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Doctors at Work Podcast.

Episode #89

How can senior doctors support early career doctors? With Ollie Burton

Mat Daniel

21/05/2024

Being an early career doctor is a stressful time, and how medical work is structured may lead to few opportunities for support. Ollie Burton and I discuss that despite workload challenges, senior doctors can seek and create opportunities to support and train younger colleagues. This requires clinical leadership, and real understanding that training must be prioritises in order to develop future clinicians.

Ollie is presently (at time of interview) a clinical research fellow in neurosurgery with interests in simulation, education and workforce development. He runs a YouTube channel and blog to help give insight into training as a doctor, and to educate students and patients. You can find him at https://ollieburton.com/.

Listen at https://matdaniel.net/podcast/https://open.spotify.com/show/1j8uLaUU1g5bYTRVuwUX7j?si=672ec26a73164d7fhttps://podcasts.apple.com/gb/podcast/doctors-at-work/id1701284564; or watch on www.youtube.com/@dr-coach/videos.

You can find out more about Mat at www.MatDaniel.net.
Production: Shot by Polachek

Podcast Transcript

[00:00:00] Welcome to Doctors at Work. My name is Mat Daniel and this podcast is about doctors careers. Today’s topic is how senior doctors can support those that are early in their career. And being an early career doctor is undoubtedly a stressful time. And how our medical work is structured may mean that there are few opportunities for senior doctors to support the younger colleagues.

Ollie Burton and I discuss how, despite workload challenges, Senior doctors can seek and create opportunities to support and train younger colleagues, and that requires clinical leadership and a real understanding that training must be prioritised in order to develop, support and train future clinicians.

Welcome Oli, tell me a little bit about yourself. Hi Mat, thank you so much for having me. Um, so my name is Ollie, as you know, I am an early career or a junior doctor currently working in neurosurgery [00:01:00] as a clinical research fellow. Uh, I was a graduate entry to medicine. So I did a degree in molecular biology before then doing an accelerated medical course.

I went to work in Newcastle for a couple of years for my foundation training. And then have worked my way down to London, um, so alongside my clinical work in neurosurgery, uh, I do plenty of research here and there, and I do a lot of content creation. And that’s, that’s the other thing that keeps me busy, making videos for patients and the public and for students to try and help them.

grasp medicine and how it works. And the topic for us today is how senior doctors, um, can support early career doctors. Um, and maybe I can start by asking what kind of support do early career doctors need? Sure. So in a, in a relentlessly kind of tick boxy way, I would separate these down into the types of domains that [00:02:00] you’re trained to discuss at interview, these different aspects of your life, the sort of clinical, academic, managerial, personal aspects.

So clinically, obviously, We rely on senior doctors for our, for our training or the bulk thereof. Um, if I want to become a surgeon or a radiologist or whatever you like, UK training typically works in this apprenticeship based model. And that, that relies on a very strong relationship between a senior doctor and a more early careers doctor in order to work at all.

And when it doesn’t work, it can have devastating consequences for someone’s, not only for someone’s training, but for someone’s career as a whole. Um, same story with academia, you know, you will, you will find yourself absolutely stuck very quickly. If you are trying to engage in projects without the appropriate senior support that you need.

And speaking as an early careers researcher, myself, my, my toolbox of [00:03:00] things I can do by myself. is much larger than it was, for example, when I was a student, but I’m nowhere near being able to lead a clinical trial or even, you know, a multi center cohort study or, or these kinds of clinically impactful studies.

I’ve still got a long way to go. I would be very reliant on my senior doctors to help me figure that out. Um, personal, we could go to next. Obviously, many people have have issues at home or at work or things may be not going how they planned or stresses that they weren’t expecting. And I think if you have a senior that is understanding and supportive and tries to empathize with you and help you as much as they can, that obviously makes a huge difference for someone’s life.

well being and just feeling that they’re, that they’re listened to. And then I’ve swapped my order around, but managerial and leadership, um, elements as well, where you need. [00:04:00] You need strong role models, depending on the model of leadership to which you hold yourself, but normally we rely on these inspiring leadership figures and looking at someone and going, I want to be like them, you know, I want to be like them when I grow up and be a good leader like them.

So I think if you can see among the senior doctors that you work for, if you can see a strong leadership figure and identify them as. As a role model and someone you want to be like and you take that forward into your own leadership kind of engagements then you’ll be a much better leader for it. I’m interested in this idea of both apprenticeship and role modeling and I think one of the things that comes up in some of my discussions.

Um, with doctors is that, that people say, I, people at your stage will say, I don’t see the end, the light at the end of the tunnel. They say, I work and I work and I work and you know, and what’s the end of it? And they don’t see necessarily [00:05:00] something that is worthwhile. They don’t see people that are thriving, people that are people that are happy.

And that makes it very difficult because, you know, if you say, okay, I’m gonna really work hard for the next 10 years, and, you know, at the end. This is, this is what my life is going to be like as a GP slash consultant, whatever it might be. Um, but people are not necessarily seeing that. So how, how important is it for senior doctors to showcase a successful, happy, thriving career?

I think for, for, for exactly the reason that you’ve outlined, it is very important. People do need that sense of hope. They need something to look forward to and to, to work towards, but I would, respectfully, I would separate this idea, I think you can be a very successful senior doctor, so a GP or a consultant, but you could also, at the same time, be someone who people don’t want to be like, right, you [00:06:00] know, you, you could be, Um, at the world’s best transplant surgeon, you could be, you know, incredibly technically skilled and saving lives, but you do nothing but work.

You are always at work, you never see your family, you never do anything else. And that’s how you got as good as you are, and obviously that makes you very successful at what you do. But people might not want, they might not want to live like that, they might not want to be like that. And so I guess I would separate the The technical domain and the technical success from, from the, the life, as it were, what people are actually doing and whether they are happy or unhappy, because again, you could be the best surgeon in the world, but you could be deeply miserable.

And I guess, particularly now, with the changing landscape of pay and conditions and relationships with, with the, with other staff members and things, all of these things are, I suppose, discrete. [00:07:00] Entities where someone might might come and watch Matt Daniel operate and say, um, Matt’s the best surgeon in the world and I want to be as good a surgeon as him, but I don’t want to work as much as he does.

Or, you know, etc. And I guess I suppose they’re different things to consider would be my answer. How do early career doctors make those decisions about the relative importance of different aspects of life balance? You know, how much do I want to work, how much do I want to train, where do I want to end up, you know, family?

So how do people make those decisions and balance it all up? For me, certainly, and I can’t speak for my colleagues, but for me, it just comes from speaking to people, you know, and I think I work in neurosurgery, for example, which is a peculiar specialty in and of its own, and people work very long hours.

It’s a very consuming specialty. [00:08:00] And so I suppose having a safe environment where someone like me or even a medical student, you know, earlier on can say, um, Mr. So and so, Ms. So and so, how You have kids, you know, how do you balance all of these things, because clearly you, you’re spinning a lot of plates all at once.

And when you do ask, you tend to get some really good answers, but I think if people don’t, if they don’t feel safe to ask these kinds of questions, or, or say you wanted to raise something like the possibility of working less than full time, or something in a surgical specialty, which might be, an anathema in some specialties at the moment, or this horrific thing.

You need that, that confidence that asking these questions is not going to destroy your career, um, before it starts. Um, so I guess there’s, there’s what you can glean from, from asking directly and getting an honest answer. There’s what you can [00:09:00] observe. And I think even, even as a student, you can quite astutely observe who is, who is happy and who is not.

You can. you can see that just from how people project and how they relate to others, um, perhaps in their department, you know, dysfunctional units exist sadly in all specialties and even walking through them as a medical student, it’s quite easy to tell where people are happy and where they’re not. So that might influence your, your view of these things.

Um, I’ve been lucky, I suppose, in the sense that. In many of my specialty experiences, senior doctors have been very keen to, you know, so you’re going to come and do a career in anaesthetics, you’re going to come and be an intensive care doctor, right? You know, they, they sell their specialty because they love it.

And I suppose that’s the other side of all of this. My, my angle’s [00:10:00] been somewhat negative thus far, but Just as you have that, you have people that love what they do, all day, every day, and they’re the happiest people in the world, and they want everyone else to do it, and see how good it is. What, what makes one specialty?

Is a specialty, are some specialties just happier than others? And, you know, and if so, what makes people in specialty happy? Or is it departments, that some departments are happier than others? You know, what, what makes one department happy and another one not? That’s really interesting, because I think, and I realize as I’m, as I’m formulating this, I have no evidence for this, so this is just, um, this is me pontificating a little bit, but you would think that specialties, perhaps with higher on call burden, higher acuity in presentation, where you’re doing more resident on calls, [00:11:00] perhaps long into your career, perhaps training is long, multiple fellowships, no prospects of a consultant job at the end, you know, and obviously I’m talking about neurosurgery there.

I can very well imagine that that kind of situation would make someone more miserable if they didn’t have to face those same barriers. But What I want to be very careful not to do is to, is, is to, to pinhole this idea that negative experience necessarily means that someone is going to feel negatively about their specialty, because despite all of those hardships, someone may love it, and a specialty may not.

That, that doesn’t have those things, perhaps you cct quicker and there’s very little on call and you can work from home or all of these things that might make your life easier and more flexible. [00:12:00] You can still have a horrible time, depending on the circumstances. So I guess there are, there are broad scale issues that will influence your, your positivity or negativity and different specialties will have their own challenges.

But I think it’s probably more about. the individual level and individual departments in which people work because I think even it even if you’re having a terrible time if all of you in a department are having a terrible time together and you’re working through that adversity together you might You might feel okay.

Um, but someone who is working in a, in a much shorter specialty, perhaps with less burden like that, but you’re not supported, you’re alone, you’re not being trained properly, you’re going to be miserable. So I, I guess it’s a, an interplay. It’s interesting, actually, that, that, yeah, there’s, there’s many, many things [00:13:00] there.

So if I think, if I think back to my career, because obviously I’m substantially older than you, and I remember when, When I first started working, the hours and the workloads were terrible, yeah, um, and people really, really struggled with that. But what existed was there was real camaraderie. Everybody was in it together and everybody did shift works together and, you know, and there was a mess and we got free accommodation.

And, you know, and tea and coffee and if you’re on call on Christmas Day, you went from ward to ward and every ward gave you a Christmas meal and every ward gave you presents and every patient brought you chocolates. Um, and it was just, just totally, totally different. So, you know, the workload was, was hard, but the whole support system, you know, the reward, the camaraderie.

Um, really kind of acted as a counterbalance to that. Yeah. Um, and I think lots of that I think has disappeared, you [00:14:00] know, I mean, I’m a long way sort of removed from early career doctors, but I don’t think people don’t spend a long time in the mess. People don’t go out for dinner together. You don’t do on calls with your team, you know, you’re not all in once every five days, the registrar doesn’t buy pizza for everybody in the team.

So it’s a big, because you know, that whole. teamwork and camaraderie has been fractured, um, and disappeared. And I, you know, I would love, I would love to try and get sort of some of that back. And I think the problem is, is, is I think the structure, um, of how we work, um, has, has changed. And, um, And probably because, because us as doctors gave up, we gave up the power to structure how we work here.

Cause you know, if you kind of think that when I was at your stage, you know, the consultant reg SHL house officer, all of you would be on call together. at the same time. Okay. Um, and that’s, and that meant that, you know, once every five, six days, [00:15:00] whatever it used to be, you were on call together, but you were always on call together.

The whole team was together. Yes, it was hard work, but you always work with your consultant and your edge, um, et cetera, the same, the same team. And obviously that doesn’t happen anymore. Um, I wonder sort of in terms of what you were saying about, um, the, the, the, there’s a fit between a specialty and an individual, isn’t it?

Yeah. Um, and which, which then goes to, to, you know, I love the high or not me, but one loves the high acuity. Sort of stuff, you know, the, the out of our stuff, the emergence, yes. So the stabbing and the major trauma and all of that is super exciting and makes you come alive. But you know, it happens to come with resident and, and weekends and you say, okay, well I accept, I accept these bits because what I really love is the stabbing and the major trauma.

Yeah. Or you might sort of get somebody else who say, you know, actually, you know, I, I, I’m, I’m really value. The fact that sort of that I can do all of these additional things and, you know, and, and time [00:16:00] out and time away from my work. And, you know, and that’s really, really important. And I accept that, that perhaps, you know, my workload is different.

So maybe I accept that I have to have, you know, 10 minute appointments because, you know, because I want to have every weekend off and in order to have every weekend off, I accept that, you know, what I have to deal with, I have to deal with, you know, 10 minute appointments or, you know, whatever, whatever happens to be your pain point, but it’s people consciously choosing and accepting.

Yeah, it’s, I mean, what, what I think. And it’s something I really don’t want to dwell on because it can’t ever come back. But, but what you were talking about is the firm, isn’t it? The firm structure. And that’s, that’s now long dead within UK postgraduate training. But it just made me think, I went through, I did my foundation programme and For those who, who are maybe pre modernizing medical careers in the [00:17:00] foundation program.

The way it used to be is you would graduate medical school and do six months of medicine, six months of surgery, and then those were your house jobs, and then you would apply for a job working in some specialty somewhere or whatever. And start working towards becoming a registrar. Now. The current system that we use is the foundation program, which consists of six, four month long posts over, uh, over two years.

And the idea being that you see some medicine, some surgery, some community medicine, but because you’re only really there four months, obviously, it’s, it’s difficult. Nothing in, in the grand scheme of things. You’re, you’re barely getting a taster of a specialty in your, your slowly, you get to grips with one department and how it works and how the consultants work.

And then you’re ripped away again and put somewhere else. And I went through, I think my, my [00:18:00] first surgical job, for example, my, my first job as a, as a surgical house officer. I think I met my consultant maybe twice, you know, in four months. And I don’t think. It came across at the time as in they were disinterested and I don’t think they had any interest in ever meeting us because our job was kind of to keep the patients alive on the wards, do the bloods.

prescribe the meds, write the discharge letters, whatever, um, try and keep the patients alive while they’re doing other things. As I’ve now cleared the foundation program and I don’t rotate anymore. And we now have foundation doctors who, who come in and out every four months. How are you meant to develop a relationship?

with someone in that length of time, and particularly a consultant who might see, who will see six new faces, maybe more in the space of a couple of years, they’re never, [00:19:00] never going to remember these people that float in and out or be able to substantially invest in them. Um, they could try and, and some people might be able to have these, these transient, very positive experiences.

But as you say, I think we’ve, We’ve hamstrung ourselves to some degree with how we have allowed, how we’ve allowed things to change, and we, we’ve set up a situation for our newly graduating doctors in which they’re not going to be invested in, they’re not going to be remembered, they’re flung from pillar to post to keep services running, and that’s the point, you know, um, rather than educational benefit.

The bigger question for me is how we would ever undo that if it’s, if it’s possible. But yeah, I think we, we are as much to blame as a profession for allowing these changes to happen. I think. So I think you’ve already [00:20:00] identified at least two things there for me that can be done, you know, and the first one is that, that, that how the impression that the consultant will give.

you know, to, to, to an early career doctor. And I’m not, and I’m not suggesting that I’m brilliant at this because I’m not. And again, you know, if I think people come through to us and I see them for the, and if I’m somebody’s clinical supervisor, I literally, I see them, you know, for the sign in meeting and I say, you’ve got to come and do at least one clinic with me so that at least I’ve met you once.

And, you know, and literally that is the only contact that we have to sign in meeting. One clinic and the sign out meeting. And that’s the only contact that I have with somebody that I’ve supervised for four months. Yeah. Yeah. That’s, that’s, that’s actually, that’s not that I’m disinterested in them yet. So, but it’s, it’s, that’s how the work is structured.

Their work is structured away from me. So for me, that’s the problem is how, how the work is structured yet. You know, they, they are, they are not. aligned [00:21:00] to me and their work and my work are not structured together. There’s the problem. Yeah. Yeah. What needs to be fixed is that needs to be fixed so that, that, that, you know, when I’m in clinic, you know, when I’m doing my clinic, the SHO does the emergency clinic.

Yeah. So if I’m doing my clinic on a Thursday morning, the SHO does their emergency clinic on a Thursday morning, which means that both of us are, you know, together there, or, you know, that, that kind of as an example of something that potentially. Yeah. Um, could be done. Yeah. But I suppose there’s, there’s an attitude there, which is you, you’ve said, you know, how interested the senior doctor is and, and, you know, and the, the, you know, maybe what, what we as senior doctors can do.

We, we can acknowledge that, that, that this is a system, and it’s not that I’m disinterested in you. The reality is that in four months time, we’ll be lucky to do one clinic together. Yeah. Because that is how, how the system is. Yeah. Um, and that’s terrible supervision, but it is how the system is at least.

Yeah. Yeah. And I suspect elsewhere also. But you know, but maybe the consultant can acknowledge [00:22:00] that um, and recognize that. Hopefully there’ll be, there’ll be areas, maybe this is particularly bad in surgery, so hopefully there’ll be areas where, where it is much better. And then as, as people rotate through, then, you know, cherish the times when you do actually get to spend time with your supervisor, because certainly in a lot of surgical specialties, it just doesn’t happen.

Um, so, you know, when people rotate through other areas, when you do actually get to spend time with your supervisor, then that’s, that’s something, um, to be cherished. But the two sorts of things for me there would be you know, one that we can fix is how is work structured? And, you know, and two, how are we welcoming as consultants?

How do we welcome people into our department? And perhaps three is the reality is that, that, that again, if I think of surgical world, I know the registrar that I work with very well because the registrar and I are always together. Yeah. The registrar are a team. Um, the SHO and I are not a team yet, but, but perhaps, perhaps is if I give a really [00:23:00] good experience to the registrar and if I support the registrar really well, hopefully the registrar who does work with the SHO is much more than I do.

Hopefully if the registrar is well supported, the registrar will support the SHO. So maybe what can be done is the days when I will spend lots of time with the SHO. difficult to see how that’s going to change anytime soon. But if I treat the registrar well, then hopefully that registrar will provide a really good experience to the SHO.

So maybe is that trick trick trickle down caring? Let’s call it that. Maybe. And I think genuinely Matt, that the feeling on the ground, and this is speaking, so I’m an SHO in a surgical specialty, but the feeling generally is your training, your training as such your proper training in medicine or surgery.

across specialties does not really begin until you are a registrar, but for that exact reason, because until that point you [00:24:00] have nobody that is actually invested in your training because it doesn’t matter, you know, that that’s the thing. If, if you have an FY1 doctor, you know, a new graduate who comes to you in ENT perhaps, and They maybe learn a bit of ENT, they maybe don’t, whatever, they probably statistically don’t want to do ENT, because that would only be one specialty out of many.

They move on, and so what? It doesn’t really matter to you, not you personally, but your department or the system as a whole, whether that doctor is any good at ENT or not, after they come out, similar with any other rotation that someone might do, because you’re only spending four months there, but If your registrar can’t deal with an emergency case overnight, perhaps, or out of hours, it’s you that will be called, right?

So it does make a tangible difference to [00:25:00] you and the service. And I think if we think about most specialties, most higher surgical specialties, it takes people Two years of foundation, two years of core training. They’ll be in their fifth or sixth postgraduate year at the very least before, before the system starts to actually invest properly in, you know, in them as a trainee.

And that just to me seems very, very late compared to other, if you look at residency programs in other countries, I know we. We hop on about the US a lot, but even, you know, my colleagues from Portugal, Germany, Cuba, et cetera, that have come over to the UK. Um, I was at dinner literally, um, earlier this week with a, uh, with a load of urologists from different countries.

So we had like a [00:26:00] urology consultant from Canada, one from America, one from Switzerland, one, you know, Lots of different places. And when I explained how the UK training system works, they were, they were like appalled, you know, the, the, why do you do it like this? Why? And they, they recognize this issue immediately.

Well. who, who is actually training you, you know, who is investing in your training. If you’re not a resident for like five years, what are you doing?

So I suppose the question is, okay, you know, let’s think if you’re going to fix the system. So what, what, what are people doing? In those first five years, well, the first two years you are running the wards really aren’t you you are, you are, and I know it’s a bit of a toxic phrase but but you are [00:27:00] you are service provision, the really the point of you being there is to ensure patient flow and to, to keep people alive and get a taster for the basics of medicine in hours and out of hours.

But you’re not really, you’re developing broad based skills, you’re not developing specialty specific skills. And we do that for two years. Who, who, who does, sorry to jump in Ollie, who, who does this elsewhere? So, you know, the countries, the countries where people very early on, much earlier, Sort of get into training who does those things elsewhere?

Who who does the sort of run through into specialty? Well, who who who looks after the board who chases results who does? Yes, all of those things that that we sort of say in the service provision. That’s a typical f2 or st1 So if if you’re gonna say, okay, you know, let’s take those people out of that. [00:28:00] Um, Who who who does it elsewhere?

so in Canada, for example, I believe The answer to that is, and I think this is the answer to be honest in most countries, is that the residents do it. But the, the thing that comes with that is they work double or triple the hours. That’s the major, so. Either I think you, you work many, many more hours and you might have more residents, you know, you need more feet on the ground, but they’re all there all the time, how it used to be in the UK.

Um, or the answer is that you use other health practitioners. So in, in America, for example, that would be PA’s physician assistants as they are their physician associates in the UK, um, advanced nurse practitioners. Um, you, you split a lot of that responsibility with, with [00:29:00] other health groups. Um, obviously what we miss in the UK or what we, we don’t do is we don’t do the hours that those systems do.

That’s the major difference. Our training is much longer as a result. Um, but interestingly, it’s much longer. even controlling for the, the additional years of internship and things. Um, so if you look at, to compare neurosurgery, for example, in the UK and the U S neurosurgery residency is eight years in the U S despite the fact that they recruit straight into it in the UK, it’s eight years.

after the foundation program, probably after another year of working as an SHO, like I’m doing now, and then two or three fellowships at the end of that. To properly develop the skills that you should have developed as a trainee, but weren’t able to because there wasn’t [00:30:00] the capacity. Um, so we, we have a very extended system.

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So again, I’m old enough to remember when European working time directive came in. Yeah. And again, it’s, it’s. controversial opinion. I don’t think it’s been a success. Okay. No, I don’t either. I mean, I’ll tell you, I’ll tell you, I think it’s, it’s misrepresented because again, you know, if I think how I used to work yesterday, you know, when we used to do, you know, you work Friday nine till five or whatever, then you’d come in on Saturday nine in the morning and you would work until Monday at five o’clock.

[00:31:00] Yeah. So, you know, but the thing is, You weren’t awake all of that time. Yeah, at least not in ENT. Yeah, people expected that you would be asleep. People wouldn’t dream of phoning the ENT SHO sort of on Saturday after 10 o’clock at night, you know, sort of, you’d go around at 10 o’clock, the nurses would put all the charts and you would go around and you’d all do all the charts, prescribe all the fluids for the night and everything.

And, you know, people wouldn’t, nobody would phone you at two o’clock in the morning to prescribe paracetamol or rewrite a drug chart, you know, whatever it would be. Yeah. You know, A& E used to pack noses and put people in a bed and, you know, the A& E SHO was your mate. And they phone you at seven in the morning and kind of say, you know, look, I saw such and such at one o’clock in the morning, I put a pack in the nose, they’re perfectly stable, I didn’t phone you because nothing needed to be done.

Likewise, you know, with tonsillitis, they say, I admitted an 18 year old fit and healthy, I put up a bag of fluids, I’ve given them some antibiotics, I didn’t phone you at one o’clock in the morning because you didn’t do anything, but you know, can you just see them on the ward round, and then [00:32:00] you’d go round at eight o’clock, yeah.

So, so, you know, yes, we work long hours. But, but the, but we were asleep. Yeah, you know, you had another call room and, you know, okay. If there was a big emergency, then yes, you got called. And, you know, that’s why it was called on call. Yeah. You were on call. You got called if there was an emergency, not, not to do routine stuff.

And the other thing, again, you know, if I think for me going back to that, to the house job yet, which was, which was really long hours and really hard work. I think for me, the major thing there was. was, you know, you had, you had hospital accommodation. So, you know, literally you lived on site, you went in and then you went to bed and you went in and went to bed.

So, you know, yes, you did long hours, but you just lived in hospital for a year. People accepted that that was going to be a year because you knew you were a house officer and it was going to be incredibly hard work for one year when you were 20. Yeah. So at the age of 24 or 23, you worked really, really hard for one year and basically lived in hospital for one year.

And at the end of that one year you became SHO and you [00:33:00] were God. Yeah, the SHO was God. So we’ve shifted that one really, really intensive hard year where you just lived and worked in hospital. We’ve lost that. And we’ve replaced it with this years and years and years long thing where people nobody has any ownership.

And so And, and, and actually, you know, that’s kind of why for me, at least, at least in ENT, I can’t talk for other specialties, but you know, for ENT, it’s been a disaster because instead of having one really, really intense year, and then you became the ENT SHO and you were God as the SHO, you know, this kind of now, this expanded thing that, that carries on until you’re 40 and you sort of, yeah, exactly.

Yeah. Give me some examples where you, you or other people that, you know, have been really well supported by senior doctors. Yeah. So there is one, um, I think I can say the department because it’s a really positive thing to say. [00:34:00] There’s no, it’s just an observation. I, uh, I did my, my foundation jobs, um, up in the Northeast and one of my, my SHOs, my F2 rotations, I did.

With the neurology department at, um, that’s the Royal Victoria Infirmary in Newcastle, their big sort of city centre hospital and we were warned before going there, um, that it was a bit of an old school department and it was and it is. And I think what that meant practically, the way I was warned is it’s a bit old school, like, no scrubs, no scrubs allowed on the ward, have to wear smart clothes, like, you know, businesswear, whatever.

And, um, went in and I thought, all right, you know, fair enough, whatever. I tended to wear smart clothes anyway. So this wasn’t a concern, but went in and what you quickly realized, or I realized as someone who’s very interested in medical [00:35:00] education and training is that It was quite strict as an environment.

So expectations, you know, were set by the consultant and they were high and you should examine all of your own patients and, you know, come up with the plans and things. You shouldn’t just be following a ward round and scribing as a dog’s body. You were there to be a doctor. But what that department did so well was their emphasis on training and they recognized how important good training was and that without that training.

You weren’t going to get good doctors and the way they did that was they, they blocked out one of the afternoons in the week for a grand round, um, where all of the doctors, um, and, uh, like the specialist nursing staff and the, the groups that were going to come and discuss these cases would sit in a lecture theater and they [00:36:00] would present cases, you know, for one or two hours.

And we, as the SHOs would sit at the front. And so we’d be first in the firing line for any questions, you know, what do you think about this scan, whatever. And then when we weren’t able to answer it, we’d go to the registrars, who were next, and then the consultants at the back, as it got more and more difficult.

And similar with, with protected SHO teaching on a, I think it was on a Friday or something, where the consultant would sit with us for an hour and go through something. But the point was with this, that it was so fiercely protected. From like service demand, if you like, where if I was called during the grand round or, or during this protected teaching, the consultant would take the phone from me and say, You know, no, they are in training.

Like, and that this is important for their training and would, would deal with it. Um, [00:37:00] and I’ve never worked anywhere else like that, where it was so, so the idea of training was so vigorously protected by, by the consultant body. And they, they really stuck up for the doctors in that sense. Um, or if you were.

Uh, if you were in theater or whatever doing so, so they knew I was interested in neurosurgery. So they let me go and spend some time with the neurosurgeons. And again, would be very clear. No, this is a training exercise. He is there to be trained. He should not be called back to the ward. Because as, as early careers doctors.

We, we have no gravitas, obviously we are, we are no one in the grand scheme of things, especially in an established department. If, if the ward sister that’s been there for 10 years tells me to do something and I don’t do it, as the SHO that’s been there for two months, you know, I have no agency, [00:38:00] I have no hour, as it were, I can’t stand up for myself.

We rely on our senior doctors as the The grown up version of our profession to stand up for us and our training and I remember that really vividly. So there’s something there about culture, but also I’m going to say departmental leadership. Yeah. Because again, if I, if I turn that round, you know, kind of what, what happens, what happens at consultant level, people say you need to do more clinics, you know, when you need to, you need to reduce doctor’s hours, you need to put more clinics, you need to put on extra theatre sessions.

Um, and then instead of the departmental leader, whoever that happens to be, pushing back and sort of saying, you know, no, Wednesday afternoon, we do not do any clinical work. The whole department stops every Wednesday afternoon and every Wednesday afternoon we have training or once a week on Friday for an hour, whatever that might be.

is, is that, that [00:39:00] somewhere in the far distant past, most departmental heads will have had, Oh yeah, you know, let’s grab that. And again, I remember the days when nobody worked, nobody was clinical on Friday afternoons. Yeah. That used to be perfectly normal. No department was ever clinical on a Friday afternoon and Friday afternoon every week always was educational activities.

Yeah. Somewhere along the lines that our, our previous leaders. Would have said, okay, well, we now need to work Friday afternoons. Um, and somewhere along the line, you know, sort of the Wednesday lunchtime or whatever it went. And then somewhere along the line, you know, the, the, the rotor coordinators then thought it’s perfectly okay to schedule people to be on call.

Like first, this happens with GP trainees often. Yeah. Cause I think trainees where we are, they’ve got a weekly half day release scheme, but, you know, but somewhere along the line, the rotor coordinators thought it’s perfectly okay to schedule those people. to be clinical, um, which is the rota coordinator’s job, but I guess there was a failure of medical leadership there because [00:40:00] the department doesn’t push back and kind of say, you know, no, no, this is not acceptable.

I think we have the, we’re going to have these battles of accountability. And this actually is, is my. I think my great failure, perhaps, as an early careers doctor to understand this, and it’s only as I’ve become more involved with groups like the BMA and starting to speak to people who work at the Royal Colleges and in government.

And I think we, you know, we certainly as a medical student, and even now as a foundation, an early careers doctor, you see your consultant as God, you know, don’t you, in that sense that you’ve described. To my consultant. knows everything about everything and they, what they say happens and everyone respects them and everyone looks up to them and they’re seen as the great, you know, the people who know what’s going on and can affect [00:41:00] change.

So in the example we just talked about, if, if, if Matt Daniel says, no, Friday afternoons are for training because If we don’t do training, then our doctors are going to be worse and patients are not going to be better served. Um, this is not acceptable from a professional standpoint and we need to do the training, but whoever sits above you, presumably then turns around and says, well, tough, you know, you, we have more patients and we need to run another list.

on Friday afternoon or whatever. And I think what I have, have always failed to understand is what happens at this interface, because now let’s say now all of the consultants, not just you, but all of the consultants say, this is extremely important. We need this training. If it doesn’t happen, patients are going to suffer.

Can you please sign in an email? [00:42:00] that you are okay with training not happening and doctors getting worse and patients not receiving proper care because our doctors won’t be as skilled. What actually happens In these kinds of discussions, because this is where, to me, accountability seems to somewhat fail.

Because that decision to remove that training isn’t ever, it isn’t ever attached to anyone. No one actually takes responsibility for it. That person above you, it just sort of disappears into the, into the web of the NHS. Where does responsibility lie? I think that the problem there that you’ve outlined again is, is, is for me is how, how, how our profession is led.

Yeah. So do you know who, who are our leaders? Cause my guess would be that, that, that, you know, if, again, if you talk with that Friday afternoons, they probably were a bunch of consultants. [00:43:00] that shouted and sort of says, this is not acceptable. You can’t do it. And they were overruled same as I don’t know what happens in general practice.

But, but again, when I was a student, general practice, Wednesday afternoons, all general practices used to close. Yeah. Remember as an undergraduate doing my GP attachments and my GP took me cycling on the Wednesday afternoon because, and he said, bring your bike. Have you got a bike? And I can see I’ve got a bike.

I said, bring your bike on Wednesday. And I kind of like, why am I bringing my bike on Wednesday to a GP attachment as an undergraduate student? Yeah. And it’s because, you know, this is what we do in general practice on a Wednesday afternoon. We go cycling and I went cycling with my GP because they closed.

Yes. So, um, and, um, and, you know, and I kind of thought, OK, I mean, I might want to do general practice if this is right. Yeah. Um, so, so I think somewhere along the line, you know, people did stand up and they were overruled. Yeah. and opted out. Yeah. And the people that made it happen were the people that progressed their medical career.

Yeah. Because, you know, the medical leader, you know, the people that [00:44:00] implemented those things progressed and the more they implemented unpopular short term decisions, you know, the more they progressed. And I think that that’s not just medicine. That’s how, that’s what happens everywhere in the world. Isn’t it?

You know, people get rewarded for, for, for doing the bidding of the person above, not necessarily what needs to be done. And medicine is no different there. Um, I guess sort of the, the, you know, part of the, part of the challenge there, again, you know, if, if I think of that, um, Friday afternoon is, is the, is the, is the fact that, you know, people simply opt out, yeah.

Um, and maybe, you know, a senior doctors, one might sort of say that, you know, that, that’s, that just isn’t acceptable. Yeah. You know, if something’s right, um, you need to keep pushing at it, but then, you know, people burn out, you push, you push, you push, you push, you push, you push, you push, and 10 years later, you kind of give up.

Um, I think it’s also for, for me, you know, in that example, we’re talking about Friday afternoons, I think, [00:45:00] um, you know, It’s, um, it, it’s, it lacks, the solution lacks imagination, yeah, because, you know, for me, I kind of think, you know, okay, theatre’s empty on a Friday afternoon, so, so how about ENT operates on a Friday afternoon, but not on a Tuesday afternoon, and, and, but on a Tuesday afternoon, all of our theatres go to neurosurgery.

And you know, neurosurgery takes EMT theaters on a Tuesday afternoon, and neuro neurosurgery has Wednesday afternoon and a Wednesday afternoon Neurosurg is off. But that means pediatric surgery sort of operates in neurosurgery. So theater still gets used all the time. Mm-Hmm. clinics still gets used all the time.

Yeah, because I can see why a theater’s empty, you know, it’s a waste of resources. I can see. Yeah, you should be using it, but an imaginative solution. is a system wide solution, where people sort of say, well, okay, ENT is not using the theatre on a Friday afternoon, let’s give it to neurosurgery.

Neurosurgery is not using the theatre on a Tuesday afternoon, let’s give it to paediatric surgery. That for me would be an imaginative [00:46:00] system wide solution, so. But that, that is why I think, and perhaps to, to round off an idea that this idea of clinical leadership, you need. You need people who can, who can imagine things like that.

You need people who understand how clinical resources are distributed in order to come up with these solutions. And as someone who I’m about to do this year long leadership fellow scheme, I think that is the value in clinical leaders and having doctors, you know, speaking from my own perspective, we need doctors who are leadership trained, who are Who are able to think like this and implement solutions and that’s maybe what we’ve lacked, you know, historically, maybe, and we just relied on, on the gravitas of the consultant as a, as a body, as an entity.

to, [00:47:00] to enact change. They are the consultant and what they say goes, but maybe we need more than that now. And we, we, you know, we need people, you know, people from your generation who understand leadership, who understand influences, who understand systems, you know, who understand negotiation. And, and, you know, and historically maybe that is that that’s what we didn’t have.

We didn’t have understood leadership in its broadest context. So I’ll bring us to a close early and maybe if I could ask you to summarize what would be your top tips for doctors at work, um, doctors at work. I think the most important thing and the thing I try to remember every day is that we’re going in to help patients.

And. Whatever stresses we do or don’t have, um, some of the most satisfying experiences I’ve had at work have been able to still go the extra mile for a patient and get a really good outcome, even when things are very [00:48:00] stressful and very bad. And although it felt horrible at the time, those are some of the most satisfying encounters I’ve ever had.

Um, being honest and open with those that supervise you and asking for help when you need it. And talking about the stuff that we’ve talked about today, and saying, I don’t think something is right, or I think this is a problem, or I need your help with this, and a lot of the time you’ll be ignored, and you won’t be helped.

If you don’t at least try, then you can’t say that you’ve done right, um, in those situations. But actually, the third thing, and it’s perhaps a tangent, is to value yourself. Um, and this applies. More generally, I think, if you are, if you are being used and abused at work, do not sacrifice yourself for the well being of the system.

Um, you should try not to burn your candle at both ends, I [00:49:00] suppose, just to keep the machinery running. The machine needs to survive by itself without you throwing yourself into it. And if you’re not satisfied and if you’re not being looked after properly, then you have to be prepared to leave because otherwise nothing will change.

Wonderful. Thank you very much, Ollie. Thank you, Matt. It’s been lovely to chat to you.

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