Tuesday, November 22, 2005

Your Hospital Needs You!

For those that do not know, medicine is much like the army. At the very top of the ladder is the general, or consultant, who masterminds the entire operation. The consultant is a cerebral creature who loathes getting his hands dirty. (In this he is second only to the semi-mythical Commander-In-Chief, or Professor, whose body has been so neglected in favour of his intellect that over time many have evolved into nothing more than an enormous, glowing brain in a jar which is carried around the wards on a litter by its simpering minions.) A consultant's involvement in the care of his patients is to be limited to the minimum possible: a zero-eye-contact, post-take-ward-round handshake is ideal; a second brief pre-discharge glance is acceptable; but any more interference with his busy golf schedule is liable to bring on an attack of the vapours from which the juniors may never recover. The practicalities of implementing his action plan are of no interest to him; that it be done, and preferably done yesterday, are his sole concern. Indeed, so elevated are the Consultants that they often feel that they have broken free of the irksome constraints of "best practice" or "evidence". Faith is the principle that would seem animate these exalted beings: how many times have I heard my consultants declare that they simply "do not believe" in such-and-such a drug or such-and-such an intervention when the evidence in their favour is overwhelming.
Next come the sergents, or registrars. The registrar is, to many, less of a position than a predicament. It is their misfortune to be the most senior man on the battle field. Whilst the on-call consultant languishs in his leather arm chair at home, the registrar must lead his soldiers into battle against the combined forces of the patient massive and their army of A&E doctors, who will use all manner of lies and trickery to get a annoying patient off their hands and onto those of the medics. Dodging referrals, batting away crusties and calming his panicking and incompetant troops are some of the many balls that the registrar must juggle. As a rule, the closer a registrar comes to promotion to consultancy, the less his soldiers will see him as he retracts from the fray to his GHQ, conviently located in the mess, from whence he can relay his orders by telephone.
On the front line are the the captains, or the senior house officers. Deep within the enemy territory of A&E they toil to clerk the endless list of uninteresting patients. With no hope of any help from above, they watch the referral list grow with mounting distress. In their hearts a dark and bitter place sloshes full of resentment at the privates, or house officers, who, by virtue of a new law called the European Working Time Directive, are more likely to be found in the mess with the registrar than at the coalface with the SHO.
With so little experience, the house officer trembles and quakes at the prospect of A&E. Indeed, should their worst nightmare be realised and some unruly SHO demand their help in A&E, they flounder and flail through the clerking with all the elegance of a cow on an ice rink. The only hope for the unfortunate victim of their inept artistry is that somebody more senior might spot and prevent their deadly errors: the toxic doses of inappropriate drugs; the penicillin prescribed for the allergic patient; or the three litres stat of i.v. fluid pouring into the veins of a 93-year-old chap in heart filure. Then again, as we all know, the only sure way we learn is by our mistakes and what's a few unneccesary deaths between friends.
So, in the future just remember: in medicine, whether you like it or not, you gotta be a team player!


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