General Practice

Beginning a consultant career

BMJ 1996; 312 doi: (Published 02 March 1996) Cite this as: BMJ 1996;312:559
  1. Michael Jennings

    The initial few weeks were marked by a blend of thoughts, feelings, and emotions, some more striking than others. To my surprise there was no fear or apprehension, no awe or trepidation, and no insecurity—but excitement, confidence, achievement, and anticipation. The most notable experience was coming to the grave realisation of where the buck now rested. This was the prevailing thought when I came face to face with a patient in a bed, and the name above the bed was mine. There rapidly followed a sense of pride in having accomplished a major career goal; reticence was replaced by comfortable command. Responsibility weighed a little more heavily when faced with difficult patients or relatives, but they will inevitably crop up from time to time.

    I have the uneasy feeling that some of my more experienced colleagues do not share my high hopes and expectations. Have they been worn down by the burden of increasing numbers of patients; squeezed between stringent requirements to meet patient's charter standards and the obligation to develop a consultant led service; alarmed by the threat of performance related pay; and troubled by the reduction in junior doctors' hours and consequent augmentation of their own duties which competes with the desire to maintain a private practice? I do not know. The rising tide of expectations which has occurred on the back of the NHS reforms is threatening to submerge some doctors and they clearly need help rather than confrontation. This may form the greatest single challenge to the political and managerial framework of the NHS over the next decade.

    Getting here was not easy. The road to consultant status is arduous and demands time and patience. Failure at interview is unaccustomed and deflating and can provoke feelings of unworthiness and rejection.

    My inauguration has conferred a sense of belonging, of coming of age, of expectation of future progress, and anticipation of developing quality service and research. I hope to maintain personal enthusiasm through the development of management skills, careful planning of career development, and the preservation of a belief in the altruistic principles on which the NHS was founded. But then I am only just beginning my consultant career.—MICHAEL JENNINGS is a consultant in Sheffield

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