Another Professionalism Debate

Professionalism is something that I personally reflect on a lot. I want nothing more in my medical career than to do no harm and to be professional so that I provide the best for my patients.
At medical school I always seem to be coming across situations in which I question the professionalism of the doctor/healthcare professional I am working with. I understand that in stressful situations when there is a lot to do and think about sometimes common courtesies get missed, but there are times when I see things that make me question professionalism and how we come across as medical professionals.

The case that got me thinking about this issue again this time was on our hospital placement. Each fortnight we go around the wards and practice on unsuspecting patients our history taking and examination skills. For patients this must be a really daunting prospect anyway. Our hospital tutor goes to the patients and asks them if they would be willing to talk to, and get prodded by the medical students in advance of our session and  if they say yes in we go. There are six of us and you can see the shock and mild panic at the number of students on every patients face as we file into the bay and crowd round them, hemmed in by the curtain. And then our hospital tutor introduces them and we take a history/do our examination. The poor patient has to sit there whilst 6 of us go through the motions one after the other. Nothing we are subjecting them to is painful and I think some of them enjoy it as a way to pass the time but there are occasions when we go in and it is clear that the patient wants to go back on their previous ‘yes’ to being a guinea pig. For example there are occasions in which the patients family are there and they clearly want to spend this time talking to their family member and not to us.
In this situation though what is the right thing to do? Should we be quick (this is often the option that our hospital tutor goes for, allowing only a couple of us to do the examination or taking a rapid fire history himself) or should we recognise that the patient doesn’t want to be examined right now and leave them be. I personally would prefer the latter. Whilst it is important for us to be able to practise examinations, none of these patients actually have signs, we are more just looking at normal at the minute so we can practice on ourselves. I don’t see that there is any need to disturb them when they clearly don’t want to be disturbed. I wonder how we come across if we don’t pick up on these signs and act accordingly and I worry that we come across as rude to the patient.

There was a specific situation during our hospital placement that made me particularly uncomfortable and after discussing it with my colleagues it was clear that they felt the same. There was a patient on the neurology ward who we went to see to practice respiratory examinations. When we entered his bay it as clear that it would be difficult to take the respiratory examination as he had his arm in a sling and a neck brace on and we were informed that we shouldn’t sit him forward. He also had external fixation on one of his legs and it was difficult to get in close to him. I was expecting our hospital tutor to leave him be and not let us examine him because none of use wanted to risk hurting him but he pressed on and let one of my colleagues have a go. As soon as we entered the bay it was clear that the patient wanted to chat, he was talking in confused sentences but appeared to believe wholly that he was getting his point across. What made me uncomfortable was that our consultant completely ignored him and talked only to us. All the time that he was talking the patient was trying to get his attention to tell him his story, from what I could gather, but our consultant continued to ignore him.

This made me uncomfortable. Understandably though we were rushed for time and I know he was trying to get the best for us from an educational point of view. I would have felt much more at ease if our consultant had spoken to him a little, even just said yes at the end of a few of his sentences to appear as though he was listening. This type of thing makes me question how we come across. In my mind that made him less professional but the patient, who was admittedly very confused, didn’t seem hugely fazed. Our consultant redeemed himself by talking to the patient very well after my colleague had finished her examination but it still grated on me that he had ignored him until that point.

It also makes me wonder about a larger problem. The NHS and medical care in general is supposed to put patients first and yet we as trainee doctors are constantly doing procedures which our seniors could perform better than us. How is that putting patients first? It is putting our medical education first surely? Of course new doctors have to be trained for the future well-being of patients and I suppose that finding the balance is the key.

Anyway enough reflection. I need my bed to have a productive day of revision tomorrow!

Why We Shouldn’t Complain about the NHS…

I’ll admit that I’ve done it, and I’m sure we all have at some point. Admittedly when you are sitting in A&E, nursing a concussion only to look at the clock and realise you’ve already been here for 3 hours it is hard to see the rosy side of our healthcare system with it’s long waiting times and ever decreasing availability of services. However we shouldn’t be so fast to complain.

I learnt a couple of days ago that someone I know from America is dying. He has a congenital heart defect and requires a new pacemaker as well as a follow up surgery to try and reduce the defect. Unfortunately he cannot afford either of these things.
And that’s that.
The American healthcare system just watches whilst he dies from something completely preventable.

Now, the American system is fine for those people with insurance and it tries to help those who are the poorest and can’t afford healthcare but it misses a chunk of people in the middle. Unfortunately for my friend no insurance company will cover him with reasonable premiums because he has a congenital disease. So he can’t afford to pay the premiums, and certainly can’t afford to pay upfront for the surgery despite hardly missing a day of work in his life.

His family are very strong and are glad that they’ve had the time that they’ve had. They have accepted that at any day they could wake up and he could not be with them anymore but we have to ask ourselves why they should have to accept this? Both him and his wife work extremely hard, they are pillars of the community and yet because they don’t have the monetary means the healthcare system leaves them by the wayside.

Healthcare is there to alleviate suffering. My friend is suffering because he can’t afford care and his family are suffering with the knowledge that they can’t do anything and will suffer more when he eventually passes away. It’s pretty ironic don’t you think that it is a healthcare system which has caused this suffering?

I had strong and mixed emotions when I heard about this, I was mad that this is happening to such a young man and wonderful family, I was sad for them and then I was extremely grateful. The horrifying truth is that in the UK my friend wouldn’t be dying because we have a healthcare system that is free at the point of access and that does not discriminate based on economic standing.

So yes we may have to wait 4 hours in A&E or 6 weeks for our knee op and that’s annoying, but at least we get care and we don’t have to worry that we can’t afford it.
I have a new found respect for the NHS and the values it upholds and if anyone catches me moaning about it again, feel free to give me a slap!