“Don’t let medicine eat you up, make medicine work for you”

It’s a fine balance in medicine, between dedicating your life to medicine and keeping yourself happy and well. I’ve held on to these words that were shared with me as a medical student, coming back to them particularly when I have become overwhelmed by medicine.

I’m reflecting on these words here in the Orkney Islands too. Not because I feel overwhelmed, quite the opposite. I’m reflecting on the quality of life that doctors seem to have here in Orkney. This is in contrast to the conditions of many doctors working in the UK and New Zealand.

Doctors, nurses, carers and healthcare assistants work long days and weekend and nights – that’s what we’ve signed up for. For a healthcare system to thrive we’ve got to value the people working within it. Not just for the sake of the doctors but for the safety of the patients, and for the sake of our healthcare system as whole.

We signed up for long hours but we didn’t sign up to work in a factory. Churning patients through 10 minute appointments (standard within UK National Health Service GP practices) and ticking pre-determined boxes is not why we chose this job. If a kid comes in with an ear infection, 10 minutes is no problem. If a patient walks in and says they want to kill themselves? Or they haven’t been to the GP in years and everything is starting to crumble? You’ve got no chance. Then you’re running late and the rest of your patients are mad at you before you’ve even started. Most importantly, what kind of therapeutic relationship can we build in ten minutes? A shaky, time pressured one.

The phenomenal placebo effect of a good therapeutic relationship is well known. If your patients trust you and you tell them they are going to get better, they probably will. If you prescribe them an antibiotic, that antibiotic is going to work better if you have built a strong relationship with that person. Healthcare factories erode these relationships. People know that you’re rushing, that you’re already running late, and that you’ve got twenty more patients to see before you can start your paperwork.

If this all sounds too emotional, we should probably talk about the economics of these healthcare factories. Shorter appointment times and zero breaks definitely sounds a bit cheaper. The problem is that people leave this system, crushed by the cogs and completely worn out. They enter the Land of the Locum! Where you can earn more money, for a quarter of the work. Here in the UK, GP locums can be paid up to $1700 NZD per session (half day). After talking to people here it seems it’s not uncommon for junior doctors to quit their NHS jobs and register with a locum agency too. The more GPs that leave their permanent positions to locum, the more pressure gets placed on the remaining permanent staff to pick up the administrative tasks and the complex problems. I probably don’t need to point out that this forces more doctors to give up their NHS positions to enter the Land of the Locum. These escalating costs and lack of continuity of care could (will) cripple this health care system. We’re a few steps behind in New Zealand, so we have the chance to make our permanent positions more attractive. But we’ve been warned!

So let’s leave mainland Britain behind and travel back to the Orkney Islands. Anecdotally, the quality of life is better for doctors out here. Some GPs have gone from working in extremely busy practices with no breaks and late finishes, to a quieter pace of appointments and finishing at 4:30pm more often than not. Commute time is almost non-existent and Orkney has been named as one of the best places to bring up your kids. The fantastic community here is a story for another day. Perhaps appointment times are 15 minutes long, or not all of the 10 minute appointments have been filled, but there seems to be more time. Of course living in an isolated community is not without it’s challenges. But I have had a delightful time reflecting on life as a doctor in a smaller community, and thinking about whether that’s how I might make medicine work for me.