I think that there are a number of problems about a consultant based service
which would have to be addressed before it could be acceptable to many
current consultants.
1. Many of us are unhappy about the idea of doing shift work at nights
when we are getting on in years. There would have to be a system whereby
"senior" consultants could opt out and work a more normal week. Other
possibilities might include differential pay or early retirement on full
pension for Emergency physicians - can anyone see other NHS consultants, who
hold all the political power, agreeing to this?
2. And while we're on the subject of other specialties, which of us fancies
the idea of busting our guts at three am to hand over patients to medical or
surgical SHOs?
3. There is much more to a consultant job than seeing patients, even though
this is clearly the ultimate aspect of all our jobs. Indeed, given our
unique situation in hospital medicine, interfacing with so many specialties,
it's not surprising that our admin workload is probably the largest of all
the specialties. Also, because we deal with so many patients in an acute
setting, there are lots of complaints (mostly about the attitude of juniors)
to deal with. We have to teach - students, junior docs, nurses, paramedics
etc, more than any other specialty and without the luxury of university
departments and Senoir Lecturers. We are expected to take part in a great
deal of clinical audit, again with our multi-specialty links addind to this
load. All of this takes a great deal of time.
4. We see ourselves doing all this, taking part in many in-house
committees, eg, for poisons info, emergency planning, computer systems,
security monitoring etc, etc while many colleagues on seven session
contracts do just that. I bet not many of us get a half day a week to make
up for the times we are in for hours at night dealing as first responders
with major trauma cases.
5. There simply won't be enough of us to have a true consultant based
service for years. One of the problems has been that those who have tried
to do this have done it with woefully inadequate resources - four or five
consultants. No wonder most of these schemes have failed, with people going
on stress-related sick leave in some cases. Do you know that the
anaesthetists say that, to have a 24 hour consultant service requires eleven
people!!
6. Different people have different skills and strengths - some are good
administrators, teachers, researchers, auditors, and, yes, most of us are
still reasonable clinicians. Few of us can do everything well, I suspect.
Surely the thing is to have departments with several consultants who can
provide a range of real expertise, and with sensible levels of middle-grade
support to allow trainees to get ALL the experience and support they need,
clinical and the rest. How many departments really need a live-in
consultant presence 24 hours per day? Isn't this a poor use of scarce and
vulnerable resources? Is it a coincidence that BAEM has just published a
booklet on coping with stress? If we cannot have another life as well as
our work, I suspect that we may well become less efficient in many aspects
of our jobs. I have to say that I want to have a life outside medicine.
There's more, but I've probably bored you all asleep.
Slainte,
Rocky.
----- Original Message -----
From: Carlos Arturo Perez Avila <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, September 27, 1999 6:01 PM
Subject: Willies
> I understand your position. You are not alone in thinking this way. I
feel,
> personally, that the sooner we move to a consultant based service the
> better we will be.
>
> SpR, bless them, contribute to less than 30% of the service provision in
my
> view. Want to go on many training courses and days and spend a lot of time
> studying and reading and not in the sharp end of thing. Some of us as a
> result have to spend a lot of our time, quite enjoyable, at the coal face
> with our SHO's. Some of our consultant colleagues do not like this but my
> narrow minded view is that is why I study medicine to see patients, and if
> I specialised in A&E is to see ALL types of A&E patients not just the
> selected few which have an interest, which ever that may be.
>
> I am all for a consulatnt based servive with some SHO's and SpR's who can
> then be properly trained in what they want.
>
> My main concerned is that the porfession appears to be very divided as to
> what their individual roles as consultants should. Their range goes from
> american stayle consultant run department to "I am a consultant I will be
> in my offcie supervising!!!!"
>
> What do people think.
>
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|