From now on

Tuesday 15 December 2020

As 2020 dwindles to a welcome close the world will remain altered by the events of the past year. Time has often passed all too slowly under lockdown and subsequent tiered restrictions. Continuing to physically go to a workplace has certainly proved invaluable to my mental health, although the medicine I practise when I get there is not as personally or professionally satisfying as it once was (but more of that later). I think we, as a profession, cannot underestimate the impact on the population (patients) of the prolonged periods of isolation and restriction we have seen in the past year. I suspect these will play out in various arenas in years to come – health, deprivation, educational attainment, perception of risk and appetite for it. I hope you find something that resonates in my musings, or better still something to make you smile. 

Last Christmas

The year opened with reports of a novel viral infection in a little-known Chinese city. Twelve months later, with the death toll topping 1.5 million worldwide and still rising, hope is finally back on the table. The possibility of an effective vaccine becoming the lived reality over the coming months, leading to resumption of normality, is tantalisingly close but still deferred. However, normality after Easter is infinitely more attractive than no normality. As always happens, results from uncontrolled use in the field differ from those seen in clinical trials. The promise of a vaccine with no side effects was never truly likely – biological systems are unpredictable. A pertinent reminder that the added value of expert doctor input into complex situations will not disappear with the advent of artificial intelligence or different ways of working.

A button nose and two eyes made out of coal

An uncomfortable truth was highlighted by a presidential peer during one of our regular liaison meetings. The space behind one’s ears. Ears are bendy but there is a limit to what they can accommodate. When you start with glasses and add on a mask it is precarious. But when you get to the age of needing hearing aids as well, most ears just cannot cope with the traffic and something has to give. As I have said over the past year, I am most looking forward to abandoning face coverings, especially at work. There is inescapable evidence that I am reaching the position of my peer and am deafer (and older) than I like to admit. This mainly manifests by saying “pardon” a lot when interacting with patients and those working in shops. Previously a smile or expectant look would save face and gloss over the gap, but the mask prevents that manoeuvre as well. Had I wished to wear a mask, I would have pursued a career in surgery. And as one eminent surgeon reflected during a meeting – it is quite different wearing one when there is no air conditioning…

For kids from one to ninety-two

The need to protect patients by reducing footfall in COVID-positive areas has led to the rapid adoption of virtual consultations. This undoubtedly has benefits in terms of time out of patients’ lives spent travelling. However, the negative aspects of this have been downplayed by many of our political masters. There is a wealth of difference between a well-resourced video consultation with a quality product – supported technologically at both ends and allowing patients privacy, dignity, access to support in real time from family members and the wider healthcare team – and a phone call with variable reception and no speaker or volume control. I believe we should embrace some of the positive changes we have implemented as a result of the pandemic but wholesale unquestioning adoption of virtual consulting carries with it a high price. For one thing, it turns out it isn’t just me lipreading. And in those who are definitely not deaf? I have been forced (reluctantly) to accept I must have an accent. Verbal communication, we are taught, forms less than 5% of any consultation. Phone calls cut off virtually all ‘soft’ aspects of communication skills. Despite years delivering often unpleasant news to a wide variety of patients I have, in common with many colleagues, found the months of virtual consultations tough and tiring as well as leaving me with a feeling of not having delivered the best care I could to the patients. Not a good recipe for retaining me within the workforce as I age. But how much worse must it be for our patients?

Pleased as man with man to dwell

…But only if you are in the same household (or in three households at Christmas). The bewildering and changing array of restrictions across the four nations and between different areas has kept us continually assimilating information. Lifelong learning was never this good before. Casual conversations have left Strictly and Game of Thrones behind, instead substituting probing questions on the legality (or not) of one’s behaviour at the weekend. Cross-professional discussion on what constitutes a household, a bubble and a substantial meal have at least ensured we are all thinking about practical applications of theoretical knowledge. Our minds will be supple after the pandemic, even if our bodies aren’t.

Dashing through the snow

Much of this year has been spent out of doors – often the only time we were allowed get fresh air or permitted to mingle with friends. Looking at some popular Christmas songs, the outdoors theme abounds and I wonder if they were composed in another pandemic and have migrated into folklore: “field and fountain, moor and mountain”, “figgy pudding……so bring some out here”, “walking in a winter wonderland” to name but a few. When it comes to ‘dashing’ there is nothing to beat the newest, quickest mode of travel: being hauled from the breakout rooms on Zoom back to the main meeting. If you haven’t yet had the experience, I would heartily recommend it. The surrendering of control to the ‘organiser’, a brief moment of existential angst that you have been ejected and the return to full sensory input in a large group of folk as slightly discomfited by the change as you are.

Another year older

December marks my appraisal, a time to consider achievements and challenges. This year was pared back, but my trust has not fully heeded the GMC shift to establish appraisal as a standalone space for reflection and planning personal future development. A memo that failure to complete stat/man training would potentially impact on appraisal progression and allocation of study leave did not do a massive amount for my mental wellbeing. We need to keep as many folk working as we possibly can across both specialties and actions such as these do not create the workplace culture we need to achieve this.

I saw three ships come sailing by

Any finally – no overview of 2020, in Britain at least, can be considered complete without the obligatory mention of EU exit. The UK officially left the European Union on January 31 2020 but the transition arrangements don’t finally stop until December 31 2020. We will then see if the extra ‘three ships’ plying the channel, not using the short straits or with their express ticket (you can tell I have been to a few briefings on this) will sufficiently support the supply chain so that we don’t notice the final divorce from our European neighbours.

Marching to and from the enemy

This year has been a rollercoaster of experience for us all. No one is untouched. Good and bad news alternating at a dizzying pace, often on the same day. Obvious lessons being learned for a second or heart-breaking third time. There will come a time for inquiry, but not yet – we still need to get through the winter. However things develop, I am sure deputy CMO Jonathan van Tamm will have a suitable metaphor at hand to explain it. Maybe I could book my place in the vaccine queue behind his mother – he must have inherited that cheerfulness from someone.

Here’s to a better 2021 –

I wish you a brave New Year

All anguish, pain and sadness

Leave your heart and let your road be clear.

Dr Jeanette Dickson
RCR President

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