Holiday, nhs

Club Tropicana

Holiday resolutions – full of good intentions and emphatic declarations of how things will be different but how long does it take for them to be broken?

In my experience…. a couple of hours…. then the familiar feeling of never having been away sets in *sigh*

This time I decided to try approaching my return to work rather like an extension of my holiday.  It has many similar features after all.  Not convinced?  Well lets look at the evidence……


The night before I pack my work rucksack, sadly It’s not nearly as exciting as actual holiday packing.   For a start there’s no inflatable unicorn drinks holder. However it does contain the same essentials – a form of ID, portable air con in the form of my lovely Spanish fan, a variety of snacks and money, well at least a card that’s been paid off this month. I think…

The fragmented night before sleep

I wake up. Again. It’s 5.20am, it’s dark and I suddenly realise that my alarm has been set to 6.30am instead of 6.00am?!?  I leave at 6.45am for my train.  Horror of horrors I could’ve slept in!  Thank goodness I woke up except now I have 40mins before I actually needed to be up and I’m proper awake.  Oh joy. Yes the sleep before you head off on hols is pretty much the same as that the night before heading back to work.  Rubbish!

 The journey

I have no pre allocated seat and there’s no drinks trolley bringing me gin (this is a work commute people, not the time zone freedom that international air travel permits!)

I do however have my own entertainment system in the form of noise cancelling headphones, podcasts and music. Sometimes the white noise of people snoring or tapping on their phones can be perfectly pleasant too.  Rather like the background hum of a plane. Must not fall asleep. Must not fall asleep. Zzzzzzzzzzz

You have reached your destination!

The destination

It’s bright and sunny as I arrive at the Costa del Larbert.  I see some people outside enjoying the ‘fresh air’. The aroma of freshly ground coffee and muffins greats me as I walk through the doors. White washed walls of the building remind me of the Mediterranean.  Yes, my brain is beginning to fall for this being just like on holiday. I wonder if I’ll have any messages……

The welcome pack

Good morning Dr Copeland – you have 204 new emails. That is so nice!  I bet it’s all good news.

Ooooo – what’s this? An animated email trail.  I forgot to pack my holiday read so lets see what’s this about. Right…. They said what?….. . So I said…… And then he said…. And then I was like ‘no way’ …. So I said to her…. And she said…… And then…… Lol, a winky face emoji…..

Well I’m glad that didn’t escalate and everyone is still talking to each other.

I best head to the where all the action is – off to the ward.

Good morning welcome meeting

Hello everyone and welcome to sunny Costa Del Larbert.  It’s great here – lots to see and do.  On that note Mr X fell last night and doesn’t seem quite himself.  The family of Miss B wants to speak to you.  And can I ask who’s covering….

Beep, beep, beep

It’s my welcome back page – how many have phoned in sick?  Well that is a problem….

Back to reality

While all this is going on my brain keeps popping up ‘Club Tropicana’ while I wait for the computer to load or the person to pick up the phone.  I smile at the ridiculousness of it all.

Holidays are, by design, a break from reality.  A chance to recharge and switch off from work.  However today tells me that by injecting some of my holiday mood into everyday work life, occasionally there is fun and sunshine.  To be honest all that’s missing is the sea….

health, Uncategorized

Le Freak

I’ve had total writers block this past couple of weeks which is very unlike me.  In the end I decided to write a list of all the things that I’d been involved with including snippets of conversations.  I find even the most throwaway of comments can spark something.

What came out was largely service delivery related.  Or in other words, staffing and rota work.  Most people would agree that taking on any kind of rota is somewhat of a poison chalice.  It did take a fair bit of persuasion to get me to become involved in the junior doctor one.  However I strongly believed (and still do) that get the rota right and everything else will fall into place.

Now I’m not going to spend the rest of this blog talking about rotas.  However it did get me thinking about other areas in healthcare that seem easy on paper but somehow never quite translate to that in real life.

Take ward rounds for example.  Why is it that doctors seeing the same type of patients can take vastly different times?  It’s not like the problem is all that different or the initial results any more complex. The doctors themselves have been through a generic training scheme.  The paperwork is the same.  So what is different and why can’t you standardise them to do the same thing every time?

Simple – you cannot standardise people.

What I have seen over the years is that people do unpredictable things especially when they feel they are being forced into something or being backed into a corner.

And therein lies the contradiction in healthcare – we are constantly being asked to change things in order to standardise what we do.  The more you ask people to change, the more likely they are to resist and nothing changes.

I also think some people actually enjoy treading water because it’s perceived as taking less energy.  And let’s be honest, it’s familiar territory so is less scary.

In stroke I teach that recurrent, stereotypical events are not recurrent TIA’s.  If you think through the pathogenesis and mode of action you quickly realise that it just doesn’t make sense (there is only one caveat to this with a critical carotid stenosis but I digress….). However it takes a big surge of energy on my part to stop this cycle of doing what has always been done, revisit the history, explain to the patient what it might be (including I don’t know) and coming up with a plan.  It also takes a lot of energy, trust and faith on the patients part to work with you in this.  The sense of satisfaction when you get it right though makes it all worth while.

If you take this example and think about how we apply it to other aspects in healthcare e.g. organisational change, rotas, ward rounds – it becomes easy to see why the same problems/issues recur time and time again.

So what do we need to do?  Well if it was that easy I wouldn’t be writing this and the NHS would be totally fine…. I do think it’s a bit like what the quote says.  Don’t moan about the problem or expect it to change.  Stop doing what you have always done. Revisit the issue. Adjust your sail.  See what happens.

You might just be surprised……


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.