Another rock analogy

Brimham Rocks, Yorkshire, England

Ok, here’s the real kicker. If the previous problems were pebbles, this one’s a boulder. Picture yourself in Crash Bandicoot running downhill ahead of a massive rolling boulder. That boulder is the focus of today’s blog post. Let’s talk about work culture in an HSE hospital.

I’ve put this one off for a very long time. There’s just too much to say and it’s all very unpleasant. Honestly, I’m still unsure how to organise my thoughts around this topic, but I’ll give it a go.

We’ll start with day 1 of Intern year. The most important thing they teach you is how to write your medical notes. The typical medical note on a daily ward round begins with the date and time, team name, yada yada and ends with the plan. - Here’s the important part: for any decisions made, remember to casually but clearly shift the responsibility onto someone else. For example, starting a patient on a new drug? Make sure to run it by the relevant specialist team and then write, “Start [drug and dose] as per [specialist team].” 

You might argue that the primary team is being thorough and diligent by consulting a specialist team, but in reality, this is often done when the primary team knows exactly what to prescribe or which scan to book or what test to run, but they’re just covering their ass by requesting a consult - in large part so they can write in the patient’s record, “as per anyone else but me,” so that if there’s ever a lawsuit, they’ve covered themselves. This is a waste of the primary team’s and the specialist team’s time, because, of course, the primary team already knows the right answer. But supposedly it’s worth it because of the huge risk of litigation.

Also in that first week, you hear, “Don’t worry, there will always be someone around to help you if you need it.” Yes… theoretically. But in reality, when you’re working nights and the emergency department is hectic and you, as the least experienced doctor in the hospital, are alone covering several wards, well, you’re going to have to hang tight! In the hospital you learn by doing - ideally, you’ll have “seen one” before you “do one,” but sometimes a quick read of the protocol or a quick verbal explanation over the phone, will have to suffice. For a job with enormous responsibility and huge risk, you’d hope for a little more support!

There is teaching, but in my experience, the teaching often covered the consultant’s hot topic of the hour. It was interesting, yes - the bits I could understand, but most of it went over my head and none of it covered the common patient presentations. So teaching wasn’t exactly practical. It was also scarce - but I think we can blame the chaos of the pandemic for that.

The other form of teaching was humiliation. Little newbie intern picks up the phone to request a scan or a consult (as requested by the consultant) and very quickly realises they were not prepared to make that phone call. For my non-medical readers - making phone calls as an intern was by far the worst job of the lot, we never seemed to have the right information at hand or if we did, we were ridiculous for even making such a request! (Remember, we, the interns, are not making the request - our very knowledgeable and experienced consultants are. We’re just the messengers.) Basically, consultants and registrars don’t like receiving calls from interns because interns rarely know what they’re talking about (fair enough) - and they actually sent out memos to say they do not speak to interns, but our teams would ask us to make the calls anyway, and we’d just have to accept the consequences - which were brutal.

If taking flak from other doctors for no apparent reason wasn’t enough, the nurses and ward clerks were usually armed with sharp tongues. The best advice you’re given on day one is to get on the nurses’ good side, and it is so important! Because when you fail to, it’s a constant struggle. This bad blood between nurses and doctors is definitely a result of toxic hospital culture. It’s all on the basis of hearsay, rumours and stereotypes. It’s incredibly unpleasant, unhelpful, and hugely inefficient.

So if doctors are disrespecting doctors and nurses are disrespecting doctors and doctors are disrespecting nurses - that leaves the patients - well, due to the lack of beds and long wait lists, patients are disrespecting healthcare workers, too. Medicine is long past being the glorified and respected career it once was. Of course, you’ll have colleagues which will be your friends for life, but I found the overall atmosphere in the hospital to be quite heavy, judgemental and competitive. 

I could tell you so much more: consultants who are above speaking to interns on their own teams, SHOs who are above intern jobs and refuse to lend a hand even when the intern is drowning, ward clerks who go out of their way to be unhelpful just because they don’t favour you, it’s endless… and I think you get the picture.

I do believe the negative culture rubs off on you like chimney soot. It’s everywhere and it’s hard to avoid, and I don’t think I’ll ever forget the time I spoke down to a nurse - the reason doesn’t matter. I didn’t say much but I should never have used that tone with anyone. Speaking down to people is never warranted and should never be excused. But unfortunately, it has become commonplace in the hospital.

Lastly, I just want to say, I worked for people I didn’t care for, but I also worked with some of the most thoughtful, caring and supportive people I’ve ever known. It’s not all bad, it’s just not good enough.