I have been off for half term this week, so no interesting patient stories to learn from. It hasn’t felt like a week off though, as we have spent the week painting and decorating. I would be lying if I said there were no times when I wished I had paid someone to come and do it for me, but now it’s done I’m glad I did it! My 11 year old daughter has wanted a refresh of her room for a while, understandably as it was last done 10 years ago. I want to in-still in her a DIY work ethic, so we did it together. I want my children to understand the value of hard work, of attention of detail, not needing to rely on others, and the satisfaction that comes from a job well done. I am super-proud of her work this week, and her room looks fantastic.
Working hard and seeing the results appears to be something we are losing in the medical world. I read an interesting article on a doctor’s news platform today about allocation of trainee doctors to jobs after they qualify. I really don’t mean to sound like an old man ‘in my day…etc etc’, but in my day (I graduated in 2001) doctors typically got offered jobs by the consultants they worked for in the clinical posts they did at medical school. If you worked hard and impressed, you got a good job, if you didn’t, you didn’t. Clearly there were always going to be more sought after roles than others, and geography often played a part in which jobs were highly valued, but we all knew by and large we worked in a meritocracy. I worked incredibly hard all through those years, and they were some of the best of my life. I don’t think I’ve got rose-tinted glasses on, they were challenging but very happy and rewarding times.
That system has been eroded over the last 20+ years, but until recently at least there was a ranking system, whereby the highest ranked trainees in the country got their preferred pick of jobs. This is due to be replaced for the next medical school graduates by a computer generated system to level the playing field and be ‘fairer’ to all. As a result, surveyed current medical students say they are less likely to try as hard to get the best grades, as it will make no difference to what job they get. Nearly half, yes half, are considering options outside the NHS. They haven’t even graduated yet!
Taken at face value, these are worrying sentiments. When I am in need of healthcare, hopefully many years hence, I want to be looked after by doctors at the top of their game, who have worked their absolute hardest to achieve the best of their ability. Doctors who have spent years in the job, honing their skills, not only medical, but empathic human factors. I worry the system to nurture that is disappearing. We sometimes read in the news that there is a need to attract the best talent in business, banking and so on by making them attractive propositions. It often seems to me that sentiment does not extend to healthcare. Yet thankfully the application rate to medical school remains high and extraordinarily competitive. It’s the post-graduate side that seems in most need of CPR.
You may have noticed if browsing the topics pages on my website there has been a bit of maintenance going on recently. There is so much content on there now, that we have found sometimes in trying to watch a video, computers have been trying to download the whole library before playing it! This slows the whole system down and leads to issues. My website designer has been working on it and has found a solution, but please bear with me as the content is ported from place to place. Most of the videos are now there, I’m working in the articles. Once done it should be far easier to navigate, and of course play the content.
Speaking of videos, this week’s research video I found particularly thought provoking, and triggering! You may have seen online results of a trial evaluating keto diets. I get asked about these diets not-infrequently. My first take away (and if you remember nothing else remember this – anyone saying ‘this is the best diet and everything else is inferior’ (or words to that effect) should not be trusted. There is no best. There are some common good principles, but we are all different, and what’s best for you may not be best for me. Putting that aside, I found the messaging around this trial – that a keto diet which raises LDL-cholesterol can be good for your heart if you fulfil certain criteria (such as low BMI) at best is a massively underpowered exaggeration. I’m not saying don’t have a keto diet by the way, they can really help to make some people feel great, but don’t do it in a mistaken belief it will lower your heart risk. Do check out the video!