Being a doctor is a vocation but the reality of practice for some is not without its challenges. Guest blogger Victoria Bradley writes about her experience as a doctor in training.

When you type “being a doctor is…” into google, three of the top five answers predicted are “hard”, “overrated” and “stressful”. I think that’s a pretty good representation of life in the modern NHS. Healthcare environments can be abrasive places to work, and we can be cruel to each other. Morale is low, there are online ‘dropout clubs’ for doctors who can’t bear it any longer and, through it all, the media headlines demonize us.

Being a doctor in training has the benefits of supposedly protected time for education and structured supervision, but actually often brings a difficult balancing act between training and service. A recent JRPCTB (Joint Royal Colleges of Physicians Training Board) survey showed 91% of CMTs (Core Medical Training) reported spending 80-100% of their time ‘on service’1.

In the midst of all this squeezing it’s easy to lose sight of our patients.

Unsafe working environment

Earlier this year I was in a core training post and I alerted my trust to an unsafe working environment on the ward where I was working. I had every factor in my favour to help me report my concerns – I was in the last week or two of my job, so had no concerns about what might happen to me after, I’d passed my ARCP (Annual Review of Competence Progression), and I felt well supported by my peers and seniors. I was lucky that the trust where I worked took me seriously and made me feel supported and secure in what I had done.

But having gone through that process I came to a horrifying realisation. That I have seen countless examples of poor working environments over my career and never before have I done anything about them.

I defy any doctor to not recognise these scenarios. The night shift of trying to cover too much because the locum didn’t show up. Being asked to do a procedure solo you’re not confident at because there isn’t anyone more senior to supervise you. That member of staff everyone thinks is “a bit rubbish” and tries to avoid giving clinical responsibility to. The rushed decision making because of bed pressures.

All of those situations place patient care at risk but how often are they raised as issues? I would argue a tiny proportion ever see the inside of a board room, unless an SUI (Serious Untoward Incident) results. Most are grumbled about over a pint in the local – but that’s as good as it gets when it comes to debriefing our concerns.

And that’s because the prospect of putting your head over the parapet is deeply intimidating as a trainee. We are frightened to be labelled as trouble makers, to have our working life made miserable by the people we report. The survival instinct within us gets in the way. And everything we read about whistle-blowers in the press only reinforces that.

Working together
“Those in training are perfectly positioned to recognise and raise patient safety issues”

The ‘happy doctor’ paradigm

For me, the way doctors are treated in the NHS is at the core of this problem. To achieve the work we do with the resources we don’t have there has to be an assumption of saintly vocational dedication, and an absolute subjugation of a doctor’s needs. When we feel that we just want to get through the day and out the other side intact there is no scope for us emotionally or intellectually to be a good advocate for our patients. The corporate world has long known that happy workers means greater productivity and improvement across the board in key business demographics2but this message does not seem to have filtered through to the NHS.

If we could achieve those happy doctors – those in training are perfectly positioned to recognise and raise patient safety issues. They move around often enough to see the problems that long term members of staff have come to accept as normal, and they work across all clinical areas.

The proposed changes to the GMC national trainee survey  [Editorial note – this refers to some new questions being piloted in next year’s survey looking at how the training environment can support doctors in training to raise concerns] begin to ask trainees about the supportiveness of their workplace in general and perhaps take the first step to identifying those trusts furthest from the “happy doctor” paradigm.

In the meantime while our utopia is achieved the survey provides a safety net for doctors to report their concerns; as a last resort it offers to enable those who cannot otherwise make that leap.

Victoria BradleyVictoria Bradley is a Medical Education Fellow at Kings College Hospital NHS Foundation Trust in South London.

Footnotes

1. Tasker F et al. Survey of core medical trainees in the United Kingdom 2013 – inconsistencies in training experience and competing with service demands. Clinical Medicine 2014 Vol 14, No 2: 149–56
2. Harter J et al. Causal Impact of Employee Work Perceptions on the Bottom Line of Organizations. Perspectives on Psychological Science July 2010 vol. 5 no. 4 378-389