One Profession: thoughts after Newsnight

Last night we watched Newsnight’s vague attempt to create a debate between two junior doctors on the same side. The interview set-up of course could never hide the glaring fact that The Department of Health and NHS England remained nowhere to be seen. In the run up to an unprecedented and desperate decision by junior doctors, their absence only confirmed their disgrace. Junior doctors have made it clear that they feel pushed into industrial action by a government who refuse to get back around the table. The point of course that seems obvious to the majority of people outside of The Department of Health is that forced introduction of working conditions that your frontline staff are at odds with was never an option. Mr Hunt will talk to you about time already spent talking, he will tell you that the people of the England need closure on this topic, for the sake of the NHS. The truth is that what the people who rely on the NHS need is an amicable resolution and that is something quite different. Talking remains the only option; for as long as it takes. There will never be a time when Mr Hunt’s ‘nuclear option’ becomes the sensible thing to do.

The absence of any government accountability on Newsnight last night, left two Junior Doctors in the hot seat; orthopaedic surgical Registrar Roshana Mehdian and registrar in palliative care Chris Kane. What I would like to point out today is that the problem was never that these two professionals have slightly different views on our upcoming industrial action. The problem lies at the feet of a media which seems unused to the concept of professional and honest discussion between peers and suspicious of the honesty required in medicine; where we admit to possible risks and discuss them openly, in the hope of coming to the best solution for our patients.

Participation in industrial action for a doctor is difficult and it requires two separate thought processes. First we ask ourselves do we think that a full strike by junior doctors has become warranted on the bases of our treatment and the proposed working conditions? The answer to that question by doctors in overwhelmingly yes. The BMA have triggered action in response to an overwhelming 98% mandate for it’s members. The second question is one that comes to every doctor multiple times per day, whether it is about if you can refuse emergency care within your department or what time you go to bed at at night; is this fair to my patient?

I am taking a liberty here, but I feel absolutely sure that both Roshana and Chris will have been through this exact same though process. At the end of it, they have come to different conclusions, but what we need to remember is that both these doctors can be right, at the same time. Their decisions are both moral and just, within the context of their specific work. The process of questioning the effect everything has on patients requires an honesty and professionalism that we simply do not see in mainstream politics. The politics of junior contract from a government point of view has thus far been about spinning statistics, repeating lines and mistruths and keeping up an appearance of unwavering self assurance for the public. I have said before, that is simply not our fight song, we were never going to sing like that. As medical professionals, our behaviour will always be different, and I am not sorry for it. We are not a political party trying to drag ourselves the top of the opinion polls by whatever means necessary. We are not afraid of honest discussion and we are not afraid to do this openly.

My personal view on the industrial action is that it is the responsibility of every single doctor not to presume safety will be maintained, but to actively check that their departments can cope. Similarly, despite their avoidance of public scrutiny on Newsnight, it is the responsibility of NHS England to take the move by junior doctors seriously and free up emergency and urgent cover as much as possible by cancelling elective, non urgent work. It is also the responsibility of our employer to speak up on a specific trust basis if they feel their own system will not be able to cope; because junior doctors and our consultant colleagues will listen and do everything they can to ensure safety is maintained. Let’s not of course forget that doctors have been coping with an increasing frequency of rota gaps, less than optimal staffing and over reliance on a carousel of locum doctors for a long time now. This is what we do. This is what we are used to.

Next week I will be on strike because I have assured myself that the consultants within my department are perfectly capable of maintaining a safe service. I believe that the majority of junior doctors will be able to come to the same conclusion but I also believe that we should listen to those who have concerns within the context of their work. Last night, Roshana and Chris refused to give Newsnight the standoff they craved and it was entirely the right thing to do.

Junior doctors remain united; one profession, we stand together and we stand with our patients.

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