The Surgical Reg

This week I have started a new job as a Surgical SpR in a Major Trauma Centre. I was assured by my service manager that I had be allocated a two week ‘shadowing’ period, as I am new to the hospital and therefore have no IT access, badge, any idea how the system works or any experience of working in a Major Trauma Centre. He then went on to say that unfortunately due to a rota gap, there would not actually be anyone to shadow and would I mind awfully holding the trauma bleep. I cannot say I was terribly surprised that, as in most new positions in the NHS, I would be starting very much in the deep end. Shortly after this less-than exhaustive induction, the trauma bleep went off for my very first Code Red trauma call. Time to start shadowing myself! As I couldn’t find my way to the Resus Bay from within the hospital, I walked out of the hospital and came back in the patient entrance to A&E from the street. The patient was just being wheeled into Resus by the Air-ambulance doctor at th...

The question of how to choose a subspecialty is an anxiety that has insidiously been creeping into the periphery of my consciousness over the past few months. I am now midway through my ST5 training year, and thoroughly comfortable with my identity as a surgical registrar. Unfortunately, my levels of self-regard have clearly not yet reached sufficiently lofty levels, and I am still utterly unable to imagine myself as a consultant. I am therefore at rather a loss as to how to answer my TPD’s recent enquiries as to my thoughts regarding a subspecialty, and have ignominiously left that particular e-mail unanswered for an unacceptably long time. But this is a big decision! Training feels preposterously long and arduous; but is actually only a trivial 8 years compared to potentially 30 to 40 years of sub-specialist consultant practice! Nonetheless, before the end of training, a declaration must be made as to which of the five sub-specialties is preferred; the major sub-specialties being Bre...

Why does it take so long to train a surgeon? The typical trainee will not finish training until the age of 35-40 years old. I am currently 34, and still have years of moving around the region, jumping through hoops and fighting to get operating time and sign-offs to look forward to. Surgical training is not a comfortable place, and I have not met a single trainee who is content with year after year of no fixed routine, no certainty, constantly moving around, no time for friends and family, difficulties setting up a home, financial worries and concerns about the future. Furthermore, new consultants are now very much  not  expected to be the finished product, and it is anticipated that they will still be learning how to operate and function as a senior surgeon for some time after completion of training! Elsewhere in the world however, surgical training is often much quicker than our minimum of 8 years of surgical training. The Americans for example, despite all of their advanced...

The papers are screaming vociferously about the current crisis in the NHS. People are dying in the back of ambulances whilst stuck in a queue to get inside the hospital, and still more patients are dying on trolleys or chairs in corridors once they get in through the front doors. As a Guardian-reading lefty, I have subsequently been subject to a smorgasbord of sensationalist statistics over the last couple of months. For example, in September 5,025 patients waited for more than 12 hours to be admitted to hospital in England[1]. The figure for October was 7,059 people – the highest number on record apparently[4]! The target that 95% of patients attending A&E should be seen within four hours has also apparently gone out of the window, as they are currently only hitting an unseemly 62%[3]. Furthermore, an estimated 6,097 people in the UK died in 2020-2021 due to the roadblock of A&E delaying their care[4]. The Association of Ambulance Chief Executives also recently weighed in to g...

Since rotating onto this current placement on the first Wednesday in October, I have been rotated only to normal working days. Gone is the previous Rota Master's fickle torture regime of a single night shift followed by a day shift, followed by a night shift madness. Instead, the new Controller of Spreadsheets appears to group on-calls together in a big lump! It all kicks off next week, when I have a week of long days on-calls, followed by a week of nights on-call, followed by weekend of nights, finishing up with a weekend of days on-call!  I have surprised myself with the realisation that I am wholeheartedly looking forward to receiving the bleep on Monday morning?!? Despite the higher possibility of getting a lunch break, the feasibility of using the bathroom when you need to, and the ability to get a decent amount of sleep at night that comes with elective work, I find that I do get tiresomely fatigued with day after day of Multi Disciplinary Team Meetings, ward rounds, outpatie...

The first Wednesday in October. All Change! Change of course, being the one constant in Surgical Training. On this occasion however, on stepping off the merry-go-round, I was most surprised and relieved to discover that I was not to be starting with a night shift in the hospital that I'd never worked in before - miracles never cease to exist!  The HR Department however, held little else back in the way of surprises - it was all very much in line with their usual tried and tested protocol. The On-Call rota of nights and weekends had been sent 2 weeks prior to starting, and was obviously incorrect almost every regard. Having finished work in one NHS hospital just 14 hours earlier, and now a continuous full time NHS employee of 8 years vintage, Occupational Health had now suddenly decided to play their usual charade of finding a reason that I was not fit to work in a hospital somewhere on the exhaustive health questionnaire that they had received 2 months previously. Not to be outdone...

As a surgical trainee, there is always a constant, nagging pressure for numbers, numbers, numbers! Looming ever-present in our subconsciousness is the next stony-faced ARCP panel member peering over the top of their glasses and demanding an explanation for exactly why our numbers are so disappointing. Unfortunately, this pressure can on occasion lead to the rather undignified business of sharking - ie getting involved in an operation that another surgeon feels should be 'theirs' by virtue of the rota, groundwork with the patient or relationship with the consultant. Yesterday I found myself at somewhat of a loose end (not counting my overflowing in-tray of admin paperwork). Thankfully, just as I was about to grudgingly settle in for a session with the dictaphone, I got a call from one of the consultant to say that a cholecystitis patient on the ward was getting a little septic, and he needed someone to book her onto the emergency list for a cholecystectomy. I dr...