I remember being at school, thinking about careers having done one of those computer programs that told me my top 3 careers were "Funeral Director, Embalmer and Fence Erector". I remember that every grown-up I asked told me NOT to pursue their own career. And I remember changing my mind a few times through my Upper Sixth... I wanted to be an interpreter in the EU, then pursue journalism, then considered something science-y before somehow settling on medicine.
Anyopne who's read my blog before will know I haven't always been happy with my job, and the nature of an introspective activity like blogging is that you're unlikely to post your happiest times because you're out busy HAVING those happy times! So please read on in the knowledge that there have definitely been many happy times over the past two years!
Nevertheless I meet very few people that enjoy every day of their job. Why is that?
Is it that I work in the NHS? I would hazard a guess that the free-to-all nature of the NHS makes it likely that working in the UK as a professional offers a different and unique experience than anywhere else. I find it hard to accept that my actual role as portrayed in TV drama, the news and at various Trust inductions is that of a caring individual who will ensure excellent care and quality to each and every patient I see. (Unless you get your news from the Daily Mail, in which case my role is to give you cancer).
Does that sound awful? I wish it were my role. What I actually find is that in a typical week I will try and start optimisic but am gradually dragged down. To enable an "excellent" experience for a patient is, in my view, impossible en masse. I certainly think some patients do get it. I don't think that the service pressure enables it to be possible for all though.
It's all about expectation I suppose. We're conditioned to think that the best possible is what we should aim for. But from a public health and economic point of view, actually achieving that is costly, and the model most hospitals actually work on is "adequate" care as a minimum. That is to say, you get everything done that you need, but not neccessarily as quickly or painless or beautifully as you'd like.
I love it on Casualty when one of the doctors spends an entire episode comforting a patient. In real life I have to see, make decisions and actions on about 5-10 patients an hour, as opposed to the hour of on-on-one people seem to get at Holby City. Maybe I should look for jobs there.
Some of my saddest days are those where I have to decide whether to stay late in order to make that patient experience more than adequate. I'll admit the sadness comes as I have to acknowledge that my own life cannot become subsumed by my job more often. There's only so many times you can cancel meeting friends or partners.
Should I work more than my contracted hours to do this? Part of me wants to. And patients would value it.
The mercenary side of me wonders whether it is my responsibility. I work a 48 hour average week for a decent wage. But 48 hours is 6 eight-hour days a week. To work just an extra hour a day really adds up.
Here's the maths. In my 27 months of work, there have been 15 months of posts where I work at least an extra hour per day. That is 6 hours extra a week. 24 a month. And so taking into account holiday and such, about 240 extra hours a year. (This is a rough estimate not a figure to start quoting...)
Every doctor I know does this. What is the size of the NHS junior doctor workforce? I don't know... Thousands of doctors? Just how many hours go unrecognised, but contribute to improved patient experience?
What becomes even more frightening is that consultants work way more hours than they are supposedly contracted to. And don't even get me started on nursing staff, whom as a professional group at large go so above and beyond it's a joke.
What am I trying to say then?
There are a lot of underappreciated and miserable NHS staff who bust a gut unnoticed and unrecognised every hour of every day. Maybe some of us are crap, but most of us aren't. NHS funding has been ringfenced in the recent sweeping Budget cuts... good. But I think the expectations of the public, as fed by goverment and media are steadily leading to catastrophe. "Excellent" comes at a price. Adequate may just have to do.
