Why junior doctors don’t speak up…

Once upon a time, young doctors trained in an opaque and informal apprenticeship system. This led to excess doctors in some areas and specialties, and too few in others.

And the juniors took difficult exams set by wise Professors in mysterious robes, so they could join Royal Colleges of Clever Specialists and become senior doctors themselves.

But nepotism, patronage, inconsistent standards, unfairness, overwork, patient harm and bullying were rife, and constant job moves caused chaos. The profession realised something had to change, and a ‘system’ slowly emerged. 

Now the young doctors applied for ‘rotations’ with a series of linked fixed-term jobs in their desired geographical area and specialism. The rotations were specially designed to give the young doctors the training and experience they needed to become senior doctors. 

Some rotations were rather like Cinderella’s dirty, mouldy old pumpkin; worse for wear, malodourous and off-putting. And some were shiny and glamorous, in luxurious buildings that sparkled like golden carriages, well designed and well resourced. 

Not surprisingly, only the prestigious ‘golden rotations’ were highly sought after, and so nepotism, patronage, inconsistent standards, unfairness, overwork, patient harm and bullying continued. 

So, after a while, a new system emerged to design, run and monitor all of the rotations. Everyone hoped this would sprinkle fairy dust on the mouldy-pumpkin-hospital Cinderella posts. They wished that all the jobs, all the hospitals, and all the juniors, would soon become golden and shiny too.

In every area, every specialty would have its own independent ‘Deanery’ with lots of kind and wise senior doctors, loved by the juniors, and linked to the universities and the Royal Colleges of Clever Specialists. 

These Deaneries would check and monitor all the jobs, all the training, and all the juniors. They would make everything fair, and safe, and good, and shiny. And they would send gold coins to the pumpkin hospitals to pay the junior doctors and they would send them lots of the right types of juniors. Soon, all the hospitals would shine like a freshly-polished golden carriage.

But the King got fed up. He didn’t like giving lots of gold coins to all these hundreds of Deaneries who never did what he told them. And he didn’t like being taken for granted by the kind and wise doctors, the Royal Colleges, the junior doctors, the pumpkin hospitals and the universities. 

So he shouted at everyone. He made the Royal Colleges stick to exams, and he took all the Deaneries under his own control. And he mixed them all up into one enormous beast called Hee, who had small and faraway castles called regional offices. And Hee bought a computer to decide which junior doctors it wanted, where it would send them, what specialty they would train in, and whether they were good enough to continue. But it kept breaking, so Hee was sad, and the wise old doctors kept trying to cheer it up. 

Then the King gave all the kind and wise senior doctors lots of impossible tasks. He told them to spend some of the gold coins on training non-doctors, and he cast a spell so they wouldn’t realise they were under his power. 

And then Hee and the wise doctors forgot that they were the ones who decided things. They forgot who decided which junior doctors were wanted, where they would send them, what specialty they would train in, and whether they were good enough to continue.

And they didn’t believe that nepotism, patronage, inconsistent standards, unfairness, overwork, patient harm and bullying existed. So when Cinderella the junior doctor told them the magic fairy dust hadn’t worked, they kicked her out of her ungolden rotation. And Hee told her she was banished, and could never be a junior doctor again. 

She went to the King, and theRoyal  Colleges, and the universities and told them about Hee, but they all said it was the pumpkin hospital’s problem, and Hee had nothing to do with the fact she had no job. So she went to the judge, and he agreed. 

But then some fairy godmothers turned up, and she started a campaign. And that will be a story for another night. 

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