I hate this time of year. It’s not that it’s the end of the summer holidays (we have had neither a summer nor a holiday this year). Rather, the return to school heralds another spike in infectious illness. R only has a cold but this has meant 5 ambulances in the last week alone. Unfortunately, August is also the month when the new junior doctors join the NHS*.
You can understand my frustration: I have spent 6 months (since the last rotation) training up the doctors on R’s behalf only to be presented once again with new ones. I may lack a medical degree but I have put in more hours in hospital wards, clinics and emergency departments than any of these fresh-faced neophytes. And while my expertise begins and ends with R, expert I surely am. My efforts have not gone unnoticed. On a recent admission, the examining doctor told me, amused, that she had been advised to “just do whatever mum tells you to do”.
To be fair, since the children’s hospital went “paperless”, things have improved. The junior doctors can access R’s recent discharge letters – and google Rett syndrome – before examining her. The best of these junior doctors realise that, even armed with the Wikipedia page on Rett, there is no shame in asking for more detail – generalisations can easily become unhelpful stereotypes. Too many of the young doctors that we saw in the past attempted to bluff their way through. (Paramedics, in my experience, never bluff and always ask for an explanation. Moreover, when we meet the same team again, as has happened more than once, they remember.)
If it were just the junior doctors who rotated, it wouldn’t be so bad but we are also faced with a raft of new GP registrars, who have never met R and don’t appreciate how complicated she is. Quite a number of these have no paediatric experience and, worse, have forgotten rule number 1 of paediatrics – listen to mother.
I found one new registrar particularly frustrating this weekend. We were not communicating well. When I asked “Have you spoken with the on-call neurologist about giving R medication for the cluster?” he was apparently unaware that the correct answer to this question is: “Yes” and the only acceptable alternative is “No, but I’ll get in touch directly”. Instead he replied “No. That’s not necessary at this point. I’ll monitor R for another four hours to establish whether she is really having a cluster of seizures”. (Four hours later, she was admitted following further seizures – in other words, she was having a cluster).
His junior colleague, however, had caught my drift. About 15 minutes later, she returned and whispered, conspiratorially, that she had spoken with neurology. I have high hopes for this one.
*Even with the technology available in medical schools today, it is still the case that a lot of learning takes place on the job. I understand this and, as someone whose veins are probably visible from space, invite any first year junior doctor to practice inserting a cannula on me. I just prefer them not to practice on R. (Very few junior doctors, I find, introduce themselves as such. The clues are in code on their name badges. I googled the abbreviations after a particularly harrowing experience where an FY1 (Foundation Year 1) was so focused on inserting the cannula that he completely failed to notice that R had stopped breathing.)