QJM vol. 97 no. 12 © Association of Physicians 2004; all rights reserved.
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Modern medicine
6.30 am. Woken by the alarm clock before the morning chorus. The roads are pretty clear on my way in, so for a change I manage to find a place in the main hospital car park, opposite the one reserved for the director of finance.7.45 am. A working breakfast with the chief executive and medical director. Apparently they want me to re-write the section about my unit in the Trust's annual report. Bob, the CEO, comments that it is ‘too factual’. Sarah—once my registrar, now the MD—suggests that we should cut out a lot of the text and replace it with nice photos: she knows a good agency that provides these. I argue the toss for a while, but they manage to convince me that good PR is an absolute necessity for hospitals these days. I couldn't help noticing how well Bob and Sarah are getting on. I can remember how she used to call me ‘sir’, but now she is the only one apart from my mother who calls me Charlie instead of Charles.
8.30 am. I attend the first shift in this year's CPR training. Evidently the old mantra of ‘ABC’— airways, breathing and circulation—has gone the way of the dinosaurs. The nurse running the session tells us a much longer and more helpful mnemonic, which I forget for the moment, but I have written it down in my Filofax. (Apparently I am the last doctor in the Trust who still has a Filofax instead of one of those electronic things with a large toothpick. I shall ask my children to get me one for Christmas, and no doubt their own children can teach me how to use it.) Bob is at the training session too and makes an ass of himself by saying that he would maintain cardiac massage in preference to applying pressure to an arterial wound in someone who is haemorrhaging to death. Odd, when you consider he used to be an anaesthetist.
10.00 am. Just in time for a meeting of the ethnicity and diversity sub-committee, which I now chair (Sarah can be very persuasive when she puts her mind to it. When we did my job plan she said something about it being a bit lightweight: ‘just seeing lots of patients and dabbling in research, but not much else’). There is a big agenda. We commission some very useful statistical reviews covering everything from consultants’ discretionary points to ethnic monitoring of our car park staff—who were accidentally left off last month's survey. This business of ethnic monitoring is another area where I used to be less than politically correct, but I got an ear-bashing over this from Bob's new young wife at a dinner party a while ago, and I am now thoroughly on message about it.
11.30 am. I get to the next meeting by the skin of my teeth. It is a mandatory fire and safety training that I signed up for several weeks ago. I feel rather ashamed of myself because I seem to have forgotten the difference between the three different types of fire extinguisher. The fire officer who does the presentation is an absolute wizard with PowerPoint, and I am a bit surprised when he mentions that he no longer works on the front line as a fireman. He looks quite a fit young man.
1.00 pm. Lunch. I always used to miss this and eat on the hoof, but the inspectors from the Commission for Health Improvement visited us earlier in the year and noticed ‘a culture of comfort grazing rather than a model of healthy eating’, so nowadays I am careful to be seen in the canteen. I hold a conversation in the queue with two of our honoraries who tell me that they are introducing a system of ‘educational governance’ for everyone involved with the training grades. I am of course familiar with clinical governance and research governance, but I must confess I have been training my juniors on the old principle of ‘sitting by Nellie’. I shall try to pull my socks up and go to a few meetings about this. Sadly my lunch break means that I don't get time to record the morning's activities for my appraisal folder. I also feel rather embarrassed afterwards to discover that I missed a lunchtime meeting on detecting poor performance in colleagues.
1.30 pm. Most of the afternoon is taken up with the serious business of building up our patient liaison service. I am now the consultant rep on this (Sarah's influence again—what is it about that woman?) We have to interview a number of candidates from the local community to join us. It is a formidable task. Fortunately our head of human resources has already done a ‘comprehensive mapping exercise of local stakeholders’, and she brings along a very thorough set of government guidelines about making such appointments. We take an hour just to familiarize ourselves with these, but in the end we manage to appoint some good people. Evidently there is a very robust appeals procedure for anyone who feels unfairly rejected.
4.30 pm. All our non-medical staff are in the process of having their contracts revised: something to do with modernization and Europe, I think, although I am not entirely clear about this. Consultant medical staff are exempt, because we have our own splendid new contract, but I was touched when the union shop steward asked if I would give some input. (I was rather touched to discover that there still was a shop steward.) Unfortunately at the meeting itself I find that I don't really have much to contribute. My suggestion that ‘Operating Theatre Assistant’ remains a better term than ‘Parasurgical Resource Officer Grade One’ does not win favour. Apparently Bob is very keen on ‘rebranding’, Sarah even more so.
5.30 pm. There is a note on my desk when I return to my office. One of my more vulnerable patients has apparently phoned up in a state and left a message with my secretary. ‘He says he is pretty desperate,’ she has written, ‘and would be terribly grateful if you could phone as soon as possible.’ I pick up the receiver, but then suddenly remember the tremendous telling-off we had all had from Sarah (and Bob) about not sticking to the Working Time Directive. Apparently our next star rating may hinge on this, and possibly even our hope of becoming a foundation hospital. Reluctantly, I replace the receiver. I shall have to make the call tomorrow—if my other commitments permit.
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