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Domhnall MacAuley on the “back then” brigade

20 Aug, 10 | by BMJ

Domhnall MacauleyReading the Times (Wed 11 August), it was clear I was mistaken in thinking they had gone away. The “back then” brigade are back; hankering over the good old days when doctors were trained properly. Not this namby pamby part time medicine where junior doctors clock off early. Not like in our day.

Let’s recap. In the good old days, young doctors were committed to their vocation and worked long hours without complaint in a training system that suited a medieval profession. They mortgaged the best years of their lives away, working 100 plus hours per week as medical cannon fodder with the unwritten promise of a long term career. Multi talented high achievers with bright open minds, they could more or less write off any active interest in sport, language, culture, or music after qualification. Their lives changed irrevocably. A few rare individuals did manage to retain outside interests but others’ talents withered quietly on a long term one in three rota- an existence focused on recovery in time for the next on call or preparing for another examination. With few opportunities for interests or contact outside the medical microcosm, it was an inevitably incestuous environment where junior doctors lived worked and socialised together. For many, the years from age 25 to 35 were a lost decade. Could there be any connection between the commonly held patients’ view that doctors cannot communicate, are arrogant, detached, and are unable relate to the problems of ordinary people. Might there be any significance that dysfunctional communication seems to underpin many major medical misadventures?

Can any caring professional really want young doctors to go back to the awful existence we imposed on junior doctors in the past? Now young doctors have a life. Hours are still long and tiresome, but at least when they go to work they can see the distant horizon.  If there are problems with training and exposure to clinical care then perhaps, rather than harping back to an archaic and demeaning past, we could look to creating a new and innovative model for the future.  Times have changed, the gender balance of medicine has changed, the world outside medicine has changed. Surely we have the imagination to create a system where learning is life long, where training is incremental, where knowledge and experience are shared over a more extended apprenticeship. It is time for us to think differently. Let’s be honest: back then, in our day, it was dreadful. Do we wish to impose the mistakes of our past on the doctors of the future?

Domhnall MacAuley is primary care editor, BMJ

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