I think I can say without fear of contradiction that I read a lot. As anyone who has been to my lovely yet humble abode will not have failed to notice there are books everywhere; all, well, mostly, on shelves, in almost every room, not that there are all that many rooms or indeed all that much space in these rooms.
Like all doctors I have to read the myriad emails, guidance documents, clinical updates, journal articles and more that flood my post box as well as various email accounts (sadly I do have more than one of these) but somehow, I also find time to read other stuff. I must confess that I have an interest in medicine, which helps given that I am a doctor, and here I mean I have interest in both clinical and non-clinical aspects. I am especially fond of medical biography, and hearing about others’ experiences is usually interesting, useful and eye- opening. I am glad I am not the only one, and there is even a name for medical biographies – the “medimoir”.
I have recently read two excellent books about what is it like being a junior doctor in the NHS today: Adam Kay’s, This is Going to Hurt: The Secret Diaries of a Junior Doctor and Rachel Clarke’s Your Life in My Hands – A Junior Doctor’s Story. I can assure you that I know neither of these authors, yet their stories and experiences resonate with me, even though I was a junior doctor more years ago than I will admit. And in case you are wondering, yes, I have myself written about my own misadventures of my time as a junior doctor, but sadly publication success has so far eluded me. So, if there are any lovely, wise and brilliant publishers reading this who are feeling charitable, please do get in touch.
But I digress. I recently read these two books and this got me thinking about the life of the junior doctor. It seems to me that things are a lot worse for today’s junior doctor in the NHS, at least when compared to what I went through. While doctors now are not routinely working up to three days non-stop without sleep and sometimes food, and on half pay for this compulsory overtime, there seems to be much less support, team spirit or job satisfaction. Thinking about this made me recall my own experiences many years ago, including one particular post which was notable for not being that bad, which perhaps I should not really admit. The job was in the ‘community’, that mythical place of yore where patients live and actually just refers to anywhere outside a hospital. It is also where doctors live, apart from when they are stuck in a hospital when the hours are so long, they cannot ever really go home. Or not any more, as the days of free on-site hospital accommodation for junior doctors is a thing of the past.
Anyway, in this less than overly busy job there was plenty of time to wander the mean streets of the local ‘hood, which was in a rough and yet to be gentrified part of town. It had a surplus of colourful locals, a thriving market, not just for illegal substances that mother would most definitely not approve of, (the ‘high’ street was rather aptly named, but for the wrong reasons) as well as a few charity shops. It was in one of these that I found, for the princely sum of £1, a short book (114 pages) that is well worth reading should you ever be able to find it. The title is, rather enticingly, ‘Angry Young Doctor’, by a Dr Louis Goldman, published in London in 1957. There is naturally no ISBN number and the publisher, Hamish Hamilton, is no more, having been subsumed at some point into a larger Publishing House, Penguin Books. This book is a fascinating read, not least at it suggests that things for junior doctors have always been, shall we say, fraught.
The front cover has no picture but the following words:
“Did you know that: A young doctor’s effective income in his first year is between £5 and £6 a week and he must be on call 24 hours a day?
Litigation by aggrieved patients against the NHS has so increased that surgeons and anaesthetists are often afraid to take any calculated risks?
More than 100,000 patients are awaiting operations in Britain?
To obtain an appointment to see a consultant can mean a delay of four months?”
On the back of the book is this:
“The young doctor in Britain today who thinks of his future in terms of a specialist career would be well advised to think again. Generally considered a respected and secure member of a great profession, he is in fact a man condemned to a dozen years and more of itinerant employment in various posts with no guarantee of a permanent position at the end of that time.
The hospital patient, confronted by a bureaucratic system, cowed by white-robed mystery of the Hospital, loses both his normal sense of discrimination and his powers of protest. At the same time the increasingly scientific basis of medicine leads almost inevitably to a de-humanised approach. The result of these two factors is a condition where a patient may be reduced to the abstraction of a disease.”
Having just read two contemporary books about the junior doctor experience, these words, and the many more that comprise Angry Young Doctor’s 12 short chapters, sound relevant and far from historic. The pronouns ‘he/his’ clearly would now rightly need to include ‘she/hers’ and perhaps because of the massive shortage of doctors in the UK and the possibility of developing an alternative career, lack of employment is less of a problem than in 1957. However, one thing that remains is junior doctor dissatisfaction, and with it the likelihood of conflict, for which naturally enough, mediation should play a role.
The book does discuss examples of conflict, with clear evidence of this from some of the chapter titles such as “Forced Labour – The House Officer” and “The Tortuous Road to General Practice”. Even more interesting, is the statement on page 33 that junior doctors have no direct representation in any level in the health service. The two books about the junior doctor experience that I have recently read would suggest that this is still the case. I was also intrigued by the prediction on page 50 in the chapter entitled,” The Registrar Problem”, that by 1988 there may be a medical Big Brother – referring, of course, not to the popular television programme of yore, but to George Orwell’s seminal novel, 1984. Cynics may well believe that this prediction has come true in the form of the UK government and the General Medical Council, but on this I plead the fifth.
There is loads more in the book that is worthy of presentation, and I intend to present this in my next blog (or maybe even series of blogs?), so stay tuned. I will try to look at more of the themes in this fascinating book and see whether other things have changed and if so, how.
To close, here are the last words of the last chapter, which, I suggest, still have a contemporary resonance, at least for doctors:
The cost of the National Health Service, be it remembered, has also been bitterness, frustration, insecurity, fear and insensitivity. This cost has yet to be accounted for.
Consultant psychiatrist with extensive medicolegal, managerial and judicial expertise acting as medical consultant to ASM and an accomplished linguist and academic.