Sunday, April 22, 2007

The Medical Heroes

Three eminent doctors speaking about the proposed changes to doctor training include:
Dr Chris Allen
Professor Morris Brown
And Dr David Clow. You may remember the now iconic video when Dr David Clow spoke during the London doctors' march back on the 17th March.

Here, Dr David Clow returns exclusively to 'The Psychiatrist Blog' to express his views about the changes to medical training:

"Good Things About Reforms
Before I make criticisms of the reforms of the recruitment and post-graduate training of doctors in the UK, let me state some beneficial reasons for reform:

The first is that the cost of job advertisements has spiralled over the years to fill all the posts that become vacant in an organisation the size of the NHS. So, in itself, the use of a workable computer application service for NHS jobs may seem to be a good idea to save costs that could better be used for patient care.

Second, the increased output from medical schools and junior posts has led to multiple applications. For example, I was getting over 200 CVs to short-list and out of those short-listed over 50% would not attend, as they already had a job, or had since been offered something they preferred and this process was a waste of time to all concerned. Furthermore, it led to the degree of rudeness from some trust personnel who on occasions did not even acknowledge those who had not been short-listed.

Why Modernising Medical Careers (MMC) is not the answer
However, despite the need for reform, MMC is fatally flawed because it is being run by self-appointed experts in ‘Medical Education’ and not Consultants at the coal face. The facile mistake is the idea that passing a competence test means that the doctor is competent. Competence tests only measure the ability to pass tests, and not clinical skills.

MMC needs to realise that our "trainees" spend three quarters of their time with no teaching, but are "covering patients” they do not know, because of the way we have chosen to implement the European Working Time directive. Staff are over-tired on their shift patterns that ignore circadian rhythms, and destroy any quality of life. No-one in manufacturing producing 24 hour programmes would use this system.

It’s also important to realise the need to teach ‘the knowledge of the science and art’ of medicine. It is doubtful that one can simply learn "communication skills" second hand. It is best done by learning from experience, teaching and practice in order to improve on your ability. This is the model that we should adopt; see one, do one and then teach one. MMC only looks at the first. MMC must include work and experience for our trainees who have the knowledge but not the experience of working, as they have never followed up their patients and cannot get through the work in the time constraints.

If I can explain from my own experience. As a student I won all the prizes for surgery and felt this should be my career, but when operating under Consultant assistance my manual dexterity was incompetent, and it was clear to me that my patients would be better choosing someone who could operate better. General Practice was attractive, but seeing 60 patients in a surgery and trying to welcome the 61st was impossible . As a middle grade working in paediatrics in a district hospital I found the best form of medicine for my skills and interest. The inflexibility of MMC in making career blind ends at the F2 stage has to change. How can doctors make sensible career choices when they have never worked in their chosen field and thus do not know what to choose?

To restore any faith in the MTAS a public announcement needs to be made that it has been scrapped. I take very seriously the complete disillusion of my fellow marchers at a system that ignores all their previous work, qualifications and experience for selecting a career.
The way of marking, has produced a lottery which only the defendants of the indefensible may argue is completely fair to all candidates.

The Chinese Communist Government allocated positions according to the candidates’ political reliability. Their performance, on such a random method of choosing, resulted in widespread starvation till the system was reformed to allow for choice and competence. If we continue to devalue doctors we risk getting the sort of Health Service, where no one really cares for the patient or their relatives.

This is something I care passionately about. I have devoted my life to the NHS. As I get older it is very likely I will also need to start using it and calling upon the help of these young doctors. Patricia Hewitt needs to change and to show that she really cares about the quality of the NHS by addressing the substance of the objections to the system she has introduced. "

Dr David Clow, Consultant Paediatrician, Greenwich


Anonymous said...

It's so good to hear someone talking straight common sense. As doctors we want to get on with our jobs and to care for patients. The government are trying to make it all so complicated - it isn't - some good old fashioned common sense can sort it out. Sarah... Patricia Hewitt should just ask Dr David Clow.

Dr Michelle Tempest said...

I'd like to thank Dr David Clow for so kindly writing to me and taking time to write this about doctor training. Thank you. Michelle

Midwife with a Knife said...

The thing is, a computerized job application system in medicine can be done well. The National Resident Matching Program in the US actually works quite well, even though it does seem like a bizarre way to allocate employment.

There's a centralized application service, which mostly covers your licensing exam scores, your CV, and a small "personal statement".

It gets distributed to the programs that you're applying to. Those programs then interview the candidates they want (kind of like the short listing you do, I think). Then the candidates rank the programs in order that they'd want to go there, the programs rank the candidates in the order that they want. Then through the magic of computers, each person is assigned to the residency which they ranked the highest that also ranked them high enough. This program, apparently is skewed a bit so that the applicants' choices count slightly more than the programs' choices.

It really works quite well. There's also a scramble day a few days before the results of the match are released where unmatched candidates can scramble into unfilled programs.

So, anyway, jobs for doctors in training is one of the few things the US health care "system" does well. It's just such a shame to see such turmoil caused by something that in concept can work well.

Man in a Shed said...

You make the point about the failure of a centrally planned system (ie Chinese Communist government), but then go on to say you love the NHS.

Is it not possible that the NHS is the problem ?

Anonymous said...

excellent points

Dr Michelle Tempest said...

Thanks Man in a Shed - The submission was from Dr David Clow and I think he makes some very valid points. On one of them that the NHS has central control. Perhaps there should be more localism within the NHS?
Thanks Midwife with a Knife - it's good to know that your matching programme works quite well.
Tuesday is a big day as there will be a mass lobby organised by RemedyUK.
Thanks for all the comments.

QUASAR9 said...

Hi David Clow (and Michelle) -

What I don't understand is how long hours for Medical Students and Junior Doctors evolved.

You are quite right they are in breach of EU work directives if they work more than x-hours.
Even The EU has its good points

Of course I can appreciate that competitiveness, means some students are willing to work harder and put more hours in, or sometimes they are foreced to put more hours in to catch-up keep-up with others who have better memories or info retention skills.

But why does this pressure exist:
If you cannot complete in seven years, does it all have to go to waste, can you not retake exams the following year - why not?

Tuition fees - and the need to work more hours to pay your way. Well whose bright idea was that. Sure if daddy picks-up the bill it is all well. Nut clearly it forces others to work xtra hours to pay their way.
Alas now we have american style tuition fees introduced by TB and a labour government who themselves enjoyed the benefits of free higher education, with maintenance grants (according to need).

Quite commendable of you, to recognise your surgical dexterity was not what you'd expect from a surgeon - and choosing to become a GP.

As for HR and recruitment, alas it is one of the curses in life, that so many people are unhappy in their jobs they are applying for other jobs.

So they may prevent me being shortlisted for the job I want - and worse not even attend the interview, because they are already in work, or got a 'better' job offer.
But this is a malady across the board, whether in industry or whatever profession you choose.
Large employers require application forms (and even reject CVs) because it is easier to measure whether the applicant meets the requirements, and to photocopy shorlisted candidate details for selection panels.

For sure I know this task may be handed to a 'lesser mortal' who will follow a very rigid selection procedure in shortlisting candidates, and is often unqualified to decide who would be the best candidates to shortlist.

Alas, the world is imperfect.
But I guess the answer if you don't want to be inundated with CVs is to have an application form (accompanied by a cv) and the selection of shortlists done by those who know what they are looking for or what they need.

The NHS is not the only place where some may meet the suitability requirements on the application, but fall short on other skills.
Teaching & Education are rife with people who secure the jobs because they can't tick X on a box, but then lack the other skills needed, which someone who cannot tick X on the box (and therefore is not selected for interview) may well have in abundance.

Such is life, we live and learn
and we die
Sometimes may we die never having learned - or - lived.

David Anthony said...

Dr Clow sounds like a very wise man. I feel much the same about education in general ... constant testing and grouping by use of a rigid national curriculum does not benefit the individual nor society in general.

I feel the same is happening here with the MMC. People do not matter anymore, it's all about reducing individuals to cold numbers and records.

In many ways we are in this mess because the government is trying to run the NHS like a communist economy... a five year plan to train a certain amount of junior doctors that then cannot find a place in the marketplace.

If we allow doctors to follow their dreams and ambitions then it will be a lot easier to help them find jobs .. because they know what is best for themselves ... a computer can never decide this.

ps// I wonder how Dr. Clow's career might have been held back had he been called Dr. Claw!?

Anonymous said...

I love the way that you have people returning back to keep us updated...- brilliant !

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