The Five O’Clock Scalpel Drop

Are today’s doctors practicing a vocation or just shift-workers?

Doctors were once committed vocationalists. Now, they’re just shift-workers. That was the case made recently by consultant cardiac surgeon Jullien Gaer who wrote to The Times amidst the resident doctor industrial action, to voice his grievances at the current generation of resident doctors.

He argued that medicine has shifted from a profession filled with young, ambitious professionals, driven by vocation, to one populated by employees whose primary commitment is to the clock. Changes to resident doctor contracts are blamed, citing anecdotes of surgical trainees de-scrubbing and clocking out of theatre mid-case as the clock strikes five, as well as other surgical doctors who have not considered reviewing the relevant imaging before a morning list.

A Change in Time

Where else to start but the obvious rebuttal which states that these stories are anecdotes, and not evidence. Individual stories are not sufficient to prove a profession-wide cultural shift. And whilst logically, this is true, it is hard to argue that contractual changes and workplace reform hasn’t pushed medicine towards shift work and changed attitudes.

For many doctors today, being a doctor will always just be a job, a job that pays the bills and is not worth staying back for overtime if unpaid, especially when it’s a regular occurrence rather than a one-off. Doctors today are searching for a balanced lifestyle and a job that doesn’t come at the expense of personal well-being.

Back in the proverbial ‘good old days’, consultants recall a time where surgeons were expected (often unreasonably) to prioritise the profession above all else. These sacrifices came at a huge personal cost for some, but others argue this fostered deeper immersion and mastery in the job.

Our On-Call readers know how much we love asking for data, but perhaps this statement will have to wait for proof. The true impact of surgeons viewing medicine as a job rather than a vocation will only become clear when the current generation of surgeons put down their scalpels and new consultants take up their place. Only then will we have concrete data to compare these approaches

The Archetypal Surgeon

Can we make a case for Mr Gaer? Few would defend a surgeon leaving a case unfinished simply because their shift has ended but more broadly, we can consider the type of surgeon we would want operating on a loved on. Picture this archetypal figure and then try to describe what this individual looks like?

Many would say that the individual would have, right at the top of their motivations, a sheer love and passion for the profession. A type of passion that is not going to be curtailed by running an hour over the end of a shift. Others may respond by saying these two things are not mutually exclusive, you can still love a career and prioritise a balanced professional and personal life.

However, in a training environment with limited training numbers and competitive bottlenecks, the willingness to give up discretionary time can often translate into greater skill and faster career progression.

But for most of the public, the question is less about ‘rules’ or ‘rights’ but about trust: In a crisis, whose hands would you rather your loved one be in?

It’s Not All About the Pay! The Great Career Choice Debate

A-Level results day is a familiar memory for many of us. Earlier this month, a new generation of bright and ambitious students received results that confirmed their places in medical schools across the country. The decision on what and where to study is often made at such a young age, when few of us are aware of how much these decisions could shape our financial futures.

The recent Department for Education numbers show that Economists have the highest average salary ten years after graduation (£68,600). Closely behind this sits Medicine and Dentistry at £61,000, with Mathematical Sciences in third at £51,500. Before you scroll past in frustration at another salary-by-degree piece, we know pay is not the only factor in choosing a career.

Nassim Nicholas Taleb once said that: “anyone who claims to understand AI, knows nothing about AI”. One thing that we can know for certain however is that the artificial intelligence revolution will change the workplace as we currently know it. Much talk is made of how it will influence healthcare but what about other degrees.

Using the AI occupational Exposure (AIOE) tool, which scores an occupation by how replaceable it is by AI, the highest scores were in Economics, Accounting and finances and mathematical and statistical based jobs. Healthcare based jobs found themselves much lower down the list because of factors such as the procedural elements and the emotional intelligence required.

What is the Price of Freedom When Autonomy Meets Misinformation?

The HPV vaccine crisis reminds us that informed consent requires access to truth, not just the right to choose

Freedom, Liberty, Autonomy… These are values that our society rightly champions. Promoted by thinkers from the time of the enlightenment, these ideals continue to inform both public and health-related policy (and even sneak into our interviews and exams).

But what happens when the autonomy of the individual clashes with the health of the collective? We are facing a vaccination crisis in the UK, with the steepest drop in uptake being for the HPV vaccine despite the irrefutable evidence of its effectiveness, not just in cervical cancer but vulval, penile and head and neck cancers.

HPV has long haunted humankind with its risks that extend far beyond just the textbooks. Over 90% of cervical cancers are caused by HPV with the HPV ‘Gardasil’ vaccine being an extraordinary feat in modern science. It is over 99% effective against the four most dangerous subtypes of HPV and has been constantly monitored for adverse effects and has been deemed to be safe.

Uncomfortable Truths

There remains a moral discomfort about the Human Papilloma Virus (HPV) vaccine which stems from HPV being a sexually transmitted disease. This tempts some to believe that vaccination is a tacit approval of such behaviour. For many parents, the idea that their children have normal sexual urges makes them queasy.

Many religious conservatives fall into this group and generally advocate for abstinence above vaccination, with the fear that young people will become more promiscuous without the ‘fear’ of cervical cancer or genital warts. Despite all the data available on sexually transmitted disease from several countries which suggests that abstinence alone does not work, this group continues to push this line of argumentation.

The numbers may provide us with some insight into how we can best address matters going forward. If we assess vaccination uptake by geographical region, it illuminates some key differences. London has the lowest rate of HPV vaccine uptake with only 60.9% of females and 56.5% of males vaccinated.

Less than 50 miles away in the South East we find the highest vaccination rates in the country with 79.7% of females and 74.2% of males being vaccinated. A study by the BMJ found several factors that influenced vaccine uptake, with lower rates seen in cohorts from disadvantaged socioeconomic backgrounds and among minority ethnic groups, while higher parental education was associated with greater uptake.

Rethinking ‘Free’ Decision Making

Autonomy requires access to the truth. Picture a hypothetical: Imagine I take a patient and control all their access to social media and news. I then feed them pseudoscientific misinformation through these outlets, filtered through algorithms that favour bias and flashy headlines. Finally, I ask the patient to make health decisions based on that information. On the surface, you may say they were ‘free’ to decide, but where is the freedom in this?

If our decisions are based on the information we have access to at any given moment and that access is governed by forces that largely sit out of our control, this notion of free decision-making begins to crumble. We need to rebuild a truth infrastructure as doctors. It will be difficult against these powerful algorithms, but that does not mean we should not try.

It is also correct that vaccine scepticism is not the only reason for this decline. The drop off after the pandemic suggests that some of the population is experiencing a case of ‘vaccine fatigue’. This is not the same as the anti-vax stance, it is instead more of an indifference to public health appeals after the over-exposure during the pandemic - a case of Chris Witty and Boris Johnson’s overload after having them on our televisions for months on end.

Persistent school absences and families moving across boroughs also contribute to children missing vaccinations. We are all too familiar with patients who slip through the cracks and are not followed up within our health service.

Vaccines saves lives. So it is not hyperbolic for the On-Call team to state that countless men and women depend on doctors to challenge misinformation and uphold the evidence.

“Welcome back to NHS Infectious disease 101 and today we address the plastic pinny with the open back. This is of course because NHS bugs are only able to mount an attack from the front”

“Given the success of orthogeris in keeping alive the patients that orthopaedics have operated on, when will the rest of the surgical specialities get to join the party. I am waiting for gensurggeris and ENTgeris”

“Night shift bowel has really affected me this week. Decided to do a bit of googling and alas, it is known that night shifts play havoc with gut function.”

“Is it a posterior circulation stroke or vague ‘dizziness’ - a question I end up tangled in far too many times”

What’s on your mind? Email us!

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

One in Five UK Doctors Considering Leaving, GMC Warns. A concerning report from the General Medical Council finds that 19% of doctors are considering quitting their profession, with 12% actively exploring opportunities abroad. Nearly one-third report being unable to advance their careers, while 43% are researching roles overseas and 15% are already pursuing them. The GMC is urging systemic reforms in training, career progression, and working conditions to stem this exodus.

Recent research by the Independent Healthcare Provider Network tells us that the group most likely to use private healthcare are… 34-44 year olds. Millennials are increasingly expecting private healthcare to be provided by employers, with two-thirds agreeing that “all workplaces should offer private healthcare as part of their employee benefits package”

Oxford Medical School has a new child genius entering their ranks. Mahnoor Cheema achieved 23 A/A* A-level grades and will begin her journey to becoming a doctor later this year. We should feel a sense of pride every time great minds choose our profession… Someone just let the poor girl know not to take it personally when a nurse consultant launches into an unprompted lecture

NHS England recently ‘Named and Shamed’ the three NHS trusts are in dire need of national intervention on all major performance areas. NHS England also published a second list compromising of trusts that will receive management. Read here to find out more.

Weekly Poll

Last week’s poll:

Do you think that every medical graduate deserves a consultant post if they want one?

…and whilst you’re here, can we please take a quick history from you?

Something you’d like to know in our next poll? Let us know!

The Mounjaro Price Spike: Is The UK Paying Its Share?

The weight loss injectable market shifted last week when the US pharmaceutical giant Eli Lilly announced they will raise the UK price of Mounjaro by up to 170% for those wanting to buy it privately.

In the UK, we impose price controls on medicine by first getting NICE to analyse the cost effectiveness of a drug and then having the NHS negotiate a price for the medication at lower rates. It takes millions of pounds to fund the research needed to create new medications and in response to this, the American government has began voicing concerns that Europeans are ‘free-riding’ on American research.

Trump has revived calls for a “most-favoured nation” policy, meaning Americans should not pay more than the lowest global price. If a drug sells for $100 in the UK (due to NHS negotiation) but $300 in the U.S., firms would have to match the lower figure in America. Therefore, companies like Eli Lilly may look at this policy and decide that in order to protect their revenues and research budgets that prices would need to be raised, as we are seeing in the UK.

For those receiving Mounjaro on the NHS, prices will remain unchanged. But if you are sourcing your Mounjaro privately, you may be in for a nasty surprise when you next click checkout.