2. Profession Flashcards
What do doctors do other than treat patients?
CAMP
- CLINICAL: Doctors engage in meetings to deliberate with other healthcare professionals over patients’ management plans and invest time to remain well versed with the medical field, by reading journals, attending conferences and courses and retraining to inform their management plans. This is something expected of them as Good Clinical Governance Practice. i.e. practice compliant with the latest evidence.
- This is something I was fortunate enough to observe when I sat into a colorectal MDT since the healthcare professionals cited literature and experiences which substantiated their decisions, analogous to what I’ve seen in my law degree, almost as if they were a sort of Supreme Court for the patient.
- ACADEMIC: They participate in Medical education through teaching medical student, trainees and other professionals in settings like university or within hospitals and may venture into research work depending on their specialty or post
- MANAGERIAL: They engage in the bureaucratic aspect of Medicine, carrying out admin work such as organizing rotas, theatre lists, producing discharge summaries or ward round checklists
- They engage in quality improvement activities, such as carrying out audits, reporting critical incidents and analysing the causes of mistakes proactively to better personal and team performance.
- Seek to improve experience of patients e.g. finding ways of making clinics or theatres more efficient, reducing waiting times etc.
- PERSONAL: Try to balance their work and professional lives in a profession that is emotionally and physically demanding. This is especially important in Medicine, since a doctor needs to be in their best frame of mind to make high stakes, important clinical decisions.
Do you think doctors really make a difference?
- I do, both implicitly and explicitly. In my work experience when sitting in outpatient clinics, patients expressed gratitude to their doctors for the treatments prescribed to them. Sometimes it was explicit though thank-yous, and other times implicit, such as a patient grateful that he could return back to work or through body language – smiles, thumbs up etc.
- As you have suggested, there may be instances where it appears doctors are making a little difference. Indeed doctors don’t deal with life and death daily, and no days is dramatized quite like Grey’s Anatomy. For example, when shadowing junior doctors I observed the great deal of admin work they do. Even still, its bureaucratic effort such as producing discharge summaries that helps patients formally leave the hospital, so a difference is still being made albeit non-clinical.
- What I would like to add is, from start to finish, patient care is a team enterprise: it involves care by nurses, paramedics, radiographers, dieticians etc. Doctors undoubtedly do make a difference, but would be unable to do so without a multidisciplinary team providing holistic, round the clock patient care.
Is Medicine an art or a science?
•Medicine is both, and its both dimensions in equal proportions that drew me to this field.
•In my personal statement, I defined Medicine as “a science which relies on evidence to guide practice, and an art requiring creativity and skill to optimise patient care.”
•The scientific dimension includes combining specialized scientific knowledge, skills and training to form clinical judgements. It’s the ability to investigate into the human body, interpret data, synergize with medical equipment.
•The artistic dimension is how you interact with a patient. It’s the
•Ability to form a rapport with patients, based on a relationship of empathy and trust. It’s the ability to show adaptable communication, during patient consultations or when breaking difficult news to patients. It’s having a sense of social and cultural awareness.
•These humanistic skills are something I had to utilise soon in my capacity as a PALS Officer, since to do my job effectively I had to recognize signals in body language and eye contact, to identify concerns patients had not vocalised.
•In this sense, there is a dual aspect to Medicine, and it is both in combination that inspired me to apply to this profession.
–>Science: systematic acquisition of knowledge that is verifiable, and a process for evaluating empirical knowledge
–>Art: product of creativity or imagination
Do you think a doctor’s enthusiasm wanes over time?
- I do, but this I’d say is a feature of every profession. You enter a profession with utmost enthusiasm, wanting to put your specialized knowledge, skills and training to make the difference you set out to. Then, you come across your first ungrateful or hostile patient, you’re disappointed by the bureaucracy in the profession and finally you’re working under intense NHS conditions that you had only previously read about. The natural effect that this would have is a toll on your enthusiasm and passion.
- But, during my work experience, I tried to probe what anchors the doctors I came across in a profession known to be both emotionally and physically demanding, exacerbated by difficult NHS conditions. The majority of them cited their initial attraction to Medicine is anchoring them, namely the ability to make a difference to patients’ lives.
- So, given the inevitable fact of working professionals losing enthusiasm, the most one can do is select a profession you feel fulfilled and motivated by and use that to remind us why you come to work every morning in the first place.
- I’d also say that, as you progress in your career, there are a lot of new opportunities and milestones to reach. You can specialize and acquire further knowledge to deal with new, complex conditions. You might be able to train doctors that are more qualified. Perhaps you can venture out into university research or contribute to health policy. So, when your job becomes monotone, it’s a chance to transfer your skills into something related.
How does politics influence healthcare decisions?
I’d say politics has a massive influence: healthcare decisions are is inherently political, since it incorporates the same considerations of resource allocation, cost effectiveness, prioritising need etc. into the enquiry
(1) Funding
(2) Public Health
(3) Regulation
(1) Funding
•The NHS champions a ‘comprehensive service, available to all’ but the reality is the services available depend on the health budget, sourced by National Insurance contributions. Political decision to set this at 2% and 12% respectively. In addition, because the budget isn’t enough to meet the demand, decisions need to be made on how scarce resources should be rationed. For example, using QALY is political (Quality Adjusted Life Year) because it selects quality of life and cost-effectiveness as parameters for resource allocation.
(2) Public health
•The policy decisions made by a government are reflective of their vision for healthcare. For example, Wales’ decision to shift to an opt-out system of organ donation in 2013 or Sugar Tax in 2018.
•Even major awareness campaigns can be politicised, since public health campaigns have the ability to change a public’s perception or orient them to act in a certain way, and this too is a political decision i.e. if you want to stamp down on abortion, should you make it illegal or make family planning more accessible.
(3)Regulation
•The extent to which the pharmaceutical industry should be regulated, and how, is a political decision, because it entails striking a balance between patient and profit.
•Regulation reflects how a government feels about the interrelation between the market and healthcare. For example, does the government believe in stamping down on evergreening, do they want to incentivise drug research into ‘neglected’ diseases by providing tax breaks to pharmas
10 years ago, most doctors wore coats. Now, few do. Why?
(1) Practical utility
(2) Shift from a paternalistic to a partnership model of decision making
(1) Practical utility
•White coats protected clothes
•Minimised risk of infection since they were easy to wash
•Helped differentiate doctors, useful in emergency situations
(2) Less common now due to a shift in the doctor-patient relationship
•Previously, doctors assumed a paternalistic role, and a a hierarchy was perpetuated by white coats by creating a barrier between doctors/scientists and patients/public.
•Now, with greater access to medical information online and landmark cases that have entrenched patient autonomy, the relationship is less hierarchical, and more deliberative.
•This sort of deliberation requires removing barriers that create a divide between patients and doctors, for example, by opting for suits and tie
+Imbalance of power
+No longer elitist or exclusive
-Symbolism and reassurance
-Infection risk
More females than men in the profession
(1) Exams
(2) Government campaigns and addressing inequality
(3) EWTD/flexible/PT work
(4) Nature of women
(1) EXAMS: girls tend to perform better in exams that boys –> high academic performance is important in a competitive field like Medicine
(2) Government campaigns that have sought to address the imbalance in a field that was previously male dominated –> increased childcare provision cited as a reason for more females in Medicine in the Deech report to the Department of Health
(3) Compared to previous years, initiatives like the EWTD and flexible, part time work means the work life balance is more attractive for women who want a career and a family –> currently 42% of female GPs work part time
(4) Nature of women: Medicine is a career that attracts the empathetic and compassionate, and it could be that those traits have been conditioned into women by society. Likewise, society has conditioned men into more lucrative fields, perhaps attracted to greater prestige and money, such as banking and law.
The time that it takes to become a consultant has been decreased. What are the implications of this?
+More efficient training: such that, equally competent doctors could qualify in a shorter amount of time, bringing as much knowledge and skill to the profession –> The IFS (Institute for Fiscal Studies) ‘meeting the needs of a growing and ageing
population would require hospital activity to increase by a projected almost 40% over the
next 15 years
+Problem of super specialisation
Importance of IT in Medicine
(1) Facilitates accessibility
(2) Serves multiple purposes
(3) Yields efficiency
(1) IT facilitates accessibility
- Centralised databases allow patient information to be readily accessed. This may be important when accessing documenting on e.g. patient’s religious backgrounds, ethical beliefs, family contacts when making decisions on behalf of patients, in their best interests
- Facilitates multidisciplinary coordination. For example, pathology results or X rays can be accessed on system for remote access by doctors, doctors are able to send referral letters and produce reports
(2) IT serves multiple purposes
- IT can be used to analyse data as part of research or auditing –> faster, more accurate
- IT can be used for teaching purposes through the use of simulators in surgery or digital cadavers
(3) IT yields efficiency
- Patients can make GP appointments and ask for repeat prescriptions online –> this may address inequalities in health, for example, geographical disparities where resources and staffing is concentrated in more city than rural areas
- Easier dissemination of NHS information enables patients to access information that would otherwise be acquired in a doctor-patient consultation, and may help them make more informed decisions at home
Does the bulk of medical treatment occur in the community or hospital?
- The community –> primary care is the first point in the referral pathway. People’s first point of contact is therefore the GP, who may or may not refer patients to a hospital specialist.
- Some GPs have started to specialise further (e.g. in diabetes, dermatology, ophthalmology) and can provide basic specialist care in their practice.
- Some hospital specialists will refer patients on treatment plans for e.g. asthma, diabetes, arthritis to the GP for continuous monitoring
- Specialist doctors such as community paediatricians or community psychiatrists who provide treatment in community
- Many self-medicate by purchasing drugs from pharmacies or supermarkets
Describe the extended role of nurses
(1) Clinical nurse practitioners
- Running specialist clinics
- Minor operations and procedures
- Taking histories
- Examining patients
- Carrying out investigations
- Prescribe drugs within protocol
(2) Nurse managers
- Matrons on wards
- Manage nurses over regions
(3) Research managers
Advantages and disadvantages to increasing the role of nurses
+Nurses generally spend more time with patients
+Relieve burden on doctors
+Greater continuity of care in their communities, since they change posts less frequently than doctors
- Taking charge of less complex patient conditions and procedures
- Nurses with extended roles work according to protocols, to which they are confined
- Patients may feel more secure in being dealt with a doctor than a nurse
