Sanna W Khawaja: An NHS full of secret agents

sanna_khawajaWhile I enjoy the occasional spy movie, I always find myself irritated at the protagonist, who very often spends the film focused on a mission with little or no knowledge of the “bigger picture.” Quite often he or she knows little about the organisation they work for, and, at times, they even accidentally end up in a gun fight with their own colleagues.

I was mid-rant about these “secret agents” when it recently dawned on me that I too have been trained like a secret agent (albeit without the martial arts).

Training as a doctor in the UK for most of us means training to join the NHS. We go from black gowns and mortarboards to the blue and white lanyard of the NHS doctor in a matter of days. After five or more years of training, we arrive to day one of our mission with barely enough knowledge of our own role within the organisation, and virtually no idea of how the hospital is actually being run.

Did your medical school teach you about the structure of the organisation you will work for? Or the process of national policy making, which will affect your ability to help your patients and ultimately your day to day life as an NHS doctor? Perhaps on induction your new hospital did a whistle stop tour of the hospital/trust management structure? I have to confess to almost complete ignorance of all of the above when I arrived on the wards, and I’m keen to hear about other doctors’ experiences at different medical schools or hospitals.

Doctors face a lot of criticism for showing little interest in leadership and management. We are accused of apathy towards our hospitals, trusts, or even our health service as a whole.

However, such critics are talking about some of the most passionate people in our country (if I may say so myself). People who have spent years of their lives dedicating all curricular and extra curricular hours to transforming themselves into well rounded, well read, and socially apt people—and that was just to secure a place at medical school. We are not an apathetic bunch; we are driven, hardworking, and desperate to make a difference. We are also, unfortunately, mission focused—or at least our training is.

Perhaps, if I understood the work of a departmental manager, I would be less inclined to believe that he or she is simply determined to complicate my day. Perhaps if I understood some part of the finances of my hospital, I would be better motivated to pay attention to the “clinical coding” aspect of my notes.

But on a greater level, perhaps if I had an earlier awareness of the operation of our health service, I would be a more active agent for its protection. Setting aside the fact that (or, indeed, particularly because) the recent versions of the “Structure of the NHS” flow charts are mind boggling, I feel that more efforts need to be made to incorporate this subject into the UK medical school curriculum. We need to arrive at the hospital on our first day not just as cogs in a large machine, but as engineers that can help keep it running. Ultimately, as in all matters, education is the first step to engagement.

Sanna W Khawaja has recently completed her foundation training in Manchester. Find her on Twitter: @SannaWaseem

I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.