Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Low morale within junior doctors
- Brian T Little (5 April 2002)
-
Health For all - For doctors too !
- Dr Susheel Oommen John (6 April 2002)
-
Unhappiness-Don't Foregt Racism
- Jay Ilangaratne (6 April 2002)
-
Unhappy Doctors in Brazil
- CELIO LEVYMSN (7 April 2002)
-
Unhappy doctors: what are the causes and what can be done?
- Irving Taylor (8 April 2002)
-
We need to learn to be kinder to ourselves
- Lizzie Miller (9 April 2002)
-
I am still happy to be a doctor
- vijay Rajput, Camden New Jersey USA 08103 (10 April 2002)
-
Unhappy doctors and 'consumers' of disease
- David H Bevan (10 April 2002)
-
Rational Expectations
- Robert A knuppel, New Brunswick, N.J. 08901 (10 April 2002)
-
BUSY, TIRED AND FRUSTRATED
- Shailendra Goswami (10 April 2002)
-
A little more understanding from everyone!
- Kala A. (11 April 2002)
-
Another piece of the jigsaw: Proactive or reactive general practice?
- Peter Davies (11 April 2002)
-
The true reward
- David W Evans (11 April 2002)
-
Caring for patients or better management processes?
- Robert W Leckridge (15 April 2002)
-
Make patients happier and you'll be happier
- Roger M. Goss (15 April 2002)
-
Re: Make patients happier and you'll be happier
- Somdutt Prasad (16 April 2002)
-
The Cure for "Unfufilled" Doctors: Career Expansion
- Francine R. Gaillour (20 April 2002)
-
Seeds of unhappiness are sown in medical school
- Jason O Roach (27 April 2002)
-
Re: Unhappy doctors: what are the causes and what can be done?
- frank stratton (11 May 2002)
-
Dont Forget Europens, please
- Kim Sri (16 June 2002)
|
|
|||
|
Brian T Little, Research Fellow Craigavon Area Hospital
Send response to journal:
|
This interesting article appears to be targeted at consultants. (1) It does not appear to address the reasons for low morale in junior hospital doctors. Adapting their model of a ‘Compact’ specifically for junior doctors, it would again appear that the reason for low morale is that it might be perceived that more is given on the side of the junior doctor than is received in return. For example: What junior doctors give: Sacrifice early earnings, More shift work at antisocial hours, Fend off attempts by trusts to reduce banding scale, Staying late to do work that could not be completed during new agreed hours, Studying for Royal college exams, Publishing and presenting papers, Attending specialty meetings, Attending specialty courses, Applying for new job every 6 to 12 months until SpR, Organising a research project and getting funding for it, RITA’s, working at an international specialty center to gain extra experience, completing your exit exam, obtaining a CCST, and applying for Consultant posts. What junior doctors hope to get: A Consultant or substantive GP post, job security, with reasonable remuneration, 10-12 years post graduation. The article does address the issue of current medical posts not living up to expectations, but perhaps the reasons given for low morale within junior medical staff could be audited using the BMA 1995 Cohort study? This could then be used to target the morale issues raised. Reference: 1.Edwards N, Kornacki MJ, Silversin J: Unhappy Doctors: What are the causes and what can be done? BMJ 2002; 234: 835-838 |
|||
|
|
|||
|
Dr Susheel Oommen John, Resident Department of Internal Medicine
Send response to journal:
|
Dear Sir, The article on unhappy doctors is a timely eyeopener, the universal discontent among all cadres of doctors, from medical students to the consultants just reflects that there is serious flaws in the present system of training , working environment and renumeration. This discontentment does not seem to have localised to the developed and affluent countries alone but rampantly prevalent in the developing counties too. Although doctors are considered "Gods " and even worshiped in these countries that lack basic health facilites and infrastructure,the doctors seem to be leading miserable lives. Medical education still continues to be highly expensive, extremely demanding and unrewarding . Persons opting for non medical careers , spend lesser on education, settle down faster and recieve much better renumeration and benefits in proportion to the efforts put in. How can a wounded and burdened soul care whole heartedly to the suffering ? It is high time that the government and other concerned authorities concentrate on Restoring the wounded and neglected medical fraternity. Concrete change in attitudes from the governments that will promote the " Health of the HEALERS" such as better working conditions, recognition and rewarding of the efforts and more flexible and friendly health policies can help in restoring the dignity of the doctors. This is a political emergency and requires rapid recognition and early intervention, for what can be as worse as a sick and wounded healer ? Susheel Oommen John | |||
|
|
|||
|
Jay Ilangaratne, Editor Medical-Journals.com
Send response to journal:
|
Sadly, the authors have missed an important cause of unhappiness which affects thousands of doctors in the UK-it is racism.It is,in fact,covert racism within the profession which is hitting ethnic minority doctors in various ways.Perhaps,'unhappiness' is too mild a term to describe the adverse effects of racism.Its devastating effects are not just limited to destruction of careers,but can also permanently destroy one's family and social life.Needless saying, the very effects of racism can bring a life-time of ill-health to the victims.Providing lip service to address this 'infectious disease' has been the standard response of the medical profession including the BMA and NHS.Perhaps, many would know by now that the BMA too, has been found guilty of unlawful race discrimination(in breach of Race Relations Act 1976) against a UK doctor;one could see the full decision of the employment tribunal by visiting,www.chaudhary.uni.cc/ . |
|||
|
|
|||
|
CELIO LEVYMSN, Staff Neurologist,MD,MSc Albert Einstein Hospital,Sao Paulo,SP,Brazil,CEP (ZIP) 01224-010
Send response to journal:
|
Here,in Brazil,the largest country of South America,doctors are unhappy too.I am not only a neurologist in my place of work,the Albert Einstein Hospital;I am also a member of the Medical Ethics Comission and a formlermy Senior Counsellor of the Sao Paulo State Medical Council,the Medical Ethics Court,one of the places where the medical conditions of work are discussed.Few years ago,the Federal Medical Council of Brazil sponsored a large research to perform a picture of the brazilian medical professional profile.There are interestig things to apply to the theme and the objetive of the article:brazilian's doctors are suffering - circa 90% of them,after graduation,residence and fellowship,are receiving very low salaries;the public health system of Brazil,named SUS,is fully decadent,with poor equipated hospitals,ERs,etc.,and the majority of the population,more than 100 millions of people,depends integrally of the SUS.Some about 40 million have private health planes,but they pay also few honoraries to doctors.However,even in this black picture,very few doctors abandon the profession.There are also a social component:the media,and a large ammount of people,belivies in a "white mafia",some kind of conspiracy of doctors against the patients.Of course this is a fantasy,is rare to someone pursuit and prosecute physicians using this argument,but it is a very important cause of unhappyness.And more:the frustation,after years and years dedicated to education,to be considered a potential criminal,a insensible person and in various occasions,a incompetent doctor.All these facts are aggraveted by the enormous ammount of bad medical schools,all of them private,most of them even without a hospital for training !There are some cases and causes of sad doctors and professionals in a continental country as mine.The original center of the problem:the health and ecomic politics of the federal and state governments,based on a rigid neoliberal structure,that demonstrate clearly privileges to financial institutions and banks,for example,and very few interest at the political staff on social schedules,including health and education. |
|||
|
|
|||
|
Irving Taylor, Professor of Surgery Department of Surgery, University College London, W1W 7EJ
Send response to journal:
|
Dear Sir Unhappy doctors: what are the causes and what can be done? I read the above article with interest. Perhaps excess accountability should be considered. As a Professor of Surgery and Honorary Consultant Surgeon I am attempting to compile a comprehensive list of the various bodies that are assessing/appraising/validating my performance and activity. I would be most grateful if your readers could peruse the following and inform me of any glaring omissions; after all I would hate to think I might have forgotten some. University Internal Quality Assurance Committee
Hospital
National GMC Re-validation Procedures
Yours sincerely I Taylor
Edwards N, Kornacki M J and Silversin J Unhappy doctors: what are the causes and what can be done? BMJ 2002, 324: 835-838 |
|||
|
|
|||
|
Lizzie Miller, Occupational Health SW6 4PH
Send response to journal:
|
Dear Editor, I would like to take this opportunity whilst focussing on doctors unhappiness, to ask your readers if there are willing to help their fellow medics. We need to help ourselves as much as we can rather than asking others to step in and rescue us from our misery. Outside interventios are rarely welcome in the long term! The Doctors' Support Network is about helping other doctors and by doing so receiving support for yourself. This quote is taken from a letter written to the Doctors’ Support Network. ‘It has made a significant difference for me to be able to talk to someone who understands where I am coming from. Its not like talking to my psychiatrist, who I feel is continually watching me for some sign of illness, it is good to know that someone understands why I feel so ashamed of being ill. … thank you….’ Mental health problems are not restricted to patients, doctors too become ill. The enormous amount of stigma associated with mental ill health within the profession can makes it that much more difficult to come to terms with the illness. In the Doctors’ Support Network, we have no doubt that it helps to talk to someone who has, if not a similar experiences, a similar understanding of the problem. The Doctors’ Support Network (DSN) is a group of almost 300 medics who are experiencing or have experienced mental health problems. The Network runs monthly meetings, has a monthly newsletter and an email forum. Together with PriMHE* the DSN is setting up a peer telephone support line with funding from the DOH for doctors who have or have had mental health difficulties. It will be called the Doctors’ Support Line (DSL). All calls will be answered by doctors. These doctors will have either have had experience of mental health difficulties themselves or have an understanding of what it is like to be in that position. It will also provide callers with information about the GMC, retraining and other areas that people need help with in order to reorganise their lives after illness. We are looking for volunteers from within the profession, who working from home will help answer the calls. Volunteers need to be good listeners with an open helpful approach, able to resist being prescriptive and most of all mindful that the caller is their peer not their patient. They need to be able to offer between 2 and 4 hours of their time each fortnight, and will receive expenses, a two-day preparatory course and ongoing support. We hope that volunteers will gain new skills, confidence and insight from their work with the DSL. For further information, Deirdre McLellan is Project Manager and can be contacted on 020 8891 6593, The Stables 2a Laurel Avenue, Twickenham TW1 4JA or mailto :Deirdre.mclellan@primhe.org The Doctors Support Network can be contacted on 07071 223372, www.dsn.or.uk or mailto: lizzie@dsn.org.uk Yours sincerely *PriMHE – Primary Care Mental Health, charity established in 1999 to work to support the mental well-being of health care professionals |
|||
|
|
|||
|
vijay Rajput, Assistant professor of medicine Robert Wood Johnson Medical School, Camden New Jersey USA 08103
Send response to journal:
|
I agree that all profession including medicine has lost both autonomy and influence throughout the world. Incresing diverse society has questioned both traditional values and societal structures.It is hard to tell student that the liabilities of a career in medicine outweigh the assets. No doubt that there are major problems in the delivery of health care, and we ought to be vanguard of those seeking solution to them.The satisfaction I get of being able to relieve pain and restore health, the intellectual challenge solving clinical problems, and variety of human issues we confront in daily practice will remain the essense of doctoring, irrspective to change in the organizational and economic structure of medicine. Medicine is still a great profession, one held in high esteem by the majority of the public, despite the increase in medicolegal issues.Eventhough physician's income may have declined in last two decade, they still remain in the upper decile of all U.S.income. We must mobilize our own allies- patients,students and the public at large. It is they have the greatest stake in the battle to preserve excellence in health care.Our student need to know the the problems facing medicine. But these problems need to be seen in perspective. We need to focus on our primary responsibility to serve as advocates for our patients, students and young junior doctors, we will all maintain our professional integrity and provide leadership for a broad public coalition in defense of health care. As long as we emphasize self-serving complaints regarding threats to our income and to our freedom to preactice as we see fit - we still remain isolated and impotent.The society is asking for a return of of medical professionalism, with its core values of scientific expertise and altruism.(1) 1. Carola Eisenberg " It is still previlage to be a doctor" In "On Doctoring" edited by Richards Reynolds and John Stone Publisher Simon and Schuster, New York NY 1991 |
|||
|
|
|||
|
David H Bevan, Senior Lecturer/hon consultant haematologist St George's Hospital, Blackshaw Road, London SW17 OQT
Send response to journal:
|
Dear Sir, By subscribing to the concept of sick people as 'consumers', the authors further the global political-economic project to define all aspects of human life in commercial terms - and thereby contribute to the very malaise they describe. Diseases are more correctly described as the 'consumers' in this context. The traditional compact pits doctor and patient (as more or less equal allies) against this potentially irresistable consumption, and requires a degree of stoicism from both partners. The commercial model replaces [(doctor+patient)vs(disease)] by [(consumer)vs(disease+doctor)], subjecting doctor and patient to new discontents: the doctor becomes accountable for the effects of disease, and the now solitary consumer-patient confronts a potential conspiracy. The medical discontent detected by the study occurs irrespective of national boundaries because the new commercial paradigm is itself an aspect of globalisation. Cui bono? A working hypothesis identifies profit for transnational pharmaceutical and health-insurance industries, together with states hoping to offload medical costs, if a patient's trust in a doctor is replaced by a consumer's faith in personal expenditure. |
|||
|
|
|||
|
Robert A knuppel, Professor and Chair OB/GYN University of Medicine and Dentistry, 125 Paterson Street, New Brunswick, N.J. 08901
Send response to journal:
|
The cause of personal unhappiness is very complex and we are in a time of rapid technological advancement and health status improvement that appropriately results in review of our paradigms. People are much healthier, information is more democratized, supply/demand equilibrium remains imbalanced,trust in all professions is eroded, gender roles continue to demand discussion, and healthcare is a commodity.One issue that I have identified is difficulty in finding in most US medical schools a concerted effort to discuss any of the aforementioned reasons for changing the model let alone implementation of change. The white elephant in the room may be the immovable, inflexible training field. It is time for our medical school leaders to proactively adjust expectations. A purely reactive establishment reflects the threatened personalities involved which mutes discussion and creativity. Most of our leaderrship is involved in accountability that is punitive and not used as a truly learning experience. Without proactive implementation of a cultural change in medical schools and fields of training, we must await the pain of prolonged unhappiness in the working environment. Do our academic leaders have the right stuff to grab the cultural rudder and really change the content and methods we use in the curriculum extant for the past 30 years. |
|||
|
|
|||
|
Shailendra Goswami, DNB trainee, Lisie hospital, Ernakulam, Kerala, India. Lisie hospital, Ernakulam, Kerala, India. 682018
Send response to journal:
|
“What is this life, full of care, We have no time to stand and stare?” Poet: W.H. Davies Dear sir, The article has brought a very important issue into limelight. Doctors are becoming more and more dissatisfied from their medical profession. Increasing demands of society and government, increased workload, decreased esteem, increased accountability, decreased medical autonomy [1], less pay [2]: reasons are many and solution transcends the imagination. The magnitude of frustration is so much that some doctors take early retirement and many search for non-clinical careers in the field of administration, education, etc [2]. The major problems are exhaustive workload [3], less time for family [4] and little or no recreation. The plethora of work and ever increasing demand of society for personalized medical care has made them too busy. Their exhaustive duty schedule makes them tired, and less time for family makes them frustrated and angry. This also results in dissatisfaction in married life. What happens next? We all know. Measures should be taken to decrease workload on Doctors, so that they may spend more happy hours with their family [4]. This would make them happier and may rejuvenate their affinity in their profession. It is important to solve this problem as soon as possible, because frustration among doctors directly affects quality of health care. Representatives from the government, patients and doctors should sit together and discuss this vital problem and adequate measures must be taken with mutual understanding and cooperation. Time has come when things should change for the better. Government has already taken a step in this direction: department of health is organizing a meeting in London in this month to discuss this issue [5]. Let us hope this meeting will effectuate the much-awaited revolution in the lives of busy, tired and frustrated doctors. References: 1) Nigel Edwards, Mary Jane Kornacki, Jack Silversin: Unhappy doctors: what are the causes and what can be done? BMJ 2002;324:835-838 ( 6 April ) 2) Jerome P. Kassirer: Doctor Discontent. NEJM Volume 339:1543-1545 November 19, 1998 Number 21 3) Richard Smith: Why are doctors so unhappy? BMJ 2001;322:1073-1074 ( 5 May ) 4) Carol Dumelow, Peter Littlejohns, Sîan Griffiths: Relation between a career and family life for English hospital consultants: qualitative, semistructured interview study. Student BMJ July 2000. [http://www.studentbmj.com/search/search_f.html] 5) Editor's choice: Why so unhappy? BMJ 2002;324 ( 6 April ) |
|||
|
|
|||
|
Kala A., Specialist OBGYN Chennai 600 090, India
Send response to journal:
|
Overwork, under payment, job insecurity, anti-trust suits, political interference, too limited resources, too many patients, high expectations, punitive action against dissent all remain practical realities in medical practice today. Good old fashioned study of the problems faced by everyone, a little more understanding of one another's point of view and a genuine interest in helping out are the only way out. Will everyone be willing to do that and act on that resolution? |
|||
|
|
|||
|
Peter Davies, GP Mixenden Stones Surgery, Halifax HX2 8RQ
Send response to journal:
|
Sir, I read this article with interest, and particularly noted the idea of a "compact" between doctors, patients and the state. To set up a compact it is necessary to have some role specifications and at present these are at best vague in primary care. About 30 years ago general practice was exclusively concerned with reacting to symptoms and making a diagnosis from these. Indeed at present patients still tend to get very worried about URTI, gastro-enteritis, rashes, ear ache, febrile children and abdo pain. Usually these symptoms are due to minor self limiting diseases and indeed doctors are doing more work treating distress about the symptoms than they are in treating the illnesses themselves! Indeed doctors often complain that their surgeries are of this kind of "trivial" illness. The danger in filling our surgeries with this stuff is that we miss the seriously ill patients as we are distracted by too many patients worrying needlessly. One current political demand is for 48 hour access but I suspect this will simply fill our surgeries with more of this kind of minor illness. Alongside this traditional reactive work there has been a developing drive towards proactive care of specific diseases. Politically this is represented by NSFs. Historically it develops on from the idea of "upstream intervention" in the river of disease model. Basically this model sees acute problems as needless complications of undertreated risk factors. If someone is overweight, hypertensive and smoking why wait for the myocardial infarction before you do anything about it? The difficulty in this kind of approach is getting patients interested in it. What worries patients is not really what they should be worried about. Few are very bothered about their obesity, their excess alcohol or other harmful behaviours. Even fewer of those who are bothered can be bothered enough to do anything about it. In the new compact we need to decide if general practice is to continue on a reactive model responding to excess worry about minor illnesses or whether it is to throw its efforts into energetic and effective treatment of the current real threats to health of people in this country. Until this conflict is resolved it is difficult for general practitioners to know what they should be aiming to achieve in their consultations. If we do not know what to aim for we can have no idea what we have achieved, if anything. If we cannot appreciate our achievements we will become demoralised and unhappy. NSFs or 48 hour access: Whose choice is it? |
|||
|
|
|||
|
David W Evans, Retired physician 27 Gough Way, Cambridge, CB3 9LN
Send response to journal:
|
Conspicuously absent from the list of "What they (doctors) get in return" (Box 1) is the unique satisfaction of having done one's best to help those in need. That is surely the lasting reward for a lifetime's commitment to Medicine - and still the best reason for choosing it as a career. |
|||
|
|
|||
|
Robert W Leckridge, Associate Specialist Glasgow Homeopathic Hospital G12 0XQ
Send response to journal:
|
Nigel Edwards and his colleagues' article takes an interesting but rather depressing view of the issue of doctor unhappiness. I felt distinctly less happy after reading this than I did before it! The conclusions reached seem to be that the issue could be satisfactorily addressed by asking doctors to work within guidelines, be accountable for management-set objectives, contribute towards the setting of these guidelines and objectives, work within resource constraints and work in teams rather than alone. To support this great plan doctors should be given time off dealing with patients ("the hamster wheel") to engage in, and train in, these management activities. I don't think you make slaves in the galley any happier by giving them the opportunities to manufacture their own oars and chains to national standards by following oar and chain manufacture guidelines! The essay by Antonia Felix in this week's BMA News gives other clues to the problem and potential solutions. She makes it very clear why she became a doctor - "I want to help people" and she gives a couple of examples where she felt personally rewarded by being able to do this. The examples themselves are interesting. They are not about producing "cures", or delivering objectives or guidelines - they are examples of care. The Guardian has also been asking for comments about the NHS this week - see www.guardian.co.uk/publicvoices. Read some of the comments from the doctors who have contributed. They are unhappy because they lack the time they know is necessary to spend with their patients, because they are faced with so-called solutions to the problems of the NHS which are based on "managerialism" and because their training and job structures fail to enable them to be effective in relieving the suffering of chronic disease. Here are the clues. The answers are unlikely to lie in different management, in guidelines and greater accountability. The answers might lie in creating the structures and training to let doctors do what they became doctors to do - care for people. Ask any of your doctor colleagues when they feel happiest in their jobs and they are likely to tell you that it is when a patient improves after their treatment - when a patient recovers from their acute event, or comes back to outpatients saying they feel much better and more able to cope with their lives - these are the experiences which bring doctors happiness. The clues are in the Edwards article but seem to get lost - "At present the problem is that there is often not the time to have the conversation about expectations or to develop the relationship to use time in consultations most productively". Better guidelines, targets, objectives, training in management and being freed up from seeing patients to work in administration is not likely to deliver and answer to that problem. Yes, public attitudes have changed too, but the problem is not that they now lack a deferential attitude, the problem is that they are no longer prepared to take a merely passive role in decisions and actions about their care and their lives. This is a very healthy development but doctors will need to be given the time and resources to develop these healthy partnerships if the NHS is to address this cultural change. |
|||
|
|
|||
|
Roger M. Goss, Director Patient Concern
Send response to journal:
|
LETTERS TO THE EDITOR 14 April 2002 Edwards et al focus predominantly on organisation and relationships within the profession as the key to happier doctors. (1) They recognise that the relationship with patients is the greatest challenge. But even here, they see resources and organisational rather than attitudinal change as the solution. Perhaps concentrating on reducing the number of complaints and unhappy customers would offer a more effective route to better job satisfaction. Roger M. Goss Director – Patient Concern 1. Edwards N, Kornacki J, Silversin J. Unhappy doctors: what are the causes and what can be done?. BMJ 2002; 324: 835-838 (6 April) |
|||
|
|
|||
|
Somdutt Prasad, Consultant Ophthalmologist Wirral Hospitals NHS Trust CH49 5PE
Send response to journal:
|
Totally agreed, The old world was - doctor orders treatment - patient accepts. The new world is- doctor offers advise - patient explores -accepts or rejects or chooses alternative Responsibility in the first instance lies with the doctor. In the second instance clearly with the patient. I am sure that the majority of doctors are happy with the second situation, provided there are no comebacks. Unfortunately, medical practice today in the UK means that the patient has all the rights to make the decision, but if anything goes wrong (as it inevitably will in the imperfect science that is medicine), the doctor is held responsible, Is anything fair any longer???? Shouldn't the decision maker accept responsibility for thier actions? |
|||
|
|
|||
|
Francine R. Gaillour, President & CEO Ki Health, Inc.
Send response to journal:
|
In reading the article and the various replies, I am surprised to see no mention of career development as one approach to "unhappiness". As a Business Consultant and executive coach who works very closely with healthcare providers, physicians, and physician executives, I am continually impressed with how creative and resourceful some previously unfufilled physicians have become. The missing theory here is a mismatch of internal values with external work. The internal "compact" with oneself is to honor our passions, values, talents by what we do in work or profession. For many doctors, medicine just doesn't completely honor internal values---even in the best of working environments and with excellent compensation. The natural response is to be "stressed", "unhappy", feel "stuck" and oftentimes, get depressed. Rather than looking at the external environment (society, racisim, reimbursement) as the source of ills, look internally for the inspiration to expand career possibilities. For some help with the "cure", take a look at an excellent Internet resource for the "restless physician" : http://www.physiciancareerventures.com. From a physician who has made a number of career transitions, one word of advice: venture out into new territory. Sincerely, Francine R. Gaillour, MD, MBA, FACPE |
|||
|
|
|||
|
Jason O Roach, Final Year Medical Student Guy's King's and St. Thomas' Hospitals Medical School
Send response to journal:
|
Edwards et al correctly point out that in order to reduce unhappiness among doctors training and preparation needs to equip doctors better for the reality of the roles that they will face. While the authors suggested this should happen earlier in doctors careers it is my contention that it should happen even earlier still - at medical school. The reality is that students are still trained in a way that doesn't represent practice. There is a perhaps subconcious emphasis on "medicalisation", a problem addressed recently by Richard Smith and others1. Students who are trained primarily as diagnosticians can potentially find the reality of medicine a huge culture chock. Valiant efforts are being made to address these problems centrally, but clinical students often face teachers who still expect and teach older philosophies. The numbers involved make policing the educational experience of individual students techinically difficult. Until a new generation of trainers arrive, fully supporting the development of the "new compact"2 it may be difficult to ensure that new philosphies are instilled into ever increasing numbers of students. One potential approach is a move towards graduate entry. This theoretically will attract people who have considered more carefully the implications and realities of a career in medicine. This approach has disadvantages too of course. I agree with the authors that more discussion and research is required, but if students and their trainers are excluded, we will not be dealing with the problem as effectively as we could - that is, surely, at it's beginning. Jason O'Neale Roach Former editor StudentBMJ Final Year Medical Student Guy's King's and St.Thomas' Hospitals Medical School 1. Smith R. Too much medicine. BMJ 2002;324:859-60 2. Edwards et al. Unhappy doctors: what are the causes and what can be done? BMJ 2002;324:835-8 |
|||
|
|
|||
|
frank stratton, sho
Send response to journal:
|
Such a senior figure such as Irving Taylor is in a position to do something about the obsessive appraisal system in the U.K. Why doesn't he ? It has no doubt invigorated by the Shipman scandal and others. All these consume money and time -but these have been created by consultants for consultants - so they have less time for teaching juniors relying on the testimony of nurses and their immediate subordiantes . And it suits them because it is a "more talk and less action" activity and these positions of responsibility make them look sooooooooo professional. All they are interested in is boosting their pay cheques and keeping up the traditional hei |
|||
|
|
|||
|
Kim Sri, Gp TW106LG
Send response to journal:
|
Sir I know racism is very much in our profession but now am shocked to see Europeans doctors in UK experiencing similar problem. These non-english speaking doctors passing the Membership exams are left in the lurch. They find themself isolated and disappointed becasue they rearly enter SPr rotation. The doctors selected to SpR rotation is mainly based on how well they can speak (English) and not based on work experience or publications. The British Medical profession does not consider European training and experience for SPr rotation but are using them to fill the staff shortage. Its sad to see postgraduate trained doctors from Europe are also discriminated similar to coloured doctors. I feel the term racism in medical profession should be changed to ANGLICISM. |
|||