The forgotten six thousand (guest blog)

confusedmedic

One of the benefits of writing this blog is that it’s given me the chance to meet other medics who have decided to do different things with their lives. I’m so pleased to introduce this guest blog by theconfusedmedic, a fourth year medical student who has currently interrupted  her studies to pursue other things outside medicine. She currently working as a junior medical writer for a medical communications company and would like to explore medical writing as a career option. She plans to return to medical school in the next year or so to complete her MBBS but beyond that, she’d like to do something outside of practising clinical medicine.

A medical student’s view on the junior doctor contract dispute

Last year, a post on Reddit went viral and this heartbreakingly candid photo of a doctor grieving over one of his patients was shown to the world.

Evidently, the reality of being a doctor is tough. It’s draining, both emotionally and physically. They sacrifice so much of their time and self to help others. The reward can be great; doctors make a huge difference in people’s lives. However, if it goes wrong, they have to pick themselves up and do it all again for the next patient that comes through their door.

The junior doctor contract debate that has come to light over the last several months has angered and frustrated thousands of doctors around the country. The changes to the contract have been widely rejected and deemed unsafe for both doctors and patients. Yet, despite the strikes and protests, news broke recently that the contract was going to be imposed anyway.

The whole medical profession is up in arms yet again, and rightly so. The definition of the word ‘contract’ is: “A written or spoken agreement, especially one concerning employment, sales, or tenancy, that is intended to be enforceable by law.” The key word here is agreement. At no point has anyone agreed and accepted this contract. So why has the government suddenly decided they are going to force it on thousands of employees?

Besides the 50-odd thousand junior doctors in England, there is a significant cohort of people who were never really considered or consulted on the matter of a contract that would dictate their future – they are the 6,000 medical students in England whose voices were overlooked by the government. Six thousand people who will leave medical school and have a job contract enforced upon them that they didn’t agree to.

Amongst my friends and fellow medical students, the general consensus is one of outrage, disappointment, and uncertainty. Outrage at the audacity of the government to go ahead and impose a contract widely condemned as unsafe and unfair; disappointment at the lack of meaningful responses from the government; and uncertainty over what this means for the future of training.

I asked some of my friends for their personal views on the matter and what it would mean for them. Will they complete their foundation training in the UK then leave? Will they apply to do foundation in Wales/Scotland? Would they leave medicine altogether after graduation/somewhere down the line? Or will they stay in the NHS and fight this thing until the bitter end?

The responses were mixed. Some are considering and preparing for alternatives: Wales and Scotland; taking an F3 abroad and playing it by ear; taking the USLMEs. Some are looking for ways out of medicine altogether (I only have to look down my Facebook feed to see events pop up for ‘Alternative Careers in Medicine’ and the like, to know people are considering their options). Some don’t have much choice in the matter of whether to stay or go – the financial investment and ties to family and friends are too strong to consider leaving. And why should they have to?

One common thread amongst medical students is a desire to fight this contract for a better future for themselves, every other medical student that will follow them, and the patients of the NHS. A friend made a good point about how governments will always change and politicians are always attempting to make big reforms; we just have to fight them and stick it out. It took a lot of brave people to keep the NHS running thus far, and it will need a lot more brave people to do the same now.

However, I know for me personally, I don’t know if I could do it. Prior to this contract saga, I had my own personal doubts over a career in medicine anyway and it is looking even more unlikely that I will practice as a doctor. I actually find it quite sad to say because at one point that was what I wanted to do. Unfortunately somewhere along the way, I lost that desire and am currently on a leave of absence to work out what I want to do next. The thing is, it doesn’t surprise me to know that I am not the only medical student who feels this way.

We are incredibly lucky to have, in my opinion, the greatest healthcare system in the world. Sadly, the current government are hell bent on destroying it. The NHS probably won’t be sustainable forever, and it has its flaws, but there are so many more positives about it that we, as medical students, doctors, and members of the public, have to fight for. Medical trainees from all over the world aspire to work in the UK health system, but with the changes this contract will bring, all those highly sought after trainees will go elsewhere. And those that are in the UK already will leave. If practising doctors are considering their alternatives, and medical school graduates like myself are looking at other options, where does that leave the NHS?

It’s easy for the government to sit back and make whatever decisions they want to extend working times, reduce overtime pay, and remove safeguards for doctors. They are not the ones who will have to deal with the fall out. They won’t be the ones who will end up being treated by doctors who are tired, overworked, and damn right miserable about the conditions they work in. That will fall on the general public and all the people who rely on the NHS for their health care.

And it’s just not fair.

Read more from theconfusedmedic

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My Last Day…s

On Tuesday 1st December 2015, we all thought it was the last day. Every four months, foundation doctors rotate round into their next specialty, meaning a new team, new patients, new rules and sometimes even a new hospital or town. Tuesday was to be that day, but then the unprecedented industrial action was called over the junior doctor contract row. The first strike was planned to take place on our rotation day, and with the government being so continuously unreasonable, the strike seemed imminent. We all said our goodbyes on Monday – to our favourite patients, the nurses, the ward clerks and our senior doctors, knowing how our day to day closeness would fade into brief smiles in the corridors and occasional chats in the coffee shop queue.

For me, there was another goodbye to make: to medicine. It was a very busy day and we were short-staffed, but for once I was grateful for this. It was a distraction from the enormity of what I was about to do: walk out on my profession and my security, into the unknown. My colleagues reassured me with reminders that I can always come back if I change my mind in the future. I know they’re right and I appreciate them trying to make me feel better, but right at this moment, I do not think I will ever come back. Unless financially I am forced to locum to support myself, I think this is it for me.

With this in mind, I found myself becoming very emotional as the day went by. “Is this last time I will write a drug chart? Is this the last time I will order an x-ray?” I even felt sad doing a discharge summary! Grappling with hopeless IT systems and pointless tick boxes has been the bane of my life for the last 3 years, and yet I seem to have become strangely attached to it.

The hardest reality to face was that of blood taking… I remember how nervous I used to feel when I first started doing bloods and cannulas on real people back in medical school. I remember the venepuncture failures when I first started working, and sidling up to my seniors, looking sheepish, to ask for help after two unsuccessful attempts. Then I did a Geriatric job – thin, faded arms with sagging skin and veins as thin as paper, which collapsed into bruises at the touch of a needle. My Paediatric job was the most challenging of all – tiny, premature, newborn hands with miniature vessels made visible only by a transilluminator, and the harsh, yet irrepressible guilt as their innocent screams ring through your ears at 3 in the morning while you stab at the skin they have owned for barely ten minutes.

Thanks to these experiences, I am now rather good at taking blood, and over the last four months, patients have told me often that my technique is painless. It is a skill that I can’t really take elsewhere with me, and it does feel like a waste. I cried after cannulating a patient yesterday.

As I walked around the hospital doing various jobs, I got a sense of how privileged I have been to have occupied this world for a time. I scoop up a set of back-breakingly heavy patient notes, and the unattached bits of paper inside all slide out unpityingly onto the floor. As I sigh and pick them up, I realise I am looking at someone’s cancer records. If I wanted to, I could log into the system and look at their bloods, or pull up their scans and see the tumour myself. I could read their clinic letter and find out what their prognosis was. I am privy to some of the darkest moments of people’s lives every day. How odd to lose that suddenly.

I wander over to theatres to find a consultant, and peer into the operating room to see if he’s nearly finished. There’s an anaesthetised patient on the table, half naked with a long bloody slash down one leg. Hip replacement. Isn’t it weird that I get to see this? It’s so normalised for me now that I don’t even think about it, but other people – non-medical people – would find it overwhelming. Inspiring. Fascinating. Gross.

As the day came to an end, I said my goodbyes, took a deep breath and went home. I didn’t have time to be emotional, as my mind was pre-occupied by the plans I had that evening with some colleagues: we were planning to go into central London in our scrubs and stethoscopes to talk to the public about the junior contract row – a ‘meet the doctors’ initiative. I thought it fitting that the last thing I would do as a junior doctor would be standing up for the profession.

Just as my train pulled into Liverpool Street, however, the news came through that the strike had been called off! And agreement had been reached at the eleventh hour! I messaged my colleagues and there was a lot of confusion over why this had happened and what it meant for us, so our meet the doctors plan sort of disintegrated. I had to laugh because I’d just spent the whole day mourning the loss of my daily grind, and here I was going in the very next day to do it all again!

It did feel very strange that this political storm was going on during my notice period. I’ve been vigorously defending my fellow junior doctors whilst knowing that I’m going to be jumping ship very soon. It does feel like I’m abandoning them, but then perhaps they can use me to their advantage and tell the newspapers that Jeremy Hunt’s schemes forced me to quit!

My actual last day was again very busy, as several patients were unwell. Two patients had post-op bleeding and needed blood transfusions. One developed an awful looking wound infection and another was found to have cellulitis. One was paralysed from the waist down, but had the attitude of an angel and the patience of a saint, while another walked cheerfully around the ward for most of the day, but then would crawl back into bed whenever the doctors came in, complaining of ‘unbearable’ pain and not being able to move at all. I had referrals to make, letters to other hospitals to send, rehab units to call, discharge summaries to do, drug charts to re-write, bloods, x-rays, cannulas, and of course, a tour of the hospital and a patient hand-over to do for the person taking over my job. At about 4pm, I sat down to have lunch. Then one of my patients developed signs and symptoms of a heart attack! Nightmare day! I sorted everything out for him and was just about to leave when the emergency buzzer went off in one of the side rooms. I smiled at my colleague as we ran over – it seemed as if Fate did not want me to leave! Luckily it was just a false alarm.

I finally left the hospital at about 6.30 pm. I expected to feel upset, relieved, overcome by the significance of the moment, but I did not. This long, drawn out goodbye has only left me feeling incredibly anxious, and when I got home, I cried for nearly an hour. My worries about locuming, the future and financial stability got the better of me, and I suddenly felt very scared and alone.

What am I going to do now? How am I going to employ my time? How do I make a living? I try to believe I can do anything I want to, but it’s hard to do that at the moment. My nails are bitten to pieces with the stress of it all, and I can’t shut my worrying brain off. Deep down, I know that resigning was the right thing to do, but right now, it feels awful. This is the culmination of my ‘break-up’ analogy. Divorce papers signed, possessions split, paths diverged – bring on the wine and the ice-cream, because I just need to feel my way through this.

goodbye

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The first day of the rest of my life…

I am an ex-junior doctor.

I worked in the NHS for just over two years. I went to medical school for six years. But in 2015, at the age of 26, I resigned from my job. I wrote the post below shortly after I handed in my resignation, and I have been using this blog ever since to document my career journey, and the emotional process of leaving something that had become such a huge part of my identity.

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16th October 2015

I’ve quit my job as a doctor. I can hardly believe I’ve done it, but I have.

Despite all the political turmoil surrounding junior doctor contracts at the moment, and the threat of worsening working conditions, this government’s idiocy is not the only reason I’m leaving.

This has been a long time coming. I never really wanted to be a doctor, but when you’re 15 years old and choosing your GCSEs at school, it’s very difficult not to be influenced by the adults around you who tell you that you’re good at science, and therefore you should do medicine.

I have tried. I really have. I passed every exam at medical school, I got a good job in London, I got very good feedback from my peers, my mentors and my patients – but there was always something missing, and that something ate away at me inside for months on end, killing my passion, fading my colours away.

I don’t know what I’m going to do. I have no plan as such, only a dream to get back into my true loves: creative writing and modern foreign languages. I have no new job lined up for when I finish on December 4th. It is perhaps a little mad to do things this way, with no plan B, but quitting will hopefully give me the impetus to do now what I have been putting off for a very long time.

I want to use this blog to document my journey, and also talk about my experiences as a doctor: the good, the bad, and the terrible. I can now be brutally honest about what it’s really like to work for the NHS – since I’m leaving anyway, I won’t have to worry about losing my job for speaking out!

The NHS can be a brutal and frankly unsafe place to work, and I realised that, without the desire to give up my entire life for his profession, staying in it would be simply too hard. If it isn’t your passion, the huge sacrifices involved in being a doctor just don’t feel worth it.

I have no regrets about my medical career; it was a fantastic experience and has made me who I am today, but it does not define me. The day I leave will be the first day of the rest of my life, and I cannot wait to get started.