The life in the NHS in the eyes of it’s future.

Saving lives, rich consultants – it does seem idyllic with a hint of heroism. However, the modern-day struggle of the NHS now creates a very different picture – instead of filthy rich doctors gliding through hospitals in white coats, you now have sleep-deprived 26-year-olds fresh out of medical school, sprinting from one corner of the hospital to another, to complete tasks way beyond their capability, with the small glimpse of hope for a lunch break at any point today. The public glory of the profession of definitively fading.

I spent 5 days at my local hospital, the home of some of the country’s greatest surgeons, as well as the temporary accommodation of thousands of unwell patients. I expected to sit in a staff break room for hours on end, my time only broken up by intermittent conversations with my “mentor” about medical school and being a junior doctor, maybe being able to once see him with a patient, my head poking through the privacy curtains. Instead, I was given a full-access view of life as an NHS doctor, from the early months as a FY1, to a senior consultant, seeing both the moments of heroism, and the mundane paperwork they are plagued with. I started just seeing meetings discussing individual patient care, where the doctors would call in their colleagues from around the UK to gain further insight and an alternate view. I was able to watch my “mentor” see patients in an outpatient clinic, talking through treatment plans and explaining the details of a potential surgery. I was able to go to radiology and see lung biopsies being taken, using only 3 images to guide the doctor on where to place the needle, with any slight incorrect movement leaving the patient violently coughing up blood, which was conveniently followed by a visit to the Pre-Operative Assessment Unit, where I could see the specialist nurses taking notes of the patients full medical history, an arduous process if the patient was above 80 where a pacemaker fitted 10 years ago is not such a clear memory. Finally, the crème de la crème, I shadowed a FY1 around an Upper GI ward, watching her prepare everything for the morning ward round, and see her perform basic tasks like taking bloods and ordering tests. So, if you are considering a career in medicine, maybe pre-GCSE, maybe doing A-levels that currently mean nothing to you, or maybe an accountant who realised they were more into saving people than scamming them, in my opinion, here are some key values of a (junior?) doctor: 1. Commitment I don’t think it was possible for me to say any of the healthcare professionals who I observed were in any way disinterested or unengaged. Everyone, from Health Care Assistants to Clinical Leads, was fully devoted to each and every patient. My “mentor” readily gave up an evening at home with his family to perform an emergency surgery on one of his patients who suddenly fell ill. The doctors take calls about patients when on holiday or “off”, because in the “NHS reality”, there are no “off” days. A system of providing universal healthcare for free relies on the commitment and loyalty of its staff – it would not function if doctors simply “clocked off” when the assigned shift was over. If you want to have a 9-5 structure private dermatology is the way, but certainly “don’t expect to make it back for Love Island” as one FY1 so eloquently expressed it. 2. Humility Long gone are the days of an omniscient doctor in a white coat, where his word is final. Now decisions made about patients are based on discussion with other colleagues, which means potentially having to admit your mistake to someone of a more junior position. As my mentor explained, as a doctor it is essential that you never build up a sense of overriding authority due to your position, as this is where major mistakes happen. Modern medicine in the NHS is based on teamwork and collaboration, there’s no room left for egos. Not only between doctors is humility essential, but between all staff. I was told, and saw, that doctors rely on the nurses, HCAs and administrative staff roughly as much as their fellow doctors. The hospital would grind to a screeching halt if there were no nurses to do the day-to-day jobs and procedures for patients, or to provide the essential pastoral care to patients suffering even the worst symptoms. The FY1 I shadowed said that the most important thing to grasp as a “fresh” doctor is to learn from the nurses, and not to place yourself above them just because you have a stethoscope and MD. 3. Independence The NHS is not in the same calm waters it was, with the same level of support that Aneurin Bevan probably had in mind. The constant stinging reminders of the Brexit vote also remind us of the “brain drain-esque” migration of EU NHS staff. In the year ending Sep 2017, 13% of nurses leaving the NHS were EU nationals, up from 9% in 2015/16. As my mentor explained, in previous years you had plenty of nurses around so the reason for NHS delays was lack of beds. Now we face a scarier issue, it is not that there are no beds, it’s just there aren’t enough nurses to properly treat/attend to the patient. In this particular hospital, my mentor claimed that half of the EU national nurses had left since 2016, leaving beds on certain wards laying empty, with queues for treatment practically going out the main entrance. What does this have to do with being a doctor? Your have to hit the ground running coming out of medical school, divergent thought and independent learning are the apparent key to “success”, or just not killing your patient. There aren’t enough nurses for a FY1 to handover procedures they don’t want to/can’t do – there is a lot more responsibility on a junior doctor now. 4. Selflessness As stated previously, if minimum wage, sleep deprivation and mounting student loans sounds like your American Dream, you’ve hit the jackpot with the NHS. However, most healthcare workers don’t feel that way – you cannot be in it purely for money or any other self-serving purpose. The NHS was founded on the individualistic principle of universal healthcare, like a red sore thumb in our current government. Every single one of the doctors I observed genuinely cared about the patient’s outcome, even if part of it was fear of being held accountable for any mistakes, whether that be through unessential visits to check up on their patient, or spending time “clocked off” checking their treatments for mistakes. If you choose surgery (like my mentor), you may spend hours through the night operating on a patient, never to be met with any kind of gratitude or reward, left with hopefully only the satisfaction you have helped a patient live a longer/more comfortable life. My mentor left me on Friday with the warning that you have to be prepared to commit everything to an institution, even if you never get anything material back. This is not an exhaustive list, nor is it in anyway more qualified than a sixth form student’s opinion. But from my time at the hospital, it became apparently clear that you must be dead set on becoming a doctor, as otherwise not only will you most likely not make it out of medical school, but the life of a junior doctor will not seem worthwhile.

The current situation of the NHS, with decreasing staff and an expected £30 billion funding gap for the NHS nationally by 2020, means that it is desperate for individuals who are not only versatile and capable, but fully committed to medicine, as it has very little room to nurture those sitting on the fence. As my mentor said, “taking on the task of night shifts, low pay, long hours should not stay a burden, but should become your privilege”.