Today I March For You…

MarchPicWhat’s all the fuss about I hear you asking? Why did 20,000 doctors take to the streets of London on Saturday? Isn’t it all just about money? Is it because we don’t want to work weekends? Isn’t Jeremy Hunt promising us a 7 day NHS which can only be a good thing? Why aren’t doctors supporting that?

A lot has been said in the press over the past few weeks, and I feel compelled to offer my thoughts.

#SaveOurNHS

The NHS was founded in 1948. Its core principles are that it meets the needs of everyone, that it is free at the point of delivery and that it is based on clinical need regardless of a person’s ability to pay. Of course, a lot has changed since 1948… The UK population is growing year on year and so there are an ever increasing number of patients using the service. People are living longer, and their needs and demands on the system have become increasingly more complex. Advancements in technology mean we are diagnosing more diseases and much earlier, and treating them with more expensive drugs.

The Problem

Some argue that the NHS was never meant to offer the level of care that it does currently. It is no secret money is tight with many NHS trusts running at a loss. Over the past few years, since the change in the Health and Social Care Act in  2012 the NHS has undergone huge privatisation, with traditionally NHS contracts being offered to private companies. It is this fragmentation and privatisation of the NHS that worries doctors.

Why Attack Junior Doctors? What Have They Ever Done To Anyone?

Under the new contract, a normal working day will be from 7am-10pm Monday to Saturday. Currently junior doctors get a basic salary, around £23,000 in their first year of working, plus additional increments called banding depending on how many antisocial hours they work.  If the new contract goes ahead, it is likely junior doctors will take a pay cut of up to 30% for working the same, if not more hours. The government are also proposing to remove safeguards in place that exist to help prevent doctors working over their contracted hours by removing the financial penalties trusts have to pay.  It also penalizes doctors who want to carry out research, which is vital for finding new treatments and cures for cancer and other diseases.

Scotland and Wales are refusing to impose the new contract, and rightly so.

Why Does It Matter To Me?

Junior doctors need to be protected. They are ‘junior’ from the first day they qualify, up until the day before they become a consultant. This can take anywhere between 5-12 years, if not longer. They are not only our present, but our future. Your lives really are in their hands. Even if you are among the privileged few able to afford private health care, it is still your concern because even the most experienced of doctor, was still an NHS junior doctor at one time.

Isn’t It Still All About Money?

Most, myself included, view being a doctor as a huge privilege. We did not go in to this for money. Certainly, the level of debt, and hours we have to work wouldn’t make it worth our while if we were just doing it for the money. We fund all of our exams post qualification, we can miss Christmas’, our loved ones birthdays and sometimes even weddings because of the on-call rota, and we do it because we care about our patients.

But doctors also have families, bills and mortgages. If the contact is imposed, many simply won’t be able to afford to continue working as a doctor. A large number have already left seeking greener pastures abroad, with many others exploring their options. These are some of the brightest individuals the UK and it is a travesty they are being driven away. It isn’t about a 10% pay rise like the MP’s had, its about not giving them a 30% PAY CUT. So yes, maybe it is a little about the money, but I’m alright with that! But please remember, overall, what doctors are actually fighting for is patient safety #NotSafeNotFair.  We need a realistic service that works for everyone – not just the government.

I Want A 7 Day NHS?

There already is a 7 day NHS and doctors already work 24 hours a day, 7 days a week. We offer an on-call service at weekends, which means anyone that needs to see a doctor will be able to see one. Doctors are in full support of increased provisions at weekends, as long as they are properly staffed and properly funded. We aren’t entirely sure how this is going to happen safely within the time limits the Jeremy Hunt is proposing as there is already not enough money, hospital doctors and GPs to fully staff a 5 day service.

What Does It Mean For The Future?

Demoralised and devalued staff are not good for anyone. Under the new contract doctors will be spread even more thinly, working more hours and for less pay. Tired doctors make mistakes and it is our duty to protect them and ourselves.

The worry is that making the NHS unsafe in this way gives the government even more reason to further push private health care, by showing the public that it isn’t working in its current form. Don’t forget, private companies are already cherry picking the most lucrative NHS services, affording their shareholders huge profits.

Why All The Fuss?

If this continues doctors will leave the profession or move abroad. There won’t be enough doctors and other allied health professionals to staff the service and the NHS will become unsafe for patients. This means, in a few years sadly, you may have to pay to see your GP, pay for your life saving care and pay for all your medication. As will your grandparents and your children. As a doctor working in the private sector, I would likely get paid more, work less hours and have better working conditions. The 20,000 doctors who protested on Saturday are wholly aware of this, but they still marched for you! We need to protect them and our NHS.

Expecting the Unexpected…

5450896108_93cdda258cAs doctors we are trained to manage risk and uncertainty. Given the variety of patients we see on a daily basis very little surprises me now, and even less shocks me. Just about anything can walk through your door, every 10 minutes, and you have to be prepared.

During my registrar year I have been so fortunate to have had Dr Daniel Goldwater to mentor and train me to deal with challenging clinical encounters. At times, we have spent hours debating what we have seen and learnt from our patients. We often use the ‘prospectoscope’ as a tool to look forward to decide what the best management plan should be. This means looking at all possible outcomes (usually along the lines of what if they have a heart attack and die) and then deciding how we can do the best for our patient. This is then backed up by ‘the sleep test’ whereby if we can go to sleep at night with a clear conscious then as a doctor you won’t go far wrong.

There are 2 rules in the Goldwater house – “tell no lies” and “always tell the truth.” This transparency and strong moral compass, which I also identify strongly with, has allowed me to develop my own thoughts and opinions in very positive environment. As I look onwards to my own life after GP training, I’m not sure where I will be working or what I will be doing, but with a solid foundation, I feel ready for what lies ahead.

So it did indeed surprise me when I actually started to feel a bit nervous about going to Africa. I really have no idea what to expect. Most medics will agree that because you have to be such a control freak at work, your personal life can often be left in somewhat of a mess. I feel a little bit like that now. My tickets are booked, but that’s about it!

But I think that’s half the fun, all I really need is my passport and my toothbrush right?!

Trust me….I’m a junior doctor!

So it’s only fair I tell you a bit about myself. Overall, over the past 5 years the transition from the first day on the wards as a doctor to the present day has been so great, I barely recognise the girl that was.

I don’t think any doctor ever forgets their very first day. I think a mixture of fear, delight and awe at those who make the job look anything other than impossible pretty much sums it up. You learn VERY quickly. The smell of the hospital soon becomes homely, you are not bothered if a patients bodily fluids ends up on your new pair of shoes because you have stopped buying expensive ones, and most importantly you no longer pray to not be the first person who turns up to a cardiac arrest or medical emergency because you can actually save a life.

And medical emergencies happen, all the time. Whether it is 4am on Christmas morning or 2pm on any other Wednesday, you can guarantee something will be going on. Noone can really prepare you for life as a doctor. The long days, weekends and  nights on call make your friends and family often believe that you are a phantom existence. It is not a job, it is a lifestyle and it can be bloody hard work!

You see people at their most vulnerable, and you invest so much of yourself in doing the best for them. You see many injustices, bad things happening to good people, and you are the person that has to convey this news to them. You stare death in the face  more often that you allow yourself to admit. Even to this day, no matter how often I am asked to certify death in someone that had passed on, I always take someone with me for fear of being alone. It is these small things that keep you human.

I have gained a broad range of experience from General Medicine, General Surgery, Psychiatry, Obstetrics and Gynaecology, Paediatrics, Infectious Diseases, Genito-Urinary medicine and, of course, General Practice. The life experience is immense,  you cannot not be changed by what you see. You never know what is going to walk through your door. I often think to myself that if I have learnt so much from my patients in such a short space of time, the wisdom of more senior colleagues is unfathomable to me at times. I am just starting out, and whilst I have the basics down, life throws new and exciting challenges at you and the patients you serve daily to keep you on your toes.

It is definitely not glamorous, but it definitely is worthwile. If there is one thing I have learnt, life is short, one must live it, and I plan to do just…

Hello, I’m Doctor Pri!

I am a graduate of the Guy’s King’s and St Thomas’ School of Medicine. It is here, after being interviewed by Dr Dipak Kanabar, I started my journey fresh faced and starry eyed at the age of 18.

Now, I find myself after 11 years of training, standing on the edge of the unknown. The notion I may actually become a member of the Royal College of General Practitioners seemed almost unreachable at points, and yet this week, those words ”competent for licensing” appeared before me. It’s a strange and humbling feeling, being fully entrusted with peoples lives, and it evoked a lot of unexpected emotion.

My greatest realisation, however, about coming to the end of training, is that it is actually only the beginning of absolutely everything! At which point it dawned on me, that I have spent so long trying to get here, I haven’t really thought about what comes next! Fortunately for me, I was not the only one feeling like this, my trusted colleague and dear friend from medical school, Alka, felt exactly the same way.

It is no secret that the face of General Practice is changing, everything is in a state of flux, and whilst I was so proud to read just a few weeks ago that the NHS was voted the best health care system in the world, unfortunately at times, you can feel you are being pulled away from what drove you to medicine in the first place.

My mother was born in Jinja, Uganda and my father attended Makerere University School of Medicine, Uganda. They, like all the Asians’ were expelled under Idi Amin’s rule in 1972 and fled to England. They have never been back to The Pearl of Africa, but it is somewhere I have always wanted to visit.

I decided this natural break in my career would be the perfect opportunity to use the invaluable clinical skills I have acquired and combine it with a visit to a country very close to my heart. After emailing everybody around the world with any links to charitable projects in Uganda, I had just about lost hope, when I was put in touch with Dr Dipak Kanabar. It seemed like fate. As a man who took a chance on me all those years ago, he is also a man who has a love for his home town of Jinja. Within minutes he had put me in touch with Dr Debbie Singh Ahderom, an Australian GP living in Jinja and our plans had been made.

As I undertake this personal and professional adventure, I look forward to sharing my thoughts, feelings and experiences. Please do join me in discovering what lies ahead.