The Daily Rhino
Monday, December 22, 2008
Death of a GP
Dear Lord Darzi,
I’m an SHO – sorry, CT1 – and have never had any inclination to become a GP. Hence, in my somewhat selfish way, I disagreed with, but largely ignored, your infamous polyclinic plans. Yet two funerals I attended this year brought into sharp focus why I, and thousands of doctors, feel polyclinics are a step in the wrong direction.
My mother’s younger sister met her husband at medical school in India and mirroring countless similar couples, came to the UK in the 1980s to start a family. Both worked as hospital SHOs for a time before becoming GPs in the north of England.
My aunt stayed at the same practice for many years, becoming a fast favourite with patients due to her caring nature and comforting smile. She raised my two cousins, the eldest of whom is now an F1. My uncle also excelled in his career and expanded his practice immensely. He pioneered many new initiatives, sat on various committees but never forgot his priority was his patients. His devotion to their care won him a profile in the Daily Mail as ‘Britain’s favourite GP’; secretly nominated by patients and staff. He found the whole thing embarrassing.
Both would routinely go far beyond the call of duty for their patients. Yet they would be the first to tell you that they were not exceptions. Their dedication to care, the relationships they built with patients and their place in the community is shared by GPs across the UK. Genuine family doctors.
Their diagnoses of two different cancers came years apart, but they died within three weeks of each other this summer. They were in their mid-fifties and desperately tried to keep working as long as they could. Both felt most comfortable in an NHS hospital when unwell.
I organised both funerals in the same crematorium. Its capacity was one hundred and on both occasions it was filled more than twice over. I enjoyed chatting to patients who simply felt ‘they ought to be there’. They emphasised how they regarded my aunt and uncle as honest friends, who they confided in, trusted and who never hesitated to tell them the truth.
A tall man with long hair, tattoos and a leather jacket, smiled when he thought about my uncle’s place in his life:
“I’ve had seven children, three wives and four houses...Dr X has been the only constant in my life!”
It is this one line that makes me fearful the British public’s relationship with their most important doctor will change forever.
My cousin wants to follow in her parents’ footsteps as a general practitioner. I want her to be able to experience the lasting relationships with patients my aunt and uncle did. I want her to be a constant in their lives.
Dear Lord Darzi,
I’m an SHO – sorry, CT1 – and have never had any inclination to become a GP. Hence, in my somewhat selfish way, I disagreed with, but largely ignored, your infamous polyclinic plans. Yet two funerals I attended this year brought into sharp focus why I, and thousands of doctors, feel polyclinics are a step in the wrong direction.
My mother’s younger sister met her husband at medical school in India and mirroring countless similar couples, came to the UK in the 1980s to start a family. Both worked as hospital SHOs for a time before becoming GPs in the north of England.
My aunt stayed at the same practice for many years, becoming a fast favourite with patients due to her caring nature and comforting smile. She raised my two cousins, the eldest of whom is now an F1. My uncle also excelled in his career and expanded his practice immensely. He pioneered many new initiatives, sat on various committees but never forgot his priority was his patients. His devotion to their care won him a profile in the Daily Mail as ‘Britain’s favourite GP’; secretly nominated by patients and staff. He found the whole thing embarrassing.
Both would routinely go far beyond the call of duty for their patients. Yet they would be the first to tell you that they were not exceptions. Their dedication to care, the relationships they built with patients and their place in the community is shared by GPs across the UK. Genuine family doctors.
Their diagnoses of two different cancers came years apart, but they died within three weeks of each other this summer. They were in their mid-fifties and desperately tried to keep working as long as they could. Both felt most comfortable in an NHS hospital when unwell.
I organised both funerals in the same crematorium. Its capacity was one hundred and on both occasions it was filled more than twice over. I enjoyed chatting to patients who simply felt ‘they ought to be there’. They emphasised how they regarded my aunt and uncle as honest friends, who they confided in, trusted and who never hesitated to tell them the truth.
A tall man with long hair, tattoos and a leather jacket, smiled when he thought about my uncle’s place in his life:
“I’ve had seven children, three wives and four houses...Dr X has been the only constant in my life!”
It is this one line that makes me fearful the British public’s relationship with their most important doctor will change forever.
My cousin wants to follow in her parents’ footsteps as a general practitioner. I want her to be able to experience the lasting relationships with patients my aunt and uncle did. I want her to be a constant in their lives.
Labels: medicine, NHS, polyclinics
Friday, February 01, 2008
The bastard son of MTAS
Originally published in the February issue of Medical Student Newspaper.
GOOD morning my friend! A warm good morning to you all. I love you, faithful readers, I love you with all my heart. But sadly I wish to commit heinous murder upon you at this present juncture in time, and indeed upon anyone that gits in mah way cos I is mad.
What, you might ask, has made such a normally cheery (I can be cheery) soul like me so irate? Did that A&E job finally make me crack? On the contrary, I finished it since I last saw you and have moved onto renal and transplant medicine. Wonderful wonderful.
Was it a bothersome patient what yanked my crank? No, I have been tolerating humans quite well recently. Is it the fact that my girlfriend’s Mum is staying with her for a month? Yes you’re quite astute, that’s probably not helping BUT it ain’t the root cause.
You’ve guessed it – job applications. I have brought you MMC news from the coalface over these last sixteen months, but at no point have I ever felt so low. Sure I’ll be cracking jokes in this piece, but secretly (and by writing this here, not secretly) I want to end my life. And I haven’t forgotten about murdering you either.
So what’s the dilly-yo? In a nutshell, for those shitbricks that haven’t been paying attention for twelve months, in 2007 the government unleashed its full wrath upon those lazy doctors and made tens of thousands jobless. 28,000 doctors applied for 15,500 jobs.
They did this by installing a woeful new application system, reducing the number of training posts despite record numbers of new graduates and not accounting for the many overseas doctors that work here but inviting a lot more in.
Thousands of junior doctors, many of whom are my friends, left the country. No one outside the rank of SHO seems that annoyed, so please do tell non-medics why they should be. Each of these doctors cost a quarter of a million pounds of taxpayers’ money to train. We, as a nation, have just let hundreds of millions walk out of the door. Australia, New Zealand and Canada’s gain is our huge loss.
I never thought I was the ‘leaving kind’. I love London and want to stay. That could be my downfall.
This year, it is worse. We were reassured but I think we all knew this to be false. However, last year we were provided with some ammunition. The Tooke Report, detailed in previous issues of this newspaper, made two key assertions. First, that government involvement with the training of junior doctors must stop. This has not transpired. Secondly, that the European Working Time Directive (which I recall being my first cover story as editor in 2004) is detrimental to junior doctors’ training by preventing sufficient hours learning on the job.
Reasons things will be worse this year include: many of the jobless SHOs from last year will be competing with this year’s glut for the same finite amount of jobs (in fact less, as much of the run-through allocation is filled). A recent ruling means that British-trained doctors are given no preference to overseas doctors when allocating jobs.
Overall, an estimated 22,000 applicants will compete for 9,000 jobs. Friends in other professional disciplines often seem confused as to why this is a problem. “Competition is healthy” they say, echoing what the government has been trying to dupe patients with. The key point is that in the UK, doctors can only train in the NHS, there is no alternative as there would be in a bank or law firm.
Continuing on from this analogy, consider my story, which I fear will be typical.
Today I received an email from Oxford Deanery, telling me I have been invited for interview in six days. I have heard, from an unsubstantiated source, that about five hundred applications for Core Medical Training were received by Oxford. They have 27 jobs to give away. So I am delighted I have been granted an interview.
But I have applied to both London and Kent, Surrey and Sussex because I, like a vast swathe of my colleagues, have been scared shitless by what happened last year. I have tried not to hedge my bets and end up jobless.
Let’s imagine I do well in the interview (you need a fertile imagination) and am offered a post. At this point I know none of the following: which hospital(s) I will be working in, my pay, my rota nor what firms I will be doing. Yet I have 48 hours and nor more to accept. If I don’t reply, I am assumed to have rejected the offer.
If I accept, I have to withdraw from all other Deaneries. The only problem is, London make their offers two and a half months after Oxford. So if I decide I want to wait it our for London – and then get offered nothing, I will have thrown away a job. Or if I hold out for London and get given a job I don’t want, I would rather have stayed with Oxford.
Taking our comparison back to banking or law, which companies do you know that would make a job offer with no details about the job whatsoever? Which industries can you think of where the boss doesn’t choose his own staff? And although some jobs make you move around the country, which gives a few weeks’ notice as to location, forcing the employee to sell, buy and move houses in a month?
Lastly, see if you know any banks or consultancies that would send this message to its employees. My ultimate boss, the government, sent all junior doctors a letter in January. It essentially said “don’t apply for anything competitive, you probably won’t get it. Don’t turn down any job applications, you will be lucky to even get one. Don’t be upset if you end up doing something you didn’t apply for, you should be thankful you’re employed.”
It amounted to: Aim Low. No fucking way any City firm says that to its employees. We’re being grown as a generation of ‘just passable’ docs. MMC engenders a culture of striving for mediocrity.
As I said before, I love London with all my heart. I want to make my life here. But in the last few weeks I have done some deep thinking. I had a hot bath recently – where I do my best thinking – and asked myself one question, “do I want to be a doctor?” I had toyed with the idea of leaving. Friends enquired at banks and they want to start me on £80-100,000p.a. But I realised I like being a doctor. It’s what I’m best at and I want to do it. This was a relief as I had started to have doubts.
The second question I asked myself was, “do I want to be a doctor in the UK?” I now know that without drastic change of far more than just the subject of this article – nurse quacktitioners, paltry consultant opportunities and the media’s attitude to us – I cannot stay here. The system has broken me.
Originally published in the February issue of Medical Student Newspaper.
GOOD morning my friend! A warm good morning to you all. I love you, faithful readers, I love you with all my heart. But sadly I wish to commit heinous murder upon you at this present juncture in time, and indeed upon anyone that gits in mah way cos I is mad.
What, you might ask, has made such a normally cheery (I can be cheery) soul like me so irate? Did that A&E job finally make me crack? On the contrary, I finished it since I last saw you and have moved onto renal and transplant medicine. Wonderful wonderful.
Was it a bothersome patient what yanked my crank? No, I have been tolerating humans quite well recently. Is it the fact that my girlfriend’s Mum is staying with her for a month? Yes you’re quite astute, that’s probably not helping BUT it ain’t the root cause.
You’ve guessed it – job applications. I have brought you MMC news from the coalface over these last sixteen months, but at no point have I ever felt so low. Sure I’ll be cracking jokes in this piece, but secretly (and by writing this here, not secretly) I want to end my life. And I haven’t forgotten about murdering you either.
So what’s the dilly-yo? In a nutshell, for those shitbricks that haven’t been paying attention for twelve months, in 2007 the government unleashed its full wrath upon those lazy doctors and made tens of thousands jobless. 28,000 doctors applied for 15,500 jobs.
They did this by installing a woeful new application system, reducing the number of training posts despite record numbers of new graduates and not accounting for the many overseas doctors that work here but inviting a lot more in.
Thousands of junior doctors, many of whom are my friends, left the country. No one outside the rank of SHO seems that annoyed, so please do tell non-medics why they should be. Each of these doctors cost a quarter of a million pounds of taxpayers’ money to train. We, as a nation, have just let hundreds of millions walk out of the door. Australia, New Zealand and Canada’s gain is our huge loss.
I never thought I was the ‘leaving kind’. I love London and want to stay. That could be my downfall.
This year, it is worse. We were reassured but I think we all knew this to be false. However, last year we were provided with some ammunition. The Tooke Report, detailed in previous issues of this newspaper, made two key assertions. First, that government involvement with the training of junior doctors must stop. This has not transpired. Secondly, that the European Working Time Directive (which I recall being my first cover story as editor in 2004) is detrimental to junior doctors’ training by preventing sufficient hours learning on the job.
Reasons things will be worse this year include: many of the jobless SHOs from last year will be competing with this year’s glut for the same finite amount of jobs (in fact less, as much of the run-through allocation is filled). A recent ruling means that British-trained doctors are given no preference to overseas doctors when allocating jobs.
Overall, an estimated 22,000 applicants will compete for 9,000 jobs. Friends in other professional disciplines often seem confused as to why this is a problem. “Competition is healthy” they say, echoing what the government has been trying to dupe patients with. The key point is that in the UK, doctors can only train in the NHS, there is no alternative as there would be in a bank or law firm.
Continuing on from this analogy, consider my story, which I fear will be typical.
Today I received an email from Oxford Deanery, telling me I have been invited for interview in six days. I have heard, from an unsubstantiated source, that about five hundred applications for Core Medical Training were received by Oxford. They have 27 jobs to give away. So I am delighted I have been granted an interview.
But I have applied to both London and Kent, Surrey and Sussex because I, like a vast swathe of my colleagues, have been scared shitless by what happened last year. I have tried not to hedge my bets and end up jobless.
Let’s imagine I do well in the interview (you need a fertile imagination) and am offered a post. At this point I know none of the following: which hospital(s) I will be working in, my pay, my rota nor what firms I will be doing. Yet I have 48 hours and nor more to accept. If I don’t reply, I am assumed to have rejected the offer.
If I accept, I have to withdraw from all other Deaneries. The only problem is, London make their offers two and a half months after Oxford. So if I decide I want to wait it our for London – and then get offered nothing, I will have thrown away a job. Or if I hold out for London and get given a job I don’t want, I would rather have stayed with Oxford.
Taking our comparison back to banking or law, which companies do you know that would make a job offer with no details about the job whatsoever? Which industries can you think of where the boss doesn’t choose his own staff? And although some jobs make you move around the country, which gives a few weeks’ notice as to location, forcing the employee to sell, buy and move houses in a month?
Lastly, see if you know any banks or consultancies that would send this message to its employees. My ultimate boss, the government, sent all junior doctors a letter in January. It essentially said “don’t apply for anything competitive, you probably won’t get it. Don’t turn down any job applications, you will be lucky to even get one. Don’t be upset if you end up doing something you didn’t apply for, you should be thankful you’re employed.”
It amounted to: Aim Low. No fucking way any City firm says that to its employees. We’re being grown as a generation of ‘just passable’ docs. MMC engenders a culture of striving for mediocrity.
As I said before, I love London with all my heart. I want to make my life here. But in the last few weeks I have done some deep thinking. I had a hot bath recently – where I do my best thinking – and asked myself one question, “do I want to be a doctor?” I had toyed with the idea of leaving. Friends enquired at banks and they want to start me on £80-100,000p.a. But I realised I like being a doctor. It’s what I’m best at and I want to do it. This was a relief as I had started to have doubts.
The second question I asked myself was, “do I want to be a doctor in the UK?” I now know that without drastic change of far more than just the subject of this article – nurse quacktitioners, paltry consultant opportunities and the media’s attitude to us – I cannot stay here. The system has broken me.
Labels: junior doctors, MTAS, NHS, Rohinplasty articles
Monday, October 15, 2007
Four hours to drama
My regular column in Medical Student Newspaper has been reprised this academic year. This year it is, of course, 'F2. Woohoo.' Originally published in the October issue,
I’M CANCEROUS. Yes that’s right, I’m back for a fourth year running. This year, I come to you from the dizzy heights of the most superlative foundation doctor there is, THE MIGHTY F2.
A new generation of fresh-faced F1s replaced me and all my ilk. Now I’m supposed to know shit, you know, and stuff.
A&E’s a funny place to work. Over 90% of you will spend four months ‘on the medical front line’ as I am now. Unless you choose to pursue this field (ya crazy fool), your A&E rotation will be the job that brings you more excitement, boredom and frustration than any other. Mostly frustration.
No longer is the emphasis based on diagnosis, which is what draws so many into medicine, but on exclusion. Can you send this healthy 30 year-old chap home...are you SURE he hasn’t had an MI? Let’s refer him to the medics for a twelve-hour trop and take up a hospital bed just in case. It’s mind-numbingly un-stimulating at times.
There are many positives about working in A&E. Exposure to a wide range of problems, dealing with genuine emergencies, seeing instant results. My particular hospital has four great consultants and as St. George’s is a Centre of Excellence for countless specialties, I see some crazee sheeyrt.
However the one overwhelming negative is that it is A&E. There is no area of medicine that has been toyed with by the government as much as the emergency department.
Because waiting times are so easy to quantify and brag about before an election, A&E is a convenient place to pull numbers from. It is also one of two first points of contact for patients. The other is, of course, general practice, which has been tinkered with almost as much, chiefly to the detriment of A&E departments.
The ridiculous lack of sufficient out-of-hours GP provision, NHS dentists, the creation of stop-gaps like NHS Direct and obscene waits for GP appointments mean we are inundated with complaints that are neither accidents nor emergencies.
Yet each person that attends A&E has to be seen, diagnosed, treated and moved out of the department in four hours.
As all five Rohinplasty readers will know (it’s going up), I am obsessed with a solid evidence base. I use that as a chat up line sometimes. Anyway, one would like to think that those responsible for these four hours used all the available data to construct a sophisticated model of a working A&E and thus extrapolated a suitable figure.
The truth is probably more along the lines of pin-the-tail-on-the-number, with an arbitrary figure being plucked from the air.
The reality is a shambles. Of course no standard duration can be applied to A&E patients, as there is no one type of A&E patient. Some are out within ten minutes but some need several hours.
A far more sensible system, as I’m sure an honest government would concede, would consist of clinicians deciding how long each patient needed to be safely dealt with.
However politicians make decisions, not doctors, so that ‘four hour waits’ can be political weapons.
Only 2% of patients are allowed to ‘breach’.
I figured, like many others, a cavalier attitude was the way forward and thought I would ignore breaches and put the patient first. The NHS doesn’t work that way.
Unwell patients often need to stay in A&E until they are stable enough to be transferred. Pissheads need to sober up before they go.
The Medical Assessment Unit, or MAU, that most of you will be familiar with by now, owes its existence to the four-hour-wait. MAUs were created to stop the clock. The vast majority of patients admitted to a hospital come under the care of the general physicians. Hence all medical patients now go to MAUs where there is no timer.
There is no guarantee they will be adequately treated by the time they arrive there and there is no guarantee they will be seen by the doctors looking after them, hence negating the entire reason for the four hour rule.
I must be careful with what I say about my employer, so suffice it to say that unfortunately cooking the books MAY OR MAY NOT OCCUR at SOME hospitals around the country. Will that sound sufficiently vague in court?
Picture the scene. A patient needs a urine dipstick to make a diagnosis of a UTI. However a nurse is off sick and the nursing staff is over-stretched. No one gets the urine sample. The patient breaches. If this breach were recorded perhaps management would see that missing nurse’s value.
However if the number of breaches is the same as on any other night, the hospital realises she’s unnecessary and sacks her. They congratulate each other on more money saved. The system is broken, nothing changes.
We have some bizarre A&E mentality now that stipulates the customer is always right. But the patient is rarely first.
Nurses will drive you slowly mad with a phrase you will quickly grow tired of, “come on, your patient’s about to breach.” I normally cave.
Title reference to Nine Hours to Rama.
My regular column in Medical Student Newspaper has been reprised this academic year. This year it is, of course, 'F2. Woohoo.' Originally published in the October issue,
I’M CANCEROUS. Yes that’s right, I’m back for a fourth year running. This year, I come to you from the dizzy heights of the most superlative foundation doctor there is, THE MIGHTY F2.
A new generation of fresh-faced F1s replaced me and all my ilk. Now I’m supposed to know shit, you know, and stuff.
A&E’s a funny place to work. Over 90% of you will spend four months ‘on the medical front line’ as I am now. Unless you choose to pursue this field (ya crazy fool), your A&E rotation will be the job that brings you more excitement, boredom and frustration than any other. Mostly frustration.
No longer is the emphasis based on diagnosis, which is what draws so many into medicine, but on exclusion. Can you send this healthy 30 year-old chap home...are you SURE he hasn’t had an MI? Let’s refer him to the medics for a twelve-hour trop and take up a hospital bed just in case. It’s mind-numbingly un-stimulating at times.
There are many positives about working in A&E. Exposure to a wide range of problems, dealing with genuine emergencies, seeing instant results. My particular hospital has four great consultants and as St. George’s is a Centre of Excellence for countless specialties, I see some crazee sheeyrt.
However the one overwhelming negative is that it is A&E. There is no area of medicine that has been toyed with by the government as much as the emergency department.
Because waiting times are so easy to quantify and brag about before an election, A&E is a convenient place to pull numbers from. It is also one of two first points of contact for patients. The other is, of course, general practice, which has been tinkered with almost as much, chiefly to the detriment of A&E departments.
The ridiculous lack of sufficient out-of-hours GP provision, NHS dentists, the creation of stop-gaps like NHS Direct and obscene waits for GP appointments mean we are inundated with complaints that are neither accidents nor emergencies.
Yet each person that attends A&E has to be seen, diagnosed, treated and moved out of the department in four hours.
As all five Rohinplasty readers will know (it’s going up), I am obsessed with a solid evidence base. I use that as a chat up line sometimes. Anyway, one would like to think that those responsible for these four hours used all the available data to construct a sophisticated model of a working A&E and thus extrapolated a suitable figure.
The truth is probably more along the lines of pin-the-tail-on-the-number, with an arbitrary figure being plucked from the air.
The reality is a shambles. Of course no standard duration can be applied to A&E patients, as there is no one type of A&E patient. Some are out within ten minutes but some need several hours.
A far more sensible system, as I’m sure an honest government would concede, would consist of clinicians deciding how long each patient needed to be safely dealt with.
However politicians make decisions, not doctors, so that ‘four hour waits’ can be political weapons.
Only 2% of patients are allowed to ‘breach’.
I figured, like many others, a cavalier attitude was the way forward and thought I would ignore breaches and put the patient first. The NHS doesn’t work that way.
Unwell patients often need to stay in A&E until they are stable enough to be transferred. Pissheads need to sober up before they go.
The Medical Assessment Unit, or MAU, that most of you will be familiar with by now, owes its existence to the four-hour-wait. MAUs were created to stop the clock. The vast majority of patients admitted to a hospital come under the care of the general physicians. Hence all medical patients now go to MAUs where there is no timer.
There is no guarantee they will be adequately treated by the time they arrive there and there is no guarantee they will be seen by the doctors looking after them, hence negating the entire reason for the four hour rule.
I must be careful with what I say about my employer, so suffice it to say that unfortunately cooking the books MAY OR MAY NOT OCCUR at SOME hospitals around the country. Will that sound sufficiently vague in court?
Picture the scene. A patient needs a urine dipstick to make a diagnosis of a UTI. However a nurse is off sick and the nursing staff is over-stretched. No one gets the urine sample. The patient breaches. If this breach were recorded perhaps management would see that missing nurse’s value.
However if the number of breaches is the same as on any other night, the hospital realises she’s unnecessary and sacks her. They congratulate each other on more money saved. The system is broken, nothing changes.
We have some bizarre A&E mentality now that stipulates the customer is always right. But the patient is rarely first.
Nurses will drive you slowly mad with a phrase you will quickly grow tired of, “come on, your patient’s about to breach.” I normally cave.
Title reference to Nine Hours to Rama.
Labels: A+E, medicine, NHS, Rohinplasty articles
Wednesday, July 04, 2007
SHO me the exit
Cross post on Pickled Politics.
SEVEN of the suspects arrested under suspicion of involvement with the terrorist attacks over the last few days are NHS junior doctors or medical students. Britain's threat level has only today been stepped down from 'critical' to 'severe' and heightened security at airports remains in place. As a shifty-looking NHS junior doctor flying out of the UK on Friday, these events have had particular resonance.
The suspects, of Iraqi, Saudi, Indian and Jordanian origin, have opened a debate on the role overseas doctors play in the British health system. It is a widely acknowledged fact that the NHS survives on the contribution of doctors trained abroad. Many would go so far as to say that the NHS would not exist today had doctors from the sub-continent buoyed it through its early decades. Today approximately 128,000 of the 277,000 doctors on the GMC Register are from overseas medical schools.
The requirement of a work permit for foreign junior doctors only came into place last year, as the UK was producing more doctors itself (many of whom are now leaving for Australia, New Zealand and Canada). Medical Student Newspaper covered the fact that even overseas undergraduates in British medical schools, who pay almost £100,000 in tuition fees, were instructed to apply for work permits despite being halfway through training.
The normal vetting process for doctors involves a professional and linguistic assessment (the PLAB) and a probation period working in the NHS before a full registration is offered. Doctors from the EU are exempt from these checks. No doctors are specifically questioned on their political views.
Members of British Muslim medical groups, such as Dr Abdula Shehu of the Muslim Doctors Association, are afraid there will be a backlash against Muslim doctors. To me, this sounds improbable. Doctors can't be picked out on the street - most people know doctors via being treated by them. I doubt people will suddenly assume their family GP Dr Hussain is a terrorist.
However not much has been said about medical students, who interact with a far more diverse group of people than doctors. We have previously touched upon the religious fanaticism that lurks on British university campuses and I'm sure there will be sympathisers amongst British Muslim students, just as there is likely to be some ill will toward normal Islamic students.
What appears to be happening is a questioning of Britain's reliance on overseas doctors. Gordon Brown has already pledged a review of NHS recruitment and 'skilled migrant workers' background checks. Intelligence agencies said they will have to "widen the net" when searching for potential bombers. A somewhat romantic illusion that doctors are above activities like terrorism has been laid to rest, but the debate over the ability to cure and kill is a fascinating one.
The Times today revealed details of the two Indian suspects, now known to be cousins. Both spent most of their time in the UK socialising only with other foreign doctors, often just Indians. Details of the other suspects' lives is patchy, but again most character testimonies have come from Muslim friends and acquaintances. In my hospital accomodation, a cluster of several apartment blocks, several are populated solely by immigrants. It is quite possible to have a job in the NHS and live with, work with and socialise with only those from outside the UK.
The disparate group of eight people seem linked only by two things, being Muslim and medicine.
The NHS is prohibited from actively recruiting from countries at risk of a 'brain-drain' (though less than a quarter of recruitment agencies the NHS uses has signed up to this), but a doctor from such a country is entitled to apply independently. A huge proportion of the NHS is accounted for by foreign workers, with thousands of doctors from 150 countries, nurses from the Phillipines, India, Ghana and Nigeria or cleaners from Nepal, Ghana and Nigeria. These countries' health systems are woefully understaffed.
In the wake of 7/7, we clutched at straws for what might have driven those men to kill. Poverty, social deprivation, a lack of feeling British. This time, whilst I can assure you juniors doctors are not flushed with money, they are certainly not on the poverty line. These doctors had no call to feel British as they weren't, but it seems apparent they resented the country they had chosen to work in.
Their reason for attacking the UK might have been the same as previous terrorists, but how did they become subject to such extreme views in spite of their high educational level and respected job? Much could be speculated about doctors from Iraq - they sought revenge for a fallen friend, an insult to their country - but then why were Indian Muslims angry?
I realise I am posing more questions than I am answering. I do not feel increasing security checks on skilled migrants will solve the problem. We do not know if some of these men (and woman) were radicalised in the UK. For me, and many like me, the very nature of the NHS is under scrutiny. A thoroughly British convention, it is a puzzling behemoth of nations. Isolation for someone new to the UK is very easy in the NHS - how many other mass employers routinely provide cheap digs next to your workplace combined with 60 hour weeks?
The NHS remains perpetually over-stretched and under pressure to cut waiting times; see more patients; improve treatments. None of this is possible without sufficent staffing, frequently drawn from the countries that need medical professionals the most. Whilst not apparently linked to recent events, the fact the NHS is driving thousands of its best and brightest abroad every year can only be worrying.
I'll end with an anecdote. After the Tsunami, I spent a month working at relief camps around Sri Lanka's coast. I returned to Heathrow with a shaved head, a month's tan, a big rucksack and four days of stubble. The security officers saw me a mile off and took me to a special area where they searched me and my bags. They rummaged through sweaty clothes and pirate DVDs, firing a series of questions at me.
As soon as the chap looking through my bag found my stethoscope, both officers immediately packed everything back in and apologised for bothering me. I was sure the "I'm a doctor" line would be an evergreen get-out clause for airport security. Oh well, wish me luck this weekend.
(Kind of related, I thoroughly recommend Michael Moore's new film, Sicko.)
Cross post on Pickled Politics.
SEVEN of the suspects arrested under suspicion of involvement with the terrorist attacks over the last few days are NHS junior doctors or medical students. Britain's threat level has only today been stepped down from 'critical' to 'severe' and heightened security at airports remains in place. As a shifty-looking NHS junior doctor flying out of the UK on Friday, these events have had particular resonance.
Almost three months after junior doctors were in the news protesting a disastrous job shortage, a friend at work quipped "I think some of these guys are taking their MTAS protests a bit far." Hey, perhaps these guys were just pissed off at being laid off...
"Brilliant": Mohammed Asha topped his class several times.
The suspects, of Iraqi, Saudi, Indian and Jordanian origin, have opened a debate on the role overseas doctors play in the British health system. It is a widely acknowledged fact that the NHS survives on the contribution of doctors trained abroad. Many would go so far as to say that the NHS would not exist today had doctors from the sub-continent buoyed it through its early decades. Today approximately 128,000 of the 277,000 doctors on the GMC Register are from overseas medical schools.
The requirement of a work permit for foreign junior doctors only came into place last year, as the UK was producing more doctors itself (many of whom are now leaving for Australia, New Zealand and Canada). Medical Student Newspaper covered the fact that even overseas undergraduates in British medical schools, who pay almost £100,000 in tuition fees, were instructed to apply for work permits despite being halfway through training.
The normal vetting process for doctors involves a professional and linguistic assessment (the PLAB) and a probation period working in the NHS before a full registration is offered. Doctors from the EU are exempt from these checks. No doctors are specifically questioned on their political views.
Members of British Muslim medical groups, such as Dr Abdula Shehu of the Muslim Doctors Association, are afraid there will be a backlash against Muslim doctors. To me, this sounds improbable. Doctors can't be picked out on the street - most people know doctors via being treated by them. I doubt people will suddenly assume their family GP Dr Hussain is a terrorist.
However not much has been said about medical students, who interact with a far more diverse group of people than doctors. We have previously touched upon the religious fanaticism that lurks on British university campuses and I'm sure there will be sympathisers amongst British Muslim students, just as there is likely to be some ill will toward normal Islamic students.
What appears to be happening is a questioning of Britain's reliance on overseas doctors. Gordon Brown has already pledged a review of NHS recruitment and 'skilled migrant workers' background checks. Intelligence agencies said they will have to "widen the net" when searching for potential bombers. A somewhat romantic illusion that doctors are above activities like terrorism has been laid to rest, but the debate over the ability to cure and kill is a fascinating one.
The Times today revealed details of the two Indian suspects, now known to be cousins. Both spent most of their time in the UK socialising only with other foreign doctors, often just Indians. Details of the other suspects' lives is patchy, but again most character testimonies have come from Muslim friends and acquaintances. In my hospital accomodation, a cluster of several apartment blocks, several are populated solely by immigrants. It is quite possible to have a job in the NHS and live with, work with and socialise with only those from outside the UK.
The disparate group of eight people seem linked only by two things, being Muslim and medicine.
The NHS is prohibited from actively recruiting from countries at risk of a 'brain-drain' (though less than a quarter of recruitment agencies the NHS uses has signed up to this), but a doctor from such a country is entitled to apply independently. A huge proportion of the NHS is accounted for by foreign workers, with thousands of doctors from 150 countries, nurses from the Phillipines, India, Ghana and Nigeria or cleaners from Nepal, Ghana and Nigeria. These countries' health systems are woefully understaffed.
In the wake of 7/7, we clutched at straws for what might have driven those men to kill. Poverty, social deprivation, a lack of feeling British. This time, whilst I can assure you juniors doctors are not flushed with money, they are certainly not on the poverty line. These doctors had no call to feel British as they weren't, but it seems apparent they resented the country they had chosen to work in.
Their reason for attacking the UK might have been the same as previous terrorists, but how did they become subject to such extreme views in spite of their high educational level and respected job? Much could be speculated about doctors from Iraq - they sought revenge for a fallen friend, an insult to their country - but then why were Indian Muslims angry?
I realise I am posing more questions than I am answering. I do not feel increasing security checks on skilled migrants will solve the problem. We do not know if some of these men (and woman) were radicalised in the UK. For me, and many like me, the very nature of the NHS is under scrutiny. A thoroughly British convention, it is a puzzling behemoth of nations. Isolation for someone new to the UK is very easy in the NHS - how many other mass employers routinely provide cheap digs next to your workplace combined with 60 hour weeks?
The NHS remains perpetually over-stretched and under pressure to cut waiting times; see more patients; improve treatments. None of this is possible without sufficent staffing, frequently drawn from the countries that need medical professionals the most. Whilst not apparently linked to recent events, the fact the NHS is driving thousands of its best and brightest abroad every year can only be worrying.
I'll end with an anecdote. After the Tsunami, I spent a month working at relief camps around Sri Lanka's coast. I returned to Heathrow with a shaved head, a month's tan, a big rucksack and four days of stubble. The security officers saw me a mile off and took me to a special area where they searched me and my bags. They rummaged through sweaty clothes and pirate DVDs, firing a series of questions at me.
As soon as the chap looking through my bag found my stethoscope, both officers immediately packed everything back in and apologised for bothering me. I was sure the "I'm a doctor" line would be an evergreen get-out clause for airport security. Oh well, wish me luck this weekend.
(Kind of related, I thoroughly recommend Michael Moore's new film, Sicko.)
Labels: current affairs, MTAS, NHS, religion
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