Friday afternoon disease in the NHS

Re: Friday afternoon disease in the NHS

james herriot lied — Sun, 04 Mar 2012 19:14:56 GMT

What's brown and sticky?

A stick.

Sorry. Just trying to lighten the mood somewhat. (Gets coat and leaves own thread)

Re: Friday afternoon disease in the NHS

bob lehner — Sun, 04 Mar 2012 18:59:12 GMT

[quote user="Julian Earl"]you remember your failures far more easily than your successes, after all[/quote]

I do agree with this.

Clearly veterinary graduates are high - achievers, by definition and 'failure', whatever that may be, can be very wounding. For some people a complaint from a client, or a clinical mistake can fester and eat away at you, growing out of all proportion to its true worth. I know I can remember these sorts of unpleasant things many years later, whilst praise or thanks tend to be rather quickly forgotten.

The reality of working in a 'normal' general practice, with the inevitable constraints of lack of equipment (as compared to the university setting), deficiencies in one's own expertise, lack of professional back-up and frequently the financial limitations imposed by the client on what you can do, may inevitably lead to frustration, self-doubt and disillusion.

Add in long hours and the incessant demand for your services from a clientele who may seem to have excessive expectations and then perhaps appear ungrateful for your efforts and this can inevitably lead to stress and depression (I certainly believe these two do go together) in certain types of personality.

Easy access to lethal drugs and our everyday familiarity with and acceptance of death as being a 'release from suffering' may then have an inevitable and tragic result.

Re: Friday afternoon disease in the NHS

Mark Hedberg — Sun, 04 Mar 2012 18:30:53 GMT

Anecdotally, my sister is working on her masters in psychology, and she says chronic stress is apparently very much linkable to depression. I won't disagree...

Re: Friday afternoon disease in the NHS

plantagenet — Sun, 04 Mar 2012 18:14:09 GMT

I seem to be very stressed at working long hours then very depressed I'm not making a better living!

Re: Friday afternoon disease in the NHS

Robin Grimmer — Sun, 04 Mar 2012 15:30:11 GMT

speaking from personal experience, I used to be stressed and depressed when working long hours with on-call.

That's why I locum now, I don't think I could go back to full-time in general practice.

Re: Friday afternoon disease in the NHS

Julian Earl — Sun, 04 Mar 2012 15:23:06 GMT

[quote user="james herriot lied"]

[quote user="Julian Earl"]

Also, most vets do not work from "8.30 to 7 at least"; surveys show that most vets work around forty eight to fifty hours per week

[/quote]

Agree with your general points there, Julian - but not to be pedantous: wouldn't those two figures come to the same thing? Fifty hours a week, ten hours a day, start at 8.30 and get a half-hour for lunch if you're lucky: seven o'clock finish? I know I do.

[/quote]

Then there are the hours when called out, plus those on some Saturday mornings, maybe Sunday mornings as well. Many practices give staff half-days, or regular days off as well, so counter-balancing the evening and out-of-hours time spent working. My real point is that many, many people work equally long hours as us and they don't have the same suicide casualties that we do.

[quote user="CatherineBoden"]

[quote user="Julian Earl"]

Ithink that if you are really busy, you don't have time to get depressed, you're too busy working. Stressed, yes, but depressed? No, not when you have things to do. Do you really think that people working behind a desk don't get fed up of their job at times as well? That shop assistants don't get annoyed by their customers? No, there must be more to the suicide rate than hours of work and working weekends.

[/quote]

Although stress and depression are two separate problems I would imagine that the two can be quite closely linked. If you are extremely stressed about something then that can lead to depression. And stress isn't just about being busy, I don't think you have to be rushed off your feet to be stressed.[/quote]

Are stress and depression necessarily closely linked? I don't know, I'm not a psychologist but I imagine you can be deopressed without being stressed and vice-versa. The two can go hand in hand I suppose, but perhaps one doesn't have to involve the other.

Anyway, I didn't say stress was just about being busy, far from it, I suggested that it is other factors in the job that lead to stress e.g. failure. In fact, being relatively quiet is as stressful, albeit in a different way, as being over-busy. The easiest is being just busy enough. That's why weekends can be stressful - it's not the work, it's the waiting for the phone to ring that keeps one on edge. I've never met a vet who says otherwise .

Re: Friday afternoon disease in the NHS

CatherineThomas — Sun, 04 Mar 2012 14:54:09 GMT

[quote user="Julian Earl"]

[/quote]

Re: Friday afternoon disease in the NHS

Lorna McHardy — Sun, 04 Mar 2012 14:41:59 GMT

[quote user="Julian Earl"]

All in all, I think it is sole responsibility, the pressure not to get things wrong, and the easy access to pain-free methods that combine to give our profession the highest statistic.

[/quote]

I think that's a reasonable summary of some of the multiple stressors... but ultimately, I think it's a personality thing. My subjective impression is that this profession attracts idealists and perfectionists to a job where idealism shatters on financial constraints and perfection is unattainable by definition in most cases. Therein lies the stress. None of the factors involved are, after all, suicide- or addiction-inducingly stressful by definition or even exclusive to the veterinary world.

Re: Friday afternoon disease in the NHS

james herriot lied — Sun, 04 Mar 2012 13:58:27 GMT

[quote user="Julian Earl"]

Also, most vets do not work from "8.30 to 7 at least"; surveys show that most vets work around forty eight to fifty hours per week

[/quote]

Re: Friday afternoon disease in the NHS

Julian Earl — Sun, 04 Mar 2012 13:31:54 GMT

[quote user="Robin Grimmer"]

[quote user="Lorna McHardy"]

I've never bought the 'vets are used to killing things' argument... it's a complete non sequitur. Access to and knowledge of efficient means I'm sure is a factor, but it applies to doctors as much as vets - and farmers, whose suicide rate is also horribly high. But I don't think it's a major factor, since it isn't that difficult to achieve if you really want to do it even if you've no spare bottles of insulin or lethobarb lying around. I, for instance, have the Forth Bridge within easy reach...

So yes... I'd agree with Wynne that the various aspects of job stress are the main factors that make our rates so much higher than those of the general population.

[/quote]

I agree. I've never bought this argument. And doctors have just as easy access to drugs to OD with. I think the reason for high suicide rate amongst vets is work stress - long hours and that feeling that you are never off duty. Even if you have OOH cover, most vets work 8.30- 7 at least - and sometimes you will get that emergency coming in just before you close. Plus Saturdays and inpatient care. GPs work much shorter hours and have a much greater back up. And GPs don't deal with emergencies. They don't even seem to do minor surgical procedures like they used to.

[/quote]

I think the reason may be stress but not for all of the reasons you suggest. I think that it is a lonely job as a new graduate, both as in working alone, but also the effect of having sole responsibility for one's decisions. In a hospital I would suspect that there are more staff around when things go majorly wrong - CRASH teams, anaesthetists, consultant surgeons and so on. As a vet, there's you, a nurse maybe, and that could be it. Speaking to others, it seems like this type of situation weighs heavily on your conscience when things go pear-shaped - you remember your failures far more easily than your successes, after all.

Also, most vets do not work from "8.30 to 7 at least"; surveys show that most vets work around forty eight to fifty hours per week even if you can be on duty for seventy to eighty. That is another pressure of course, the waiting for the phone to ring, but enough to trigger suicide? I doubt it. Ithink that if you are really busy, you don't have time to get depressed, you're too busy working. Stressed, yes, but depressed? No, not when you have things to do. Do you really think that people working behind a desk don't get fed up of their job at times as well? That shop assistants don't get annoyed by their customers? No, there must be more to the suicide rate than hours of work and working weekends.

All in all, I think it is sole responsibility, the pressure not to get things wrong, and the easy access to pain-free methods that combine to give our profession the highest statistic.

Re: Friday afternoon disease in the NHS

Hanna Bennett — Sun, 04 Mar 2012 13:28:48 GMT

[quote user="Sarah Keir"]

How urgent is urgent? If you were about to drop dead, would you still need to wait a week? If you were a vets' dog would your vet owner wait a week or is it something that must be done now/next day/next week/next available opportunity? Sorry to sound sarcastic but I'm too used to being woken up in the middle of the night with emergency sore ears/diarrhoea....

[/quote]

considering at the time she thought i had subacute appendicitis with an abscess at risk of rupturing i would have thought urgent meant urgent... still i guess there was always a&e if the pain got worse...

Re: Friday afternoon disease in the NHS

James Laidlaw — Sun, 04 Mar 2012 08:54:51 GMT

The vast majority of GP's don't have direct access to drugs like vets do either.

Re: Friday afternoon disease in the NHS

Utlendigur — Sat, 03 Mar 2012 23:09:06 GMT

I don't think it's so much being "used to" euthanasia, more a case of putting a lot of emphasis on quality of life, and euthanasia as an acceptable solution to a poor QOL. Doctors don't have that dilemma, since they are expected to keep a patient alive no matter how atrocious their QOL is. I suspect many vets simply get to the point in a stressful job, exhaustion, lack of support, lack of a life outside work, difficult clients, difficult cases etc where they decide their QOL is too poor to be acceptable, and chose euthanasia as the solution - which, given the knowledge and access to means, is likely to be successful.

Re: Friday afternoon disease in the NHS

Robin Grimmer — Sat, 03 Mar 2012 22:56:29 GMT

[quote user="Lorna McHardy"]

[quote user="Gillian Mostyn"]

Do you really equate increased job stress with increased suicide rate? Don't you think it is more about the fact that vets are 'used to' euthanasia and have a very easy way of achieving it? Most people who have the urge to do themselves in would need to plan it pretty carefully, whereas vets have access to the drugs immediately. Leaving no time for them to have a change of heart....

[/quote]

So yes... I'd agree with Wynne that the various aspects of job stress are the main factors that make our rates so much higher than those of the general population.

[/quote]

Re: Friday afternoon disease in the NHS

Lorna McHardy — Sat, 03 Mar 2012 22:15:27 GMT

[quote user="Gillian Mostyn"]

[/quote]

So yes... I'd agree with Wynne that the various aspects of job stress are the main factors that make our rates so much higher than those of the general population.

Re: Friday afternoon disease in the NHS

Gillian Mostyn — Sat, 03 Mar 2012 21:58:58 GMT

[quote user="Hannah Wynne Richards"]When doctors have a higher suicide rate than veterinary surgeons, then I'll believe that they are under greater stress[/quote]

Re: Friday afternoon disease in the NHS

Robin Grimmer — Sat, 03 Mar 2012 21:33:07 GMT

I had an MRI scan done of my knee last year privately. It was a very swish brand new centre and I was impressed to be told that I would have my scan results within 48 hours. However, I was told that to get my scan results I had to make an appointment to see my consultant, who was booked up for 3 weeks! Needless to say I wasn't very happy and after some pressure they got my consultant to phone me with the results.

Re: Friday afternoon disease in the NHS

Mark Hedberg — Sat, 03 Mar 2012 20:48:38 GMT

Oddly enough, the fact that the NHS is so slow meant that my patients never seemed fussed about waiting 3-4 days for some results! ;)

Re: Friday afternoon disease in the NHS

Gillian Mostyn — Sat, 03 Mar 2012 20:05:18 GMT

yeah - similar story. Went to GP who suspected I was hyperthyroid (resting HR 110, goitre, lost weight etc) and referred me for an urgent appointment with the endocrinologists at the local hospital. He also gave me propranolol just to bring down my HR while I was waiting! My urgent appointment ended up being 6 weeks later! It actually took so long to go through the system - ultrasound scan, endoscopy of vocal cords, blood tests etc - that my subacute thyroiditis started to resolve before they actually got around to medicating me.

I have never had a problem with any of the doctors I have come across - it is the system that lets them down.

Re: Friday afternoon disease in the NHS

Sarah Keir — Sat, 03 Mar 2012 20:03:40 GMT

Re: Friday afternoon disease in the NHS

Hanna Bennett — Sat, 03 Mar 2012 18:51:03 GMT

I had the interesting experience of visiting my GP then being referred for an urgent ultrasound the next day, then having to wait a week for the results to be sent back to my dr for follow up. Then she wanted to book me for an 'urgent' surgical referral, but there were no appts available on the NHS, and even going private I had to wait over a week. Having done so I am now going back into the NHS 48 hrs later for a CT scan and probable surgery... Really reassures you!

Re: Friday afternoon disease in the NHS

Anthony Todd — Sat, 03 Mar 2012 15:42:13 GMT

[quote user="Rachael Winder"]I think unfortunately service is very variable. Personally I and the rest of my family have had nothing but bad experiences with NHS [/quote]

It's just human behaviour. Don't worry about it, all of you, once the latest reform gets through parliament everything remotely connected with human health will be sorted completely; quick, efficient, effective, just perfect!

All that is needed is "reform", nothing to do with people not doing their job at all.

As a total,but parallel, aside we have just done three long legs with a well rated airline and the difference in meal service efficiency and organisation was astounding, same plane, same training, same nationality of staff but what a total difference!

Re: Friday afternoon disease in the NHS

Sarah Keir — Sat, 03 Mar 2012 12:27:37 GMT

I did flush with lots of running water and it bled lots. I was at the GP within 3 hours of it happening (for somehting unrelated) and got augmentin tablets but their script was for 250mg TID so I immediately doubled it. Thing is, at the time I didn't think it was a particularly bad bite But the next morning it was like a banana that wouldn't bend LOL

Re: Friday afternoon disease in the NHS

Gerry Henry — Sat, 03 Mar 2012 11:33:53 GMT

I hope the next time a cat bites you, you 1) flush immediately and thoroughly (be brave) with a fine spreull needle and H2O2 1:8 soln 2) take 1000mgs of synulox and 800mgs of metronidazole daily for 5 days, otherwise ...

Re: Friday afternoon disease in the NHS

Sarah Keir — Sat, 03 Mar 2012 11:21:53 GMT

I've found the medical care in the NHS to be average (the GP) to excellent (my surgeon), however the nursing care is terrible, even third world quality.

Last year a cat bite on a finger led to an infected tendon sheath and therefore a four day stay in hospital and 2 lots of surgery. A&E on a friday morning was very speedy, seen within half an hour, surgery within 4 hours of turing up! However, nursing care was appalling. As I was mobile and only a hand deficient, I had to get elderly ladies on my ward to the toilet/get them water/get nursing help when help button not answered for over half an hour. We had 15minutes to eat our meals which is enough for a greedy pig like me but not for a fragile inappetent old lady; food was barely edible, all microwaved pre-packaged cheap stuff, and not enough for a hungry person. The toilet was filthy and not cleaned all weekend; someone swept the ward but not under the beds. My surgeon was excellent and even allowed me to watch him operate and showed me a new suture pattern (I had local and was high on being starved for 30hours). The follow up physiotherapy was excellent and thorough.

So if I ever end up in hopsital again, heaven forbid, I will make sure my husband is on hand at all times to fix me drinks and food, to help me to the toilet and wash me....