Layla's space

With all its sham, drudgery and broken dreams it is still a beautiful world.

Monday, December 14, 2009

Working in the sticks

I moved jobs a few months ago (or 'rotated' as the Deanery would have it) and am currently working in a District General Hospital just outside London. When I told a few friends and colleagues where I was going to be working, there were a few sniggers (including from me) and jokes about local yokels, chavs etc and generally about the contrast between this place and the large London teaching hospital I was working at previously.

Actually, I much prefer it here. In my (relatively limited) experience, large teaching hospitals are rather dysfunctional. The administration side of things at my previous place of work was a nightmare - the secretaries were off sick half the time (and they were pretty piss poor when they were there). There are far too many people with their heads up their arses in a lot of these big places, who are only out to puff up their own over-inflated egos. More 'lowly' staff are demoralised and bored, and have no incentive to do a good job. They therefore tend to be monumentally unhelpful and trying to get anything done/ordered/chased up is a major drama. If you need to order a slightly unusual test, or get something done urgently, you get put on hold umpteen times and pushed from pillar to post, department to department, because it's not anybody's responsibility. 'That's not my job' is a favourite phrase.

Here, however, I have found almost everyone to be incredibly friendly and helpful. There is more of a sense of community I suppose, everyone knows everyone else (or it seems that way, though it's not that small a hospital) and therefore seems more inclined to help you and point you in the right direction. If you need an echocardiogram result, for example, you just call up Maureen in Cardiology and she'll fax it to you. My old teaching hospital? Forget it - there was never anyone to answer the phone in the echo department, they refused to fax results and tended to lose most of them anyway. I used to go to the department myself and look through their (useless) filing system until I found the result I needed.

In the Oncology Department, people are generally a bit saner. In my (again, rather limited) experience, Oncology Consultants in teaching hospitals are generally mad. Usually very good at their jobs, but mad as a bag of cats. Mad, and they all hate each other, which results in a horrible, snidey, competitive atmosphere in the department. Here, amazingly, they all seem to get on. They seem to actually care about their trainees (ie us), and seem to be relatively sane (there are, of course, exceptions).

There are downsides to working in a DGH, of course - mainly lack of resources. So for example, getting urgent scans can be difficult due to staff shortages, machines breaking down, etc. There is a 'longer than there should be' wait for treatment in the Radiotherapy department at the moment as they've just laid off a few radiographers (yeah, smart move Mr Chief Executive - you've saved money on their salaries but now we're going to get fined millions for not hitting cancer treatment targets - well done you).

But anyway, all in all, I feel less stressed out (now I've said that I'm undoubtedly going to have a really stressful day today), more appreciated and generally happier at work. Oh, and did I mention that I usually leave work on time these days?

Just call me Dr Local Yokel - I'm a total convert.


Blogger StorytellERdoc said...

Hey there, I just caught your blog and really enjoyed your postings. Good for you for pursuing a less stressful workplace. Although we all at some point want to do the same, we don't have the courage you had. So well done.

Thanks again and enjoy your day.

January 07, 2010 1:24 PM  
Anonymous Anonymous said...

i just stumbled on this blog randomly, some excellent entries!

I'm a 4th year medical student currently, so it's been interesting to read your posts about hospital life!

Regarding your post "Muppets" I think the hospital system is becoming more about doing stuff just to put on your CV and look good. It's not about who is the best clinician, but who has the best looking CV's.

My dad's a doctor in Geriactric medicine, and he goes that the system now is becoming a system of referrals. Where doctors just cant be bothered to deal with the problems, and refer it to someone else.

January 07, 2010 9:10 PM  
Blogger Layla said...

ER doc - glad you enjoyed the blog.

My move to a smaller hospital was not from choice - it was a compulsory part of my training rotation, although a welcome one. I am planning on ultimately working in a small hospital as a Consultant however - quality of life over egocentricity every time ;)

Anon - I totally agree, juniors are increasingly focused on buffing their CVs and getting all those stupid (in)competency-based assessments done rather than on doing a good job, and the system supports them in this, indeed pushes them to act this way.

When you qualify, please remember the main aim is to be a good doctor - fight to get the hands-on training you need, not just tick boxes.

January 08, 2010 8:31 AM  
Anonymous Anonymous said...

Layla thanks for the reply.

I completely agree with you, the main aim is to be a good doctor. To treat patients like they should be treated, and the main thing to concentrate on is to be a good clinical doctor, and not just to look good for the CV!

That's the reason I went into medicine!

As a DR yourself now with some years of experience, what would you suggest to concentrate on in these last years of medical school? I'm sure the real life of a DR is much different.

And also these days how is the life of a F1/F2?? is it really busy? can you manage to live a normal life?

Also it's a great speciality you work in, Oncology. We'll have a rotation at university in Oncology next year which should be interesting! You oncologists do a great job!

January 08, 2010 8:59 AM  
Anonymous Anonymous said...

Oh and by the way last night instead of studying I managed to read all the posts on this blog! It certainly gave me some insight into the working life of a DR

January 08, 2010 9:00 AM  
Anonymous Anonymous said...

Oh and just a interesting side story after reading your posts "Muppets" about SHO'S.

My father works as a Dr in Geriactric medicine, and has been for the last 26 years in the UK.

So a relative had a problem with her nose, it was a nasal swelling on the middle of the nose, and it'd been a problem for some time. But it wasn't just some normal swelling. The nose looked a bit like the 'saddle nose' condition.

So my father thought it could be a granuloma of some type, wegeners or sarcoidosis.

First he had to persuade the GP to refer the relative to a hospital.

Once referred to a famous London teaching hospital, the SHO looked at the patient and stated it could just be a injury, the patient must have bumped themselves somewhere. However, the patient stated there was no such injury.

Bloods were taken - but there was no sign of inflammation.

But since this swelling had been there for some time, and didn't look due to some injury, my dad requested the SHO for a scan.

The young SHO rejected the advice of a senior DR, and didn't want to do any scans. He just stuck to his opinions that it's probably a injury.

So later my dad called up a more senior doctor, and told him about his suspicions so the Dr's ordered a scan.

Once the scan was ordered there was presence of some form of a smooth mass, they then performed cytology and there was no malignancy. Then went for biopsy and it was sarcoidosis.

The patient later saw that same dr in the hospital, but he was too embarassed to even approach, because of not requesting the scans!

January 08, 2010 5:32 PM  

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