Hear Our Nurses Roar

Posted on November 26th 2015 by Gagan Bhatnagar on the clinioncdoc.

I would not be where I am today without the compassion, dedication, and guidance of countless nurses. I am not a patient, I am a junior doctor.

For every heart-wrenching story I have to tell about my own experiences in hospital, there was a nurse stood right beside me. There was a nurse running with me to a cardiac arrest, who despaired with me as we alternated chest compressions to time. There was a nurse next to me who ran to fetch blood products needed to keep someone alive as they bled out because the porters would not have made it in time. There was a nurse with me when I told a patient for the first time that she had lung cancer. It was the nurse that held the patient’s hand, that hugged her, that cried with her. Nurses are the first port of call, they are the personal touch of the NHS that doctors can never be.

I’ve been alerted to a multitude of elderly Mrs. Smiths by nurses who just knew something wasn’t right. It might have been because her vitals were deteriorating or it could have been that she just didn’t mention her late husband that morning as she normally would. Nurses epitomise the good will that the NHS is run on. They laugh and cry with their patients. They will empty bed pans with one hand while fluffing pillows and blankets with the other. They will make their patients a cup of tea with one hand while dispensing life-saving medication with the other.

I am in awe of nurses because I know that I, nor the vast majority of the public, could ever do their job. They do the dirty side of healthcare that we shove out of sight and out mind. The cleaning of bed pans, washing of incontinent patients, and changing clothes soaked with vomit are only a few of the things they do on a daily (if not hourly) basis. They do this through gruelling 12 hour night shifts with no time for breaks, often getting punched, kicked, or spat on by confused or aggressive patients.

How much is their inherent caring worth? By any means – nurses do not earn an astronomical salary. Starting at a £21,692, their salary can go up to £28,180 after many years of working. As a ward nurse, that’s it – that’s your salary. The majority of us would consider that to be a paltry sum for the emotional and physical turmoil which nurses endure. As a society we thanked and encouraged nurses by offering to pay their tuition fees and providing them with a small sum of money to help get through an intense 3 years, knowing full well that what we get in return far outstripped that value.

Removal of nursing student bursaries is the latest in the Government’s string of attacks on the NHS. Nurses are already in a recruitment crisis, most wards are understaffed and overworked. The Government’s proposals will further compound a recruitment crisis. With all the stress associated with the job – is it fair to add in a student debt that they will likely never be able to pay off? How will this encourage more young compassionate people to go into nursing? How does that make nursing an attractive career prospect? A recruitment crisis will only lead to further demise of the NHS.

Thankfully, the value of nurses is not measured in money, it is far more intangible. However, this does not give the Government license to force such savage cuts on the NHS. The Government has once again demonstrated that it does not value workers that do not generate profit. The Government continues to promote a false economy while battling against doctors and nurses, the very workforce that keeps the NHS running. For this reason we see the NHS underfunded, understaffed, and on its last legs.

Nurses are our lions, they are the pride of the NHS. Hear them roar.

I thank them whole-heartedly and am eternally grateful to them. They are the NHS. I will stand shoulder to shoulder with my colleagues, for the long-term safety of our patients, and the future of the NHS. Please consider signing this petition:

https://petition.parliament.uk/petitions/113491

I’m a Junior Doctor – On the Precipice of Strike Action

Posted on November 7th 2015 by Gagan Bhatnagar on the clinioncdoc.

Industrial action is not a step that a doctor takes lightly.

I am a junior doctor, having been qualified for 6 years, and am training to become a Cancer Specialist that delivers chemotherapy and radiotherapy. I am not an activist, nor an anarchist, nor an anti-government protester. The last 12 years of my life have been dedicated to a singular agenda – patient care. I will not drone on about the sacrifice of blood, sweat, and all too often tears that have accompanied my training, suffice to say that I am where I am through significant personal sacrifice.

I am not unique, nor am I alone. There are 50,000 junior doctors who have made the same sacrifice with a common goal in mind – patient care. It is precisely for this reason that I have voted for industrial action. As counter-intuitive as this may seem to the non-medic – doctors truly are striking for the safety of the public. 

Allow me to explain – we are trained, nay, indoctrinated to analyse the risk versus benefit of every action we take as doctor. We use scientific evidence to help guide our decisions – this is aptly known as ‘evidence based medicine’. When I prescribe chemotherapy I have to analyse all the life-threatening side effects that could befall my patient, and weigh it up against the benefit my patient may receive from the toxic drug. I make a similar risk assessment when I prescribe Paracetamol (do they have liver failure? Are they on other medications?).

In a similar manner doctors up and down the country have weighed up the risk versus benefit of the new junior contract and the possibility of industrial action. Thankfully, we have scrutinised the details of the Department of Health’s offer and have not fallen victim to catchy headlines and government rhetoric. Sadly, the devil truly is in the details.

We are desperate not to strike, because the service will halt and there is a possibility that patients might come to harm (though we will do everything in our power to ensure necessary safeguards are in place). Having analysed the contract with the same keen eye with which we analyse our patients, many doctors are reluctantly voting for industrial action because the alternative is far worse. 

Doctors envisage a future where we are overworked due to lack of penalties on Trusts for overworking us (the Health Secretary has still offered no safeguards for this). We envisage a future where women, who make up a majority of junior doctors, cannot balance family life and career and have to choose between the two. We envisage a future where doctors are penalised for pursuing research for ground-breaking new therapies for cancer or dementia. We envisage a future where a doctor’s experience is not valued and rewarded. We envisage a future where the work-life balance of vital specialties such as Accident & Emergency is untenable and will suffer crippling losses to the work-force (which is already under-recruited). We envisage a future where children simply don’t want to be doctors because the gruelling training is not valued by the government. Some envisage a future of private health-care being pushed through by the government where patients may be asked to choose between cancer treatment and selling their homes.

This future would be a grim place to be a patient. Unfortunately, the risk versus benefit ratio is heavily in favour of a short term inconvenience to avoid a long-term catastrophe.

The Health Secretary, whatever his intentions, has little understanding of the front line and what doctors and nurses sacrifice to make the NHS work under increasing financial strain. For a decade we have continually been doing more with less, and the service is spread dangerously thin as it is. His words ring empty when he commends us for being the back-bone of the NHS but in the same breath tells us to ‘get real’. Or when he suggests doctors are not willing to negotiate when of the 23 key points he has stated 22 are non-negotiable (the single point he is willing to negotiate is travel expenses). 

His lack of understanding has been shown clearly with his repeated misuse of scientific data for which he was reprimanded by Fiona Godlee, the chief editor of the British Medical Journal. His promises of 11% payroll rises (while apparently remaining cost neutral) fall to pieces when the details are examined. Unfortunately Mr Hunt is playing a game of politics while the entire medical profession is whistleblowing at a contract that is unsafe for patients and may be the demise of the NHS.

Like any other person, or any other profession, we want to feel valued. Reducing our pay (in real terms) by up to 25% is just one of the issues at stake (Mr Hunt has offered a ‘temporary pay protection’, future junior doctors will be worse off). We are not asking for a pay rise. We are asking to be valued. We are asking for the right to a social and family life. We are asking to be treated as a bright and dedicated workforce that can think for ourselves. Give us autonomy. I am dismayed the Secretry of Health has not once asked for the advice or guidance from the doctors he is supposedly working with. Why not ask us how to improve service? Surely we have more insight than anyone else?

A doctor that is happy and feels valued will go much further for their patients – because that is the only thing we know. We channel our lives to be single minded – patient safety is our calling. 

If patient safety was truly the Health Secretary’s aim, he would heed our calls.

Drop the pre-conditions. Drop your threat of imposition. Adequately fund and staff your plans or appreciate what is actually feasible. Listen to our concerns and get us back round the table.

The strike is avoidable, and it is at Mr Hunt’s discretion.