Reflecting now

Thursday 1 October 2020

The start of my second year in office. A time for reflection on what has happened but also a time to marshal strength for the coming months. None of us can be in any doubt we are in a precarious situation. Rising infection rates (thankfully mainly restricted to the younger members of society who are at much reduced risk of the severest complications), a back-log of patients, imaging and care that is being tackled with gusto but without the capacity needed to get through it at the pace required and winter looming – a recipe for a severely stretched healthcare system and increasingly frustrated clinicians. The prospect of lock down-type conditions as the days shorten cannot be easy for anyone. I have always disliked the evenings drawing-in but this year, I just feel incredibly wearied by it all. I suspect I am not alone.

The medicine we practise will be subject to stringent infection control restrictions almost certainly well into 2021. I personally dislike the restrictions (but am obeying them) as I feel they interfere with my ability to communicate and effectively interact with patients. Telephone consultations lend themselves well to fit folk with no major issues on routine follow-up. Not a huge niche in oncology but there are areas where they do work well.

Virtual consultations carry with them the same issues that we are all encountering in virtual meetings – increased need to concentrate to appreciate the nuances we take for granted in normal situations – making clinics a surprisingly tiring experience. I am aware that eye contact is often missing and I have a nagging worry about those patients who are digitally deprived and what impact that will have on their healthcare experiences in the future – not a recipe to minimise health inequalities.

My new patient face-to-face consultations present a different challenge – mainly due to the heat of the mask and visor in a room with no air-conditioning. My eyebrows, however, come to the rescue and are doing sterling nonverbal work (and I am so glad I have never resorted to Botox). The ‘smize’ – another new word to join furlough and lockdown. The smile acknowledging patients as you pass them in the corridor has almost entirely disappeared, especially as recognition becomes more tricky if you have never seen the patient’s face. The photographs on the radiotherapy planning system are a continuing source of amazement and enlightenment as to what my patients actually look like.

As part of the COVID-19 response, the GMC, with the Academy of Medical Royal Colleges (AoMRC) has published guidance on streamlined, pared down, light touch appraisal, due to restart in October. For me, this brings appraisal back to what it should be – ‘me time’ for busy clinicians to reflect on what they have done in the past year (in my experience generally much more than they think they have) and what they would like to do to develop themselves to have the career they truly want. I know appraisal gets bad press from a number of quarters, but I think the dedicated time, free from clinical interruptions, with someone who can provide an objective view, can support and enhance everyone’s experience. My own personal bugbear is the multiple additions required by our employers which make appraisal unnecessarily burdensome for us all.

I have lost count of the number of kindly folk who have offered sympathy that the past year is not really what I signed up for when I stood to become President. I agree I did not expect to be doing what I am doing, where I am doing it, but I think that must always be the case. National leadership roles are, by their nature, reactive to multiple external influences and, as such, subject to change without notice. I can almost see previous Presidents nodding sagely at their memories of the disruption caused by the Health and Social Care Bill or the junior doctors’ dispute to name the most recent. My experience is just the end of a spectrum, which is good – being unique can be perilous. What I have felt is the chance to make a difference, more than I expected and not just with our political masters.

I think we have changed the RCR hugely and have a great springboard to make this organisation the College we want going forward: more responsive, nimble and engaging directly and effectively with our members and Fellows. Over the coming year we plan to virtually meet each region – a huge ask which will be coming to an email near you soon. We will shortly be appointing a new staff member to improve and grow our relationships globally. We may be entering the second wave of COVID-19 but we are not stagnating. We are growing and developing, changing to meet the challenges of the new future. I look forward to facing those challenges with you.

Does this meet the criteria for reflection for my appraiser? We shall see.

Dr Jeanette Dickson
RCR President

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