by Dr Dermot J Ward
“Junior doctor” problems have recently been painting the walls and carpeting the floors of the near total space of multimedia. Perhaps the most useful effect of the EU Referendum has been to totally change the theme tune of its mood music. At least that change is welcome…
Some years ago I was surprised to hear about a survey that discovered people were prepared to accept a drop in salary in exchange for what they considered to be a more important sounding title. Before that study if someone had told me this was a fact I’m pretty sure I would have greeted the idea with disbelief. And I would have been wrong. Specially for this piece I finally visited the website of ‘English Dictionary’, pioneer in dictionary publishing since 1819. (Not exactly the OED but suitable for my immediate purpose. It listed the meaning of ‘junior’ as an adjective as follows:- “1. Capital letter lower in rank or length of service; subordinate. Younger in years — ‘Junior’ citizen. Of or relating to use in childhood. (British) of or relating to school children between the ages of seven and 11.” Taken together, there are oodles of variations on the junior theme without major deviation conveying that adjectival flavour of youth and inexperience.
When I was newly qualified in Dublin and moved to 1960s London I was never a junior doctor; a houseman, yes, medical/ surgical, an SHO, Registrar, Senior Registrar (some doctors of that genre nudging 40). I can’t recall any use of ‘junior’ prefix then for doctor.
Returning to Dublin at the end of the ’60s, I noticed that doctor trainees were called and commonly referred to as NCHDs (non-consultant hospital doctors). I was struck at the time at its being perhaps a bit clumsy, but gave it little thought. That was Irish life. No big deal. I don’t know whose idea that was, but thank goodness they had it. Most readers will be aware there is acute turbulence at present in the NHS. Mind you, the most common and regular form tends to surround some variation on Mid-Staffs or similar scandal elsewhere. Apart from such dreadful outcomes there is also the industrial action of ‘junior’ doctors. The mass media has no problem filling newspaper columns and oceans of airwaves on this hot and vexed problem. My sympathies are with the trainee doctors, but the nitty-gritty of the disagreement with politician-driven working policy is not for today. I have little doubt that ‘junior’ doctors are a devil-send to the politicians.
I recall in my latter student days, the visible, and I mean visible to me, change that occurred in the demeanour and general personality of the young men and women who, less than a year earlier were still medical students, but now were Registered Medical Practitioners perhaps a month or two earlier empowered in law for the first time to responsibly undertake the diagnosis, treatment and care of patients answerable to the patient and perhaps relatives.
Also lurking and looking over their young shoulders was the GMC, as it was then. Yes, there were their senior colleagues hopefully backing them up, but even with that support the responsibilities are huge.Human and humane life are rightly regarded as the most precious form of civilised life in the animal kingdom. And woe betide the doctor who stands accused of carelessness or dangerousness in practice — and in these more litigious days we must add ‘inappropriate’ treatment and care as a possible ruination of a young (or older) medical life. Let us not forget that the NCHD is so often the first doctor to see, examine and initiate treatment of the most urgently unwell or injured patients in various aspects of emergency care, whether presenting within an inpatient hospital population or in an emergency department. Such is the burden of medical practitioners’ lives from day one registration.
Perhaps the BMA could ballot its total membership on this particular issue.
Privacy – Terms
Dr Dermot J Ward
A recent tragedy reminded me of a moment in time. I had exchanged a certain smile with a lady across a crowded room. It was recognition not romance. The occasion, about two years ago, was a social gathering, a reunion of my medical school year’s fraternity. The lady in question, married to an old medical friend from my year, had been a patient. The tale goes back to the ‘70s. She had developed a puerperal psychosis of severe magnitude with marked restlessness, agitation psychotic delusions. She possessed a previous personality free of any mental health problems. But the intensity of her puerperal breakdown was a huge worry and concern to her husband and family. There was no time lost in her being treated with ECT and support medication. She was discharged around three weeks later to the care of her husband. There was no recurrence.
My generation of physicians, and especially those in psychological medicine, were acutely aware that postpartum patients exhibiting even mild psychiatric symptoms were at special risk of a dangerously rapid deterioration in morbidity, in a matter of days which could lead to suicide and or filicide (killing of the newborn baby,fortunately rare), This was unlike non-puerperal clinical depression, mania, schizophrenia where such deterioration might occur over weeks, even months. Another difference in this patient group was the not uncommon perhaps slight body temperature rise which might in turn signal sepsis requiring attention. A further given was an acceptance that if such puerperal psychoses were inadequately treated, return to full health could be seriously prolonged.
On December 5, 2014, national newsmedia carried the sad account of Ms Charlotte Bevan aged 30, 5 days postpartum, who had walked unnoticed out of Bristol Maternity Hospital without a coat or shoes. She disappeared, but seen on camera later, walking past, clutching baby Zaani Tiana Bevan Malbrouck who was wrapped only in a blanket. A few days later their two bodies were found in the Avon Gorge beneath the Bristol Suspension Bridge. A friend quoted, said the hospital new Ms Bevan had “mental health problems”. Her partner, Mr Malbrouck, declared she had suffered from “schizophrenia and depression” in the days following the birth and was sleep deprived. “CCTV footage from the hospital showed her walking through security gates and past at least 4 nurses without being stopped. The hospital immediately began a “thorough review” into how Ms Bevan was allowed to leave unchallenged. Sadly, the Bristol Suspension Bridge is all too well known locally for its suicide history.
BBCRadio4 also highlighted the tragedy and secured a spokesperson from the Royal College of Psychiatrists to discuss it. Probably the discussion was time-pressurised, certainly short, the main theme was how some mothers were reluctant to take medication for fear of its harming the baby. Such observation can certainly be the case. Presumably there was no time to discuss other aspects such as those touched on in para 2 above. Perfection can prove an elusive goal.
On 24th of November 2006 news media headlined how a depressed mother who tried to murder her daughter by jumping off the Humber Bridge with her two-year-old in her arms was jailed for 18 months the previous day. The mother Ms Angela Schumann, was aged 28. The judge remarked she had been one of only 3 people out of 85 to have survived the fall. On medical examination she had been found to have written on her stomach, “cause of death ,Julio”. Fuller accounts of this lady are available on the internet. Her trial was held some months after the fall because of injuries. She was finally released from prison in 2007 after Appeal Court Judges reviewed her case and intervened. I have since wondered how on earth a strong psychiatric report for her first court hearing resulting in her being recommended for treatment at worst in a secure psychiatric unit could not be made. Worrying. Perhaps I had missed something.
There are some 20 mother and baby units scattered about the UK. Interestingly I could find only charitable organsiation websites on a net search, granted not an exhaustive one. It is difficult to think of any human society in which mothers and their babies are not regarded as a supremely precious human life form deserving our highest regard, care and protection. Regrettably, it can appear current NHS society is not honoring that responsibility in “the envy of the world” NHS slogan compared with some decades ago.
(Originally published in IRISH MEDICAL TIMES, March 5, 2015)
By Sir Richard Lapthorne 17th June 2015
“I was encouraged last month by the pronouncements from Sajid Javid, our new Business Secretary. He has promised an Enterprise Bill that will cut the cost of red tape by £10bn a year and tackle the powers of independent regulators.
I remain sceptical though. Every Business Secretary promises to cut red tape. To date none have achieved it.
They sit like a succession of King Canutes ordering the tide of regulation back, but it rolls inexorably forward, as it has done for decades.
In his 2014 Annual Report Sir Mark Walport, the Government’s Chief Scientific Adviser, said that to create the conditions to support innovation we need to to manage risk, not avoid it.
The only perfect way of managing risk is to avoid it and unfortunately there is a section of the regulation industry that will only accept perfection.
Innovation matters; it is the lifeblood of an economy. Innovation leads to increases in total factor productivity, which contributes to real growth. Sir Mark has supervised a good deal of research into the subject and has concluded that the growth in so-called “Soft Law” in the UK, and its focus on avoiding failure, is killing innovation.
As a term, soft law covers a collection of rules and codes developed by regulators. Regulators rely on the continued growth in soft law so they can stand in the way of exactly the type of risk-taking that Sir Mark wants to see.
Professionally-run regulation is a means for maintaining a balanced society. However, the zealots who behave in a non-transparent and unfair manner cannot be allowed to mimic dictators of old. Like those dictators they too can destroy lives by exercising unrestrained power.
Sir Richard Lapthorne is chairman of Cable & Wireless Communications