If you cannot stand the heat get out of the kitchen

I avoid medical programs as much as I can but I could not miss a glimpse of some reality TV of what I knew as ‘house officers’ but are now known as F1s whining in a fatigued way as they moved around an averagely busy ward. Watched in amused horror as one arranged a further X-ray for an increasingly breathless patient from the end of the bed without even a cursory examination, pulse rate, respiratory rate noises in chest but no. Diagnosis delayed equals treatment delayed and increasingly poor outcomes. As I switched over in despair she seemed to be doing discharge summaries when she should be drinking chilled Sauvignon.

What struck me about all this was a never saw a smile or heard a joke or any banter among the staff just sad people shuffling around and that is not the patients. Once upon a time when house officers worked every other night and all the days in between there was much laughter, ready cups of tea etc. even dare one say it the swift half at 10.pm before the night round but no more. This is I suppose progress but seems to me to represent the modern unhappy whiny doctor who switches into some robotic communication skill, much taught these days as the speak a few words to the patient before once again reverting to type.

Where have all the muscular mesomorphs honed by a university career of drinking all night and learning enough to get through during the day and in a frantic week pre-examinations, probably the now burnt out and retiring GPs that one also reads about.

In my place of work the trend seems to continue though as the doctors have been at it longer they are faintly more efficient but never on time, never up to speed and despite writing notes on scraps of paper not really informed. This is unsurprising as they are passing through for a couple of hours only and little idea of what is happening and absolutely no idea of trends in either improving or sadly more likely worsening situations. 

But sadly the fun, banter and laughter has gone to be replaced by cautious political correctness and no ability to back your clinical judgment and buck passing at every level. As I write this Ramadan has struck as we approach the longest day with even more unhappiness and bad temper.

Registrars busily communicating with the patient as they exsanguinate, rather than quickly dealing with the problem and then remaining silent or justifying themselves as to how and why let it happen are now the norm. Long drawn out and inevitably septic labours leading to septic mothers and babies, second stages endlessly extending to failed ventouse deliveries and (surprise, surprise) undiagnosed occipito-posterior positions result from inexperience and no long term care and just an inability to see writing on walls.

So, if you want to do an acute speciality to have to have the right mind set, you have to put the hours in and you have to think through the problems quickly and efficiently and deal with them. You even have to be flexible and manage on a tight time schedule. I would like to think that the recent winner of master chef is as competent at work as she is with the turmeric. Where are the competent cheerful suck it up and move on doctors of yester year. Reflection is something you should see in the mirror not in appraisal waffles. If you can’t stand the heat, get out of the kitchen.