Margaret McCartney: Vocation, vocation, vocation
BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6526 (Published 08 December 2016) Cite this as: BMJ 2016;355:i6526In the end, vocation is what it’s all about. We’re tested on its presence before we enter medical school. We’re implored to hold ourselves to the highest standards. We’re judged according to these standards, even when the resources to achieve them are wilfully withheld.
Christmas and New Year should mean some respite and time for thinking about where we’ve come and what we’ve seen. But many working in the NHS will have none of this. Work will simply keep beating on.
This past year has been absurd: a fracturing of relationships between junior doctors and government—born of macho, party political policy making, not evidence, understanding, humility, or nuance. The funding crisis in the NHS, echoed throughout training bodies, colleges, and staff, has gone unanswered; instead, Jeremy Hunt has merely argued for better leadership—though not his own.
We want to work and live in a world where kindness and collegiality run through our days, not the meanness of jobsworths
Vocation is what keeps the NHS going. It’s why so many staff routinely stay late, fix things that are “not my job,” contribute to inquiries, fill out surveys, or take on responsibilities when we could easily choose not to. Why? Because of the feeling—and I apologise, for this is now an evidence-free-zone—that we’re humans with the capacity to do something useful and good for other humans, and because we want to work and live in a world where kindness and collegiality run through our days, not the meanness of jobsworths.
But this vocation is being abused. If we keep trying to fix the often impossible—providing excellent care when the NHS is resourced to be substandard and erratic—we’ll make avoidable mistakes. We’ll work more hours, trying to patch over the cracks.
We’ll come in earlier, stay later, but keep failing targets or inspections, and we’ll be blamed, systemically and individually. When mistakes occur, as they will, we won’t be judged through a lens that sees the pressure the NHS is under, but as the sole arbiters of error. Patients and professionals will suffer.
I worry that medicine’s capacity for vocation is part of the reason we’ve ended up this way. We don’t say no often enough to unrealistic targets, evidence-free policy, or unfunded work. We take on numerous tasks that we think are for the common good, but we ourselves are often not treated as part of that same common good.
Vocation in medicine can reward us with the huge joy and fun that should be part of professional lives. But it can also allow professionals to be exploited. Vocation should not be wet, fluffy, or incapable of saying no. It needs to be ballsy and capable of rebellion. I hope that 2017 brings righteous—vocational—fury.
Footnotes
Competing interests: See www.bmj.com/about-bmj/freelance-contributors/margaret-mccartney.
Provenance and peer review: Commissioned; not externally peer reviewed.
Follow Margaret on Twitter, @mgtmccartney
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