that makes sense.

The same paper also showed that being in hospital at the weekend was associated with a reduced risk of death!

So where the fuck did people get the idea that having more doctors on duty would prevent those excess deaths? Geoff hurls his sandwich wrapper into the bin.

Being self-interested, as everyone is at heart, Geoff worries that the proposed new contract for junior hospital doctors will affect general practice too. It would imposes a drop of 40% in GP trainee salaries. Those ARE trainees, by the way. They’re doctors training to be GPs, and there aren’t enough of them as it is.

More importantly, the new contract jeopardizes patient safety because it removes the safeguards which protect doctors from working dangerously long hours.

scalpel

No wonder many people believe the proposed contract puts the future of the NHS at risk.

Does all that make striking a good game plan? Doctors last took action in 1975, well before his time as he’s only been qualified 15 years.  

Recently a whopping 95% who took part in a Guardian poll answered yes to the question: Should junior doctors strike over the government’s proposed contract?  He thinks there were 28,000 or so people polled, nearly as many people as there are junior hospital doctors. But obviously he can’t find the article now, what with the winter care plan, new advice about FGM, and an avalanche of other vital information.

It’s the baby clinic this afternoon in Geoff’s practice. Britain has one of the best immunisation programmes in the world, he likes to think. Geoff heads into the waiting room, beams at the parents, and wonders how long the NHS has left to live.

tombstone

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You may also like:

GMC advice for doctors in England considering industrial action.

The doctors’ 1975 industrial action.

 

What They Don’t Teach at Medical School

Today GP Geoff gets a new group of medical students to teach. The names may change from week to week, but there’s always at least one swot from Germany or the Far East, a home-grown rugger bugger who is too big for his chair, a student in a hijab, a gay man, a babe who fiddles constantly with her iPhone, and an argumentative leftie.

HP Rapaport Sprague stethoscope, circa 1981

Geoff is a character from my novel One Night at the Jacaranda.  I made him up, but, if you know much about medicine, he seems real enough.

Education is not a vessel to be filled, Geoff muses, but a fire to be lit.  He has forgotten who said, it, but he’s pretty sure the fire should stay lit for the whole of their careers. So the students need a dose of reality.

fire in the political belly

Geoff reflects on his fifteen years of practice. The reality is that patients wangle sick notes because they don’t like their work. They get prescriptions for things they could have bought from the chemist. Well, par for the course.

They also suck you into their lives and dump their shit.  So you get involved when they tell you about their affairs that went wrong, the drugs they score on a Friday night, or how much they hate a sister or brother.

Or when they’re still driving even though they shouldn’t be.

FreeImages.com/Juan Miguel Rodriguez

Case in point: nice Mrs Thingy. Geoff is not too hot good on names, but he knows he advised her very clearly not to drive until her seizures were under control.

The snag is her three children. Geoff instantly forgets what she says her husband does, but he gets the gist. Mr Thingy has to get to Ealing Broadway station by 7am so he can’t do the school run.

“Can you walk them to school instead?” asks Geoff, ready to extol the benefits of blue skies, fresh air, exercise, autumn leaves, and the rest.

suburban street

“Doctor,” she says in a wheedling tone, “if I did that, it’d be a mile and half each way just for the boys. And Poppy is at a different school. There’s just no time. I’d run myself ragged, and that’s not good for my seizures.”

“Perhaps a neighbour can help?” suggests Geoff.

She gives a pitying look. “They’re all pensioners near us.”

“What about asking at the school? You may find a parent of a child in another class who lives near enough to you.”  Geoff is aware he’s running late now.

FreeImages.com/Vikki Hansen

“Well, I don’t know,” says Mrs Thingy.

“Why don’t you talk to the school secretary?” Geoff suggests. He may even need to involve Mr Thingy, find out if he can start work later during term-time. This is as far as one could possibly get from looking through the test results and reminding her about her smear. Geoff makes a mental note to do all this later.

Mrs T says nothing. She stares as if the GP is the baddie who makes up the laws.

Geoff continues, “If you have a seizure at the wheel… Well. It hardly bears thinking about.  Remember the Glasgow bin lorry crash last year? The driver blacked out at the wheel and killed six people.” 

“I know, I know.”  Her glance at the door shows she’d like to end the conversation as soon as possible.

Geoff leans back in the chair, which isn’t far as he has a cheaper model than his partners. “You realize, don’t you, that I’m obligated to contact the DVLA myself if you don’t.”  (For readers outside the UK, this is the Driver and Vehicle Licensing Agency.)

Her expression freezes.  “But I thought confidentiality…”

“Doesn’t extend to situations where the public is in danger.” He shakes his head slowly as he pulls a sympathetic face.

“Oh,” she says in a small voice. “Right.”

Geoff knows what he will discuss with his students today. Confidentiality.

And the knack patients have of sucking you into their lives.

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