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| 24 Mar 2020 | |
| News of OTs |
| Before the current health crisis, Dr Joy returned to Tonbridge School to give an inspiring talk on emergency medicine and the Helicopter Emergency Medical Service for the School’s Tenant Lecture Series. Current Sixth Formers Jack Brant and Calvin Cheng also had a chance to interview Dr Joy about his career. Q: What was your most memorable experience when you were facing a patient’s death or a heavy trauma? How did that affect you? It's not at all uncommon to interface with death and dying patients in my career, and then having to support families, relatives and loved ones. You realise that death can be managed very badly, or it can be managed well, if done tactfully. The most difficult example of this, for me, was with a teenager that had stabbed himself in the chest. We had to perform roadside surgery to try and restart his heart, which was unsuccessful. His family weren’t at the scene, and so they never understood why we hadn’t taken him to the local hospital to have treatment there. It was only in the coroner’s enquiry that I had a chance to stand in court and talk to the family and explain to them that, in effect, we had taken the hospital and the operating theatre directly to their son. They had thought, up until that point, that he hadn’t received hospital treatment. So it was important for me to be able to offer them some solace and comfort in the knowledge that the right treatment had been offered. I gravitate towards some of those difficult conversations now because I feel if they are not held well, then families remember very difficult interactions with the clinicians that have looked after their loved ones, as opposed to comforting ones. Q: Your speciality of emergency medicine was a growing field when you joined. If you didn’t start in emergency medicine what specialty would you have chosen? I went through medical school very uncertain about a career in clinical medicine and slightly fell into emergency medicine because I went to a hospital where it was very much a flagship specialty. I found that hospital a very inspiring place to work and so I suppose I chose my career in emergency medicine based on a specific emergency department, rather than the clinical specialty. I think if I worked in an A&E department in a different hospital at that stage in my career, I might have instead chosen a career in anaesthesia, surgery or possibly even general practice. Q: In the most recent general election, one of the most heated topics was the privatisation of the NHS. Do you think these fears have any real grounding? The NHS is journeying through a very difficult phase. I think that since it was first conceived and defined however many decades ago, the needs of society have really changed and medicine has snowballed in its scope and reach. The resources at the moment are not there to deliver population health on that big a scale. We also need to integrate our services much better. The NHS is a collection of microsystems in the sense that medicine isn’t practised in the same way here in Kent as in London, Newcastle, and so forth. We don’t even necessarily share the learning of what works really well in one system compared to another. I think what should happen is that we recognise that the needs of society have really changed and then give the taxpayer a choice and say – if you want integrated health care, it will cost a lot more money than it currently does. I would be in support of a model like that because I think that when you bring profiteering into healthcare it makes some business models more challenging to deliver. But there are already hundreds of privately-owned companies working at the heart of the NHS; from our IT systems, to many of our laboratory processes. Society needs to be made aware of that, and make an informed democratic decision on how it wants to proceed. Q: Your work is very stressful and very ‘high risk, high reward’. Are there any activities or hobbies you partake in outside of work to deal with this? Golf, running and playing the piano occasionally – not very well. Family life is where most of my non-work time is absorbed, and that’s the perfect tonic for a busy life. Q: How do you cope with stress during working hours? I think stress is sometimes quite a good thing. It keeps you on your toes, keeps you focused, stops you getting bored and complacent. But it can be quite a negative force. Some of the managerial processes in healthcare; the under-resourced systems within which we operate; the attitudes of some of the colleagues that we work with can each be frustrating. But you have to be circumspect about it. I think that you have to roll with the punches a certain amount and just accept that stress is part of the job and it therefore diminishes somehow. Q: How would you describe the feeling of being in the helicopter on your way to a trauma? When a 999 call is placed, it’s answered by a non-clinician who generates a triage of priority, so you tend to know very little information about the patient that you’re going to. For instance, “a baby that’s not breathing” might be all that you know. Sometimes it helps not to think about it too much, because if you make too many plans based on those little bits of information, you can arrive and find a completely different situation to what you were expecting, and you have to reset your frame of mind. Overall, you try and make sure that you get out of the helicopter completely and utterly focused on the patient you’re about to go and see. Q: On your first day with the London Air Ambulance, did you feel nervous or were you trained to be as calm as you could be? I don’t think I was calm, but I don’t think I was too overwhelmed by it. I did this at a time in my medical training when my knowledge and clinical skill set was extremely high. When you start the job you go through four to five weeks of intensive, supervised training, where you learn things like, how many grams each piece of kit weighs, or the battery life of your mechanical CPR devices. The standards you are assessed against are very high. I knew I wouldn’t be allowed to fly unless I fully met the requirements. Q: After Adam Kay’s rather damning account on junior doctors in his book ‘This is Going to Hurt’, did you experience anything similar? Yes, from time to time. Junior doctors work very hard, and that has been the case for a long time. But medical careers change seemingly from one generation to the next, and I suspect that 4-5 decades ago, they worked longer hours than they currently do. However, there might have been lower demand for their time. There were fewer patients, but there was also less medicine. It wasn’t possible to get a CT scan or every blood test in a day, since most hospitals didn’t have facilities for that. I remember running 14 consecutive night shifts as a junior doctor which was, to say the least, foolish. I didn’t see any of my friends, missed most of the World Cup and became rather introverted. Junior doctors’ hours are now monitored more closely, which is sensible on so many levels. The hours get better as you move up the ranks but it’s still tough. Q: So a trial by fire is needed? To some extent, yes. I think if you dampen and soften the experience of junior doctors by applying rules which restrict what they’re allowed to do in their working lives, this will get you a lower calibre end product. Q: Before choosing to specialise in Emergency Medicine, was there a lead-up of cases which led you to specialise in that area, or was it a ‘snap’ moment? It certainly wasn’t a ‘snap’ moment. I was interested in a lot of things and explored many options. When I started my training, I became much more interested in surgery and I decided to follow the surgical exam route. I found out when I was on call, those were my best shifts. I would be called from A&E and see patients that were newly admitted, or I’d get called as part of the trauma team to the resus room. I suppose it made me realise I was more interested in the emergency aspect of surgery than being in the operating room. The hospital I worked in also gave me some very eye-opening experiences of how Emergency Medicine can be done very well. Q: Do you ever regret your choice? I think my career choice has been a good one and it suits me. However, medicine is a fascinating career, and there are times when other specialties look very appealing. I think also, inevitably you have a phase in which your specialty becomes quite difficult. At the moment Emergency Medicine is hard because we’re practising corridor medicine for the first time in my career. We’re looking after patients in a crowded environment and you see colleagues head to their more comfortable working environments. However, they have their own stresses. There are times when I thought General Practice was a suitable career, but after seeing my wife in her job, I understand how this is also really pressured now. Seeing a patient every eight minutes means that GPs might not be able to offer the level of care they want to give. Surgical careers are fascinating as well. It is intellectually interesting, but many of my surgical colleagues are getting increasingly frustrated that all of their operations are being cancelled as there aren’t enough beds available. Q to Mrs Joy: Do you find your job more stressful than your husband’s specialty? I think we have similar pressures since we’re on the front line and we’re generalists. I think that Tony has a higher stress level as he has to constantly deal with sick people. But, in terms of the sheer volume of patients we see, some days I can have 40-50 patient interactions and that is very exhausting. I do think that working on your own can also introduce its own pressures, whereas, working in hospital medicine, you’re surrounded by colleagues. When dealing with stress in Tony’s job, there is much interplay between colleagues, but as a GP, you’re quite isolated and you alone are making the decisions. Tony: I think GPs have had to become very comfortable with managing risk. When a GP is on a phone with a patient, making tests means making referrals to hospitals. It's not so natural to do these things, and you might come home from work thinking that the decisions that you’ve made were risky. I think this is the main source of stress in primary care, and it isn’t quite so abundant in hospital medicine. |
