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Medical professionalism matters

Exploring the real life challenges experienced by today’s medical professionals and providing support that doctors want and need

Making a mess professionally

Chris Kenny is Chief Executive of the MDDUS.

Professionalism to many people means order and discipline. Consistency of approach. Clear rules about what to do and when to do it. Unambiguous ethical standards. Having a tin and doing what it says on it. Who could argue with that?

Well, nobody in theory. It’s just that life is not like that. Mistakes are made. Other people do not react as we expect. Ethical perspectives vary sharply. And, as Donald Rumsfeld famously said, “stuff happens”. So how do professions – and individual professionals – cope in that kind of world?

On the one hand, professions are a force for order. Indeed, much of the responsibility of professions is outsourced to others in a very orderly way. Regulators police the boundary of who can do what to protect the public from unqualified charlatans. They set standards for behaviour within the profession with a similar objective. Medical Defence Organisations protect the public when honest mistakes are made and keep an eye on regulators to make sure that their decisions are made in a rounded and fair, rather than abstract, way. Royal Colleges, the BMA and other representative bodies all communicate in a (more or less) orderly way to make sure that the public understand what to expect and to correct myths and misunderstandings which arise.

But all of that is necessary, rather than sufficient. It doesn’t help individual professionals in their own reflection about what is working well and not so well in their own practice or in coping with the immediate aftermath of an event in which that has, perhaps, been all too visible. Apart from ringing your MDO, what, in short, do you do if you make a mess?

What was clear from the GMC’s seminar on practical ways forward for the profession in Manchester on 12 July is that, when you have made a mess, you seek to make another one – or at least find a mess to go to!

Many participants in the seminar really missed the days of the old Doctors’ Mess, where people could unwind, but also share confidentially their concerns and worries both around issues in general but also around individual patient matters. There was a real sense that all kinds of factors – volume of work, pressure of time, fear of litigation, the sheer physical design of surgeries and hospitals – was getting in the way of that kind of sharing to the detriment of both professionals and patients alike.

I am certainly in no doubt that there needs to be more done to help give people the time to undertake the reflective and developmental role of being a professional. The importance of this has never been more widely recognised, but the difficulty of achieving it has perhaps never been greater.

I’m not certain that the old-fashioned Doctors’ Mess is quite the way to go. Healthcare no longer has that remote officer class and nor should it: breaking down medical students’ sense of exclusivity was another theme of the event. And the idea of a bar on hospital premises, remembered by one participant, is, rightly, long since gone!

But it was interesting how often examples of what you might call messy behaviour were raised at the seminar – the GP who met his peers in a confidential support group once a month, the registrar who convened meetings of all the doctors and nurses in a department on a fortnightly basis for no more than half an hour for critical incident reflection, the “young doctors” group which was still meeting although a couple of its members have now retired… None of these were management-led or even came from senior professional leadership (although perhaps they should have?) But all were addressing that crucial issue of finding time, space and trusted peers.

No doubt there are a lot of other ways of doing it. Maybe there are virtual messes out there in cyberspace (where one hopes confidentiality is always on the agenda). There’s a lot to be said for a diversity of approach, so long as the need is addressed. What seems to unite them is somebody making the effort to set them up, giving people the “cover” to commit the time and effort and keeping what is said in the room – whether literal or metaphorical.

So maybe one of the ways of coping with making a mess is take it to a mess – or make a new one of your own – and realise that you are not alone. And you might even be allowed a drink afterwards, just not on the premises (or if you’re on duty elsewhere)!

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