nhs, Uncategorized

It’s the most wonderful time of the year….


I’m always in a reflective mood at this time of year.  For me Xmas brings a sense of renewed hope and possibility.  So it’s in this frame of mind that I am casting a backwards look over my shoulder to the year that has been.

I started in Forth Valley just over a year ago and it has gone by crazy fast!

The challenge of starting somewhere new can be quite daunting.  A friend of mine cautioned me ahead of the move that I would no longer have a ‘support network’ to lean on.  At least not to begin with. Grateful for the advice I set about putting on a metaphorical life jacket prior to getting on the boat.

My first year in Forth Valley has been more like trying to navigate a boat in choppy seas.  Sure there have been periods of calm and work is plain sailing.  However all too often though the sea has been littered with icebergs.  I think it would also be fair to say that on occasion, I have sailed directly towards the icebergs in order to force hidden issues to come to the surface.

Sometimes this approach has worked very well.  What could be described as ‘confrontations’ have produced some of my best working relationships.  There are some collisions that have not ended as well.

I am trying to go with the ebb and flow of this new working life. Those who have worked with me in the past will testify this is not a change that has come easily to me.  That said there is still work to be done and my focus will always be on what is best for patient care.  How I personally go about working with others will not always be a perfect.  As I was reminded recently I am only human.  I will make mistakes.

So my thoughts turned once more to our Chief Medical Officers report on ‘Realistic Medicine’ in particular these points:

  • How can we reduce unwarranted variation in clinical practice to achieve optimal outcomes for patients?
  • How can people (as patients) and professionals combine their expertise to share clinical decisions that focus on outcomes that matter to individuals?

How can you standardise the machine of human nature when the two most commonly heard phrases I have come across this year are; ‘that’s not how we do things here’ and ‘that’s a job planning issue’. It is like being up against a proverbial brick wall.  I should stress as well that this is something that you will hear across many NHS organisations.

Now I am not suggesting we become totally altruistic in our pursuit of person centred healthcare. We do need though to somehow strike a balance between what matters to us as healthcare professionals and what is best for the service and ultimately the patients.

Do I have a solution that will see this brick wall come tumbling down?  No I don’t.  To be honest I worry more about the other side of the wall these days.  The sledgehammer approach takes a lot of energy.  Energy that is needed to guide people through a new landscape when the wall eventually cracks.

So back in my boat it is less full steam ahead and more of a steady flow. I will continue to look out for ice bergs and carefully navigate round them.  Keep my eyes on the horizon.  Looking behind will only serve to give me a crick in the neck….

Merry Xmas everyone!merry-christmas-wallpapers-1080p-hd-images


Back to the future…

In recent years we’ve grown accustomed to talking about education in medicine and the tension that exists between service delivery.

I get really frustrated by this.  To my mind the two are intertwined.  I accept that some training has to be done separately e.g. procedural skills, advanced life support etc.  There is however a large proportion of it that can and should be done as part of everyday working.

I was trying to cast my mind back to when I was a Senior House Officer (a somewhat misleading term that is now redundant). In terms of training and education there was no defined program.  Sure a couple of times a week we had an X-ray meeting and a talk from the Consultants but that was essentially it.

Only when I became a Registrar did a teaching program begin.  I’ll be honest I wasn’t a fan.  It took me away from the ward and the clinics.  While I didn’t realise it then I think on reflection it took me away from what I considered to be the real learning.

It was also around this time that the full effects of the European Working Time Directive began to kick in.  Rotas were becoming increasingly fragmented.  Continuity of care on the wards was being lost in order to populate the on call rota.  We were also being told that we had to go to teaching days or we would not be signed off at the end of the year i.e. we would not be allowed to progress in our speciality.

Throughout all this we had to deliver safe care to our patients.  It was at the end of my Registrar years that I began to think ‘surely there has to be a better way?’

I’ve always had an interest in education but a watershed moment in my career was when I did the ‘Doctor as Educator’ course run by the RCPLondon.  It properly got me thinking about not just the what we teach, but the how and the why.

Education is the foundation from which any service in medicine should be built on.  Not just as lifelong continuing professional development but as a clinical governance issue.  I also believe that a term that should be made redundant is the idea of ‘training posts’ and ‘service posts’.  If we truly believe that patient safety is at the heart of what we do then all doctors have the right to education regardless of post.  We massively contradict ourselves by separating the two out.

Where the argument becomes muddied is we continue to deliver education programs that simply do not fit the requirements of the service or the doctors working within it.  I found this paper interesting in its perspective on Generation Y or Millennials:


We need to support but also challenge our current workforce educators to think a little differently. There are educational moments everywhere.  Not all of them requiring huge amounts of time either.

We need organisations to keep up with technology which needs investment in connectivity.  There needs to be access to online educational resources, an ability to connect with other learners and most of all the ability to share resources and information in real time.

The shared learning experience begins with connection and not separation…..