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|Posted on 22 February, 2019 at 15:25||comments (10)|
When I lived in Glasgow, many years ago, my two elder sons aged 5 and 7 learned a song at school:
Jesus bids us shine with a pure, clear light,
Like a little candle burning in the night,
In this world of darkness, Jesus bids us shine,
You in your small corner and me in mine.
Maybe you’ll think I’m stupid, but it always moved me. Why? Because it’s about the purity of a child, about kindness and above all the right of a child to believe.
Believe in what? I hear you say.
It doesn’t matter whether you substitute Mohammed, Buddha or Jupiter Optimus Maximus for Jesus, it’s what we should bring our children up to believe in – about a culture of kindness. The hidden meaning of pure, clear light is innocence and kindness. This is the same in any religion It’s about that pure, clear light that emanates from the eyes of a child of any hue or culture.
Children are our hope and investment for the future. We have a duty to protect them where and whenever we can. Every time a child is abused sexually, mentally or physically it happens because they trust their abuser. It is our duty to ourselves and out morality to ensure their safety, and not allow abuse of the trust any child should be able to bestow upon any adult.
And what of the reality? Children the world over are right now being abused by the people who they should have been able to trust, by wars, local violence, by systems which deny them a decent life.
But I reflect on what I’m doing about it myself. Talk is cheap but gin costs money. The truth is it isn’t enough to just donate to UNICEF. Once I finally retire (about 18 months) I think I have to find a way to do something although I must say I’m still trying to work out just what I should do.
I guess I’ll be judged by whether I actually put my money where my mouth is over the next few years, or not – you have the right to ask
|Posted on 1 February, 2019 at 4:28||comments (3)|
There is much talk on MSN about stress interviews in industry. Young people with appropriate skills and CV’s are bullied and demeaned to see how resilient they are under stressful conditions. Personal remarks about their appearance, posture, tastes and previous performance are made to make the candidate as uncomfortable as possible, hoping to elicit a reaction. The ‘successful’ candidate would be unruffled throughout.
As a Royal College representative on interview committees for about 20 years and having a lot of practical experience as an examiner, I think I may be allowed a comment.
I don’t think you get the best out of a candidate or reveal how they react if you over-stress them. As the examiner/interviewer you know as soon as they walk in whether they are nervous. They will be anxious if they want the job – it’s common sense. With experience and concentration, you can tell how nervous they are. You don’t need to stress them because applying for a job and being interviewed is a stressful process.
If one of the criteria for the job is to see how they handle stress this can be demonstrated from situations in which they have found themselves previously and how they responded. Ask them. If the interviewer has a little imagination and is sharp enough, they can glean the answer from the question/response without increasing the adrenaline levels and Dopamine release in the interviewee’s head. Let’s face it, the candidate who vomits on the desk as soon as you ask a question is an extreme example, but so is the unemotional, unresponsive candidate, whose body language indicates a complete lack of interest. It’s the one in between these two extremes who are interesting and require some effort on the part of the interviewer.
The correct way to delve deep into someone’s head in an interview is maybe not something one is born with – it is a learned skill, it is analogous to writing strong dialogue in a book. If you have to qualify your speech line with -ly adverbs then you’ve failed to make the reader understand the content of the speech (like, ‘he said angrily’- if you don’t know the speaker is angry then the dialogue isn’t strong enough – you don’t need to tell your reader that it is so). In an interview for a stressful job you don’t need to make the candidate uncomfortable or stressed – if you do then you need to go learn how to read people properly.
In neurosurgery consultant interviews, I usually use a question of the type: ‘I’ve been a neurosurgeon for over 30 years, and I’ve made every mistake possible. What is your worst clinical mistake and tell us how you dealt with it?’
I stole that question from Professor John Pickard from Cambridge – a man much brighter than I am.
This question starts by saying – ‘You’re among friends, whatever mistake you tell us about won’t be seen as horrendous.’
This lets the candidate know that the interviewer understands that mistakes can happen. This of course is a trap. The quality of the mistake described could indicate a complete idiot depending on circumstance.
The next part of the question examines honesty. One candidate replied with, ‘I’ve never made a serious mistake but one of my colleagues…’ Believe me, if he had got to that stage of his career never making a serious mistake then he must be a God not a neurosurgeon. He didn’t get the job – either he was dishonest or lacked insight.
The best answers are honest and demonstrate what the candidates did to correct their mistake and how learned from them. The latter is probably the most important part of the answer – can this candidate learn from the mistake?
My point and bottom line, is that one does not need to make people feel uncomfortable – it doesn’t tell you anything. It doesn’t show you their best ability. You need to ask skilful questions which reveal who the candidate really is. Making them angry or sad isn’t the answer and it certainly doesn’t show that the interviewer is powerful – quite the contrary. Weak people lacking confidence thrive on other peoples discomfort and for them interviews are a way of bolstering their grandiosity and feeling of power.
Be nice to people and they’ll be nice to you.
|Posted on 30 January, 2019 at 5:14||comments (0)|
Deeply saddened by the death of a young man in Yarm on Sunday early morning. My sincere sympathies go out to his grieving family and friends. Attacked and chased by a gang of 6 or more louts, his body was found in the river 2 days later. Despicable.
I live in an area where Cleveland Police have zero tolerance for exceeding the speed limit (you can get 3 points on your license for doing 33 mph), but they seem to have enormous tolerance for violence and drugs. About time they cleaned up Yarm which used to be a lovely, North Yorkshire town where one could go out in the evening without a likelihood of assault, or seeing druggies and fights on the High Street.
Personally I would like to see a hard clampdown on drug use and distribution because the type of people now visiting Yarm at weekends has deteriorated beyond control. Why do they call it 'Black-eye Friday' in Yarm? You might well wonder.
I do understand that they are poorly resourced and under-manned but they should get their priorities right IMHO. One should use sparse resources wisely. Inadvertent traffic violations are not the same as violent assaults and drug abuse and there should be a lot more convictions for the latter than the former.
I grew up in Bermondsey which was a pretty rough area of London in the 50s and 60s and often went 'up town' to night clubs like 'Tiles' on Oxford Street. I met a wide variety of thugs, some escaped from Borstal and some carried knives or guns. Such weapons were seldom used though. I have seen a lot of violence in my time. As a Neurosurgeon I have worked in places like Liverpool and Glasgow and treated people after horrendous injuries but those thing were not all that common 30 years ago. Things have now changed (especially in London) and sadly violence, knife crime and drug abuse is spreading. I accept it may be a reflection of Home Office cut-backs and the abuse of our police by successive governments who have frankly lost the plot.
I should say I am not in the least anti-police, quite the opposite. I think they should have more resources and more personnel so they can do their job, but for heaven's sake, prioritize, before society really does take a nose dive.
|Posted on 19 January, 2019 at 23:57||comments (0)|
I think sometimes that our problem in Britain is that the voting population is not so bright. Any nation who could vote in three successive Socialist governments in the face of a predictable economic decline cannot be MENSA material. We now seem to lurch from political crisis to political crisis and although we have plenty of politicians (who look forward 5 or less years) we have no statesmen who look ahead generations. There is an Aesop fable which seems to me to demonstrate where we are with our democratically voted Brexit.
There was once a pond. A family of frogs lived there, happily and with plenty of food. Naturally, frogs from other ponds migrated to their pond – it was a comfortable, if not opulent environment.
Soon, the pond seemed overcrowded to the original family of frogs and they began to complain. The frogs split into factions, squabbling over resources and their conditions.
Eventually, they realised they needed a leader who could represent them but the squabbles continued and no progress ensued. They prayed every day to Zeus, greatest God of all. They prayed so fervently that Zeus looked down on the troublesome frogs and said, ‘I’ll give you a king. Someone who you can follow, but please stop pestering me with your prayers. You irritate me.’
So saying, Zeus threw down a log into the pond. A big green log that floated on the verdant algae-infested water. To start with the frogs loved their new King. They called him Old King Log. They frolicked jumping from the log into the water and more frogs came from far and wide to see this Great King.
Soon, the frogs began to bicker for nothing had changed in a material, palpable way. The various factions began squabbling again. Eventually they began to pray to Zeus saying, ‘We don’t like this Old King Log any more. He doesn’t do anything, and he just floats on the pond.’
Zeus said, ‘You asked for a king. I gave you one. Now stop disturbing me with your prayers.’
But the frogs continued. They despised Old King Log. They shunned him and even when the sun shone they would no longer sit upon his broad, green reliable back. They kept praying and pestering Zeus for a new king who would move and do things. They prayed to all the Gods, they argued, pestered and they complained. Their prayers became a running sore on Mount Olympus until the Gods begged Zeus to do something with these troublesome frogs.
Zeus heard their prayers. He threw them a snake. The snake, to the dismay of the frogs, gobbled them all up.
The moral: Brexit - be careful what you wish for – your prayers and votes may be answered.
|Posted on 30 December, 2018 at 5:22||comments (0)|
I once recall a conversation (a little heated) with one of my nieces when I said I understood how bad a labour pain was. She had started by saying that female obstetricians must be better than male obstetricians. My claim to understand labour pains provoked a rather more volatile response than I think it merited along the lines of, ‘You’re a man. You can’t understand.’
I felt at the time that although I don’t have a uterus, I have delivered 22 babies and witnessed many more deliveries when I trained and since then seen pain in many forms. I do understand. It’s the empathy all doctors strive to have. One never becomes inured.
So, four days ago, I hurt my back (don’t laugh). Initially (I was shifting a mattress) the pain was so bad I just collapsed on the bed and lay there until the worst acute pain died down enough to allow me to get up.
It persisted, but I was able to walk and finish what I was doing. Not surprisingly, the pain gradually escalated throughout that day. By the evening I was unable to walk because every time I put my foot to the floor excruciating pain shot down my leg and it just gave way beneath me.
Day 2 was no better. Day 3 (yesterday) I could weight bear for about five minutes before the pain became too bad and I had to sit down. Today I’m comfortable sitting and can last out upright long enough to make a cup of coffee.
I’ve operated on maybe a thousand lumbar spines in my time and always tried to expedite treatment in patients who seemed to be in a lot of pain, even though a lot of surgeons would wait longer and see if it resolved with pain-killers and rest.
Reflecting on my discomfort, I realise now there is a big gap between empathising and experiencing. My niece may have been right. I don’t have a uterus but I do have a sore back .
Many years ago, some psychologists did an experiment in which they took a Scottie-dog puppy and brought it up in a padded environment, designed so that it was isolated from other dogs and any objects that might stimulate any kind of discomfort. They then prodded the poor creature with pins. It did not react in a normal fashion and seemed unable to avoid those things causing pain. The conclusion was that they had raised a creature that felt pain but did not recognise it was noxious. They thought it meant that most of pain is subjective and without the psychological expectation, pain is not necessarily too bad. There is a grain of truth in that – only a grain.
I think that once one takes away the fear provoked by pain and it is replaced by knowledge and experience, acute discomfort can have much less effect on us than otherwise.
Mindfulness training can help patients with chronic pain because it teaches one to accept the pain, and in their terms (not mine) befriend it. See it for what it is.
Easy to say maybe – it’s just a temporary discomfort and I know it will get better in time, but for those who do not understand their anatomy and do not realise that most pain is temporary it is a fearsome and terrible thing.
I guess I’ve metamorphosised (not like the guy in Franz Kafka’s tale).
Experiencing pain does make you a bit more empathic. For once, I can tell a patient – ‘I understand the pain you have and its severity.’ It sounds daft, but I would recommend a severe back pain to any Orthopaedic or Spinal Surgeon because it makes you appreciate what your patents are feeling. Not just by extrapolating what you have seen, but by knowing.
My patients will tell you if it’s going to make me a better doctor. One hopes that it will, but you know, memory of pain fades. If it didn’t ,no one would ever have a second labour, would they?
So, we come back to the argument where we started. Do female obstetricians make better labour-carers than men?
|Posted on 20 December, 2018 at 3:29||comments (2)|
My sons asked me for this recipe so I thought I'd put it here for ease of reference and to share with anyone who wishes to try something new.
Swedish Christmas Ham
The main problem when you buy a smoked or ‘green’ ham is that when you roast it, commonly, it is very salty. This ‘recipe’ if that’s what you’d call it, allows you to get the salt out of the ham and roast it in what in my family, has always been the traditional manner.
Start by removing the rind or skin so you have a layer of fat remaining.
Put a few string ties around to keep the shape.
Place in a big saucepan in cold water and bring to the boil. Simmer for 20 minutes.
Discard the water and start again. This time once it reaches boiling point, discard the water and replace with cold water so the ham is covered.
Leave in a cool place for 24 hours or overnight at least.
Next day, dry it off and coat in Coleman’s brown French mustard (lots of it).
Roll the beast in a mixture of demerara sugar and breadcrumbs.
Roast in a hot oven, basting often. The outside is often rather carbonised, but it makes no difference to the taste. At least 2 hrs.
If the ham has little or no fat, basting is a problem. I have on occasion after half-an-hour drizzled olive oil over the oven and that eventually percolates through and you can baste with it.
Leave to stand for min ½ hr before carving.
Definitely not for Vegetarians.
[You have to have a food processor for this with sharp blades that can grind meat to a fine texture]
Ingredients: 1 onion 1 egg 1 pound of minced steak 1 pound of minced lean pork. 1 large cup of wholemeal dried breadcrumbs 2 teaspoons of ground ginger 1 chicken stock-cube. Two tablespoons of salt Pepper to taste.
Procedure: Chop the onions (easy in the food processor) Mix the breadcrumbs, ginger, salt, pepper in a large mixing bowl. Add the onion and the meat. Mix with a wooden spoon. Add the egg. The texture will be rough so you probably need to add a small glass of water or milk.
When it is all mixed well, grind it thoroughly in the food processor. Thoroughly I said. Read my lips ‘thoroughly’. You may need to do that in several lots. The texture should be roughly like a firm dough and very fine after the thorough mixing. Get it? Pick up maybe a dessertspoon sized bit of mixture and using clean wet hands roll it into a ball.
When you’ve rolled the lot, you need to fry them really hot so the outside goes a deep brown. If it gets carbonised it’s no big deal, it just tastes better! So, each frying-pan of meatballs is placed into a large pan containing about ¼ of a pint of water containing the stock cube.
Empty the frying pan into the stock and quench the pan with about half a cup of water and add that water to the stock. You should end up with enough liquid to cover the meatballs.
Simmer for twenty minutes or so. Add cream to taste.
If you’re a purist, you could drain the meatballs before adding cream and make a roux and use the stock to make a thicker sauce and then add cream and put the meatballs back into the sauce, but I like a thin sauce with meatballs. Serve with potatoes and peas.
If you intend to freeze them, don’t add cream, do it when you warm them up. The only unusual thing about this recipe is the fine texture, without which, it is just a round hamburger burger. I suppose adding ginger seems a bit odd but it really is a fantastic taste! Merry Christmas, hope you enjoy them. If you have a comment or you get into difficulties, email me on >[email protected]<
|Posted on 17 December, 2018 at 3:08||comments (1)|
I was born in 1950. It was a time when Spencer Tracy, Kirk Douglas, Bert Lancaster were on the rise in their careers. Human icons most young fellas looked up to. Cinema was the great cultural phenomenon at that time and the actors became huge.
At that time too, Marvel’s comic book superheroes were very popular in the pictorial cartoon books and magazines. Like any media one read them and loved them through the suspension of belief. It was escapism at its best – a kind of momentary flight, giving a short-term emotional gratification. But it was more than that.
The heroes were super – they had morals, they cared about other people; they helped others. I think they were good role models for any young person, because they created a kind of moral instruction shaping my view of good and bad. Be the magnanimous, kind victor and fight evil wherever you find it.
I can recall the first episode of Dr Who, which on the back of Quatermass and Day of the Triffids (both of which I was banned from watching) became the captor of my imagination in those days. I had learned from Superman that one can enjoy stories based on impossibilities as long as one abandoned reality and one could at times, escape into fantasy to get away from the realities of humdrum studying.
I remember reading Ian Fleming’s Dr No (mainly by torchlight late at night under the covers) when I was 13. I became James Bond in those days. Maybe it was the attraction of a secret life and the power that could bring.
The next leap forward in my fantasy psyche was Star Trek. As a young medical student, I never missed an episode on Wednesdays at 6pm. Nor did the other students in my flat or my girlfriend’s house. Star Trek is interesting because it depicts a very attractive environment – multi-cultural egalitarianism not based on money or the American dream, but on fairness and strict moral codes. None of the characters stabbed people in back streets for gang-related transgressions or stole money.
My Walter Mittie side remained fixed in those days. Little progress came cinematically but looking back now, Superman had moved from comic book to TV and then blockbuster movies. the world was gradually changing and advancing technology meant I could be lazy – relying on a producer or director’s imagination for the escape gratification I seemed to want so much.
The movie Star Wars was pivotal. Looking back now, I realise I was being suckered in, duped. Those stories – landmark epics – were written in the typical myth structure. The hero is ordinary with a hidden exceptional skill. He refuses the quest but is dragged into it by the antagonist. He then travels the dark forest with rising tension and then triumphs over the evil that almost engulfed him. Once you realise that, it all becomes a bit predictable, but what doesn’t go away is the desperate wish for good to triumph over evil and to witness that, even though you cannot participate.
Looking at upcoming films (in an article recently about forthcoming ‘films you just have to watch in 2019’) about 20% of them are Marvel comic book heroes brought to life on the big screen. The baddies are really bad, and the goodies cannot be harmed, except in an emotional way. I think that is the key. Emotional manipulation to let us feel what the hero might feel – forcing us into a kind of apathetic empathy and a desire for our hero to win. I don’t believe you can love a film like Rogue One without feeling that the spirit of good must triumph over evil in the end even if that triumph means they die but give us hope.
I think hope is what we all need in the present world. A desperate desire for things to get better for everyone – all races and colours – from pygmies in Africa to Palestinians in the Middle East.
We need these super heroes if only to teach us to admire their morals and magnanimity. Looking at the world we live in and are gradually destroying, breath by breath, where is Superman? Why can’t he be real?
Truth is we don’t need a Superman, just his image and code of life. Be there for others. Nietzsche felt we all have a superman within us (ok, not the American one, but a superman nonetheless) and we have a duty to release him - stand up for those less fortunate than ourselves and above all, be kind.
So, have a great Christmas and enjoy being a superhero, because the world really does need you!
|Posted on 21 May, 2018 at 3:58||comments (4)|
Note de l'auteur
Je dois expliquer pourquoi je l'ai utilisé des morceaux de texte du livre d'Albert Camus l’étranger tout au long comme têtes de chapitre.
Il a écrit de son livre "Il y a longtemps je résume l'étranger dans une phrase que je réalise est extrêmement paradoxale. «Dans notre société, tout homme qui ne pleure pas à l'enterrement de sa mère est susceptible d'être condamné à mort». Je voulais simplement dire que le héros du livre est condamné parce qu'il ne joue pas le jeu. Dans ce sens, il est un outsider à la société dans laquelle nous vivons ".
Dans mon histoire Jean est un outsider. SOE peut l'avoir formé, mais à part les événements dans le chapitre d'ouverture, il reste à l'extérieur. Il ne parvient pas à obéir aux ordres, il va son propre chemin avec ses propres plans. A aucun moment il ne fonctionne à l'intérieur des exigences de ses maîtres. SOE a perdu de nombreux agents - certains aux autres de nazis tout simplement jamais venu à la maison et est tombé hors de la grille. Comment pourraient-ils garder une trace de tous? Je pense que la confiance était en pénurie une fois que les agents ont atteint leurs destinations. Certains ont été trahis par leurs propres opérateurs radio.
Longtemps après que je l'ai écrit ce livre, je relis l'Outsider et estimaient qu'il y avait des similitudes dans les personnages du voyage si je dois dire que Jean est jamais passive comme Meursault, le personnage principal de Camus le livre. D'une part, ne Meursault joue pas le jeu - avec des conséquences désastreuses et de l'autre, mon caractère Jean, bénéficie de son comportement extériorisée à la fin mais il prend de grands risques afin de le faire. La passivité de Meursault ne serait jamais monté mon caractère, pas plus que le caractère de Camus aurait pu être un homme d'action, mais il les similitudes et les différences cessent.
Il y a un certain chevauchement avec mes autres livres. Les noms mentionnés et événements décrits à partir d'un point de vue différent (la scène de la station de Francesca Pascal). J'espère que vous pouvez pardonner ce que - je l'ai fait parce que je ne pense pas que la vie est un fait. Nous expérimentons la vie d'une série de points de vue de notre propre et souvent deux personnes témoins de la même chose, mais l'expérience quelque chose de tout à fait différent. Leurs engrammes de mémoire ne correspondent pas à la fin.
Oh, par la façon dont j'ai grandi dans cette maison à Bermondsey et écrit à ce sujet était un peu nostalgique, en particulier car il est plus là.
Je ne peux pas dire que cette histoire a des thèmes profonds ou allégoriques - il est juste une histoire d'un gars.
J'espère que vous en avez profité!
|Posted on 25 April, 2018 at 9:46||comments (5)|
The plight of the Windrush families and their British naturalisation is a topic quite close to my heart.
My father was born in India, you see. When WW2 broke out, he came to Britain, joined the RNR and as a ship’s doctor had quite a bad war in the Pacific, North Atlantic and Mediterranean. He held a British passport and settled as a GP in Bermondsey once the war ended in 1947. He obtained British naturalisation without difficulty, because he was a British subject and that did not change until the immigration act of 1948. After 1949, any foreign person whether from the Commonwealth or not, had to apply for naturalisation. There was at one time, concern that his children might not qualify for British citizenship, but this seems to have dissipated and I have had a British passport all my life. The point was, that he was here before the 1948 act came into force.
My father’s British citizenship was allowed because he came from what was then a Commonwealth country and British nationality was automatic. He always held a British passport.
The Home office according to the 1948 act have acted within the law but as in any government department they seem keen to apply the law in a draconian and uncaring fashion. Heartless really.
Many of the Windrush generation of immigrants came here on their parent’s passports. They were mostly in lower socioeconomic groups and so probably didn’t need to apply for passports early on (people didn’t travel so much in those days) and it seems for many they found the prospect of applying for a passport daunting once the Home Office regulations became well-known. They have ended up as citizens of Nowhere. Unable to get British nationality, they cannot return home either and become West Indian citizens – they have no papers.
Combined with this situation, many of them cannot afford the thousands of pounds to undergo naturalisation either. Despite this, they have lived in the UK since childhood as far back as the 50’s, contributed to the running of the NHS in various roles, paid taxes and been a valuable part of our society throughout.
The Romans treated their slaves in a similar way. If slaves had ability or knowledge, and they accumulated enough wealth, the Romans would eventually allow them to become ‘freedmen’. A freedman was not a Roman citizen and had none of the rights associated with that status. They too were citizens of Nowhere.
It is almost as if, an African shipped to the West Indies in chains becomes freed from slavery then comes to Britain and becomes some kind of second class freedman.
No rights, you see.
I saw what happened in Rwanda. Black people killing black people – no one in the international community seemed to care. I always wondered whether if they had been white or even coffee-coloured there was a greater chance of some nation stepping in to prevent the slaughter of 30,000 people with machetes and their bodies dumped in a river. Maybe, even though they were all black, if they had oil the world would have intervened.
I have a deep-down feeling that race, and skin colour contribute to the Windrush problem at its roots. It looks to me like an extension of colour prejudice. It isn’t obvious, it isn’t spoken about out loud, but I think it is there deeply embedded in foundations of this problem, like some malignant insect digging away at the roots of democracy, freedom and humanity.
And no one speaks out about it until now.
Our politicians? A wise man once said that poly is Greek for many and tics are blood-sucking parasites, but all the same, it isn’t only one party or government who have condoned the prejudicial treatment of a group of people welcomed here to help re-build after WW2; it has continued through all the governments since 1948.
I am nonplussed by the thought that there is not one of them in all those years and all those elected governments who was enough of a statesman to recognise the injustice and correct it.
Our present Government professes ignorance and hides behind that as a reason for not changing the law or at least making a specified exception to the rules. There are Government ministers who maintain that until recently they were unaware of the problem. Do you believe them?
Sorry folks, I don’t!
|Posted on 9 February, 2018 at 11:30||comments (8)|
Many will have heard of this terrible, tragic case. The doctor involved was tried for manslaughter and convicted despite serious Trust flaws which led to the tragedy.
My feeling here is rather different to the majority. I do agree that a junior doctor, left unsupervised with two juniors below her, each of whom had only a months’ experience of paediatrics, and had herself just returned from 13 months maternity leave was particularly vulnerable to a mistake being made. Where I depart from many people’s stated views is that I do not think the registrar is culpable.
After 32 years as a consultant, I know that my duty working with junior doctors is to ensure they manage every case with knowledge and insight. This is done by closely supervising the least experienced ones and checking that all the right things have been done with every case admitted under my care. Those patients admitted when I am on call are my responsibility. The buck stops with the consultant. It has always been so.
If the registrar makes a mistake then it seems clear to me that I am the one who should be held accountable, not the junior who is following my instructions. I am the consultant and the patient is my patient. If I leave a junior in charge, it remains my responsibility and I have a duty of care.
In this case, the clinical biochemistry details were given to the consultant in charge of the case, by Dr Bava-Garba before she went off shift. The matter is then his responsibility. Even had she not imparted the correct information, it remains the responsibility of the consultant to ensure the patient is safe and being treated properly.
If I have a failing registrar one must ask oneself who’s responsibility is that? Junior doctors are not a few months out of the pram, they are qualified, responsible medical practitioners, with medical and often post-graduate degrees. They are all capable of learning. Those that do not learn, remain the consultant’s responsibility and the failure is his and his alone with only rare exceptions.
Consultants are at the top of the clinical salary scale in the NHS for only one reason - because they take responsibility in the end. The registrar in this case was scapegoated and was not adequately backed up by her consultant who it seems, was elsewhere, teaching at the time. I find this below a reasonable standard, in my opinion. A consultant who knows the inexperience and limitations of the junior doctors under him, and who is absent in any case, is not doing right by the patients or staff. He should not have been allowed to be away from the hospital if he was not immediately available for the patients being admitted under his care. He must have planned the teaching, accepting that it was a commitment which once begun could not be easily left. Did he arrange for another consultant to cover in his absence? Apparently not. Accepting commitments away from work when you are on call has always been regarded as wrong. This is especially true if the consultant is engaging in private practice or other fee earning work. How is it different to arrange a teaching session elsewhere? He was on call and therefore responsible.
If the registrar in the hospital needs supervision, then that is the responsibility of the consultant. When I am on call with any new registrar, I always check with them what experience they have and what operations they have already done with and without supervision. When I am called by them I always take their experience and ability into account.
Dr Bawa-Garba, in my opinion is the victim of scapegoating to protect others who should stand up and accept the responsibilities which they assume on appointment as a British consultant.
I really hope the case is appealed once more, and others are prepared to speak out in support of this victimised and wrongly punished doctor.