23 August 2018
Square Pegs in Round Holes
Should GPs (or anyone) love work?
By Lynda Goetz
“GPs working three-and-a-half day week”; “Part-time GPs ‘pose a terrifying risk to patients’” screamed front page headlines last week. Helpful and unhelpful suggestions and comments from all quarters made points such as that being a doctor should be a vocation; that given the cost of training medical students they should have to work at least their first few years in the NHS (they do); that the cost of training should be considered as a repayable loan (well, there’s an incentive!) or that GPs were so well-paid they were lucky to be able to have the luxury of working part-time. Much of the reporting and the observations showed a stunning ignorance about doctors’ training and lifestyles. Although many GPs, including Dr Helen Stokes-Lampard, Chair of the Council of the Royal College of GPs, wrote to various newspapers explaining the reasons for the findings of the Manchester study, the damage had already been done as far as many members of the public were concerned. The reason they cannot get an appointment with their GP is that GPs are lazy part-timers, so well-paid that they don’t need to do a full week’s work.
Although this is far from the truth and very many of the GPs who work part-time also fulfil other medical or teaching roles to complement their roles as GPs, it is hardly helpful. What exactly do we expect from our doctors these days? Well, for a start, I guess most people believe they should be competent. Does this however mean that they should never make mistakes? Dr Bawa Garber, the paediatrician about whom I wrote a few weeks ago*, won her appeal against the GMC decision to ban her for life from working as a doctor. The mother of the boy who died of sepsis on Dr Bawa Gaber’s ‘watch’ called the decision ‘disgusting’. Really? Disgusting, honestly? This is a dedicated doctor whose expensive training the GMC was prepared to throw away just so that the public ‘confidence’ in the disciplinary proceedings could be ‘maintained’. The paediatrician’s appeal was crowd-funded mainly by other doctors who were horrified at the injustice of scapegoating one person for the systemic failures to which they are all subject. To me, the amazing thing is that that doctor wanted to go back into a system which treated her in such a way. Clearly she is one of those who does feel that medicine is a vocation.
In a programme on Radio 4 last week, entitled ‘Square Pegs in Round Holes’, writer and broadcaster Emma Kennedy examined various studies and research that show that as many as two thirds of people in this country feel they are in the wrong job. She herself trained as a solicitor and worked in the law for five years before realising it was not right for her (something I can relate to personally). This is hardly good for work-place morale, or national productivity. The UK is particularly bad, it seems, at directing people into the right jobs. The programme tried to get to the bottom of why this is the case.
Schools careers advice is, as most of us are aware, woefully inadequate and has apparently got worse. The programme focused perhaps too much on careers advice for girls but did make the point that real-world experience is vital. Do we still focus too much on academic qualifications rather than vocational qualifications? Access to careers advice and guidance, and short placements and project-based experience rather than academic learning directed at getting to university were all regarded as important. It was agreed that attempts over the last decades to get more young people into university may well have done many a disservice.
One of the difficulties in this country is also the fact that our exam system narrows down the subjects studied much earlier than in many other countries. Most schoolchildren in the UK will take between one and four A’ level subjects. In other countries, exam systems like the baccalaureate give students a much broader base from which to launch a career. Too many in this country feel they should go to university (it’s fun!) when in fact academic study is not what they want to do. Studying medicine or law has a defined path which people can follow, but choosing to set out on that path at 18 does not necessarily mean that everyone who does so has a vocation. Having started, however, it can be very hard to stop or change direction.
The so-called millennial generation do appear at first glance to have a different approach to work than earlier generations. They do not expect to ‘live to work’ but ‘work to live’. However, looking at the development of human society, it is really only since the industrial revolution that work has been so divorced from the rest of people’s lives. Those working twelve hour days in Victorian factories did not have a work-life balance, nor did they enjoy their jobs. The rise of the trade unions in the twentieth century happened quite simply because working conditions for many were so awful. Where we are at now is an understanding by those in their 20s and 30s that human life is short and they do not want it to be brutal or boring. They do not want to spend it doing pointless jobs or jobs they hate. Many have concluded that they do not want to spend lives “working at jobs they hate to buy stuff they do not need to impress people they do not like” (Nigel Marsh).
In order to achieve much better workplace morale and national productivity we need perhaps, as Emma Kennedy’s programme concluded, to review not only our careers advice, but the way management works. The micro-management which has defined so much of the workplace ethos over the last few decades may need to be replaced by systems which allow more flexibility and freedom to give workers of all sorts a greater feeling of control over their lives. How easy that will be to achieve on a widespread basis is anyone’s guess, although suppliers of software like Forge are clearly ahead of the game. In the meantime, perhaps journalists and the public should learn a little empathy and a little more respect for those like doctors who take responsibility for our health and well-being on a daily basis and perhaps try to understand what a great deal of emotional energy and stress goes into that responsibility (to the point where three and a half days a week is the maximum they can deal with if their own mental health is not going to suffer) which might prove even more of a risk to patients than a short working week.
