Most people have had to listen to someone from an older generation reminisce over the good old days, with a conversation that starts something along the lines of “back in my day…”
In the medical world, this kind of conversation occurs when a ripened consultant talks of the pitfalls of the modern NHS. They harp back to ‘their day’ when they worked 48-hour shifts and lived on hospital site, when matrons ruled the ward, and doctors really knew the meaning of continuity of care.
The more time I spend at St Francis Hospital, the more I believe that when I boarded the airplane at London Heathrow, it wasn’t really a plane, but a time machine that has transported me to a bygone era of doctoring.
To start with, I spend my mornings doing rounds on the old-fashioned Nightingale wards. They are long narrow wards with all the beds arranged along the sides and open windows along one wall to allow ventilation. There is little in the way of privacy, with no curtains around beds and only one set of screens that can be dragged over if a patient needs an intimate examination or procedure. The modern preference in the UK is for wards with bays (and curtains). However, the visibility of patients to nursing staff is better here and makes nursing observations easier (essential when staff numbers are low).
Another noticeable difference is that a nurse joins you for the whole ward round, every day. A benefit of not having enough staff is that communication between doctors and nurses has to be sharp, and everyone needs to play their part.
The jobs generated on the ward round are split out between the doctors and nurses for efficiency – nurses do cannulas, blood tests, sputum and urine collections, whereas I collect fluids from places that are harder to reach e.g. lumbar punctures, and fluid from lungs, abdominal ascites, joint effusions etc. There are no computers, so everything is requested and reported on paper, and we still use a lightbox to look at X-ray films!
Although it sounds like we can do many tests, the frustrating reality is that the laboratory reagents are frequently out of stock. This week, all of the renal and liver function tests (Creatinine, AST, ALT and Amylase) are out of stock. Simple tests including sodium, potassium, CRP, thyroid function tests, HbA1c and cholesterol are not available at this hospital. Clinical acumen and gut instinct are key.
Lunchtime is sacred here. In the UK today, junior doctors eat when they can, and sometimes they just don’t eat. The culture at St Francis Hospital is that 1pm is lunchtime. Doctors can either have a hot meal in the mess or pop home for lunch. It is amazing how a break, some food and some water can recharge your batteries for the busy afternoon ahead.
Outside the jurisdiction of the European Working Time Directive, being on-call here means I work a full day, followed by a night on-call, and then a full day the next day. It isn’t as bad as it sounds, as the coverage nurse at night deals with a lot of the problems enabling some sleep. Also, it means I really know what is going on with my patients without the Chinese whispers that creep in at handovers along the way.
One thing I definitely do not miss about modern doctoring is my pager! There are no bleeps here. The fact I am on the ward most of the time negates the need for daytime bleeping. During the night, the coverage nurse will try my mobile number, but if the network is down, which is often the case, a friendly security guard will knock on my door saying “Dr. Natalie, Dr. Natalie, you are called…” and waits to escort me into the hospital (which I am grateful for in the pitch black at 2am).
St. Francis Hospital is not the pinnacle of healthcare provision. I can see why things modernized and changed in the UK, but I can also see why ‘old-school’ doctors look back to ‘their day’ with fondness. I can confirm that there is something special about surviving the long shifts, living on-site and having strong teamwork between doctors and nurses. As for continuity of care, whilst it is achieved here by default through not having enough doctors, I have certainly come to understand its worth. I know I’m going to be saying “Back when I worked in Africa…” for a long time to come.