It seems to me that the debate to take to the public is the one about Modernising Medical Careers. The public really are not interested in the kafkaesque unfairness of MTAS, and there is no reason why they should be.
As a patient* I don’t really care how badly junior doctors have been treated, but I do care how well, or badly I am treated. What I want from the medical profession is:
Doctors who are
- Good diagnosticians
- Competent and selecting and administering treatment
- Able to communicate clearly and appropriately what is going on
- Good at administration and able to steer you and your notes through the labyrinth effectively
I would certainly want my doctors to be ethically sophisticated and good at working with other professional carers. I’ve no idea how representative my views are of other patients.
It seems as if the medical profession itself is not united on what comprises a good doctor, and this has left a vacuum which the government have opportunistically exploited. Research and academic qualifications used to count – but were they being used to separate excellent Registrars from other excellent Registrars? In other words, was the increasing academisation of the middle level of the profession a symptom of the triangular structure with too many Registrars competing for very few Consultants’ posts? Don’t get me wrong. Research is a vital part of the profession, but is it being done in the right place and for the right reasons? Does being able to do research make you a better surgeon, because what patients want and deserve are good Consultants, not good academics.
Forgive me for saying this, but the architects of MTAS tried to use “frozen” interview questions to elicit information about the stuff that doesn’t show up in CVs, such as approach to communications, ways of interacting with other team-members, ethical stance. They f**ked it up, big time, but they did address the things which – simplistically – patients want their doctors to have.
The questions to put to the public are:
- Do you want to be treated by Consultants who have approximately 60% less experience than previously (shorter hours, fewer years)?
- Do you think that the service you get from the NHS will be improved or made worse by making 25% of junior doctors and specialist trainees redundant? (If only they were being given redundancy packages….)
- Do you think a Consultant will be better or worse if their experience of medicine outside their own speciality has been reduced from half a dozen years to two?
Tabloid questions, yes. But this is what will outrage patients, not the complexities of the MTAS computer system.
However, in order to shape this debate, the medical profession must consider the profession, both in terms of individual career options and in the more philosophical terms of “what is a good doctor” and “what do we want from the profession as a whole”. Specifically, the profession must consider:
- What qualities, skills and experiences are required in a good doctor, and how to assess them
- How to change the structure of the profession so that it is not limited to two tracks: pre-Consultancy and the rest
- How to make successful, interesting and rewarding careers available within the profession without becoming a Consultant and without being sidelined and degraded
Just a thought before I post this: I am older than the MD of the company I work for and much the same age as most of his board. Yes, he is paid two orders of magnitude more than I am, but I love what I do on a day to day basis, my contribution is appreciated and valued by my peers and stakeholders (jargon – sorry), I have good career prospects, the assessment and promotion system is transparent and reasonably fair, and if I want to move around within my profession it is up to me do to it and the entry points are there. This is possible, because career progression isn’t based on the model of a railway track or a ladder, it is much more flexible than that.
I’m keen to hear the views of those not directly involved, those from other countries, and those who are patients or work elsewhere in the NHS. Also, I am curious to know if what I am saying makes sense, or if I’ve missed some fundamental points, so please feel free to comment.
* I do of course care personally about MTAS and its effect – (as Mums4Medics puts it) – on ‘my’ doctor’s career