My good friend Paul Gaudry speaks of the 'Sheltered Workshop' phenomenon
where juniors have increasingly less opportunity to do tasks. They plug and
play but when it comes to making a grown up decision it is the senior who
rushs in or is rushed in. But for sure if we are patients ourselves we to
want the senior to make the serious decision. Getting the right balance is
the difficulty.

But there is no doubt that the more you talk to your friends in Banking,
industry, accounting etc the more you find the situation you describe is
prevalent there also. I don't think this is just a medical issue or for taht
matter an emergency mediicne issue.

Increasingly I find it is a bit like professional rugby; I might'nt like it
but if I want to keep watching the sport I am going to have to come to
accept it.

So how do we 'value' our staff and try and be proactive and prempt the
'strike' ? Who takes them on away days ? Who provides fresh fruit every
day, and chocalates ? Who has quality decaff coffee avaialable 24/7 ? Who
has a fridge of cold beer for Fridays, which has to be emptied ? For sure we
don't do all of these but increasingly I seriously consider that it may pay
us to do this. A few years ago a friend of mine did all of this for his IT
firm with effect. For sure there is a challenge here for us in Y2K+5 which
did'nt exist 'in our time' Do we need to ensure greater empowerment and
involvement ?

Furthermore, we also have the difficulty of dealing with the
'non-believers', These are the doctors given to us to service the demands in
Emergency Medicine. Inevitably we will have increasing numbers of staff who
are there on 'rotation' under sufference. Do we need to ensure greater
empowerment and involvement ?

Perhaps the solution lies with Benjamin Franklin:
Tell me and I forget
Teach me and I learn
Involve me and I remember

Humans are creatures of habit. Our juniors are no different. They to are
all for progress but just dont like change. When they come to us
'contaminated' by life as a medical SHO, or as disempowered Junior House
Officers with that form of practice / way of thinking and try and apply this
to emergency medicine, not surprisingly, they feel threatened which brings
with it a fright and flight response.

One thing is for certain and that is change. Even life in emergency
medicine will not stay the same. Lets not expect things to be the way they
were, rather lead from the front and embrace the change. If we are more
senior then surely we should be able to root out the 'sick leave' issues and
pre-empt them.

In the end maybe you are just going through a bad patch. We have had two
great teams for the last year. But a bit like stocks and shares I know a
downturn will come.......

John Ryan

.



----- Original Message -----
From: "Jonathan Jones" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, June 16, 2005 7:16 PM
Subject: Sickness and Morale


> Dear all,
>
> Over the last year, and particularly the last 6 months, our SHO sickness
> levels have shot up - both of the longer term and short term ("D+V") type.
> The traditional explanation for this is low morale.
>
> My initial thoughts were along the lines of - but they do less hours, have
> lots of senior support etc etc, why low morale? (The 'In my day' school of
> thought - and me so young!)
>
> Then thinking more along the lines followed by my health promotion
> researcher wife - what if the issue is related to self-esteem? Loss of
> self-esteem and self-efficacy leads to apathy, depression etc. Related to
> this is the concept of locus of control: those with an internal locus feel
> empowered, those with an external locus are disempowered: they blame
> external factors for their situation.
>
> By increasing supervision, together with pressures of getting juniors to
> make rapid decisions re: 4 hour wait have we removed their self esteem? Is
> all the constant hounding making them feel unvalued and simply cogs in the
> machine (I know I feel that way sometimes!).
>
> Any similar experiences / thoughts or is this just a big pile of toss?
>
> Jon
> Leeds Gen Infirmary
>
>