Fran Kirkham is an F2 doctor at the Royal Sussex County Hospital in Brighton, having graduated from the Cambridge Graduate Course in Medicine in 2016. She originally did an English degree at Cambridge University and worked in PR and Communications for 7 years. She hopes to pursue a career in Community Geriatrics.
“So we drove on toward death through the cooling twilight.”
~ The Great Gatsby, F. Scott Fitzgerald
An FY2 taster week can have a multitude of meanings. For some, it offers a reprieve from their mundane day job, almost as desirable as annual leave. For others, it is an opportunity to try a specialty that piqued their interest as a student. Yet others use it for cynical CV-building, knowing exactly to what profession they aspire and ‘proving commitment’ by spending an extra week doing the job they plan to do for the next 40 years. This may gain marks on the flawlessly-designed points-based applications which determine our chances of working in a specialty that bears any resemblance to our future career hopes or a location which is vaguely practical. Of course, a week is not realistically enough to get a sense of any job, nor ‘prove’ commitment to anything. But, as with many things in the NHS, this is the system in which we operate, so we make the best of it.
As a budding geriatrician, I could have arranged a taster on an Elderly Care ward, swapping from the vastly dichotomous endocrine ward where 90% of patients are over 70 and admitted for entirely non-endocrine reasons. I decided that was unlikely to enrich my understanding of the specialty nor alter my ambitions. As my main interest lies in Community Geriatrics, another idea could have been to work with a community consultant, as I did in my free time at medical school and during my elective. Again, anyone with a true interest in a specialty will have endeavoured to gain experience through some means previously. Instead, I drew on my previous career in PR to ‘think outside the box’.
During training, it is difficult to get exposure to unconventional career trajectories. We are rigidly schooled into believing our options are binary and that our aspirations must fit into pre-defined categories to fulfil the unyielding criteria required to access the correct escalator. You are either academic or non-academic, medicine or surgery, respiratory or cardiology, ad infinitum. The foundation programme is adept at churning out obedient, hoop-jumping, administratively exceptional doctors to fill specific roles in service provision. It is no surprise that a record number of juniors are taking time out of formal training and the low morale in the profession cannot be entirely laid at the feet of Jeremy Hunt, although his misunderstanding of the motivations of our generation is a symptom of a socioeconomic approach to education and employment which has been decades in the making. NHS employees are no different to other sectors, except we work longer hours, get paid less relative to our skillset, suffer more from the chronic underfunding of the public sector and feel worse when we fail because our failures equate to tangible suffering for patients. I wanted my taster to explore unusual avenues available to someone interested in the relationship between caring for patients, interactions within the profession and changing values across society. So I got in touch with the BGS.
Like most geriatricians, I’m a big picture person who bemoans the progressive silo-ing of medicine. I’m fascinated by the tangled web of social, psychological and physical factors which contribute to, and are complicated by, health and illness. Geriatricians recognise the complexity of humankind and the futility of treating diseases rather than patients. In interviews, no doubt we eloquently express our passion for helping people, yet, in our target-driven culture, the outcomes we chase are a falling CRP, a clear chest and, ultimately, an empty bed. It is hard to make a difference to someone without understanding what matters to them, and what will determine whether the person in front of us recovers is a multifaceted array of influences which expand way beyond the antibiotic we prescribe.
Geriatricians take a holistic view, working in multiprofessional interdisciplinary teams to address the wider factors impacting on patient wellbeing. By considering a patient’s own priorities, they focus on quality of life, looking to ensure the later years are enjoyed rather than endured. There is a long way to go, especially in community work, striving to keep patients out of hospital where possible and, if not, prevent further deterioration in function, which is why the BGS is essential. Practitioners and departments can become understandably insular, thus a broader outlook is needed to meet the impending demand of an ever-increasing older population. The NHS is notoriously poor at disseminating innovation and enabling cross-sectional learning, thus organisations such as the BGS are vital in facilitating education and advocation. I hope to learn how the Society brings geriatricians together, encourages and sponsors research and influences health policy. Just as patient care can only be effective if tailored to their context, doctors’ morale can only be maintained by providing a nurturing environment, and systems can only improve if tackled comprehensively from the ground up and top down with committed long-term investment in people and structures. Sadly, my taster week probably won’t solve the underlying crises in healthcare, nor is it likely to get me any CV points, but it offers an opportunity to develop as a multidimensional individual, which is often wanting in the foundation programme.
This is an excellent commentary on the way geriatric medicine should be developed .. I say this as one of the old people who is currently enduring life rather than enjoying it. Please , NHS, listen to us and what we need and you will find plenty of empty beds in the hospitals.