BMJ 2003; 327 doi: (Published 28 August 2003) Cite this as: BMJ 2003;327:509
  1. Linda Cardozo, professor of urogynaecology, London (lcardozo{at}

    Thursday morning starts, as any other, with an 8 am ward round of the postoperative patients. There are only three “survivors” to see, as the usual lack of beds meant the operating list had been severely cut. The ward sister warns that next week's operating list will also have to be reduced, because the department's “overspend” has resulted in eight beds closing. At 9 am the outpatients' clinic starts. Patients are waiting to be seen, and the medical students are eager, but many of the patients' medical records are unavailable and the electronic patients' records system is “down.” We have to decide whether to ask the patients to book another appointment or to try to sort out their problems without their investigation results. Some women have come a long distance and, naturally, are concerned or angry. “I am so sorry to keep you waiting” seems trite after its 10th repetition.

    The clinic finishes at 1 pm. Having dealt with the urgent queries and correspondence, and feeling thoroughly demoralised, I drive to Heathrow and board a plane for the United States. Eight hours later, feeling very virtuous, as I have read half of a thesis I am examining and written reviews on two manuscripts submitted for publication in journals, I alight at Chicago to be met by a limousine and taken to a modern conference hotel. I enjoy stimulating discussions over dinner with professional colleagues from around the world.

    Friday morning starts early, as we have much to discuss at the global advisory board meeting of a large drugs company that will launch a new drug early next year. At the end of the day we all feel something has been accomplished. I am thanked by a vice president of the company and assured that my comments are valued, so much so that he suggests upgrading my flight home to first class so I “have a good night's sleep.”

    Monday starts as any other. At 7 am I see the preoperative patients in the private hospital I work in. They have all been properly prepared for surgery that day. The operating list starts at precisely 7 30 am, and no delays occur. The anaesthetist and theatre staff are cheerful, the list runs smoothly, and we all leave the hospital in good time to resume our “other lives.”

    On arrival at my “three star” NHS teaching hospital I am not surprised when the ward sister says that I must “prioritise” my operating list to ensure that there are no cancellations the next day (even though more beds might be available by then). But how can I prioritise on clinical grounds when all the procedures are “elective”? Should I really have to decide between a woman who has put her children into care for her operation, a woman who has come from the other side of the country because she has already had several failed procedures locally, and a woman whose operation has been cancelled twice before? Surely these are administrative decisions, not clinical ones? All I can say to the women is that it is not in my power to provide beds for all the women under my care who need surgery.

    Consultants' main problem is that they feel grossly undervalued and unable to fulfil the roles they were trained for

    Tuesday starts with a delay in getting the first patient to the operating table, because the operating list starts at 8 am, and so does the nursing “shift.” The anaesthetist is irritated because the operating list is not as published (only three beds were available for seven cases). The theatre staff are annoyed that their afternoon will be spent being redeployed to other theatres because of the curtailed operating list, the trainees are upset because they won't see much surgery, and the medical students don't understand why there is so little clinical teaching.

    Thursday again, and nothing has really changed. Again I need to apologise to patients for missing notes or because their investigation results are not available. A different set of specialist registrars need support, and a new group of medical students are bewildered by the clinical conditions. But, oh, how privileged I am! I can again escape–this time to join the scientific committee of an international multidisciplinary society to select abstracts for presentation at the annual scientific meeting. My opinion is valued and my suggestions are influential.

    As a strong supporter of the NHS I realise that without my base in a teaching hospital much of the intellectual stimulation and escape that I so value would be impossible. But many hospital consultants can't escape and must suffer the daily problems in the current NHS for all of their working lives. They may complain about their pay, the long working hours, or inferior facilities, but their main problem is that they feel grossly undervalued and unable to fulfil the roles they were trained for. Perhaps some who intended to devote their working lives to the NHS could be forgiven for thinking that defecting to industry or private practice might offer a better quality of life?

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