Continuity of care in hospitals is already a thing of the past, says Jobbing Doctor
When considering what it is like to be a hospital doctor, Jobbing Doctor is stuck in a bit of a time warp.
I remember the old days of medical training, more than 30 years ago. Things were different then: L P Hartley described the past as a foreign country, and when I talk to the doctors of the present it certainly seems that way.
This is not a post about an older man reminiscing about the good times: being a junior doctor in the 1970s was hard, hard work. I don’t think the patients got a terribly good deal as we were all chronically exhausted, and I’m sure mistakes were made. We worked hard, but then everyone worked hard.
The thing about being a junior doctor then, is that there were certain really important factors that made it a valuable, exciting and rewarding job. They have gone.
One of the things that made being a junior at that time was working in a defined team. There was a pyramid structure at the top, and clear lines of accountability. As the junior in the team you were the work horse: tasks you did time and time again. The first two hours of most days involved taking bloods from patients. There were no such things as phlebotomists. You did it. Clerking patients was done by you, and nobody else. Whilst the patient was an inpatient, their welfare was directly your responsibility, and you tended to share that with a colleague from a parallel team. That is why one in two rotas were quite a feature.
What it meant, however, was two main things. You knew the patients, and the patients knew you. The nurses knew who to deal with. While the senior housemen looked after the outpatient side, you dealt with the ward. Now it is rare for you to see the patient on a regular basis any more. You never have the opportunity to learn medicine from the patient, and indeed learn from your mistakes.
Does this matter?
It does on two counts. Firstly, doctors are leaving medicine and the NHS in epic numbers. One report put the figure at close to 25%. This level of attrition is a huge waste, and it is not just the poor quality people who are going. I see a very variable level of quality of those coming into general practice training. That is worrying.
Just as worrying is the fact that my patients are getting a raw deal. There is no-one in the hospital who is a doctor they recognise. With the blurring of roles and uniforms, often people are not even recognised as doctors. There is no continuity of care, and this was demonstrated by a clinical case recently where a patient had seen four different doctors at four different clinics over a nine-month period, and the action that was taken was to order a variety of tests, and not to make a diagnosis or engage with the patient. I did have one letter, which was typed two months after the outpatient clinic, and arrived at my surgery a further month after the date on the letter.
Fragmentation of care means no care. I am now the only doctor that many of these people see, recognise and trust. I frequently get asked to explain what is going on, and I don’t even have any form of letter. I have to chase up results for patients who are told to wait three months for the results of a brain scan!
How would you like it if you had to wait three months to know if you had a brain tumour?
The Jobbing Doctor is a general practitioner in a deprived urban area of England.
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