Thursday, 19 June 2008

Junior Doctors

Today, I had a quite distressed patient's spouse come to me. This spouse almost broke down in saying how depressed their love one was, at not knowing what was going on, what their fate was or if they were going to be around for much longer. I had some vague knowledge that the patient was having all kinds of scans and bloods done, so it was just a depressing waiting game of diagnosis. I told this, more sensitively, to the spouse who expressed great relief in actually hearing something from someone, and asked if I'd say such to the patient. Being not entirely clear, I told said spouse I'd try to find the nurse in charge or at least get my facts straight beforehand, but I'd be happy to try.

Whereas I try to know everything pertinent about the people I look after, this patient was not particularly one I knew lots about. Their nurse was in a hefty handover session, so wouldn't be around for a bit. I looked through their notes, and found the House Officer assigned to the patient. The HO was hesitant to tell me... well... anything. Ward Rounds were four hours away with the big consultant type and so the HO repeated for me to wait until then. I revealed the spouse might not be around at that time, to a muted reaction. Eventually I recieved permission to at least have an informal word with the patient, now my facts were clearer. Which I did.

The patient expressed dismay. They referred to doctors as 'Gods walking around the hospital'. Finding myself in the rare position of having to defend doctors, I replied that medics are not all knowing and all powerful. They have to wait for blood results, for scans to come through, etc. My arguments, I'd like to think, were compelling, but the patient was mostly unmoved (although their spouse was very grateful, so the talk was not for naught).

The HO said that they would go and have a word 'at some point', but with ward rounds on the horizon I doubted it'd happen (my shift ended before rounds began, unfortunately).

I'm, as Hot Third Year seldom lets me forget, a mere first year. But my talk with this patient helped, at least a tiny bit. I wondered why the doctor couldn't go and have a big word, before rounds. I'm not saying the junior doctor should've went and made unrealistic promises, or lied, or anything like that! Rather give him a little more information about the tests and results, stuff like that.

The HO I'm thinking of is, to be honest, wet. Lovely, intelligent but a bit of a wet squib. I was with this HO and another patient earlier, where the HO was consenting the patient for two rather uncomfortable procedures. Now, don't get me wrong, I'm aware that noone in healthcare should make promises they can't keep, on pain of suing, but the whole thing was a bit doom and gloom. The procedures are Gastrointestinal-based, which means I have some knowledge of them, and have watched doctors consent patients for them before. The procedures are quite... well. Everyday. The risks are pretty minimal, and if I was a doctor I'd be pressing this point home a bit more, as I've seen other (more senior) doctors do. Inspiring a bit of confidence, without making unrealistic promises. This HO left the patient a bit... uninspired.

So I got to thinking. Is being wet, mild mannered, quiet and subservient like some evolutionary response to working under certain consultants? Does it make life easier, or does it make you more likely to be promoted or have good things said about you? I am not for one second criticising junior doctors, let it be known. 'Wet' is not a criticism and although I suppose a lack of charisma counts as one, it's not meant as a barb. The ability to inspire confidence is certainly one learnt through experience, but it is also something some people are talented with just through their use of words. Naturally, almost.

I'm sure a lot of junior doctors grow in confidence as they grow in experience, and make terrific Senior House Officers and beyond. It seems a shame, however, that the role of HO, the medic the patients see more than any other, is home to quiet types, when some patients could do with someone with a bit more... pep.

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