Training days

5 Dec 2016

The medical curriculum teaches you about the art and science of medicine. We graduate with a set of base skills around the doctor patient relationship, and we then develop these skills in our early years, fine tuning them to improve our ability to separate the wheat from the chaff. The intern year is when we really start to learn about the business of medicine, and this is a direct consequence of most tasks falling to the bottom of most ladders. Doctors are spending more time with computers and less time with patients, in a trend that shows no signs of slowing down. You see, your day isn’t your own anymore. It doesn’t belong to you. It belongs to the Blue Blazers.

The idea of “Blue Blazers” is a concept that was coined by Samuel Shem in The House of God, and it is no less relevant today than it was back then. In the book, the Blue Blazers were the hospital administrators. It was a tongue in cheek satirical reference to those who ran the fictional hospital, quite often to the detriment of the patients. Now I don’t want you to think that this article is a beat up on hospital administrators. It’s an exploration of how we’ve ended up with a system in which we are more distant from our patients than ever before. What you want to do in medicine is treat your patients. What you end up doing is a series of tasks that are often to the benefit of amorphous clipboard-holders, and they don’t seem to serve any meaningful purpose for your patients. For the benefit of this article, Blue Blazers are the “faceless men” of healthcare; the ones who seem to have a stranglehold on your time, without an understanding of how that time works.

Let’s take a look at the modern doctor in training. You won’t find a single health service in the country that won’t expect you to complete some mandatory training of some kind. You need to prove to your employer that you know how to put out fires, how to manually evacuate patients and how to administer a unit of packed red cells. This is usually unpaid and simply work that you are expected to do in your “free” daily time (a concept so hilarious it could only have been imagined by a Blazer). Doctors like to ask why. It’s in our DNA, our training and our practice. We want to know why because we need to justify every decision we make to our patients if called upon to do so. But large organisations don’t generally appreciate foot soldiers who ask why. It is not ours to question, and this is where the conflict between Blazers and doctors really reaches its peak. Resistance is often interpreted as malicious and belligerent behaviour, when in reality it is more often a call for common sense.

Medicine is a profession, and our ability to practice the profession is becoming more and more restricted by the day in a series of operational directives, internal memorandums and mandatory competencies. Every task in isolation is small and fairly justifiable on its own merits: it’s hard to argue against proper hand hygiene training for all healthcare professionals and nor would you want to. However, when you add them all up, you end up with a job in which you don’t have enough time to actually do the work effectively and to learn while you’re doing it.

There are at least two giant glaring errors with the practice of mandatory training in Australia today. Firstly, there is no recognition of prior learning. All doctors are treated as incompetent in the eyes of the Blazers. Despite the majority of health services delivering excruciatingly similar learning packages for common tasks such as fire safety and blood safety, they will demand that you complete their package and their package alone, with no real evidence as to why. Secondly, the training is usually not provided by those with a clinical background. While it’s all well and good to teach doctors about the local nursing protocol for the administration of PRBCs, perhaps that time would be better spent talking in depth about the indications for transfusion in the first place, thus terminating inefficient practices and improving blood safety in a way that is most effective for doctors and their patients. People can scream and chant about hand hygiene all they want, but if your goal is to raise compliance, you need to get seniors to set the example until it becomes routine. We’re just as Pavlovian as the next person.

It doesn’t matter if you work in the clinic, the community or the hospital. These systems are brutally designed for the lowest common denominator, and they are failing our profession and our patients. The AMA Council of Doctors in Training has argued for the standardisation of mandatory training packages for some time now, but in a world with so many various Blazers to appease, it’s hard to find the greatest opportunities to drive change. This is work we will continue to do, amongst many other tasks at hand for 2017. In March of every year, we hold a Trainee Forum where all trainees are invited to come and hear about a number of relevant topics, and to contribute to the work plan for the coming year. It’s about setting the right priorities so we can best tackle the year ahead, and 2017 will start with our first meeting in Sydney and a number of discussions around this and many other pressing issues for doctors in training.

In the meantime though, the holiday season is fast coming upon us. Whoever you are and wherever you are, I wish you a safe and happy holiday. I’d like to give a special shout-out to those souls who work hard over this time to keep our community healthy and safe. All the best for the New Year, and I look forward to working with you and for you.

Until next time,

Z

Dr John Zorbas

Chair, AMA Council of Doctors in Training