Surgery

I had an interesting conversation with a newly qualified doctor just recently, who is from Canada, studied in Melbourne, and spent time in London as part of her course. I think she has a solid perspective of what works and what doesn't work in health care.

As someone whose only experience with health care is in the UK, I found it to be an enlightening conversation to say the least. She stressed, for example, how poor the organisation of the NHS is from within, and how it affects various aspects of the business. In particular, she outlined how shocked she was at the work of the nurses. I recall various media reports on how nurses are overworked and underpaid. When I told her of this, her eyebrows disappeared into her hair line and she essentially said that from what she could see in the two hospitals she worked at in London, they do not deserve more. In fact, she said that due to the incompetencies that kept cropping up, if she had the power, she would have fired many of them on the spot.

When she was observing surgeries, she reported that the nurses were almost a hindrance. They had no idea about the process of various surgery routines, and no idea about the tools that were needed. When asked by a physician for equipment, they often handed over the wrong tools, or simply couldn't find them. When the latter occurred, they would have to go from the room, sometimes for ten minutes at a time, in order to collect the correct instrument. The surgeon and patient would be left waiting for that period. An inefficient use of time for the surgeon (and nurse) and dangerous for the patient.

She compared this to the process in Australia, and said that whilst the nurses were similarly seeking higher wages, they ran the show. Surgeons relied on them, patients relied on them, visitors relied on them. They know each and every patient in their ward, know where the files are kept, know where every bit of equipment is and know the details of every procedure in the operating room so that each detail can be taken care of. Think of Mad Men's Joan. She is the office equivalent of an Australian nurse. Wholly indispensable. In London A&Es, the nurses appear to have no clue where anything is, how it works, and they have no inclination to pro-actively introduce order. As far as I can gather, many seem to believe that it is a good thing to walk around the corridors looking rushed, stressed and overworked, lending the appearance of being a superwoman (or man), whilst in reality wasting valuable space.

The light of my friend's experience in London were the interns. She mentions one in particular that she shadowed, and saw something amazing. The interns "hold it all together", she said. This particular intern had been a qualified doctor for 2 years, but because there aren't enough positions available for qualified doctors, he has to hang around and wait for the opportunity to fully use his qualification.

She saw how harried he was, doing the job of the nurses because they allegedly had no clue where anything was kept, and appeared to have little medical training. One in particular that my friend asked a question to in relation to taking blood replied that she didn't know the answer because she'd never taken blood! A nurse had never taken blood! So student and intern proceeded to schedule various blood-taking dates into their diaries for the day.

On top of this, the doctor-nurse politics conflicted with the care of the patients. I understand that this is a documented problem in the UK, but she said that to experience it in the way that she did was disturbing and cringe worthy. A nurse, apparently, is ever conscious of the second hand reaching the five to clock off at the end of the day, never mind that there is still one more 20 minute procedure to fit in. Sure, we all have our scheduled work days, we have families and friends to go home to, but if your profession is to care, surely you... care? I stayed later at my place of work many many times, and I added apostrophes to words and reviewed customer feedback/complaints. Not exactly life and death.

Doctor and nurse will snipe because, I suppose, they disrespect each other. From one point of view, this seems to be understandable.

So A&E in London? Filled with a number of excellent surgeons, but surrounded by poor support, suspicious working conditions in old buildings that cannot possibly be sterile, and shocking organisation. Surprised?