A day in the life of a junior doctor. Shared by a junior doctor on Facebook, whose identity I’ll keep private as per usual.
The day they describe isn’t a one-off or a worst case scenario, it’s pretty common to have this level of , this kind of experience is common. And it’s this constant struggle that grinds us down; the feeling that we are struggling to provide adequate care in the face of underfunding and systems which don’t prioritise properly. We chose these jobs because we want to do good, and work to the best of our ability, so being severely pressurised and limited to the point where we can’t is very distressing. This is real; my close doctor friends were saying something very similar to me just the other day.
And worst of all, the blame displaced onto you and your colleagues by the media and those who just don’t know how the system works. It’s disheartening to feel blamed and judged for the shortfalls in our system, which have been engineered by politicians, not hospital staff.
Tonight, my hospital is on red alert. We have 40 more patients than we have beds to put them in. Our A&E is bursting at the seams. All surgery (with the exception of emergencies and cancer surgeries) has been cancelled.
How did we get to this? Because cuts to NHS budgets have led to cuts in hospitals, and out-sourcing to private companies has led to more money vanishing from the front lines. Because increasingly stressful working situations have led to many nurses and doctors taking time off with work related stress. Because cuts to social care, including home carers and nursing homes, have meant that many patients languish for weeks in hospitals, because there is nowhere to safely discharge them to. Because community hospitals have all but been obliterated, when in this climate they could be the perfect environment for our increasing number of elderly, medically-fit-but-not-quite-ready-for-home patients.
Barely a day goes by when we are not emailed en-masse by our rota coordinator, begging us to stay on and work an extra 3 - 5 hours, to help clerk new admissions, to fight fires. And we often do it. But it is not enough.
Our NHS is malnourished - the current administration have starved it of funds, of resources, of external support. And we are rapidly reaching a point where reversal is impossible.
It is September 12th 2016. My hospital cannot cope, at a time when we are traditionally at our quietest. Winter is coming… will the NHS survive? Will our patients?
My last trust spent half the year on ‘black alert’ and in a state of Major Incident. This is usually a status reserved for actual ‘major incidents’; i.e when terrible things happen which suddenly divert a large surge of patients to a hospital (for example, a train crash). What happens after a hospital declares a Major Incident is that it has effectively declared it can accept no more patients, and all ambulances get sent to other hospitals. In serious cases, A&Es might even be temporarily shut down and patients diverted to other local hospitals. But the ptoblem is, A&Es are increasingly being shut. No matter where you are, I can guarantee that your neighborhood hospitals will have less space and less capacity to help you; they may be worse! And that’s not even starting on the current state of mental health services. Which is even worse. Hospitals NEED empty bed spaces, so that if slightly more patients come in, they can cope. Winter is traditionally a very busy time of year because people get sick more often and more seriously, particlarly the very old and the very young; paeds and geriatrics are absolutely heaving during the winter. Ideally, our system should have enough slack that hospitals can absorb this. To truly beat this, we have to recognise that slack in an unpredictable system is NOT waste. However, empty spaces don’t make politicians happy; it’s easy to confuse slack with waste, and there has always been a huge pressure to make ‘efficiency savings’ from the most senior levels. Year on year, they have failed to account for the increase in spending we need to cope with an ageing , increasing population with more comorbidities. This amounts to serious cuts, but the myth of a ‘bloated, overspending NHS’ keeps being circulated in the media. As hospitals are faced with budgets that buy them less and less, they have whittled and whittled as best as they can to preserve as much as they can. But make no mistake: take out the slack and you take out our ability to cope with ANY change in demand. And we desperately need that slack. It’s absolutely not sustainable to work at maximal capacity all the time; yet this is often what we face. After I left, the code blacks continued continued. It’s far from the only trust to have reached complete capacity to the point that it is unsafe; it’s increasingly common for many trusts to spend the entire winter in and out of major incidents, despite the best efforts of their team to discharge patients in a timely manner. I’d like to acknowledge social services and community teams for the thankless and overwhelming tasks they are faced with; they are completely inundated with more patients than they can cope with on a wider level, and many discharges are delayed because of limitations to this side of patient care. Arguably, supporting community care and commuity hospitals and social services would likely have a huge impact on how many frail elderly patients are admitted, and decrease pressure on hospitals. Of the hospitals I’ve worked at, more than one have had to shut or partially shut wards due to being unable to find enough nurses to cover those wards safely. This further reduces our capacity. Many junior doctor job slots go unfilled, or are minimally covered by locums, with the day teams pickng up the increase in workload. This inevitably means we work harder, for longer, struggling to get everything done that we need. But it also means that we are open to risking patient safety. Truly protecting patient safety requires time: time to hand over properly, time to review properly, time to discuss with colleagues properly, and time to action and follow up on all their investigations and managements properly. A junior doctor or nurse run off their feet madly dashing to deal with the most urgent things is at a higher risk of forgetting (or having no time to) do something important, or checking something vital, therefore patients. understaffed. And many hospitals are understaffed. Not through choice, but through underfunding and through worsening conditions driving out the very workforce they need. There’s only so long many people can work in a pressure cooker before they decide to look after their own health, too. This isn’t just OP’s hospital, or @medical-sho‘s hospital, or mine, it is many, many hospitals all across the UK. Even over the summer, many trusts struggled to cope at times that are generally considered off-peak for hospitals. We’re getting worse at coping, and it’s not going to get any better without serious help and serious funding. And it’s only going to get worse as the cold weather sets in. Winter is coming.
(Now that I’m off mobile Tumblr (urgh) I thought I’d add a transcript for accessibility:) A day in the life of a junior doctor in the NHS: Start 07:50, ready for board round and teaching at 08:00. Ward round begins approx 09:00 - 09:15, where every patient under my team’s care is reviewed and a list of jobs for the day generated. During ward round a medical emergency is called for one of our patients and, after full assessment and initial management, it is decided they need an urgent CT Head. Quickly call radiologist and agrees for the scan to be performed. Phone CT: ’…ah. Well, you’re at the wrong hospital for an urgent CT today. One of our scanners is broken, you see and we need the engineers to come (private company). But we could do it now if you could get him here, although there aren’t any daytime porters available (different private company). Sooo…’ 'Ok, I’ll bring him down myself - no worries.’ Recruit another doctor, take patient to scan. During scan I’m reprimanded for not having completed manual handling at this trust despite having done the same ridiculous course at every other hospital I’ve worked and as a medical student.’ Scan done, thankfully looks ok. ‘Sorry, also no porters to take the patient back.’ Take patient back despite above mentioned reprimand. Rejoin ward round and try to catch up on what’s been missed. Start cracking on with jobs. Lose one doctor to theatre and one to pre-assessment. Also worth noting that majority of staff are locums (thankfully in my case excellent locums, but I’ve been in many a situation where this is not the case.). This is due to chronic understaffing and leads to poor continuity of care (but the government have fixed the staffing problem, that’s what they’re saying; right?) So you crack on with a busy day and get stuff done, often eating at a computer rather than taking any actual break. The day finishes about an hour late for the staff on normal days, which is excellent going (many of my colleagues will finish much later, daily.) and the overtime isn’t paid, which we all accept is part and parcel of the job anyway. I’m on call so am still on shift (minus break) and there are three patients to clerk in and admit, take bloods etc. One patient becomes very sick and urgent bloods are taken. As the only doctor on the ward of 40 odd patients, I can’t leave so call porters to request the urgent bloods I’ve taken arrive safely to the lab (pod system not working and no private engineers to fix it). It’s a different (private) company out of hours and I’m on hold to Vivaldi’s Four Seasons for seemingly an eternity before someone picks up. Sure, porter comes up and sits next to me and starts chatting. Politely remind of the urgency of the bloods and he leaves, bloods en-route to lab. 2h later and no results. Phone lab…'sorry, they’re not here.’ Bloods never made it. Rebleed and run to the lab and back, thankfully leaving an excellent nursing colleague with my patient. Later decide a different patient needs an urgent CT head again. Phone radiology (outsourced out of hours to a private company in order to get the scan. It’s agreed and a reference is provided). Phone CT ’…sorry the scanner is broken still. There weren’t any engineers available today. And anyway, there aren’t enough porters…’ I despair at this absolute mess around me, for which doctors, nurses, HCA’s, radiographers, physio’s, pharmacists and all the other members of staff that keep this sinking ship afloat out of good will are blamed for bringing it down, the media suggesting we are greedy and overpaid. I hope the government wake up and realise that they are the ones destroying something that so many people are so passionate about. I hope that they realise that it’s the progressive privatisation of services to companies accountable to nobody is killing it. I hope they realise that we, and the public, can see through the lies around staffing (rather hard to maintain when the patients that use our amazing organisation can actually SEE the problems). But, you know, making doctors do NON-EMERGENCY work over weekends will solve this. The government is delusional or manipulative to the extreme and I can’t actually decide which is worse. I, like many of my colleagues, want to leave because none of us want to work in a service where we can’t provide the best care for patients anymore, and that responsibility is entirely out of our control. We’re miserable because we care. It’s very simple. But I’ll stick around for now, as it really is worth fighting for. Also, one more thing; once all of the above is done for the day, then junior doctors far and wide stay in work to go to theatre, to do mandatory training, to carry out work based assessments and the endless paperwork required for OUR OWN training. For free. And we always have, without complaint. But the media will still carry on with this ‘lazy and overpaid’ mantra of theirs. Rant over
