Partha Kar: A question of faith

There’s something deep seated within the whole junior doctor angst, isn’t there? Many have joined the bandwagon and converted their angst into a lightening rod for all comers, but peel it apart…and there’s something which is a bit uncomfortable.

Something isn’t quite right regarding the relationships between senior doctors and juniors. Yes, the seniors have manfully stood by them during the strikes and bar a few isolated voices, in general they have been very supportive of juniors. But the deeper question is whether it’s because they genuinely believed that juniors needed a better contract, work/life balance and equality for all or whether there have been other issues involved. For many, it indeed has been the former—a steadfast support and belief that juniors deserve better, but there have also been the throwaway “In my day” comments and the usual “they don’t work as hard,” gnawing away in the background.

The junior doctor forums and debates have been quite interesting with a lot of them centering on the genuine angst that many don’t believe a senior doctor in the guardian role proposed in the contract would do the role assigned to them. Some seniors have pointed out the job is impossible due to the lack of time but let’s be honest, the juniors aren’t questioning the time allocated, they are questioning whether seniors would be there for them.

Examples of educational supervisors not being supportive, examples of bullying, and pressure being imposed to amend the times worked to fit in with banding abound all over. So how have we got to this point? If juniors have so little faith in seniors to look after them, why blame the contract? Why blame anyone else? There is a far deeper malaise which this contract debate has brought to the fore, and as uncomfortable as it is, maybe we seniors need to face up to that. We, as a group, haven’t uniformly been able to deliver the pastoral role which is a fundamental component of what our roles are supposed to be.

Is it work pressure? Is it genuinely the belief that the present junior doctors aren’t as good as us? Or is it just the position of power? Or is it the pressure of management, which makes us sacrifice our juniors in a flash? In my career, let me be honest, I have and continue to see examples of juniors being the sacrificial lamb—whether it be opening a new ward, whether it be compromising teaching, or whether it be a latest variation of the rota. Rarely are the juniors involved. Mostly they have decisions foisted upon them.

Fundamentally something isn’t right..maybe the basis for that starts in not respecting this group of professionals for who they are. Adults. The term “junior” carries that tone of irreverence, it fails to recognise that these so called juniors are trusted enough by society to have a mortgage, and have a family…yet in the workplace, they are service delivery components who should do as told. Years of slow burn, and years of disrespect has got us to this point in time where seniors are not universally trusted. Where do we sit with the encouragement we should offer, the arm around the shoulder, the thank-you breakfasts on weekends…whatever happened to those? Lost in the mists of time or consumed in the process driven culture of the NHS, we inherently seem to be losing the human touch. We like to pride ourselves on the compassion we show for our patients, yet somehow we seem to have ignored that with our next generation.

The onus has to be upon us to to change this, to try and rebuild the respect and trust. We must not be seen as folks out to screw our juniors but as someone to go to when times are tough. It is our job, it is our role to do so. We have plenty of good examples…they shouldn’t be seen as a rarity, they should be the norm. A friendly smile and a thank you costs us nothing, yet means a lot to a junior doctor at the end of his or her tether. There’s many things about this junior doctor contract fiasco which isn’t nice or desirable but the flip has been the exposure of this festering wound. The juniors are hurt and disgruntled, and most importantly there isn’t always enough trust. That cannot be right and it cannot be healthy. It must be repaired. These doctors are our future and we must try to make an effort to make them feel wanted.

Partha Kar is a consultant diabetologist at Portsmouth Hospitals NHS Trust. He is also Associate National Clinical Director, Diabetes.

Competing interests: None declared.

See also: BMJ Confidential Partha Kar

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  • There have been many who point to Australia and New Zealand as having the best junior doctor contracts and that we should emulate their terms and conditions. However, many of the doctors who have worked there before seem to suggest that the major difference between them and us is actually more cultural than contractual.

    Many have cited the little things which really go a long way to showing juniors that their work is appreciated: free meals in New Zealand at work, encouragement by senior staff to claim for the hours they’ve worked, having “reliever” doctors on the rota to allow for people to go off on annual leave or sickness without having to worry about swapping out of their on-calls.

    These little things really go a long way to building up staff morale. The lack of these perks in the UK, coupled with long training and a bullying culture in some specialties has bred this feeling of animosity to the system and distrust of our senior colleagues to look out for our welfare.