33,000 Votes Later: The Referendum That Exposed a Profession Divided

The profession is divided, and not just between yes and no, but between the loud and the silent…

You may have lost track of how many rounds of industrial action the profession has undertaken since the pay dispute began three years ago. The answer is fifteen. For now at least, that chapter appears to have come to a close.

This is not the place to revisit the merits of the deal itself. We trust that most engaged doctors have a gross understanding of what was on the table. Instead, the On-Call team wants to reflect on what the referendum tells us about the profession.

The Usual Turnout Narratives

Just over 33,000 resident doctors cast a vote, representing a turnout of 57%. Of those, 53% voted to accept the government's offer, while 47% voted the other way. Whatever your view of the outcome, whether you are relieved or angry, two things are immediately obvious. First, this was an incredibly close result. Second, it was not the outcome many of the loudest voices online expected.

After any vote, a central talking point will be the turnout. What is so depressing about voter turnout is how malleable it is to fit the commentators’ motivation. Some lead with the perspective that 57% is embarrassingly low for an online vote where the BMA was offering a 3-month free membership. A follow-up question of how many doctors knew about the 3-month free membership also needs to be asked. Others recognised that 57% is a figure within the expected range when compared to other referendum-type votes.

When we speak to our readers or hear from them in our inboxes, they tell us that many doctors get their news from online forums these days. The ever-discussed rdoctorsuk sub-reddit is the prime source of all things medicine in the UK.

Spend enough time reading discussions on r/doctorsUK or Medical X (Twitter to you and me), and you could easily have concluded that rejection was all but inevitable. The confidence with which many commentators predicted the result reflected a timeless mistake: assuming that the mood of an engaged online community mirrors the mood of the wider profession.

It rarely does.

Online communities always attract the strongest opinions and the greatest willingness to discuss them. Clearly, there were thousands of doctors who quietly read, rarely posted and simply cast their vote whilst remaining invisible from the outside. Let this be a future lesson to those who believe social media can reliably tell us what the median doctor believes.

Is It Over Yet?

Here’s another thought we want to run by our readers…

As the dispute progressed, discussion increasingly turned to technical questions: which inflation measure should be used, whether 2008 was the correct baseline, and whether Full Pay Restoration had or had not been achieved according to different methodologies (read this On-Call piece for our take on the RPI vs CPIH debate).

Those debates remain important - the details will always matter, but it seems many members were asking themselves a more straightforward question: "This has been going on for so long. Is this the point at which I am happy for this dispute and industrial action to end?" That is not the same question as whether every original objective has been met.

A Profession Divided

A 53-47 split is about as close as national ballots come and reflects a profession with genuinely different views about strategy, priorities and what ‘acceptable compromise’ even means.

Doctors are not a single political bloc. There is a huge plurality of thought and opinion in our profession. Perhaps that’s a good thing as it says something about who doctors are as people - individuals with a proclivity to challenge narratives and think on their own two feet. But the BMA’s life sure would be easier if that single voting bloc existed. This vote has put the truth of a divided profession out for all of Britain to see.

Do Emergency Medicine Doctors Really Live the Shortest?

So we have all heard the studies. They say Emergency medicine doctors have a reduced life expectancy compared to the rest. This was originally based on small subsets of data from the BMJ, but a paper published in Lifestyle Medicine has resurfaced the debate, analysing doctors’ obituaries to weigh in on the question.

The paper noted that the speciality with the youngest average age of death was emergency physicians, followed by anaesthetists and radiologists (We can only assume the last one was from vitamin D deficiency).

But look closer, and it may lead to confusion. The paper claimed that the average radiologist lived 75.8 years, an anaesthetist 75.5 years, and then there was a huge drop to EM doctors, who apparently only lived 58.7 years. Can this be correct? Can that possibly be right? Well, when you factor in the paper’s wild standard deviation of 23.6 and a tiny sample size of just 43 EM doctors, it's safe to say we can probably toss the reliability of these figures right out the window.

Let’s not forget some important context here. EM is a relatively new speciality, being formally founded in the UK in 1972. Because of this, the pool of EM doctors currently living into their 80s and 90s (and getting obituaries published) is naturally going to be much smaller than the older specialities. So, the data is being populated by EM doctors who passed away prematurely, mathematically dragging down the average for the entire group.

So the reliability of this antiquated claim is still up for question. Yes, emergency physicians have incredibly stressful jobs full of high-acuity cases and life-changing decisions. But ask around our community, and many EM docs will tell you that by the time you reach the senior Consultant level, the rotas can get pretty nice. In fact, plenty of EM consultants (particularly the rural ones) enjoy three or four days off a week, giving them plenty of time to take up hobbies that probably involve a bicycle or a Hyrox event.

France’s Greatest Export Wasn’t Football or Cheese; It Was Neurology

How France put its name all over neurology hall of fame

World Cup fever is here. All across the NHS, World Cup sweepstakes are beginning, and wards are wondering whether they can get away with sticking England’s games on the telly. 

The On-Call team thought we’d do something quite unpatriotic in these moments when we are meant to be rallying behind the three lions and shed some light on how one country (perhaps unlike any other) birthed a medical speciality.

France has long been one of the intellectual capitals of the world. The French gifted the world many marvels, from its cheeses, Louis Pasteur's finding vaccines for just about everything, and Zinedine Zidane’s right foot. Amongst these gifts was a foundation role in developing modern neurology and neuroscience.

Some of the most important contributions to neurology were made in French Hospitals and academic institutions. And they were keen to let the world know about them by plastering their names everywhere: Georges Gilles de la Tourette, Charles-Édouard Brown-Séquard, Jean-Martin Charcot, Georges Guillain, Jean Alexandre Barré, to name a few. Even the notable pole Joseph Babinski knew his neurology career wouldn’t fully take off without joining the French Academy.

France’s Cerebral Love Affair

Why did our French colleagues have such an affinity for the brain? It’s hard to pinpoint a specific reason. Perhaps we can start with the creation of the world-renowned Salpêtrière Hospital, which started as a store of gunpowder and transitioned to the birthplace of clinical neurology. Or perhaps intellectual heavyweights that had come before, such as Jean-Martin Charcot, inspired future generations.

Charcot is to neurology what Leo Messi is to football. Like that Consultant we all know who picks up murmurs before the stethoscope is barely on the chest, Charcot was an excellent observer of clinical signs and used his love of art to sketch his patients. 

There was no ward round at the Salpêtrière when Charcot was performing his clinical duties. Instead, patients were brought to him, as he asked them to perform a movement or to speak. Far from being a neurologist who loved using a tendon hammer, he would famously ask his assistants to test the patient’s reflexes whilst he sketched what he saw. These sketches led to Charcot discovering a link between these clinical signs and neuroanatomical findings on autopsy. His Tuesday grand round teaching sessions led to one of the most iconic scenes in the artistic history of medicine.

There it is. One of the best-known pieces in the history of medicine. Charcot is doing his Tuesday grand round, surrounded by the heavyweights of neurology.

Just look at poor Joseph Babinski, who’s been given the task of holding up our patient. Compare it to your trust’s grand round and ask how times have changed. Well, for a start, the attendance percentages look a tad higher than what we are used to, and I can’t see any free lunch on the surrounding benches.

Our patient, Marie Wittman, was said to be suffering from the archaic medical term hysteria, which describes involuntary physical or sensory symptoms with no identifiable organic cause. Hysteria had existed since ancient times, when it was attributed to a “wandering womb”, but Charcot brought us further along by studying it as a neurological and psychological condition. Of course, the term has been abandoned today due to its stigmatising roots and historic dismissal of women’s pain.

“Working as a trauma surgeon has really made me realise how truly random life can be. Sometimes the worst things happen to the best people.”

“As England prepares to face Mexico in the Azteca, a big thank you to our prime minister from a doctor working ED Nights on the night pubs have been kept open till 5 am.”

“One of the general surgery registrars I’m working with has a weird way of asking if the patient has opened their bowels on the ward round. Have a read and see what you think: ‘Are you having any action from the back-end?’”

“It’s a Sunday evening, and I don’t mind igniting a war. I want to say that I strongly believe that in medicine, deciles matter, academic rigour matters, being book smart matters, and knowing anatomy, physiology and other basic sciences matter. Are they the only things that matter? Of course not. But I see a worrying number of people pushing the narrative that these things are trivial in creating a good doctor. Let’s just say if I needed treatment and I could pick between a doctor who had all of the above and one that didn’t, I know who I’m picking without a second thought.”

“Reached the 16th point on my colleagues’ plan, and it reads ‘replace electrolytes if low’. Well, thank god for that proclamation; otherwise, I would have left the low electrolytes as they were.”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

Shoutout to our colleagues in the Wessex Deanery. They are the first deanery to offer a newly established single accreditation programme in General Internal Medicine (GIM). This leads to a CCT in GIM after just three years following the completion of your IMT years. Now, some want to be dual-trained, but we can imagine there are plenty of hospitals and particularly DGH’s that would find an individual who can run their general medicine wards without having to have time away to do sub-speciality clinics very appealing.

Wesleyan has a Health Risk Calculator that tells you your likelihood of illness, injury or death before retirement age. You may hate us for adding this to the newsletter, but if we have made you think about these things, then it’s a success.

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The Three Horsemen of Forgotten-About Financial Necessities

ISAs this and pensions that. Forget all that for a minute.

Your biggest asset is your ability to practice medicine as a doctor. So we need to protect it.

For a group of people who see sickness and ill-health every single day and witness how little disease discriminates, doctors are surprisingly awful at thinking about this stuff. This information becomes even more important if you have financial obligations like a mortgage or dependents such as children.

Before we jump in, it is worth laying out the facts on the table. Current NHS sick pay is six months of full pay and a further six months of half pay, which kicks in after five years of service. So who are the three horsemen of ‘financial-things-doctors-try-not-to-think-about’…

A few things to consider when arranging your protection.

First, you should look for own-occupation cover, particularly if you're a surgeon or perform procedures. This means the policy pays out if you're unable to carry out the specific duties of your role, rather than deciding you're fit enough to do some other type of work instead.

Without it, you could find yourself in the slightly absurd position of being an orthopaedic surgeon who can no longer operate, but being told you're still capable of working at a desk, and therefore don't qualify for a payout.

So sit down, think about your unique scenario. How old are you? Do you have dependents? Do you have a mortgage? The best person to speak to is an independent financial advisor who can walk you through all the products across the market.