By Dr Charles Stewart
Tim, a big confident guy with an assured public school accent, reported to me that he was going to discharge baby Gonzalez with a cold. An instinct told me to double check his findings and when I saw Gonzalez it was immediately apparent to me that Tim was wrong. Gonzalez was sick, and at only 6 weeks old could go downhill fast. I diagnosed meningitis and worked the next 6 hours on him non-stop after which he spent 2 weeks in intensive care (surviving intact). Those hours were the first I had stopped missing Wales.
In 2009 I completed a Paediatric Emergency fellowship in Canada, where I met my future wife. I might have stayed but returned to the UK to complete my training, which was so hard won, and to be with my mum who had taken ill.
Upon my return I re-joined the All-Wales Training Scheme, being a Wales trainee I was guaranteed a place. I was positive to be back, if not exactly punching the air with enthusiasm. I am Welsh, and feel extremely committed to helping serve the children of Wales, however, I was conflicted because Paediatrics, and medicine in general, in Wales is tough going.
Unfortunately my first day back went a long way to confirming my trepidation. There was a staffing crisis, due to an inability to hold on to non-Welsh medical graduates from Cardiff, and so we were down a doctor, it was winter and really busy. We were too stretched to find cover for holidays and medical staffing seemed invariably inept at booking stand in locums. The result was an all too regular ‘request’ for people to fill in evening and night shifts at the last minute. Morale was low.
Despite problems of politics and organisation, Paediatrics in Wales is a close knit family with inspirational characters so I had no plans to leave. The decision was made for me, though, as my chosen subspecialty, Paediatric Emergency Medicine, did not exist in Wales. This meant that if you took your child to Emergency, he or she would not be automatically seen by a doctor or nurse specialising in children’s health. This concerned me greatly but I had no choice other than to move out of Wales to pursue further specialisation in this field.
In London I was struck by how many doctors in the hospital were from Wales. In my group of twelve trainees there were four from Wales, an amazing statistic considering there are thirty odd medical schools in the UK. In addition, the hospital employed five consultants in either Paediatrics or Emergency all with expertise honed in Wales. Most of these doctors were non-Welsh and so might have ventured down the M4 anyway but, for whatever reason, the children and tax payers of Wales are getting a poor return on their investment. In March 2014, Cardiff University announced a revamp of its curriculum to entice the best doctors who, it is then hoped, would stay in Wales. The new course consists of community based learning which doesn’t exactly sound ground breaking and time alone will tell if it is successful in slowing the talent drain.
I arrived in February and the shifts were busy, space was as cramped as any I had witnessed and there was tension in the waiting room. I knew I was out of my usual environment when one frustrated parent, who had been waiting about an hour, threatened to take his baby son and go private. Accents were different but the work was the same and everyone worked selflessly for the benefit of sick children. But all of that happens in Cardiff, so why were staff here so happy? Certainly, they seemed under less pressure from external goings on. When I mentioned crises or the uncertain future for hospitals I was met with blank stares, I may as well have been speaking in Welsh, but it was during this disconnected conversation that something happened to help me understand why they seemed so at ease. A guy, known to everyone as Kim, came into the clinical office, acknowledged the group and went to work on a printer that was jamming paper. Ten minutes later he left and the printer was fixed. “But you only phoned IT an hour ago” I half stated, half checked incredulously. Blank stare. “Yes, that’s right, so they came to fix it” replied a colleague. You see in their world, my world now, clinicians got sufficient support, technical in this example, to allow energy to be directed towards patient care and not whacking a stuttering printer with an umbrella weeks after reporting it to IT.
Work was tiring with high volume of patients and the challenges that a multicultural population bring but the conditions were fair. When we took leave we didn’t have to pay back the on calls. A little known fact in society is that with a lot of medical jobs, the on calls that fall during your proposed holiday are still your responsibility. So you get your colleagues to work your shifts and you pay them back when you return. After my honeymoon, for instance, while working in Swansea, I came back to a 21 day working stretch which would be difficult for any newlyweds- here they hire locums to cover leave and I cannot describe how much of a difference that makes.
In 2013, despite all the positives of working life in London, I still felt like coming home. I was missing Wales and paying £1700 per month for a 2 bed flat never felt comfortable. There is no London weighting for doctors and life is pretty humble, unlike Wales, where everyone fights to buy rounds on nights out. So I made some enquiries and visited an emergency department (ED) near to Cardiff where I was given a very friendly tour by the director. Amid the usual exchanges on challenges, successes and frustrations that occur in every ED we discussed waiting time targets. Our ED, near the top performers in the UK, could claim to safely discharge, admit or transfer 98% of patients within a four hour target. This meant that only 2% breached this target and we were trying hard to get that figure lower. My host in Wales was pleased to report that they ‘only’ had sixty twelve hour breaches the previous month and I realised the decision to come home would not be a straight forward one.
Of course it is not all rosy, England has enormous health care disparities and I recognise my experience may not be mirrored elsewhere. The English are keen to promote private health which I believe needs more regulation, pay for performance turns clinicians into economists and outperforming rival hospitals seems as important as attaining high standards, if not more so. Crime, schooling, costs and the sense that you never really put down roots will always keep me looking for opportunities across the Wye. All I need is the tools to work with, and a guy to fix the printer
Charles was born in Montreal and grew up in Monmouthshire where he enjoyed participating in all sports, especially rugby. He studied medicine at St Andrews and Cardiff where he placed first in the All Wales Paediatrics Training Scheme selection before completing fellowships in Sydney and Toronto. Still active in sports, he is running the London Marathon in April 2015 for the Neuro Foundation. If you would like to support this cause please go to http://www.virginmoneygiving.com/CharlesStewart3
Categories: Society / Cymdeithas