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Thoughts and opinion from the wards
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Babies and Bathwater
Long ago, in the mists of time (well 1988 actually), I graduated as a fairly average student with a medical degree from a well-known medical school. Thereafter I went on to work in a district general hospital, first as a junior House officer for 12 months then as a Senior House Officer for two years.I rotated through a variety of acute medical and surgical specialties including A&E, orthopaedics, acute psychiatry, obs and gynae and so on. For each of these jobs I was the first port of call for the emergencies that came in on my receiving days/nights. I had to see them, assess them and sort them out as best I could. But I was also aware of a (largely) supportive hierarchy above me - SHO, Registrar, Senior Registrar and Consultant. Of these the Senior Registrars were the ones I looked up to most. Usually about 30 years old they were on the verge of being Consultants and as such their knowledge was often deeper, broader and more up to date than the Consultants above them. During each job I was usually in before 8am and seldom out before 6pm - 10 hour days, five days a week. On top of that I did an average of 1 in 3 on-call which meant that of the week's remaining 118 hours I worked 39 of them giving me a total working week of around 90 hours. Was this good for me? Well from the point of veiw of my social and family life almost certainly not. But it did result in a huge depth and breadth of experience in a relative short space of time. Was it good for my patients? Well, as far as I know, I never killed anyone! But beyond that I'm not so sure... What was accepted then was that to become a hospital specialist required at least 10 years of post-grauate experience and that you were unlikely to make the grade until you were in your early 30s. To become a GP you only needed 4 years of post-graduate training but I soon realised that, for me anyway, four years was simply not going to be enough for the kind of remote rural medicine I wanted to practice. In the end I did 8 years of post-graduate training before finally settling in to the job that I now do. Some years ago medical training changed. That, together with the European working time directive of a 48 hour working week, means that very few junior doctors are now doing the amount of working hours that my unfortunate generation had to endure. And I think, on balance, that that is a good thing both for patients and doctors. But part of me can't help thinking that we threw out the baby with the bathwater by failing to recognise the vast experience gained over a relatively short period of time that the "old system" could provide. Under the old system I easily met the "10,000 hour rule" which suggests to be really good at something you have to have at least 10,000 hours experience. It also makes me wonder that if it took 10 years to train a consultant "the old way" how come it takes the same amount of time (or sometimes even less) now? Have we sacrificed something in the form of experience or expertise along the way?
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