nhs, Uncategorized

Doing the best you can…

I’ve been reading Brene Browns book ‘Rising Strong’ in which she explores this idea.  I’m not entirely sure why but for the first time it actually hit home.  I’ve heard it said a hundred times but generally dismissed it.complaints_328x212_ThinkstockPhotos-515056570

Sure I know they’re trying but are they…?  Really?’


I even found myself saying it at work to be told it wasn’t good enough.  That can be hard especially when you’re being held to account for things that are out with your control.  I know I’m not the only one who has experienced this from what I see discussed on social media (Professor David Oliver’s tweets from the weekend are a good starting point @mancunianmedic)


Medicine sometimes feels like a giant mechanical beast to be dissected and analysed.  We’re very good at coming up with diagnoses, tests and management plans.  We’re great at refining ‘process’ when things don’t go well.  We also have a complaints department whose job it is to write letters with our findings.  It’s all very…. clinical.

Where is the feeling?



I’ve been a supporter of Patient Opinion (@patientopinion) for years.  I love its simple concept of real time feedback.  I have become increasingly frustrated and disillusioned with the clunky, time consuming/wasting complaints process on offer to patients and families.  Patient Opinion allows people to share stories – good and bad.  It allows us not only to be transparent and honest but also lets us share with the whole team.  It opens up the possibility of real time change in a way that the current system doesn’t.


This ability to effect change in real time I think is crucial in maintaining the trust of patients and their families.  I also think however it has a role in protecting the emotional well being of the team.

A colleague on twitter Dr James Fisher (@JimboFish) introduced me to Schwartz rounds (@PointofCareFdn).  The idea is again a simple one.  While we can do a significant event analysis we rarely focus on its impact on the team from an emotional perspective.  We don’t talk about the frustration of dealing with an agitated delirious person who we wish would just sit down in case they fall and break a bone.  Or how we felt being shouted at by angry relatives in the middle of the ward.  I understand their stress and worry but does that mean they can call me all the names under the sun and twist my words….?

I tried to introduce this to the post take ward round debrief when I was on call this weekend.  After going through the job list I asked Tania, my FY1, was there anything else we should or wanted to talk about.  It turned into a discussion about the non pharmacological management of delirium.  We spoke about trying to change perspectives to see through the eyes of the person we are trying to help. What was amazing was the realisation that actually the most helpful things are often the most simple and easy. Feeling empowered she went off to put into practice what we had spoken about. All with a renewed sense of confidence.

Having tried a modified version of it on call I’m thinking of making it part of our weekly multi disciplinary team meetings.  I think emotional vulnerability is hard especially in an organisation such as the NHS.  However if we are entrusted with the care of the most physically and mentally vulnerable – sharing our own emotional vulnerability can only be a good thing.






Shine on you crazy diamond

This week two encounters rattled my happy equilibrium of recent months. For most of the week I wasn’t able to fully articulate why and I hate that!

There was no drama.  No heated exchange of words. In fact there was nothing particularly special about either situation to cause a dark cloud to drift across the blue sky of my world.

On both occasions I felt like I’d become a more rubbish version of myself.  It was like the light had been dimmed and my energy diminished.  I began to doubt myself and was slightly less self assured in what I said.

What the hell was going on? This wasn’t me.

The more I wrestled with the why the more irritable I became until I had primed the beginnings of a downward spiral of negativity.  Helpful advice from friends fell on deaf ears.  Even the icy cold slap in the face of ‘Let it go’ was not enough to bring me to my senses.  I do love to ruminate but even I was boring myself on this one.  ‘Urgh – get over yourself woman!’

For whatever reason the idea of kryptonite entered my head and I found myself googling it. There is A LOT of information about a substance that isn’t even real.  Did you know that there is more than one colour of kryptonite for example?  I thought it was just green but apparently not.

It seems that Superman requires the sun to power him up like some kind of flying solar panel.  Kryptonite blocks this process. I felt like I was onto something deeply profound…. ‘so if I just google How does Superman defeat kryptonite? I’ll have this all figured out. Brilliant!’

Minor problem – there is no answer.  Balls.

The following day the fabulous Olwen Williams (@OlwenOlwen) tweeted this:



It dawned on me that the source of my kryptonite originated from the middle of the chart.  I had come across this concept before during a leadership course.  Various people/studies have looked to psychoanalyse those working in the NHS.  It seems each healthcare group has a unique personality profile.  In fact it turns out 98% of doctors, nurses, managers etc are all uniquely the same.

I remember one such person commenting in a proud fashion that after 30 years the NHS had finally turned them into one of the 98%.  I was dumbfounded that someone could be proud of that.

My profile is consistently not in the 98% and to see it illustrated in such a way was my light bulb moment.

I’m nearly 20 years a doctor and in that time I have struggled with conforming to the perceived norm.  I have been consistently told to change.  I have been told ‘we don’t do things that way’  that I am a ‘new broom’ wherever I go.  I have also listened to some who talk of being the 2% but their actions would suggest otherwise.  I have also heard the same people talk of their support of the 2% only to put up barriers at every turn.  It has been a confusing and at times, lonely place to be.

What I have learned and what I say to other two percenters  is to ‘keep being you, keep doing what you do because you are awesome!’.  There are others out there.  We’re pretty easy to find. Just look and invariably you’ll see our light…..








health, Uncategorized

Living the dream…

Living the dream…..

This weeks blog title was suggested by my former colleagues when I met them for dinner the other night.  We were laughing about how mad I had got when a senior manager asked me ‘How are you? Living the dream?’.  Looking back I think it was meant as one of those silly throwaway comments that the person asking is not really looking for an answer.  Unfortunately it pushed a button and as they say in Scotland I went a little ‘tonto’.  It wasn’t a particularly happy time then.

A couple years later I’m in a different place – mentally and physically. I’m in a different workplace and I’ve also gone part time.  It’s amazing!

So am I ‘living the dream’?  I’m not really sure what that means to be honest.  My dreams are weird at the best of times so I definitely don’t want to be living those! That could be another blog though….

I guess the whole thing is about work life balance although I think that very term will soon be redundant if the current trends in the workforce continue.  I was reading about Millennials (people born between 1980 and the mid 90’s)


The work to live rather than live to work is something that has resonated with me this year. The idea that there should be more flexibility in not only where but how you work.  For example does being at your desk or being seen on the ward after 6pm make you a more productive or better doctor (or any other worker)?  Are you doing it merely to be seen?  Or out of a sense of mouse wheel duty that probably someone else can do?

My new commute is far longer than the 10 minute journey I used to make every day.  It’s now somewhere in the region of an hour or so each way.  And yet I feel more energised and on top of things than I ever did before. How I use my time is different though.  My emails are done on the train.  Any projects or pieces of work are also done on the train.  I do mindfulness at the start of every day which quietens and focuses my brain.  I also like to think time spent staring out the window is a form of mindfulness too…  I get loads more fresh air and exercise which I’ll admit is also a great excuse not to go to the gym.

I finish pretty much on time every day so when I get home that’s me. Work is far away and that part of my brain switches off. Recharging even.  The other part of my brain switches on.  It’s not too dissimilar to the work side its just more fun and more silly.

This week I was at the Edinburgh Festival, the Fringe to be exact. It doesn’t get more silly than a skeleton puppet singing to Frank Sinatra in the rain.  I hadn’t been to the Festival in years and it didn’t disappoint.  While I wasn’t organised enough to get tickets the day was spent wandering the streets watching various street performers and soaking up the atmosphere.

I tried trampolining at Airspace for the first time. The safety video of ‘you may die’ did slightly alarm but I was not put off.  Dodgeball and gladiator style jumping over rotating bars all proved I have no sense of balance. I also seem to reflex squeal when I fall over.  I had thought this was limited to falling off inflatables in the sea but apparently not. It was hilarious fun!

The point of this….?  Living the dream is whatever you want to make of it.  Did my dream include being stressed out my head and blowing up at stupid comments?  No.  My dream is to work hard, make a difference but most of all have fun.

nhs, Uncategorized

Come fly with me….

Changeover week is always a bit of a funny week.  It starts off much the same as any other. There’s the ward round to be done, results to be chased and plans to be made.  The whole thing has a certain ease to it.  The familiarity of the team makes for a relatively relaxed atmosphere.  Everything is sorted. Everything is in hand.  Ahhhhh…!

IMG_4624Then Wednesday arrives and it’s a bit of a jolt to the system.  Suddenly the team is brand new and not only do they not know the patients they don’t know how things are done.  Its kind of like when a plane hits turbulence.  Its all a bit unpleasant but no one is in any kind of real danger.  That’s how I feel manning the ward on changeover day.  I’m the pilot of the plane trying to get us through the worst as quickly and safely as possible.  I consider our senior charge nurse to be my co pilot. We make for a pretty awesome team having been through it many many times!

So what makes it that bit easier? Talking.  Plain and simple.  It offers reassurance that the unpleasantness of the new will pass quickly. It creates a safe place so that no ‘stupid question’ goes unanswered.  And because I’m fundamentally nosey I get to know my new team better too.

It was also in this changeover week that a good friend of mine was admitted to hospital. She doesn’t work in the NHS so it was through her eyes I got another perspective on how we communicate as doctors.  I should say she’s happy for me to share this.  When I first visited she’d been in for 3 days.  In that time she’d seen several different doctors but was uncertain which of them was her Consultant. She also had been kept in the admissions area of the hospital rather than being moved to a ward elsewhere. Now my friend is not exactly the shrinking violet type so I was  surprised to hear her comment that she didn’t want to cause any bother by asking why.

Another doctor appeared when I was there. My friend was told very succinctly that ‘Your CRP is coming down but I’ve spoken to micro so we have a plan for the weekend.’

The doctor was about to walk away when my friend asked ‘and the plan is what?’

Biting my tongue is something I’m really bad at.  However it wasn’t my place to start interjecting with questions.  Suffice to say I asked my friend if she knew what a CRP was?  ‘Not a clue’ was her response.

I tried to think about what had particularly irritated me about it.  Technically the doctor had done nothing wrong.  I understood it all perfectly.  As a doctor….

So putting it to one side I visited my friend again  – day 5 of feeling sore and fed up.  I visited just before tea at which time I was asked to leave for protected meal time.  There were 3 other people in the ward.  None were old or obviously confused.  We both asked why I would have to leave.  ‘Its so we can help people with their tea’  Looking around it wasn’t exactly clear how they needed to be assisted so we asked again.  The reply was the same ‘its protected mealtime’.

So I had to wait outside for an hour while my friend ate her tea by herself. As she had been all day.  After eventually catching up I hug my friend goodbye, wish her a speedy recovery and start to reflect….

Back at work the turbulence had eased and everyone was feeling that little bit calmer.  Everything was in hand, everything was sorted.  As we became more mindful of looking out for one another I asked them to think about the people in the beds or sat out in chairs.  We thought about a time when we knew no medic chat.  We started to think about talking to our patients as people going through a turbulent time.  They are looking to us for reassurance that everything will be ok.  The best way to do that is just to talk like a normal human being – jargon free, calm and reassuring.  Like any good Captain would do….


nhs, Uncategorized

‘What’s the one thing you know now that you wished you’d known at the start?’

I asked the team this at the start of this weekend’s on call.  It was met with groans and comments of ‘don’t do it!’

Yes its changeover on Wednesday! Its like a second Halloween to the media.  There are stories designed to terrify the public of how you’ll meet a grizzly end if you are unfortunate enough to be admitted to hospital on the first Wednesday of August.maxresdefault

There are also emails reminding the senior clinicians that we run a service and targets are key during this time.

Somewhere in amongst all that are people.  While we focus on ‘people not patients’ could we perhaps extend that to ‘people not the FY1’?

There have been great improvements over the years to move away from the traditional baptism of fire on your first day.  There are now preparation for practice or shadowing courses.  On social media there is a great hashtag #tipsfornewdocs (my top tip was ‘when on call eat at every opportunity/like you’ll never eat again).

We are much more supportive of our new doctors than ever before.  There is growing recognition that to run a safe, efficient service you have to do the proper training and education.  I say growing recognition as at times it seems we still can’t see the blindingly obvious inefficiencies.

I listened to http://www.bbc.co.uk/programmes/p041svjg this week by Dr Kevin Fong. It was all about ‘Lean’ in healthcare.  This has been about for years in management circles – standardise the process to make it more efficient.  Which is fine if we are making cars but we are caring for people.  A point acknowledged in the program.  I then thought about our Chief Medical Officer’s report on ‘Realistic Medicine’ which also talks about standardising process http://www.gov.scot/Resource/0049/00492520.pdf



Just at the point my head was about to explode from the buzzword bingo of management language it all became clear.  Strip away the language and what you have is blindly obvious.


Time to spend with patients. Time to gain experience. Time to spend with families. Time to talk to your colleagues. Time to finish on time.



I would therefore argue that we are missing a huge opportunity during changeover to uncover the blindingly obvious.  As our doctors move hospitals, departments and wards we should be asking them ‘what do you know now that would save you time when you started?’.

You then get a different response:

‘A map of the hospital so I know where to run when the cardiac arrest page goes off’

‘What time the phelbotomist is in and where they leave forms for those that they couldn’t get. It means you don’t discover mid afternoon some bloods haven’t been done’

‘The Treatment Room: Prepared ‘Procedure specific’ trays‘ This was beautifully presented by Dr Yesmin Karapinar an FY1 at the Women’s Medical Federation Conference in May 2016 .


‘Where’s the nearest place for coffee?’  Ok that was mine.  Where’s the nearest toilet is my second question.

Starting a new job is an exciting time for most doctors – lets ensure we uncover the time to make changeover process enjoyable as well as efficient.