London Med Student

A medical student’s take on university life and becoming a doctor

New ’situational judgement’ approach too narrow

By London Med Student - 13th February 2012 10:34 am

Our careers advisor filled us in a few weeks ago on the new process of applying to the foundation schools, as I will be in the first batch of applicants. The new scheme has eliminated the white space questions, replacing them with a Situational Judgement Test of multiple-choice questions based on dilemmas we may face as an F1. The SJT counts for 50% of the points, with the other 50% based on academic performance and papers published, etc.

The few example questions for the SJT seem fairly difficult, which I guess it is designed to be. It’s very hard to know exactly which of several relevant answers are the most ideal. I find it a bit odd being asked questions about my behaviour as an F1 which feature things such as problems with handover and paperwork, something I clearly have very little experience of as a student. I spend my time in hospital trying to see patients and doctors with pressing paperwork tend to ignore us in order to get it done. However I will say that at least the SJT rewards those who get themselves into clinics - those students who have a general experience of the hospital will do much better than those who only go in when they have to.

But only half the test actually takes my achievements into account. So everything I have worked for so far in medical school - my ranking in my year and SSC marks - contributes to less than 50% of my overall points. The rest of this 50% comes from additional degrees (marks vary depending), and then a maximum of two marks from having a paper published, and/or presenting at a national conference, and/or winning a national prize (e.g for an essay). (And if you don’t have any of these already, it’s pretty much too late to get something published before the deadline).

Nothing else I have done counts. Not the audit I worked on, not my diploma that I did alongside my studies, not being president of an award-winning volunteering society, not raising hundreds of pounds for RAG. Not my BSL or first aid qualifications. I can’t even mention these on the form, because there is nowhere to put them. It’s especially annoying that I have thought these things would help my application for the last few years, but suddenly I’m getting the message that I shouldn’t have wasted my time.

I should have spent the last four years in the library, getting myself into the top decile of the year, because that’s what the marks are for. I don’t think that is right.

The most intelligent doctor isn’t necessarily the best doctor - we need to be good all-round, we need to have some life experience. I’m aware that people manipulated the white space questions (a lot of societies got started just for someone to become president of it) but are hypothetical scenarios really a better measure? Surely consistent, honest effort should be rewarded somehow.

Tags: , ,
Posted in London Med Student | No Comments »

I don’t see the relevance of Frida Kahlo…

By London Med Student - 22nd January 2012 8:32 pm

I don’t know how it is for other universities or other courses, but for me very few teaching sessions are well-defined; I don’t really know what these ‘seminars’ or ‘tutorials’ are supposed to be, as it’s never consistent.

I just turn up and take what I get…sometimes it is essentially a lecture, or sometimes if it’s genuinely a ‘tutorial’, we’ll be going through a piece of work we are supposed to have already completed.

Sometimes seminars are interactive-style lectures, which can range from a (doctor) teacher talking at us with the odd question thrown in, to a teacher grilling you over a subject in detail (painful, but it makes you learn it) or if you’re really unlucky, a teacher playing ‘guess what I’m thinking’ and asking you vague questions repeatedly until you finally say what they want to hear.

What's Frida got?

What's Frida got?

These are all relatively okay, but there’s a new breed of teaching style emerging that is becoming much more prevalent within the medical school, and infuriating me more and more often. And that is the ‘break-out session’.

As far as I can gather, modern teaching ideals say that sitting us all in a lecture to be fed information is bad and wrong, and everything should be interactive and have feedback and involve discussions of how we feel about the subject. So instead of say, sitting 400 people in a lecture theatre to listen to an expert explain a subject to us, they split us into small groups, put us into a variety of junk-filled classrooms and make us spend an hour with a chirpy medical educator who spends the first 10 minutes asking us to brainstorm what we already know about catheters. NOTHING. That’s why I’m here…

Don’t get me wrong, I’m not opposed to group discussion/communication practise. There’s some instances where the medical school does it really well - I love it when we get the chance to talk to the actor patients, or ‘expert patients’ (usually someone living with a long-term condition), because we get clear, personal feedback on how we are doing, and useful insight from an outside person.

But often I feel that it is forced unnecessarily, or with no clear guidelines to what we’re doing and why. Earlier this year, I found myself sitting with four other people looking at a Frida Kahlo painting and discussing the answers to a list of questions about how this reflected her feelings about her medical conditions.

“I guess she feels…sad?” Sorry, but without someone with some kind of arts or humanities background to help me, I’m not really going to have a clue. And what does it matter what I think actually? Unless the medical school is worried that I’m incapable of feeling and empathy (and don’t worry, I always cry at the end of Gladiator) I find it highly unlikely that a patient is going to present to me with an abstract self-portrait of her body for me to interpret.

“Hmmm, there’s a lot of heavy brush-strokes in this…perhaps she’s got MS”.

Posted in London Med Student | 7 Comments »

Reform opposition masking budgetary constraints

By Matthew Shaw, co-founder of Remedy UK - 27th April 2011 9:47 am

Remedy UK is pleased to have been invited to be a part of the NHS Future Forum - a special group which the government will consult over improving the Health and Social Care Bill.

We hope that this will be an opportunity for junior doctors to plant a foothold on a secure training structure for the future.

The Health and Social Care Bill creates two particular problems for doctors in training which we would like addressed. Fragmentation of clinical services will make it much harder for doctors to arrange training programmes.

We expect to see a lessening of the role of deaneries, which have always been fatally compromised by their internal conflicts between their educational goals and their SHA paymasters. We are keen to see the Royal Colleges given a stronger voice in maintaining professional standards, and we consider that they can best ensure that doctors-in-training are sent to the most appropriate training units.

We also want mechanisms in place to avoid the hands-off management style which could relegate manpower planning to the whims of market forces. We will be fighting to ensure that universal training structures and standards are preserved and that better mechanisms exist to plan workforce numbers. The government must not wash its hands of this responsibility and apportion blame to someone else if things don’t work out.

Last month Remedy affirmed our view that there is some good in the Health and Social Care Bill, as well as some bad, and we emphasised that the budgetary constraints - NHS chief executive David Nicholson’s challenge of £15bn efficiency savings by 2015 - have been receiving insufficient attention.

The email responses we received unsurprisingly ranged from very positive to very negative (the balance was about 3:2 towards the negative) and we have taken note of these comments. But we firmly believe that that are hard decisions to be made about rationing and constriction of services, and these decisions should be made by doctors. Not by local politicians who are looking for the next vote.

We look forward to taking part in the improvement of the Bill and defending the ability of doctors to get world class training in a new NHS.

Tags:
Posted in London Med Student | No Comments »

Obituary: Dr Peter Gooderham RIP

By Richard Marks - 15th February 2011 11:08 am

We were deeply saddened to hear of the death of Edmund Peter Gooderham on the 9 February. He died suddenly and unexpectedly a few days after his 46th birthday. Peter was a great supporter of Remedy and had been a key advisor to our legal team. A man of incandescent wit and unquestionable wisdom, he will be sadly missed.

Peter’s father was a vet and his mother was a medical social worker, and after school he chose to go to Cambridge to study medicine. He spent his third year studying Social and Political Science, and developed a life-long interest in these fields.

He qualified in 1988, and set out on a career in General Practice, but his interest in law got the better of him. He decided to study for an Open University Law degree in his lunch hour rather than doing crosswords. He completed his LLB in 2002, and the following year he gave up clinical work (he later voluntarily relinquished his GMC subscription) to take up an academic law post in Cardiff. He then moved to Manchester as a lecturer, where he taught on healthcare ethics and law. He studied for a PhD that he submitted; the thesis currently sits with the examiners.

His great knowledge of jurisprudence was matched by his relentless passion for doing the right thing and using the law for moral crusades. His well-refined sense of right and wrong was a great driving force; he was one of life’s true visionaries and inspired those around him to keep going.

He took a great interest in the pressure group Remedy’s legal case against the GMC involving the architects of MTAS. He had first-hand experience of many inappropriate referrals to the GMC. He felt that the GMC should have taken a different stance on this particular case, and was a firm advocate of accountability and personal professional responsibility. He was convinced that we were doing the correct thing, provided a great deal of background information to our legal team, and quite enjoyed the ‘whiff of mischief’.

He was incensed when the GMC won the case in court, and strongly pressed Remedy to launch an appeal. He then co-authored an article in the BMJ which pointed out the absurdity and inconsistency of the decision.

Peter was a strong advocate of the rights of doctors who had raised concerns about shabby treatment of patients. He felt that many of these ‘whistleblowers‘ had had their lives wrecked for doing the proper thing, and that the protection that existed for these doctors was virtually non-existent. He campaigned for a change in the law and the culture of the NHS. He was also a campaigner on issues of patient confidentiality, and he told a House of Commons committee that he did not want information about him to be placed upon an electronic database.

He dabbled with politics, regularly attending party conferences, and was selected to be a prospective parliamentary candidate. But he resigned his membership when David Cameron said that he wanted the Tories to be “the party of sunshine”.

Many doctors contacted Peter for medicolegal advice, particularly those who were referred to the GMC, and he gave advice to them freely and promptly. He was a regular contributor to the chat forums on DNUK where he posted under the pseudonym of Blue Dragon. The wise and knowledgeable advice that he gave so freely, often with incisive dry humour, was greatly appreciated. The breadth of his knowledge spanned across clinical specialities and other non-clinical disciplines - a rarity these days. He was the sensible side of the Dr Rant team, and wrote many articles on their blog about the way that the NHS should be run.

He met Sarah Tiley when he was at medical school. He proposed to her on Barmouth Railway Bridge (Peter was a great train-lover), and they married in 1993. She is now a GP in Shropshire. They shared many activities together, including an interest in rugby and cricket. They would sometimes go to all five days of the Trent Bridge match, and in the winter would listen to the cricket on the radio. Peter was a great fan of the outdoors, and enjoyed gardening, hill-walking and observing nature; they were planning a trip later this year to travel the length of the Outer Hebrides culminating in a couple of nights of luxury on Skye.

He is survived by both his parents, and his step-father who was a child psychiatrist.

A genuine and lovely man, intelligent humorous and human, we send our deepest condolences to his friends and family.

Tags:
Posted in London Med Student | No Comments »

Time to honour the Bristol whistleblower

By JJ Oliver - 1st September 2010 9:42 am

How would you feel if you moved to a new hospital and discovered that their mortality for the cases you were doing was twice the national average? Would you try to get things changed? And if you succeeded then would you expect to be treated as a saint or a sinner?

Twenty two years ago Dr Steve Bolsin found himself in this position when he took up a post in childrens heart surgery. After many years of struggle he got things changed - but at a huge cost to himself. Now it is time for British medicine to acknowledge the contribution of this unsung hero.

Dr Bolsin was appointed as a consultant anaesthetist in September 1988. Almost immediately he realised that there were problems in Bristol with the conduct of open heart surgery in children. He was particularly concerned about the long duration of surgery and bypass, and the consequent effect on postoperative outcomes. He soon raised this with his professor and his departmental chairman.

The Professor of Anaesthesia in Bristol recalls that Dr Bolsin had: “…expressed his concerns to me about problems in managing small babies following cardiac surgery… He was concerned that the mortality in this group of patients was much higher than he had been accustomed to… I advised him that rather than create waves with little credible evidence, he would be better advised to collect prospective data on babies and children who he anaesthetised for cardiac surgery in Bristol.”

Bolsin carefully audited the process, and continued to draw attention to the problems. In one of his letters he pointed out that the mortality for open-heart surgery in babies was “one of the highest in the country”. He expected that this letter would get a positive response. But instead of a commendation, he received a rebuke, and was sent away to collect more data.

Further data collected over the next three years showed the same patterns. He audited not only the anaesthesia and intensive care, but also at the work of the perfusionists and surgeons. The findings repeatedly demonstrated that there was a high mortality for children having major heart surgery.

At no stage was he told that he was wrong or mistaken in seeking to gather information, and he received assurances that the matter would be looked into. But nothing changed.

Between 1992 and 1995, he became progressively more desperate. He secured the help of senior doctors in other hospitals, the press and the Department of Health. For this he was rebuked, being told that he should not take information to ‘outsiders’ and that he should ‘keep his head down’. As the data he collected become more solid, his working environment became increasingly hostile.

A compounding factor was the uneasy relationship between anaesthetists and surgeons. He found that the surgeons ruled the roost, which made it difficult for any anaesthetist to appear critical of a surgeon.

After many years of adversity his data was finally acted upon. The death rates for children’s heart surgery in Bristol were dramatically reduced as a result of his determined efforts.

He also catalysed the development of a new process in medicine - clinical governance. It’s now used routinely to study and improve medical care across the country. And he was elected as the first national audit coordinator for the Association of Cardiothoracic Anaesthetists of Great Britain.

But here the tale turns sour. His career took a major nose dive, and he found himself unable to work in the UK. He eventually moved to Australia. He’s a forgotten hero of British medicine and, having recently had a quadruple bypass of his own, must wonder whether it was worth it.

The great and the good tell us that we should be impartial and committed, and that Good Medical Practice is based around the concept of integrity. The reality of whistleblowing is that the brave honest and committed doctors who attempt to change things risk professional suicide and spending the rest of their careers in the wilderness. Yet the smiling face of the Professor who Bolsin originally turned to for help is captured forever on an oil painting that hangs in the royal college.

Fortunately the British have a way to recognise and acknowledge the significant contributions that Dr Bolsin made to patient care. The Honours System exists for precisely this purpose. A group of his friends and supporters are now in the process of completing an application for him.

Remedy believes that the awards mechanism of the establishment should be used to bestow honour upon those who truly deserve it. We would wholeheartedly support this application, and invite our supporters to do the same. And there is a Twitter Group to support the campaign.

Tags: ,
Posted in London Med Student | 4 Comments »

Calling on the GMC to re-define misconduct

JJ Oliver, Remedy - 30th April 2010 2:15 pm

The Remedy judicial review being heard on 11 May could drive a coach and horses through the meaning of misconduct, and the meaning of unfitness to practice.

Doctors who are involved in management will be anxiously awaiting the verdict, since they may find themselves personally liable for their managerial decisions in future. And appeal lawyers across the country will be looking to the judgement to see whether the GMC has opened the floodgates for them.

Doctors are always happy to whinge about their managers, but serious action against doctors in management is rare. The GMC has only taken action in a handful of cases. One such case was that of Dr Roylance - the chief executive caught up in the Bristol babies cardiac surgery storm.

The MTAS recruitment process was a unique disaster. Some of the superlatives used at the time still stand out; it was described as the “biggest disaster” in a generation, and the anger it generated has still not subsided. So when Remedy wrote to the GMC asking for the senior doctors responsible for it to be referred to a fitness to practice committee then they hoped that the case would be duly investigated.

But the GMC politely declined the opportunity to hold such an inquiry. At this point Remedy reached for their lawyers, and challenged the GMC to defend themselves in court.

The case raises significant issues well beyond the events of 2007. At the heart of it lies the prickly and complex issue of what constitutes unfitness to practice. What sort of actions outside the clinical arena will render a doctor unfit to practice as a medical practitioner? The GMC have defended themselves on the grounds that: 

Whatever the conduct of [The Proposed Defendants] with regard to MTAS, I do not consider that it can sensibly be said to impinge on their fitness to practise as medical practitioners.

Yet this seems to be at odds with many previous rulings. There are many doctors who have been removed from the medical register for what has been referred to as “bringing the profession into disrepute” and for “conduct unbecoming of a doctor”. And if, for example, the doctors under investigation had knowingly breached the laws affecting international medical graduates then would the GMC still be arguing that this had no effect on their ability to work as doctors?

There has never been a case of deficient professional performance brought against a doctor for managerial issues. If Remedy is successful then this verdict will send a cold chill down the spines of medical directors and doctors working for health authorities - especially in an era of financial uncertainty.

The case is being heard in the High Court on 11 May - five days after the general election. Remedy has created a Facebook group for supporters of their case. If you agree with us, please attend court or, failing that, express your support.

This verdict is going to be studied by medico-legal bodies for many years to come.

Tags: ,
Posted in London Med Student | No Comments »

“A major blow against limiting doctors’ rights”

By Richard Marks, Remedy's head of policy - 26th January 2010 3:25 pm

Remedy is delighted that our legal team has forced the government to delay their plans to exempt deaneries from employment agency legislation.

This is of significant importance to any doctors caught up in the recruitment process, who would have been deprived of many employment rights by these proposals. The legislation governing the conduct of employment agencies was passed by Parliament in order to give protection to vulnerable workers.

A government consultation in early 2009  stated that they ‘consider that [Deaneries] operate as employment agencies within the definition contained in the Act’ and that they wished to introduce an exemption. Their reasons for doing so were unclear.

The Act gives the power to introduce exemptions by regulation, subject to consultation, and a consultation took place in the summer. Both Remedy and the BMA opposed the change, arguing that it was not in the best interest of doctors. But the government announced in November 2009 that the respondents on the issue of postgraduate deaneries ‘mainly comprised a number of Deaneries who were in support of the proposal’. They also stated that they had been presented with  ’evidence that the potential consequences could be to seriously hinder the recruitment and training arrangements for junior doctors with a subsequent impact on both costs and staffing for the NHS’.

Remedy believes that the consultation was not carried out properly. We had no idea what the ‘potential consequences’ were, and we have had no opportunity to comment on them, or on the evidence which is referred to.
Our lawyers sent a Letter Before Action to Lord Peter Mandelson on 11 December, challenging the veracity of the consultation.

In their reply, the government solicitors agreed to re-consult on whether or not to introduce the exemption. They offered  to consult specifically in areas around training and recruitment. No date has been set for this re-consultation.

The status quo has been maintained, and the proposed exemption has been delayed - possibly indefinitely. We are very grateful to our legal team at Blackstones and Leigh Day in securing this result.

This delivers a major blow against a concerted effort by government to limit the employment rights of doctors. We anticipate further attempts in the future and will do everything to resist them if they are unfair.

Doctors should enjoy the same level of protection against abuse as other parts of the workforce.

The government has also agreed to negotiate a code of conduct for deaneries, and Remedy has been asked to join these negotiations alongside the BMA. We have drafted our thoughts on this and are now seeking the views of our supporters.

Our views on the implications of Employment Agency legislation and the issues that we feel need to be addressed can be read on the Remedy website. 

Tags:
Posted in London Med Student | 2 Comments »

Recriminations begin over swine flu vaccine

By Richard Marks, head of policy of Remedy - 9th January 2010 6:40 pm

At the beginning of the summer it looked as if we could be on the brink of a major health epidemic that could bring the country to its knees. A huge machine went to work preparing for the impending cataclysm. Six months later the swine flu epidemic has been a bit of a damp squib, and the medical profession looks as if it has been ‘crying wolf’ yet again.

Millions of pounds were spent on vaccines and antivirals and a great deal of anxiety has been generated. So was this incompetence? And, are we going to point the finger of blame at someone?

The retrospectoscope is a great and wonderful tool. Looking back to the summer there was a very real threat of a new strain of a virus, which had the potential to spread rapidly across the world. Attempts at containment were unlikely to succeed. In addition, there was evidence from South America showing that this new virus had the potential to be highly virulent, and worst case scenarios suggested that up to 65,000 people could have died.

Those responsible for planning services across the country are in an unenviable opinion. If they under react and under plan then they risk leaving the country vulnerable to a great plague that will cause untold misery and grief. If they over react then they will be accused of unnecessarily crying wolf and wasting money. And if they look indecisive then they appear weak.

Swine flu has been a global problem and the planners in this country will have looked carefully at what the rest of the world was doing. And it looks like everyone else got it about as wrong as we did. Well actually some of them got it even more wrong. The French, for example, bought 94 million doses of vaccine - more than the population of the country - and they only used 5m of them.  Now they are desperately trying to unload their excess stock.

And figures published in Le Monde showed that some other parts of Western Europe bought enough vaccine to immunise their whole population twice over. The US and Canada also bought considerably more than they have used, with Canada recently donating 5m surplus doses to Mexico.

There are some that think we have drawn a line under this too quickly. Flu epidemics come in threes, and we still haven’t seen the end of it. The WHO is still warning that it will be a year before the crisis is over. So maybe before we rush to put our excess vaccines onto eBay we should just wait a little longer. 

Doctors are naturally cautious and I think most of us think that the government largely got it right. It is far better to slightly overreact rather than the opposite. I think the majority of taxpayers would agree with this too.

However the green-ink conspiracy theorists have been on the case and are pointing their fingers at the drug companies. They are suggesting that some of the independent experts sitting on WHO committees have financial links with the pharmaceutical industry. And one blog posting goes further and points the finger at an individual. 

Should we believe the conspiracy theorists? Probably not. The allegations may well turn out to be totally without merit or validity. Whenever a mistake is made then there is always someone ready to leap forward and claim that there is a conspiracy at work. But, with such large sums of money at stake, we do need to be reassured about what went on.

Tags:
Posted in London Med Student | 3 Comments »

The real truth about the UK’s drugs policy

By Richard Marks, head of policy at Remedy UK - 6th November 2009 10:24 am

Drugs policy is not about science, health or balancing of risks. It is all about politics and the careers of politicians. That seems to be the inescapable conclusion of the events which unfolded over the past week. And what is most amazing is the brazen manner in which politicians come out with this and still expect our gratitude and respect.

Drug and substance abuse is bad. We should not underestimate the harm that some drugs do; as doctors we see evidence of this on a day to day basis. As human beings we see it all too often in friends, family and colleagues. Most of us feel that society should take some sort of collective action in order to restrict the use of these harmful substances, in some way.

Most of us are also comfortable with the idea that these restrictions should be graded across a spectrum. So some drugs are freely available (such as caffeine), others should be restricted in some way (alcohol or tobacco) and others should be made unavailable. Those that are unavailable are also graded so that the penalties for using the more harmful are more severe than the penalties for the less harmful.

In an ideal world, then, the decision of how to grade any individual drug would be based on the harm the drug does, and the harm to casual users, to addicts and the vulnerable, and to society as a whole. Quantifying and balancing these risks is a difficult science, requiring a range of scientific and sociological disciplines to work together to seek an answer.

But after the scientists have done their job and quantified the risks, and assuming their findings are valid and correct, then surely the job of the politician would be to rubber-stamp them. But this is where the whole model falls apart, and where an almighty row has erupted. Because even when the scientists have measured the risks to the nth degree, the politicians still think that they know better. They want scientific advice and government policy to be two separate concepts. 

And while Alan Johnson wriggles in the limelight and takes the flak, Her Majesty’s opposition is ready to leap to his defence. Writing in The Times this week Lord Young, the former conservative minister, is anxious to defend the right of politicians to ignore advice whenever it suits them. “The Minister will have other considerations to take into account” is his explanation. He argues so forcefully that it almost sounds credible.

But what other considerations does the minister have to take into account in setting drugs policy? If the scientific advisors have done their job properly and thoroughly there should be no stone unturned. A moment’s thought and the “consideration” that Lord Young refers to becomes obvious. It is of course, the political implications, and the repercussions on the career of the minister and his government.

So there you have it. But why stop at drugs? This argument extends to every corner of government policy, including the running of the NHS. And what I find so astonishing about this affair is that there has been no pretence of a cover up story.

For those of us brought up to believe in the scientific method, and that somewhere out there lies the truth if only we could find it, this all comes as a bit of a shock. I always thought the people upstairs knew what they were doing, and were acting on the basis of the best information available to them. Scientists like to believe in the purity and absoluteness of scientific fact.

But maybe I’m just being a little naïve. Groucho Marx understood the problem much better than me. “I have principles”, he said. “And if you don’t like them, well I have others.”

Tags: ,
Posted in London Med Student | No Comments »

Doctor and nurse regulators divided over swine flu

By Richard Marks, head of policy at Remedy - 1st October 2009 10:08 am

One of the many worries about a swine flu pandemic is the effect it would have on the case mix inside hospitals. If we were overrun with seriously ill children then traditional paediatric ITU services could be swamped. There has been plenty of warning over this, plenty of constructive thought and a good deal of local planning.

The net result will involve a major rearrangement of how health care staff are deployed if the worst-case scenarios come true - hospitals might consider cancelling non-urgent surgery and moving staff around in order to cope with the changing patterns of disease. Even staff not directly affected by swine flu may be affected by repercussions of this. The exact way that this will pan out in practice is not yet known.

Earlier in the year the GMC issued some fairly sensible advice on this. It states that doctors may be asked to work outside their normal scope of practice, and some doctors who have retired, or who are not working in the profession, may be asked to return to work. They strongly encourage doctors to respond positively to such requests.

“Doctors need to feel confident that they are working within agreed standards and principles of practice, and will not be subject to criticism because of the difficult decisions they are forced to make, or the standards of care provided during a pandemic,” it says.

The GMC guidance goes on to explicitly state that: “In an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence, and the availability of other options for care. In a pandemic, this means that you may work outside your normal field of practice, either in providing care to patients with influenza, or patients with other conditions.”

However the Nursing and Midwifery Council have taken a contrary view, which is encapsulated in the cliched phrase: “We’re not happy”. In their website guidance on swine flu, modified earlier this month, they write that: “All nurses and midwives are expected to practise within their competency level…If faced with any aspect of practice that is either outside their area of registration or beyond their competency level, they must seek supervision or advice from a competent practitioner…Nurses and midwives are able to extend their scope of practice, within the healthcare legal framework, but must ensure that they have the knowledge and skills to do so in a competent manner. If competency levels are not adequate, support and supervision must be sought from a competent practitioner.”

This guidance makes it clear that nurses who are forced by circumstances to work outside their comfort zone cannot expect any support from their regulators if they get into trouble. In the meantime they have written to 90,000 nurses who are out of practice, asking them if they would like to return to work to “address any potential staffing shortages which may occur in the event of a surge in the swine flu pandemic.”

The mixed messages that this is sending out are confusing.

Most nurses I talk to are very aware of the possible clinical problems. If the brown stuff started to hit the fan then they would do what seemed most appropriate at the time. As individuals they would want to do their level best and do what needed to be done. The disconnection between the nurses on the ground and their regulators needs to be explained.

To me this issue highlights a major cultural difference between doctors and nurses and their attitude to risk and diversity.

Read MPS advice on swine flu practice.

Tags:
Posted in London Med Student | No Comments »