• New Tricks? 28 November 2016 | View comments

  • 28th November 2016 | By David Jolley

    David Oliver is worrying this week about the loss of older doctors from the NHS workforce. It is a question of numbers, the need for someone to do the work, but also a matter of experience and maybe even wisdom.

    He makes reference to his father’s experience, and the family’s, as he worked first as a general psychiatrist and then psychogeriatician in a nonteaching hospital service in the North West from the 1970s. Some clues there about workload and personal and family stress in the changing culture of the NHS.

    The responses to David Oliver’s appeal for ideas on how we might do better make interesting reading. The first seven include two from psychiatrists and one each from a Gp who became a medical escort, a hepatologist, a paediatric specialist, an ophthalmologist ad an occupational health doctor. Their current addresses span Australia x 2, USA, Dubai, Indonesia and the UK x 2. There is only one woman. So these are not the usual suspects of people who have spent their careers locked into the routines of healthcare in the UK. Nevertheless their comments are worth more than a second thought.

    Injury or ill health required some to change course and find a different and better balance between work and life via a different specialty and or part-time work. This they have found sustaining.

    Giving up administrative responsibilities and concentrating on clinical work has been life saving for some. For another the responsibilities of singlehanded practice eventually became too much and a shift to employee status in a travel setting has been refreshing. There are reminders that loss of older doctors is not a phenomenon seen elsewhere, Australia and Scandinavia being cited. Maybe there are lessons to be learned.

    The onerous requirements of revalidation, particularly as applied to part-timers, together with its absurd focus on activities which are seen to be barely relevant is ‘the last straw’ for some. ‘Unhelpful’, ‘disproportionate’, ‘expensive’, ‘ineffective’.

    There is something too, about the person who comes into the work. The oldest of the seven, still ‘at the crease’ in his 80s has practised in Asia, Europe, Africa and the USA. ‘Never a dull moment’. He is sustained by meditation, the gym and cricket! Work life balance and an undeterred appetite for sure!

    Although David Oliver points out that older doctors are more likely than younger doctors to be subject of complaints, I think the encouragement to find a way which benefits the workforce numbers and extends the satisfaction of individual doctors must be worthwhile. Carrying the well-tried values of the past and questioning the dictum that all that is modern is good, is a healthy contribution to the mix. Addressing older people as ‘one of us’, rather than ‘them’ seems to me to add to insights and to make communications more comfortable and close to what is meaningful.

    My summary thoughts are:

    • Take account of qualities at recruitment. ·
    • Take an interest in people from the start and let them feel part of something worthwhile which is for the long-term. ·
    • Look after them throughout, making time and space to nurture and appreciate their creativity. ·
    • Make it possible and financially feasible, if not advantageous, to reduce hours and change the emphasis and balance of work to other aspects of life from the mid-fifties onwards, if that is what individuals want to do.
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