Tom Goodfellow

Our esteemed editor recently had a bit of a rant concerning our medical representatives. At first I thought he was going to write about those delightful lads and lassies who provide us with pens and mugs while trying to get us to use their drugs or whatever. But it turned out that he was referring to the officials of our various royal colleges and their apparent reluctance to mount any meaningful opposition to the Health Bill (with the possible exception of the RCGP’s Dr Gerada).

Now Bob Bury was able to put him right concerning the proper function of royal colleges which is primarily education, standards and training (although Bob himself was just a teensy bit involved in a recent attempt to get some political lead into the RCR’s pencil).

However our editor, although not a medical man, is in the fairly unique position of being on the edge of the establishment and able to peer in. Consequently we should consider his views seriously. “Wad some power the giftie gie us to see ourselves as others see us,” R. Burns.

Joe public at large has a rather bipolar view of the profession, shaped largely by the Daily Wail and TV medical dramas. I never watch any of these with the occasional exception of Scrubs where the blend of dysfunction and surrealism seems to capture something of the reality of working in the NHS.

Dysfunction and surrealism was brought into sharp focus a decade ago when a small trust in a neighbouring town was deemed to be failing. My own trust was mandated to take it over and sort it. However the reaction of the local population was vitriolic, my trust branded as vile asset strippers whose only aim was to close their beloved hospital.

At public meetings the medical failings of the trust were clearly stated. A hospital in which over 50% of the medical staff are locums clearly has issues. But representatives of the major royal colleges were dismissed merely as mouthpieces of the doctors’ unions (sic) when they pointed out that recognition for training had been withdrawn due to major clinical deficiencies.

All to no avail! It was clear that the good folk of the town in question would prefer to have heart surgery performed on the kitchen table by a junior doctor supported by a porter and a cleaner, rather than having to travel 12 miles up the road to the specialist centre. They decided that an unconscious head injury patient with a steadily deteriorating GCS would have a better chance of survival in the small A&E department, with no CT scanner and being managed by a locum casualty doctor imported for the weekend from Germany.

It was too dangerous for heart attack patients to be moved - they were better off being treated in the middle of the night by a locum FY1. And the fact that the obstetric unit had very inadequate paediatric cover and insufficient deliveries to attract quality obstetricians and midwives was of no importance. Reason, rationality and clinical evidence are irrelevant to the public when a beloved local hospital is threatened.

That is, of course, until something goes badly wrong. In which case both the managers and the doctors end up in the deepest doodoo with cries of “how could this be allowed to happen?”

However our editor’s challenge is that “every time a big old challenge comes over the hill there’s a lack of coordination and cohesion in the response”. But like the proverbial curate’s egg he is right only in parts. I agree that the profession is bad at challenging inept political tinkering with the NHS. My generation should have stood up to Margaret Thatcher when she took away doctor’s clinical freedom and introduced Griffiths managers to run hospitals.

I did try to stand up against Tony Blair’s top-down, command-and-control, target-driven, name-blame-and-shame management style which further destroyed clinical freedom. I believe this period did more to demotivate and de-professionalise doctors than anything else, and it largely explains why most of us are semi-detached from the current issues. This is why so many doctors and college officers made only token protests about the latest health bill; we have become used to being ignored!

But we can and do rise to the challenge if given the opportunity. Ten years down the line the small trust which we took over is thriving and growing. Its patients have most of what they had before, plus many additional high-quality specialist services and facilities. All this came about because the doctors, with management and the allied professions, got stuck in and made it work.

We can and do rise to challenges - especially if they are in the direct interest of our patients. What we are not good at is fighting the system.

The wife and daughter, in response to their post-Downton Abbey withdrawal symptoms, have started watching on Sunday nights the BBC adaptation of Jennifer Worth’s memoirs, Call the Midwife. This is based on her experiences in the East End of London in the 1950’s.

I watched last night’s episode with them, but then wished I hadn’t because of the memories it evoked. It featured Jennie, working as a district nurse, visiting an elderly man who was housebound with leg ulcers and living alone in a tenement flat. He was dirty, smelly and the flat was foul and infested with vermin and insects. The heroine was appropriately disgusted, but her innate goodness allowed her to overcome her middle-class feelings of revulsion and she became his friend.

Television always sanitises things, but the episode brought back the memory of events when I was a medical student at The London Hospital in the late 60’s, admittedly nearly a couple of decades later than the story, so things had started to change.

The first event was a request from a social worker to see if a group of us would volunteer to clean up the flat that belonged to a couple in their fifties. The man had summoned an ambulance to his partner and they found her cold dead in the bed, probably for several days, with a fungating untreated breast cancer. He was lousy with infected ulcers and was taken into hospital for treatment.

The one room they inhabited stank, and even after 40 years the memory of it makes my gorge rise! It was a scene far worse than any horror movie. Their four cats had been removed by the RSPCA, but the floor was covered with cat excreta. Electricity had long since been cut off and we used candles and torches for light. There was utter filth everywhere with greasy unwashed dishes strewn around the room and old rotten food on the table. None of us dared go near the bed which was a festering pile of verminous rags.

It was really a job for environmental health, not a bunch of naïve medical students. We did our best but made little realistic difference to the place. I came away mystified as to how a couple could descend to such utter degradation in the second half of the twentieth century. What had happened in their lives to render them so incapable of either caring for themselves or seeking help from others? What was their story; there would be one? Surely something could have been done to prevent that lady dying in such total darkness and despair?

The second event occurred the same year as some of us were wandering round the derelict areas of Stepney in the East End one warm summer’s evening. We came across an old building with boarded up windows but which had obviously been an institution of some sort. Above the door was engraved the words, “Dr Barnardo’s Home for Children. No Destitute Child Ever Refused Admission”.

Converted to Christianity at the age of 16, Thomas Barnardo believed he had a calling to be a missionary doctor in China. However when he began his studies at my alma mater in 1866 he discovered that his mission was on his own doorstep. The rest is history.

I learned a number of important things that warm summer so long ago. That compassion is more than just sentimentality, it frequently requires rolling up your sleeves and getting very dirty. That to be an empathic doctor requires at least some attempt to understand the complexities and perversities which govern people’s lives. And that one person with vision and commitment can make a difference to lives that seem blighted beyond hope.

These days the press is full of stories about indifferent doctors, uncaring nurses and neglected patients. Sadly many of these stories are true. We, in the modern NHS, would do well to reflect on the life of such people as Dr Barnardo, and many other similar pioneers whose love, faith and commitment helped so many.

Perhaps we will regain our soul!

I have just returned from a late Autumn break in sunny climes. While dozing on a sun-bed I was approached by a vendor who wanted to sell me an English newspaper. I immediately screamed, “No, no, no!”. I closed my eyes, put my fingers in my ears and chanted, “La, la, la, la - I can’t hear you.” Looking puzzled he went away; but I noticed he did a rather good trade among other holidaying Brits, flogging yesterday’s Daily Mail and Sun.

But what masochistic idiot, while on holiday, would want to read anything in a British newspaper these days, even comics like those two? Every page is littered with words like crisis, catastrophe, meltdown, austerity, calamity, disaster. In a ‘head for the hills’ sort of way the Governor of the Bank of England has just announced that banks should brace themselves to withstand the “extraordinarily serious and threatening” economic situation, although I suspect the concept of bankers “bracing” themselves is a euphemism; but let’s not go there!

It seems that the Germans would like to take over Europe (again), the Greeks are revolting (at least they will after lunch), the Iranians are planning Armageddon (if the Israelis don’t get there first), the Arab Spring has not yet sprung and Jeremy Clarkson is being, well, himself. In Iceland a huge volcano Katla is showing signs of an immanent eruption which is likely to make the eruption of  Eyjafjallajokull resemble a school firework party and, oh horror, the National Audit Office has discovered that the Care Quality Commission is “struggling”. Well there’s a surprise!

On 30 November nearly all our radiographers went shopping for the day (sorry, took industrial action) and the entire NHS, other than emergencies, ground to a halt. Actually it proved to be a rather nice time in the department - no hassles and I caught up on lots of gossip intermingled with the odd bit of “heart normal, lungs clear”. As thousands marched to protect their pensions, politicians wailed that children were being deprived of a whole day of schooling, their lives blighted for ever by the irresponsible actions of overpaid public sector employees.

Our CEO has just done his annual Private Frazer impression (“we’re all doomed”), announcing a massive austerity package of our own to deal with the trust’s deepening financial crisis (also known as PFI) with all the usual ingredients of recruitment freeze, no paid study leave, no agency locums, etc. The trouble is that we have heard it all before, exactly the same message year after year, “this is the worst  ever; if we can just get through this year things will be better.” Only they never are!

The trouble is that I have developed disaster fatigue, an increasingly common condition these days. It is caused by relentless 24 hour news of dire events assaulting from every side. Its symptoms are a desperate desire to close your eyes, bury your head in the sand, pull the duvet over your head, drink lots and lots of chilled Chardonnay, smash the TV and radio, strangle anyone who tries to tell you anything or join a closed monastery. I think I have all the symptoms, and a few more besides.

Of course as a good Christian I turn to the Bible for solace and comfort, but read, “You will hear of wars and rumours of wars…Nation will rise up against nation, and kingdom against kingdom. There will be famines and earthquakes in various places. All these are the beginning of birth-pains.” (Matthew ch.24, v.6-8). Who says the bible is not topical?

However like Mr Henslowe, the theatre owner in Shakespeare in Love, I want to say, “Strangely enough, it all turns out well. I don’t know (how). It’s a mystery”. Well perhaps it will.

“And while you are wasting time honing your fine prose,” mutters the wife, “could I just remind you that it is Christmas in less than three weeks.”

“La, la, la, la - I can’t hear you!”