Saturday, September 06, 2008

Musings Of A Medical Dinosaur

A work in progress.
Worth reading, to start with.

The wind is changing; has changed. Jane Doe, writing the jib I've tagged above, typifies what I have come to think of as the 'modern' attitude. Respectable papers in such august journals as the Annals of Emergency Medicine are chronicling the decline of the once mighty General Surgery. In part, this is because specialisation makes being a generalist difficult, but, and perhaps this is the greater part, also because no-one wants to work the hours.

Long hours, once seen as the domain of the macho surgeon, are no, it seems to me, increasingly seen as both unnecessary and unfair. Many young Docs, confronted with the sort of punishing shifts once common in the NHS were taken aback. It was not what they were expecting. I must confess I find this hard to credit; it was hardly a well kept secret, and many medical dramas made it a key feature - see The Houseman's Tale, Cardiac Arrest or even ER for reference. Perhaps I write from a privileged position; Pa Shroom was in the business, so I saw the routine 12 hour days, and 1 in 3 (1 in 2 when someone was on leave) he worked - and this as a consultant.

I knew exactly what sort of hours I would be expected to put in.

But if you weren't sure... surely it wasn't that hard to find out..?

The way I see it, the way I saw it... you worked all the hours God sent when you were young, and I will never be that young again, and it got easier as you got older. I was always at work earlier, and later than either my SHO and Reg; I'm sure they worked harder, were cleverer... but I worked as long, if not longer.

Was I tired? Yes, all the time. Did I make mistakes? I'm sure I did. My shroomy pride has blotted the copy-book of my memory clean, but I know I didn't kill anyone. Did I learn anything?

Almost everything I learned, I did on call; often in the darkest hours of the night, often in desperation. Was this the best way to learn...?

I can't say that it was, that it is. I'm sure it's not, but it worked for me; doing my time pulling scut duty taught me the basics. Some might say that putting iv lines in, mixing and starting iv drugs isn't real doctoring. It certainly ain't glamorous, but it's as much the duty of a doctor as anything else. And what happens when the iv techs aren't there, or can't get it?

They call me, or other grumpy bastards similarly full of themselves.

Continuity? Sure, you can never have absolute continuity, but it seemed to work better. It was the exception, rather than the rule that someone on the firm was away, and we all knew all of our patients.

Is the way I learned better? I don't know, but it did work for me, and I know I'm not alone. Is that reason enough? No. To say 'I did it this way, so you have to too', is blinkered.

But it shouldn't be dismissed out of hand either.

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