Intended for healthcare professionals

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Editor's Choice

How to make yourselves redundant

BMJ 2018; 363 doi: (Published 08 November 2018) Cite this as: BMJ 2018;363:k4706

Rapid Response:

Re: How to make yourselves redundant

After somehow managing to get 2 postgraduate degrees, in addition to my first in Pharmacy, the first 12 successful years of my career were mostly in the Pharmaceutical Industry. Initiated after a relatively short but most rewarding period with the DHSS Medicines Division; now the MHRA, as one of the first three Scientific Officers employed to assist Medical Assessors. Employment was more varied for the following 10 years.

It became rapidly apparent, although I did not realise this until many years later that I had developed skills that set me apart from many of my peers. In particular: organisational; lateral thinking; ability to work on my own without continual guidance and an enduring trait of never being a 'yes man' and prepared to speak my mind to far more senior individuals than myself. As a result I was able to find (or they found me) projects of significance to do, mostly on my own, to initiate and manage change.

The first simple example of these was a new job reviewing preclinical toxicology reports prior to allowing them to be passed to Regulatory Affairs for submission for a Clinical Trials Phase approval, or Product Licence. Given I was female and had never actually worked in an actual industrial toxicology department my many comments for improvement in all aspects of long detailed reports with detail down to individual animal data, were not appreciated. The response was a slow improvement in the quality of the reports received for review such that after two years not only was the role becoming boring, so I had been looking for other 'tasks' to keep me occupied, I essentially became redundant.

Over the years I became an individual 'special projects' resource. Each project that seemed to last around two years and had some endpoint that became clear as it progressed if not obvious from the start. My achievement was the realisation that I had succeeded in what I had been asked to do, or identified as needing to be done. I rarely got any reward or even thanks; this was often taken by the particular boss at the time.

20 years later I had achieved a great deal for companies, but my reward was for the stress and anxiety and far to much working 24/7 that I completely burnt out.

What I have noticed in my local area also is that there seems to have been a direct correlation in the amount of hours put in by clinicians to their huge rises in remuneration over the last 20 - 30 years. The more pay - the less hours, working to contractual hours or many individual arrangements with less days per week, since they probably do not need the money to still have a rewarding out of work lifestyle.

As a result the availability of GP time has decreased at a faster rate to the increase in patient numbers with health problems. (My own analysis, not supported by any reviewed evidence). It is becoming less and less likely that these GPs, Surgeons and Consultants will suffer any 'real' issue with individual overwork; nurses, registrars and support staff in the NHS are not included in this.

They are putting into practice what is 'preached' to the current working population of the UK, but the latter are now working 24/7 more and more, just to survive. On the other hand GPs are becoming more and more difficult to actually see face to face with telephone triageing becoming the norm, sometimes with life threatening misdiagnoses based on these assessments, plus the assumption that a patient is always able to define one problem at a time, when many may be interrelated! Nothing will replace a face to face consultation and these are now to time limited. The growing numbers of elderly will probably find on-line AI questionnaires difficult, if not impossible to complete anyway!

So to agree, in part, with one of the respondents above. The role of a GP, or hospital clinician, may involve ongoing small successes. However, these are replaced on a daily basis by new challenges, some never resulting in making a patient well. The changes in lifestyle and work ethic of the 21st century population is changing at a rate that GPs will find it harder and harder to ever achieve many small successes, let alone become redundant.

Competing interests: No competing interests

09 November 2018
Jennie Gwynn
Retired Pharmaceutical Executive
West Cornwall