Friday, 14 November 2008

Changes II

There are some more changes in store in our practice. In just a few months one of the partners will be retiring and we are currently going through the process of advertising for a new one. We have been a little disappointed in the quality of the applications, there have been a lot of them but few have stuck out as being promising. However you only need one good candidate (provided that you can identify him or her) so we shall have to see how we get on at the interview stage.

On the fateful day that our partnership changes I shall find that I am the “senior partner”. This is not quite the privilege that it was thirty years ago, when the senior partner earned more than the other doctors and made all the decisions. Nowadays we share the profits equally (apart from seniority payments) and decision-making is painfully democratic. It is ironic that in my younger days when I knew everything, I would throw my weight around within the practice. Surprisingly everyone accepted me as the leader and did what I said. I may be more charismatic than I thought. But now I am not young enough to know everything, I see complications everywhere and am beset by doubt. So I no longer wish to be the leader and am happy to relinquish that role to the keen young Turks in the practice. It is at this point that the mantle of senior partner is thrust upon me! Life increasingly contains such sweet irony. My gloomy outlook gives me the nagging doubt that I shall somehow have greater responsibility without any compensating perks.

This week's BMJ is full of articles about the (generally poor) health of doctors. One such article deals with doctors in the final stage of their careers, and it seems that there are plenty of others who find it hard going in their fifties. There is a sensible suggestion that all doctors should receive a special appraisal at the age of fifty to help plan the rest of their career. Needless to say the NHS makes little provision to help doctors who cannot continue working in their fifties at the same pace as in their twenties and thirties. Indeed, the current plans for revalidation of doctors including tougher appraisals look likely to make life even harder for the over-fifties.

As for me, I am currently keeping my head above water most of the time. I feel weary at the end of long full days, but fortunately there are lighter days from time to time for various reasons. On the long wearying days I just keep ploughing on, because nothing lasts forever. In the lighter moments (perhaps a relatively short evening surgery as happened today) I am able to sit back and enjoy talking to my patients and appreciate what a wonderful job this can be.

I leave you (for now) with a little cameo from this evening's surgery. A mother had booked herself and her five-year-old daughter in for a double appointment. The daughter had a cough, so I examined her chest. I then examined the mother who was suffering from stomach ache, while the young girl retired to the toy box in the corner and played happily with the doll she found there. As I returned to my desk I saw that the girl had the toy stethoscope around her neck and was applying it to the doll's chest, saying “now breathe”. Then she held the doll up in the air, looked sternly at her, and said “how long have you had the pain?” This was so delightful that I could not help smiling. Perhaps I am still helping to train the doctors of the future?


XE said...

"As I returned to my desk I saw that the girl had the toy stethoscope around her neck and was applying it to the doll's chest, saying “now breathe”. Then she held the doll up in the air, looked sternly at her, and said “how long have you had the pain?” This was so delightful that I could not help smiling."

That's adorable! Oh how I love kiddo stories :)

Your story reminds me of a similar one: a little girl I once looked after required a treatment by nonrebreather mask a couple of times a day, and also required daily chest physiotherapy. There was a spare mask lying around in the living room, and she was playing happily with her toys while I prepared her supper. As I poked my head around the corner to check on her, I saw her gingerly holding the mask to her toy bear's face, and then proceeding to do chest physio on her bear! It was the most precious sight.

XE said...

(P.S. Congratulations on becoming senior partner! May more benefits come with the title than you think!)

Anonymous said...

I'm sure at the very least, you'd be entitled, as senior partner, to throw your weight around now and then ;) Or even to delegate the jobs you don't fancy.

I agree that the NHS could, and should be more supportive of staff generally, and certainly those whose jobs and lifestyles have significantly changed. However, my opinion of the NHS as an employer, is not overly good. "Caring", my eye!

You must make a good job of being the Senior - just to spite "them" :P

Puss-in-Boots said...

Hi Andrew

I love that little vignette you wrote about the child with the stethoscope and doll. It's small things like that which can lift one out of the doldrums.

I retired earlier this career move I've ever made and I love my life now. Not that I didn't before, but I was so tired, it was hard to be enthused about anything much.

I hope you have many more precious moments in your clinics.

Elaine said...

That story brought a little smile to my face. Children can be so cute.

Calavera said...

I loved the last part of your post, doc. Brought a smile to my face!

Congratulations on becoming senior partner - though by the looks of things maybe I should just be wishing you best of luck instead?! I'm sure you'll be fine. :)

Anonymous said...

"in my younger days when I knew everything"

That's what made me smile!

Things will work out well, just you wait and see...

Don't forget, you are 'a fortunate man' :-)

Meckel said...

A charming story... but I can't help but feel I would have done my best to warn her off!

Forgive me, I'm feeling quite cynical these days.

My own GP recalls how much I enoyed visiting him when I was a young boy. He thinks I was as attracted to his PC (which was quite exotic in rural Ireland in the 80s) as anything else in the surgery!

Anonymous said...

Tsk tsk Dr B; hasn't the caring NHS in your part of the world banned toy boxes as an infection risk?

On another topic, you referred to the special "doctors' health" edition of the BMJ. I'm currently atending the associated international conference on doctors' health and it's shameful how far behind the rest of the world the UK lags in terms of physician health programmes. The UK is also poor at systems to support the maintenance of doctors' health despite the evidence that healthy doctors are better for patients.

Good luck with your changes and make a good job of the new partner selection. I expect as senior partner you will get to take responsibility for solving all the problems, so prevention will be in your interests!

Anonymous said...

Things aren't any better on this side of the pond:

Anonymous said...

I was struck by your observation about youth and knowledge of everything. I have recently joined a practice run by partners 3-4 decades my senior, confident in my command of the latest whiz-bang medical software programme, armed with 'latest evidence'. Frequently I have forgotten that this is no substitute for the wisdom that accrues from years of listening, watching, and growing with our patients.

Anonymous said...

did the little girl say'how LONG have you had the pain?' or
'HOW long have you had the pain!'(before coming to see me), which would indicate a medical career intended.

Dr Andrew Brown said...

I don't know whether I am maintaining the quality of my posts, but the comments you write are getting better and better. Thank you so much!

I note the further commendations of retirement and going part time. I shall “think on”, as they say in Yorkshire.

Steph & Anonymous 04:15: the comment about being “not young enough to know everything” is of course a quotation from Oscar Wilde, and not my own invention.

Anonymous 19:15: I'm not at all surprised to hear that the NHS doesn't look after the health of its staff very well. Not that you would think so, to listen to the managers and politicians. All mouth and no trousers.

Janeway: your news is interesting but somehow I am not surprised.

Anonymous 04:15: there is a place for both approaches. I'm sure your partners will benefit from your youthful enthusiasm and knowledge, as you benefit from their wisdom. In just a few years you will find yourself in their shoes.

Anonymous 22:44: that's naughty! :-)