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Reviews Personal views

Life as a medical secretary—a new learning experience for the aspiring consultant

BMJ 2003; 326 doi: (Published 15 February 2003) Cite this as: BMJ 2003;326:403
  1. Jonny Alis, first year clinical medical student,
  2. Mitch Blair, consultant and reader in child public health
  1. University College London, and temporary medical secretary from September 2001 to January 2002
  2. Northwick Park Hospital (North West London Hospitals NHS Trust) and Imperial College, London

    The secretary's view

    It is 8 50 am and, clutching my notepad and biro in one hand and my mug of coffee in the other, I sit down for my Monday morning meeting with consultant paediatrician Mitch Blair. As he rattles through this week's “to do” list, I am jotting down the essentials: blood test results to chase, grant applications to complete, meetings to organise, patients to contact—it's all in a week's work for a medical secretary.

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    But there's a twist. In fact, I am no medical secretary, merely a medical student trying to pay off an ever increasing debt. However, my stint as a medical secretary has provided me with more insight into what life is like as a consultant than anything I have yet done. It is strange that, having aspired to be one of these folk for the past seven years, I actually stumble across what it's like while doing a temp job to reduce my overdraft.

    If you're a medical student reading this you might think you know exactly what consultants do, especially if you shadowed Dr X in your summer holidays during A levels or went on ward rounds with them every morning. But have you ever wondered what they are doing out of clinics? Or wondered why you sit around waiting impatiently for them to turn up—was there really an emergency or did the golf game last longer than expected?

    When I worked as a medical secretary, I began to see what really goes on as a consultant—the amount of paperwork, the bureaucracy, the time and effort it takes to chase things up, the relatively small proportion of the day that is actually spent seeing patients. This experience was so revealing that a month as a medical secretary would be as useful as any other rotation that we currently undertake.

    The time has come to take this into account—careers advisers, course organisers, and medical interview panellists, please take note. Can we expect a module of medical secretarial work? Should prospective medical students' university applications sport some evidence of this type of experience? I certainly returned to medical school with an insight into a side of medicine that I never knew existed.

    The consultant's view

    Jonny was a new experience for me. He was sold to me as a new temp, to keep me quiet, after I had complained for the umpteenth time about having had so little consistent support for the increasingly complex task of being a clinical academic. I had moved from Nottingham, where I had had the wonderful experience of having the same secretary for eight years, to a post where Jonny was my ninth secretary in four years. So I was pretty jaded and I knew that on the whole I wasn't a bad boss.

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    I went through induction reluctantly, like a child who has been moved serially from one foster parent to another, no longer wishing to invest much emotional energy in the enterprise, not knowing how long this particular “placement” would last. I was pleasantly surprised and a little shocked to find someone who could type fast and accurately, was well organised, and keen to help. More than that, and perhaps uniquely, this secretary really wanted to know what happened to my patients (after all he was learning my craft too). Letters would act as triggers for mini-tutorials on a variety of common paediatric problems. We placed x ray films and magnetic resonance images against the window in the office and debated them.

    Jonny could see what were the everyday, stress inducing annoyances of working in large bureaucratic organisations and—more importantly—how to make the system better. In short, he cared. As someone organising medical student teaching for paediatrics on our site, I was grateful for his ideas as an independent future “consumer.” He gave me a student's eye view of the course. Of course, the clinical students who visited our offices found Jonny immensely helpful in preparing materials, rescheduling teaching, relaying messages, and unjamming the photocopier!

    There was no one else in my department who knew more precisely what I did each day than Jonny and it was a pleasure both to teach and learn from a medical student in this way. I would recommend this experience to any medical students wishing to have a really good bird's eye view of what the modern consultant is up to. It is likely to dispel many myths and I hope that it will prove a rewarding learning experience.

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