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?