“The delivery of medical care is to do as much nothing as possible" - Rule number 13 from Samuel Shem’s The House of God. While the novel may be intended to satirise hospital medicine, this is very good advice. Medicine can be dangerous stuff. It tends to be a sensible idea to make sure it’s really necessary before you give it.
If you’re not careful, doing things, rather than doing nothing, does more harm than good. Administered at the wrong time, that magic electric medicine in the paddles on TV stops being medicine, and becomes good old-fashioned deadly electricity (Thank you Mitchell and Webb).
Doctors become very good at doing nothing, and justifying exactly why they are doing it. Swathes of patient’s notes are given over to itemising the reasons why a specialist isn’t going to subject them to unnecessarily aggressive treatment. Often they will even go on to tell you the exact type of nothing they are doing. Patients diagnosed with a whole host of terrifying sounding conditions, including actual cancer will be told that the best management for them currently is “watchful waiting” or even “masterly inactivity”.
Ask even the most stereotypically gung-ho surgeon, trained to believe “operations are good for people”, how best to manage a condition. They will develop a glazed look in their eyes and recite the mantra “The management for any condition is conservative, medical, then surgical”. Offer a walking stick before amputation. If Conservative management of a situation fails, only when you have run out of all other options, do you resort to something drastic.
So it is highly unlikely then, that nearly the entire Junior Doctor workforce in Britain would decide to stop doing nothing on a whim. Yet when faced with prospect of the new contract, 98% of us voted to do something and strike. Getting this level of consensus amongst doctors is a feat in itself. If there’s one thing we enjoy more than doing nothing, it’s disagreeing with one another.
The first industrial action taken by junior doctors since the 70s is definitely at the surgical end of the spectrum. It isn’t without risk, only the danger is not to the general public. There will be other doctors in hospitals to look after them. We risk being vilified for supposedly abandoning our patients, in the name of furthering our champagne swilling, jet-set lifestyles (seriously my life is like one long Jay Z video).
At first glance, the issues we’re getting so worked up about seem pretty self-interested. Why should anyone else care about a pay cut and an attack on our right to have lives outside of the hospital? I’m writing this on the back of seven 13-hour night shifts. That’s roughly two weeks' work in the space of one, at night. I certainly don’t feel at my sharpest, or healthiest. If you ask us to do this sort of thing more often for less (which the new contract does), some of our enthusiasm might start to wane. You may find that some doctors simply aren’t able to carry on.
Jeremy Hunt has described junior doctors as the “backbone of the NHS”. I have a little gem for him I picked up at medical school: your backbone (or spine as we call it in the trade) is important. It’s generally a good idea not to damage it. We have whole hospital units dedicated to sorting out the problems that occur when you do (for now at least).
The government have resorted to scare tactics, saying A&E departments may face closure on strike days, affecting patient safety. Firstly this is unlikely, since doctors won’t strike if their absence isn’t safely covered. Secondly, surely a day of closure is still less dangerous than the permanent A&E closures they seem to favour. In any case, the strikes are continuing as it is now safer than doing nothing - both for patients and doctors.
Join our new commenting forum
Join thought-provoking conversations, follow other Independent readers and see their replies