Medical Ranting

Doctors and future doctors! We need you!

2007-04-24T17:58:00.000Z

A brief one today, due to the exam chaos that is all around me. Much to do.

However, Remedy organised their mass lobby of Parliament today, which appears to have gone well from initial reports. Channel 4 is yet again providing outstanding coverage where the Beeb is notably lacking, so huge praise to them.

However more is still needed to exert political pressure. Doctors and medicals students can help in 2 ways:
1) Join Remedy. Even if you don't want to go along to things or make your name known, at least you'll get the regular updates so you know what is happening to YOUR careers. More than the BMA is doing! Can you afford not to? Register here:
http://www.remedyuk.net/index.php?option=com_registration&task=register (at the bottom)
2) Fill in this questionnaire: http://www.cai.cam.ac.uk/people/mjb14/
And have your say on the future of job appointments. Personally, I think options 4,6 and 7 seem to be the best from this list. Just don't forget this doesn't include MMC...!

Don't forget, even this week the government suggested making doctors do overseas posts to get round the training shortage. Brilliant. Go get 'em soldiers!!

"Don't do it!" Doctors advise

2007-04-14T22:29:00.000Z

Well its been a busy week. Remedy are orchestrating their mass lobby of Parliament, consultant numbers have been growing for the move against MMC (yes, people are still over-MTAS focussed, but its a start) and the BMA have begun to send out nomination forms for next year's committees. Political winds are moving - all we can hope is that something starts to give.

For this week it has been revealed that over half of all doctors report morale at work to be "poor" or "terrible". Even more concerning is that 69% would no longer recommend a career in medicine. One group of 6th formers were told this week to "absolutely not" go into medicine. And its hardly suprising - reduced training hours, becoming a consultant far less likely, professional identity disappearing into the abyss, and 8000 too few training posts.

The real problem is the unbelievable apathy with which this is being met, particularly by students. Whilst not worrying would be nice, the reality is that the "oh, it'll never happen" really is. Only last week a prospective medical student told me "It's fine, I'll just make sure I kiss plenty of arses!"... That's fine, but all it will get you now is a mouth full of shit! MTAS has removed all influence of local connections, replaced by a faceless 'panel'.

It suprises me how people who claim to be so keen on a career in medicine just don't seem to have the sense or motivation to research this sort of stuff. Sure, information can be hard to come by. It took until this week for the BBC to discover that "Doctors providing out-of-hours care are being replaced with less qualified staff such as nurses". No shit? Only about 2 years behind! But surely if you were that keen to give up 5 years of your life to train, you'd also be keen to find out exactly what you're letting yourself in for? It's hardly Holby City out there, is it.

It is fairly clear that the longer we all sit on our laurels waiting for it all to blow over, the more at risk we are. Get in the know and then get doing something about it!

(Remedy lobby Parliament, 24th April - see remedyuk.org for details!)

Scapegoats

2007-03-30T15:28:00.000Z

So rumour has it that Prof Crockard, captain of the not-so-good ship MMC, has resigned. This is as yet unconfirmed, but it got me thinking about the state of this sorry mess.

This has all come about as calls for Prof Crockard to be hauled in front of the GMC have increased. A letter has been sent to the Council (it even made this morning's Telegraph) citing failures in management and professionalism, among others.

There seems little doubt that as head of MMC, Prof Crockard is well-placed to be the fall-guy for this fiasco. The MTAS issue has really brought this to light, and with the BMA Junior Doctors Committee walking out of the review talks, the pressure is really on the entire system of Modernising Medical Careers.

But is it right? Yes, the system is a mess. Yes, it fails to provide doctors with a fair application process, acceptable standard of training and decent career pathway. But to single one man out is perhaps not the way to do it. My humble opinion is that it is the Chief Medical Officer who really needs to talk a look at himself. He continues to pander to the whim of the government, and I fail to see how his suggestions of reform can be any good for patients or doctors. Instead, doctors are reduced to working under constant restraint, not wanting to take risks or pioneer controversial improvements, for fear of losing their careers. Whilst paramedics/nurses/pharmacists increase their provision of independently prescribed medicines, regulation of doctors tightens to further strangle their clinical autonomy.

I don't understand why people can't be up front with their intentions. The CMOs report "Good doctors" is no more about creating good doctors than "Creating an Interprofessional Workforce" is about interprofessional collaboration. The latter I shall rant about at a later date, needless to say it should be called "creating a generic, underskilled practitioner". In the same vein, "Good doctors" appears to be more about "controlled doctors" which fits very nicely with the inflexible, deskilling MMC process.

And so perhaps it is not Prof Crockard that should take all the flak for this mess. Some, for sure, but just maybe there are others who should shoulder the burden. And don't get me started on the politicians...

Simple Guide to MMC

2007-03-24T19:37:00.000Z

Now I must confess, I'm not normally a Daily Mail reader. Today however, I am. A lovely man has written a brilliant article which explains exactly what is going on with MMC and MTAS. This serves as a great summary of some of the key issues with the process, written for non-medical audiences. Well worth a read.

Also essential viewing for anyone considering medicine as a career or currently training and unaware of what is going on!

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=444301&in_page_id=1774&in_page_id=1774

Doing something about MMC

2007-03-24T10:48:00.000Z

Okay so to follow up from my last one, here's what doctors/students/HCPs can do to help:

Write to your MP
This takes about 5 minutes of your time on www.writetothem.com
Ask them to put pressure on Patricia Hewitt to STOP MMC and fully review it, with grassroots involvement. Ask them to sign the Early Day Motion 737 about MTAS (they'll know how)

Join Remedy UK
With the BMA writing angry letters, an ever-growing group of doctors is starting to take action. Visit www.remedyuk.org and register your support. If not, at least register your views on: http://www.remedyuk.org/GetInvolved/Survey/Survey.html

Petition your seniors
ASK people what they're doing to support you! A number of high profile consultants have spoken our publicly about the state of MMC. Are yours on board?! If not, why not?!

Spread the word
Get on doctors.net.uk and read the forums. They are a wealth of knowledge. Spread the word to colleagues but also to your families and friends to get this scandal publicised.

You can make a huge difference to your careers and the state of healthcare in this country. Thank you.

Mangling Medical Careers

2007-03-24T10:25:00.000Z

I hope most people are aware of the Medical Training Application Service (MTAS) fiasco. Whilst it has served me reasonably applying to foundation training, the plight of thousands of applicants to specialist training, who have been selected without acknowledgement of skills or experience, or suitability for the individual post, is henious.

But MTAS is just part of the joke that is Modernising Medical Careers (MMC). This government 'project' was designed to reform the medical training process. All well and good. But it has created a monster that has the potential to alter the shape of medicine forever in this country, and not for the better.

The European Working Time Directive (EWTD) has served as a convenient catalyst for many of these changes. By refusing to allow doctors to be exempt from the short working week imposed by EWTD, the government are able to find alternative 'solutions' to fill the service gap. Hospital At Night schemes, which replace juniors overnight, and endless 'practitioners' (anaesthetic care practitioners, emergency care practitioners, nurse practitioners, emergency nurse practitioners, surgical care practitioners etc.) all contribute to the dissolution of skills to professionals outside of medicine. No bad thing in itself necessarily, but part of an erosion of the profession.

The next step in the MMC plan is the sub-consultant specialist grade. Rather than being rewarded for completion of specialist training by consultancy, doctors will be forced to become 'specialists'. This will of course attract less pay and less clinical prowess than the consultant grade. And it will be 'justifiable' because we will have worked about 1/3rd of the hours required by today's consultants, thanks to EWTD. Our clinical skills and experiences will have been limited by fewer hours and the fact that 'practitioners' will be seeing many of the patients with which we would have gained that experience.

There are other flaws in MMC. For example, the rigid process makes it almost impossible for doctors to get experience in alternative specialities and there is no easy way to change speciality mid-way through. Experiences such as a year overseas or aid work will become harder.

This is all before considering the MTAS issue.

MMC arrives conveniently alongside a raft of other changes to the profession. The Chief Medical Officer has decided that doctors accused of professional misconduct will no longer need to be guilty "beyond reasonable doubt", but there will simply need to be a likelihood that guilt is present. Changes to the GMC will see the lay public increase its regulation of doctors - already proven to be a problem with their involvement in the failed MTAS process.

I am categorically not against change. It is a necessary part of progress. But this change is ill-devised, unintelligent and lacks support of anyone other than peerage-hunting, government saps. We've sat on our laurels for too long saying "it won't happen", well now it is, and if we don't start making a fuss, we'll lose out. There has already been talk from the government about "downward pressure" on wages. This has been confirmed by insulting pay rises this year for doctors. Plan announced today discuss walk-in centres and other services "filling gaps" in GP cover - not recruiting more doctors.

As a doctor or medical student you have 2 choices. Sit back and proclaim that it will all work itself out in the end, and end up an ill-treated pawn working for Tesco Health (today's other new initiative). After 5 years hard work, is that REALLY the profession you want to work for??