COULD IT be guilt that led the Plymouth doctors to back Sister Pat Cooksley in her bid for reinstatement, after she was dismissed for writing up a repeat prescription all by herself?

When I trained as a nurse in the Sixties, the doctor was a common sight in a hospital. If not actually to be found on the ward, he responded to his bleep promptly and came if the occasion demanded, without complaint. The consultant of 30 years ago kept a close eye on the activities of his team - the registrars and house officers who helped him look after his patients. Nurses could feel secure in the knowledge that a physician was never far away.

If my own recent experience is anything to go by, Sister Cooksley's action is not so surprising. Whenever I return to work in a hospital - nowadays usually as a temporary secretary - I have more and more trouble locating the medics. On some days one could even be forgiven for imagining them an endangered species.

Not long ago I was temping in a large NHS trust hospital. I'd been in that particular department for a week, hired to shift a large pile of untyped dictation. The office sat just on top of the out-patient and treatment clinics. It was shared by the NHS secretaries of two different departmental consultants and their teams; but right now, Friday afternoon, I was on my own. I hadn't seen a soul for two hours. A tape marked 'urgent' had been dropped on my desk while I was fetching a cup of tea. I stuck it into the machine and was girding my loins, when the telephone rang.

The call wasn't for me, or even for the girl I was helping. It was for the secretary of the other team, but she had every Friday afternoon off. A GP, coming towards the end of her weekly tether, told me the switchboard had been bleeping every doctor on that team for the last half-hour without response. Where were they? She had to speak to one of them urgently about a mutual patient in serious difficulties.

It may seem hard to credit, but in the week I'd worked in that office I'd scarcely seen a single doctor, not even the ones whose taped voices had become all too familiar. Certainly, not one had paused in the room long enough for identification. Their routines were as much a mystery to me as their faces. The dictated tapes were brought up from clinic by a nurse. Hating paperwork, they hadn't even dropped by to sign their letters, and I'd been told not to waste time looking for them. The typed letters bulged, waiting, in a file.

I apologised to the caller, and asked the switchboard to put her through to the ward where the consultant had beds. It was the best I could think of - the nurses might have a better idea of the doctors' bolt-holes, but the GP clearly thought I was about as much help as a used bedpan.

The phone rang again just as I was discovering my urgent tape was a monumental discharge summary for a 60-day, action-packed admission. At least the call was to do with 'my' team this time. It was a doctor from one of the hospital's laboratories. He had bleeped our registrar several times during the afternoon, but in vain. A wound swab she had taken in clinic that week had grown something nasty. The patient needed treatment, now. Monday wouldn't do.

I managed eventually to find the patient's notes. Antibiotics had been prescribed but I didn't like to leave it there. Only no one answered their bleep for me and none of the team's doctors had been sighted since the clinic finished an hour before. I thought perhaps the doctor from the labs could help, but by that time he had packed up and gone. In the end I rang the patient's duty GP, who was remarkably understanding. He told me that the medication already started would kill all known germs.

These two calls - neither of which should have needed to come through to me at all - delayed the urgent discharge summary I was typing by an hour. Had I not been in a position to stay late, it would have been delayed until the Monday morning. If the doctors had answered their bleeps the calls could have been dealt with in moments.

Part of the reason why I need to 'temp' is because two years ago I put myself out of regular employment - a well-paid medical research job - largely because middle-ranking hospital doctors could never find the time to give me the help I needed. And yet these very doctors repeatedly impressed upon me the importance to themselves of what I was trying to do.

Maybe doctors are allowed too much freedom in selecting their own priorities now. Research, meetings, lecturing and teaching, reading and writing for medical journals - even keeping up with the medical gossip - are all part of the doctor's job. But the new trust hospitals are working hard to improve their images. Perhaps it is worth considering that all the administrators in the world, all the coffee machines and comfortable chairs, all the shortened waiting lists and up-to-the- minute imaging technology, cannot compare with the comfortingly regular presence of the white-coated figure in a corner of the ward with a stethoscope around his neck, a bleep in his pocket, and a willing pen.

(Photograph omitted)

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