15 November 2012

At what point do we say no?

My patients are, and will always be my first priority.

As a junior based solely on the shop floor (i.e. the wards) I'm often better suited to tell the consultant or registrar how the management plans have been panning out.

The problem comes when the seniors expect you to go above and beyond the line of duty.

I work hard - very hard. I often don't take proper breaks and almost never leave on time. However this is being taken for granted. At 1700 I'm officially 'not here / a figment of your imagination / don't ask me unless it's life threatening' however it seems to be expected that I will stay practically forever to ensure things are to my consultants liking.

I get that medicine used to be like that, however with greater workload, paperwork and responsibility comes a higher likelihood of burnout. In my current job I feel I'm heading that way.

I'm finally learning so say 'no' but it doesn't seem to be going down well.

Ive tried explaining that I'm happy to hand things on to the on-call team but it seems this isn't good enough.

What would you do?

06 November 2012


Sometimes knowing when to stop is one of the hardest things in medicine.

I find looking after a patient list so hard because I have lots of sick patients who sometimes die. It's difficult to know how far to go before you hold your hands up and admit defeat.

The debate at the moment with the Liverpool Care Pathway makes me very frustrated. The LCP is not a morphine pump to kill people (as a patient told me this week), but a (hopefully) more comfortable and less agitated way for dying people to pass away.

As part of a multi disciplinary team I have completed the paperwork for the LCP several times and it's never been something I've regretted. In fact on one occasion I felt horrific as I'd missed the opportunity to start the LCP and a patient died very distressed.

Making a decision about when to stop medical treatment for a patient is one of the hardest to make and is even harder given the appalling press coverage recently.

So much for supporting the NHS