Thank you very much for your questions. This is exactly the kind of dialogue required to shatter public misperceptions about what junior doctors do. Members of the public get fleeting glimpses of hospital doctors because we are so busy, and that can be misleading. My mum and dad worked in an ice-cream factory. I have also eaten ice-cream. I still do not feel qualified to comment on the relative workloads of different ice-cream factory workers. I appreciate your mum has done 3 healthcare jobs and you may have been a patient, so you have a perspective of what doctors do. I have been a patient and also had direct experience of several healthcare jobs so if as you say your mum has only worked in 3 roles, my experience has been more diverse than hers. I can tell you from experience that healthcare workers in general are overworked and underpaid, but I can also tell you that NHS doctors are being pushed to breaking point at the moment.
You asked how many patients I dress/undress: Countless when I was a healthcare assistant. Since then I have rehabilitated disabled people to be able to undress and dress themselves as an occupational therapy assistant and occupational therapist.
“How many aggresive patients do you deal with?”: Patients often get aggressive due to the frustrations of how long they have to wait to see a doctor. That is because there are not enough of us, and as they see nurses first, nurses deal with the brunt of the aggression. After checking for and treating medical or surgical causes of aggression, such as lack of oxygen, low blood sugar, poisoning or intoxication, infections, metabolic diseases, head injury or cancers, if patients are unreasonably aggressive I let the security staff deal with them.
How many patients' buzzers do I answer at night? Unlike a ward nurse, a junior doctor covers multiple wards at night and usually gets bleeped relentlessly. On one occasion I had to deal with two patients with acute chest pain, at the same time, at different ends of a hospital, and on another I was called to simultaneously deal with a possible transfusion reaction on one ward and sepsis on another. At night, doctors may not have time to sit down, let alone eat or drink and after some night shifts I was barely fit enough to walk home and would have been unsafe to drive. The nurses know this and try to look after us, but often we do not have time to be looked after. How many nurses have you heard of falling asleep at the wheel or being unable to concentrate and crashing their cars on the way home due to exhaustion?
http://www.heraldscotland.com/news/13166072.Hospital_working_hours_cut_after_death_of_junior_doctor/
In some places nurses are understaffed, particularly at night, and personally I think this is dangerous, but doctors are understaffed too.
You asked: “How many hours do you spend with each individual patient?” Exactly! Doctors spend minutes with each patient, because we are spread too thinly and have too many patients. We do not get the quality patient contact that would increase our job satisfaction. I had more job satisfaction from patient contact when I was a porter and healthcare assistant. Patients and relatives often get annoyed by how difficult it is to see a hospital doctor. Even nurses can get annoyed and shout at us when we do not come to talk to their patients’ relatives quickly enough because they do not realise how busy we are when we are on wards other than their own. That is because there are too few of us. When it is a choice between spending time giving vital medical care to keep somebody alive, or talking to patients and relatives, the vital medical care takes priority; that does not mean we would not rather be talking to our patients. In A&E when patients are queueing in corridors waiting for beds, the reason they are not being seen by doctors is because the doctors are busy, seeing one patient after another. You stated that “doctors do not undertake the physical workload” and that is mostly true, but our work is intellectually, emotionally and physically testing, especially if we forget to eat or drink. I would recommend our job to anybody who wishes to lose weight, because as a junior doctor you will lose weight, not only due to having limited time to eat, but also due to the number of miles you walk each day walking from ward to ward, from patient to patient, the glucose consumption of your brain and the increased metabolic rate provoked by anxieties about patient care. At the start of my medical career I used to worry about my patients when I should have been sleeping at night, but as time goes on, I have got used to that stress.
You stated: “You should just appreciate that you get to do a job you love which has a good wage.” Yes. I love my job, but it is like chocolate. In reasonable doses it is great, but too much chocolate on any one day will make you ill, and too much chocolate over a cumulative period will have serious health consequences, just like working as a doctor. “Antisocial working hours and poor work–life balance have been linked to stress, anxiety, depression, cardiovascular risk, gastrointestinal disorders, obesity in men, and workplace accidents possibly due to sleep and circadian rhythm disturbances, social marginalisation and poorer dietary habits. Excessive working hours have also been linked to increased alcohol consumption by women, lack of sleep and increased smoking for both sexes, and lack of exercise for men. Medical careers are a risk factor for substance misuse and suicide.”: http://bjgp.org/content/64/623/295 The wage is good, but if you include the unpaid hours we do, the hourly rate is often not good. In one of my surgical jobs I was working on average two extra unpaid hours per day; that is the same as working 6 days per week but only being paid for 5. If all we cared about was work, doctors would only be complaining about risks to patient care, but guess what, we would like to have lives too, and as it stands, a career in medicine in the NHS will ruin your life. When our Saturdays are considered a ‘normal working day’ it will be even worse.
“You say you should be compensated for studying through your life, what do you think us mere mortals have to do if we are teachers/ pharmacy assistants/emts etc.” I was not always a doctor. I was an army 'medic, physiotherapist and occupational therapist. I had two previous degrees before I started medical school. Trust me on this one. The ongoing personal study I had to do as a physiotherapist or occupational therapist is so insignificant compared to the ongoing study required for a medical career, that any comparison is laughable. My other half is a nurse. She sees how much work I do and I am 100% positive that she would agree with me on this one. The amount of study I have to do strains our relationship.
You said: “be thankful for obviously being academically minded enough and having a decent education to provide you with opportunity” Eduction is not handed to us on a plate and neither are opportunities. We get into medical school through dedication and hard work. When our friends were watching Sky TV, playing on their Playstations and going out, we were studying. I am dyslexic and got poor A-level grades. Due to that and another unseen disability I had to do two other degrees just to meet the entry requirements for medical school. None of that was ‘provided’ to me; I worked for it. I remember while I was in medical school I heard on the radio on my way to a hospital placement a discussion with people complaining that they think doctors get paid too much and I thought to myself ‘Anybody who thinks doctors are getting paid too much should try medical school, to see what we are being paid for’. If you pay us any less, students will give up when they hit walls in medical school, because they will quite rightly recognise that the personal sacrifice is not worth it.
“If you want to orchestrate change focus on the issues which matter, being paid upto £22 an hour is not one of them.” A NHS doctor has to work for 11 years and pass post-graduate exams to be able to earn a basic rate over £22 per hour. You seem to have missed the £10.85 starting wage, which is after dedication at school and 5 years of hard graft at medical school. This does not account for the unpaid hours we do because the NHS is short-staffed. Not having the best people in medicine will matter. But by the time you realise that, it will be too late.
“And if you even have to ask why you should be a doctor other than for financial compensation, then maybe you shouldn't be.” You may be absolutely right on this one. The entry interviews for UK medical schools should have the following screening questions:
1. Would you like to spend time with your family?
2. Would you like to choose where in the country you are going to live?
3. Do you have any leisure activities you would like to continue regularly?
4. Do you value your own health?
5. Do you like getting a good night’s sleep?
6. Would you want to be compensated if any of the above were taken away from you?
7. Would you be upset by having to move house every 6-months to a year, or commute long distances between cities to work?
If anybody answering “yes” to any of the above questions was automatically denied entry to medical school, perhaps you would get the future doctors you are looking for.
