Soundings Soundings

Secretaries for PRHOs

BMJ 2001; 322 doi: (Published 26 May 2001) Cite this as: BMJ 2001;322:1313
  1. James Owen Drife, professor of obstetrics and gynaecology
  1. Leeds

    My son the trainee solicitor, in his first salaried post after five years at university, is the equivalent, I suppose, of a preregistration house officer (PRHO). Nevertheless, he has his own telephone and an answering machine that suggests to callers that they either leave a message or speak to his secretary.

    As a houseman I had no secretary. I filled in my own forms, delivered samples, and found films deep in the X-ray stores. On teaching rounds, my main worry was that I had left some administrative task undone.

    That was in 1971, but things have not changed. In a 1995 survey, administration occupied between 19% and 31% of PRHOs' time. Teaching occupied less than 1%. When I talk to PRHOs as a General Medical Council visitor, some are happy and some complain.

    Strangely, they never complain about bleeps. The pager may have shrunk but it is still around, turning the house officer into everyone's skivvy and making mockeries of both postgraduate training and clinical practice. Surely its role as a status symbol must end now that every schoolchild has a mobile phone.

    Hospitals have tried to ease the pressures on PRHOs by appointing phlebotomists. This is the wrong approach. Venepuncture is a skill to be practised until you are flawless. It would be better to follow the lawyers' example and give them secretaries.

    Doctors will dismiss this idea as a joke. High and low, we all like the familiar hierarchy, and house officers should know their place. If pressed we will say, as we always do, that the NHS cannot afford it.

    I wonder. It costs about £225,000 to train a student to PRHO level, so the proposed annual output of 6000 new doctors will cost the country over £1bn a year. Within seven years of graduation, however, 17% of young doctors are lost to the NHS. The cost of that wastage will be over £200m a year.

    For much less money, one secretary could be allocated to every two PRHOs. The secretary would deal with paperwork, take telephone calls, and hold the bleeps during working hours. The PRHOs would see patients and attend teaching sessions. These bright and educated women and men would feel valued instead of being treated like children. They might even want to stay.

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