Professional highs

BMJ 1997; 315 doi: (Published 19 July 1997) Cite this as: BMJ 1997;315:195
  1. James Owen Drife, professor of obstetrics and gynaecology
  1. Leeds

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    Now that students are cared for by personal tutors, house officers by postgraduate deans, and registrars by college advisers, we consultants should demand someone to watch over us and help us look on the bright side. At the very least we want annual visits from a person with a clipboard, who will smile encouragingly and ask us to think of things we enjoy about our work. I have already prepared my list.

    Assisted delivery: The interview must be confidential because it is politically unacceptable for obstetricians to admit that they take pleasure in practising their craft. Soon, I expect, every forceps delivery will be followed by counselling—optional for the patient but compulsory for the doctor. Nevertheless, in truth it is deeply satisfying to demonstrate dexterity, even to oneself. The presence of a wide eyed junior detracts from this as the consultants wonder whether modern training means that their skills will die with them.

    Draping up: Unfolding the green drapes before an operation gives a surgeon a feeling of security. With the patient safely anaesthetised it is no longer possible for the managers to cancel the procedure. There is pleasure in having only one job to do and being able to ignore distractions. An operating theatre is one of the few places where you can tell someone what to do with a mobile phone.

    Outpatient clinics: Tyros in surgical specialties regard clinics as the price they must pay for the pleasure of operating. The first sign of aging in surgeons is when they start to enjoy talking to patients and the last is when they enjoy listening to them. Even senior consultants, however, dare not risk losing face by admitting to looking forward to the clinic. They give themselves away on retirement by continuing to consult in private.

    Teamwork: As army commercials keep pointing out, working in a team brings a sense of fulfilment. Like mushrooms, comradeship grows best during the night and when the manure is deep, but even so, bonding is a slow process. It takes about five years before a team decides that it can trust a new consultant. It then signals its confidence through non-verbal communication. This is why we are so dismissive of artificial team building exercises involving awaydays or paintballing.

    Making a difference: I asked a colleague what he would put on this list and he said, “Changing a woman's life.” Dramatic, but I know what he means. The feeling is most obvious in the fertility clinic, but other routine work can also transform patients. The buzz is not immediate—it comes with the follow up visit or the misspelt thank you card—but it is strong. Not strong enough, though, to transmit itself to purchasers who keep asking for written evidence that we are doing something useful.

    Getting paid: With the trust's finances as parlous as those of the Russian army, the arrival of the payslip brings a monthly sense of relief, but the thrill is only partly financial. It is good to get positive feedback, even from the finance department's computer.

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