Guest post: "Actually, the problem with the NHS is NOT women doctors"

[MumsnetGuestPosts]

It takes a brave – or exceptionally healthy – individual to incur the wrath of over half the country's 180,000 doctors. So Dominic Lawson must have a heart of oak and cojones of steel to have broken in yesterday's Sunday Times the shock revelation that the real cause of the NHS junior doctor crisis is… oestrogen.

That's right. The reason that the NHS is in crisis is the insidious creeping into medical life of ovaries, malign and deadly. No branch of medicine is safe from women and their priorities. Operations are known to have been halted - with the patient actually on the table - when the female surgeon breaks a nail. Chest compressions are being terminated mid-cardiac arrest when the junior doctor thinks her brow has started to glisten unbecomingly. And, perhaps most alarmingly of all, every Boxing Day for the last 10 years, in-hospital mortality rates have soared by 11% as female doctors desert their patients in droves, in pursuit of cheap shoes in the January sales.

Small wonder, as Mr Lawson reveals, a hidden debate is "raging" within the medical profession about this grossly irresponsible "feminisation of medicine". The underlying cause of last week's strike by junior doctors is not, it turns out, chronic NHS underfunding or inadequate workforce planning. No, it's the women like me who are firstly flooding our medical schools, then popping out babies with impunity, and finally abandoning our patients for a lazy part-timer's life.

Once upon a time, all doctors were men. That changed in 1876 when the law was changed to prohibit the exclusion of women from medical schools and universities. One hundred and forty years later, female doctors have outnumbered men for around two decades. Yet certain commentators from both within and outside the medical establishment still seem wedded to a 1950s view of the workplace in which women should jolly well know their place. They point to the one in five unfilled places in paediatrics, blaming women who work-part time for those gaps. And now they claim the fundamental reason underlying the junior doctors' position is the fact that the women amongst us are reluctant to disrupt our precious family lives by working at the weekend.

Luckily, Lawson's piece ignited Twitter in satirical outrage, and my hashtag, #likealadydoc, immediately went viral with tweets such as these:

'I know how to use gas on the HOB and on a patient in an ANAESTHETIC #likealadydoc #juniordoctors' - @WardyHannah87

'I don't run to cardiac arrests, in case I break a heel. #likealadydoc'‬ - @sbattrawden

'Frying-pan in one hand, bone saw in the other. #likealadydoc'‬ - @roshanaMN

Beneath the scorn, of course, is a serious point. To deliberately conflate, as Lawson appears to, the increase in numbers of female doctors with the medical profession's near-unanimous opposition to an unsafe, unfair new junior contract is as sly as it is inaccurate. I'm far from hostile to weekend working, already spending one in four weekends at the hospital. Nevertheless, I object to the pretence that we can magically provide new 'truly seven day' weekend services without a corresponding increase in the number of doctors. Making us work longer and harder to fulfill an election manifesto pledge might be an attractively cheap alternative - but it's downright dangerous for my patients.

And, to paraphrase a former Prime Minister, when it comes to my patients' safety, this #ladydoc is not, and never will be, for turning.

[YoungGirlGrowingOld]

Sorry for typos, sausage fingers and no glasses!

[YoungGirlGrowingOld]

Beaufort - I agree actually. Never thought of it in that way before, but it does seem to be part of the "run along now and be grateful you have (ahem) free healthcare and don't complain" approach that I am sure we have all one across. It is paternalistic and encourages deference, eve where it is undeserved.

[HashTagYesYes]

I am a doctor and I always refer to/introduce myself by my first name. So do most of my colleagues especially the female ones I would say.

[BeaufortBelle]

Well they all ignored my post about the BMA calling off the next strike

I don't think it is a derail really because it's less about titles than it is about equality. Equality should underpin the NHS but this is overshadowed by the continuous subordination of the patient to and by doctors in particular. Every time a nurse uses my first name and refers to my doctor using a title it is implied the patient is less important. It should either be first names for all or titles for all - never a mixture.

If women doctors don't feel equal in the NHS they ought jolly well to ensure women generally are treated in a way that affords them equality with every single,NHS employee. Let's try not to forget that the NHS is only free at the point of delivery and much of its power exists because of the misnomer that the funding public should be grateful for it. Why? I'd much prefer a professional rather than a paternalistic relationship with my health provider. Nothing I've ever received from the NHS has ever been provided free of charge but the balance of power is skewed. If I was paying at the point of delivery I would have a voice and management would have to respond.

[YoungGirlGrowingOld]

Beaufort I agree with you about terminology. I don't think informality should be assumed. I had a bizarre appointment at my husband's hospital the other day where a nurse said to another nurse "YoungGirl is Mrs Dr GrowingOld". Meaning "this patient is married to one of the consultants so don't fuck up" I suppose. Why not just say I was his wife? Why is it even relevant?

Anyway will stop derailing the thread...

[herecomesthsun]

well no, I think it is the role I am wanting to get across.

[BeaufortBelle]

I am your doctor, Jane Smith. How can that be misunderstood.

The confusion point is very interesting and it would be helpful I all the people in the variety of nurse style uniforms introduced themselves. I am Helen Jones, Nurse practitioner, paediatric nurse. Midwife, staff nurse - or even Healthcare Assistant which is what they invariably are nowadays. I think the role clarity is a concern and a bit of a red herring to be honest x

[herecomesthsun]

Ah right. I am reluctant to say Miss or Mrs because it is not always clear from the GP letter and notes which to use on first meeting and I don't want to offend people. It is I would think very obvious in the waiting room that I am looking to identify a new patient by their full name -It is "Alfred Pocock?" with a rising inflection.

The other thing is that occasionally one gets transgender patients - I do some pre-referral assessments -and sometimes avoiding a sex-related title can even be an advantage.

If I know the patient already then I will say Hello Mr X or Mrs. Y, how are you. Unless the person clearly has wanted first names of course.

I think it also tends to be first names if they are younger and Mr or Mrs if older.

I want to say Dr so and so because I don't wear a white coat and can easily get mistaken for a nurse or other HCP otherwise and I don't want to confuse people. Even if I introduce myself as a doctor, and it is down on the appointment letter that they are seeing a doctor, people still get really confused about which sort of professional they are seeing. Even if I wear a badge.

When I talk to people, if I use their name, I am very liable to check with them how they want to be addressed, and I am fine with them calling me by my 1stname.


If I need to refer to the patient in person or in a letter I will habitually say "this lady" or "this gentleman".

If you introduced yourself as Mrs. Belle I would happliy use that.

Myself I get called various different things as a patient in appointments - Dr, Mrs, either maiden (work) or married name, either of my 2 Christian names, as long as I am getting intelligently planned treatment I am not too bothered.

[RockinHippy]

Unfortunately both my daughter & I have to deal with the NHS often & trust me, in our pretty vast experience, the biggest problems we have hit have been with arrogant MALE doctors who, instantly think they see an over fussy silly little mother & so think they of course are gods & know best. This includes the 2 doctors that missed pneumonia 5 times & the one that no only embarrassed the hell out of DD by discussing her lack breast development openly & loudly in a TV room, completely missing that she had a serious gastric problem & refusing to pass her on to the correct team, but also needed DH to tell him that I wasn't just making her severe artificial additive intolerance up & it's in her bloody medical notes if he bothered to read ALL men & all arrogant sexist arses who needed DH to speak to them before they would listen

[chelseabuns2013]

Dominic Lawson is a dick and speaks on a variety of subjects (climate change being one I'm aware of) without any more authority than coming from the arrogant privilege.

[BeaufortBelle]

I'm posh and over a certain age fishlegs. I'd be delighted to ask you to call me Beau if you introduce yourself as first name, last name. . As I keep trying to say, it's equality I care about.

So, has anyone else heard that the BMA have called off next week's strike due to constructive talks I think ?

[MeirAya]

There's been a (genuinely) massive social media campaign about polite medical self-introductions. A NHS junior ladydoctor (working flexibly because of terminal cancer) started it. #hellomynameis

Lady-doctor obviously.

[Fishlegs]

Beaufort I agree with you.
Personally I usually introduce myself as first name last name unless the patient seems posh or over a certain age , then I use Mr/Mrs for them and Dr for me. I always feel like a twat saying 'I'm Dr Fishlegs', and I like to use the patient's full name to ensure I have the right person.

Agree with whoever said earlier about frequently being mistaken for the nurse even when I have introduced myself as the consultant (although tbf most people are apologetic once I gently remind them!).

[BeaufortBelle]

What a worry for you Want2B. I'd still follow it up with a letter. Presumably your US doctor is also writing. They still might not follow it up sadly, unless he makes an appointment and actually raises It with them.

[merrymouse]

No pesky female doctors here!!

[merrymouse]

adventures he was the chief surgeon in the 50's film "doctor in the house".

[Want2bSupermum]

Beaufort It takes over a week for the letter to get there and the matter is a little more urgent than that because he was diagnosed with COPD while visiting us. He needs to have a treatment plan put in place and he is quite capable of not telling the doctor anything about the diagnosis made here in the US because he doesn't want to cause a fuss. The man can't walk more than 50 meters without having to stop to catch his breath. The doctor here also wants his hips and knees checked. They said he definitely needs both hips replaced but thinks his knees might be ok. I know the hips can wait but the breathing issue needs to be seen to.

[AdventuresOfADentist]

Can someone explain the Lancelot Spratts reference?

[BeaufortBelle]

Why do you not introduce yourself as Dr first name surname if you call your patients as first name surname without the courtesy of a title? I would shake your hand and say "I'm Mrs Belle, how nice to meet you". If you used my first name again I'd probably say "what did you tell me your name is, silly me to have forgotten it".

[herecomesthsun]

I usually say the patient's name (first name, surname) in the waiting room to identify them. Then I say, how do you do, I'm Dr x, I'm the consultant who is seeing you and shake hands.

n conversation I think I would usually use Mr or Mrs y, but would try to avoid being too formal if the patient is a teenager or very street-style in their dress and take on life. Overformality could be a bit off-putting too.

[JessicasRabbit]

To echo what a pp said, is a million times rather see a doctor who works 'part time' than a doctor who is massively overworked. My GP practice has 7 doctors and they all work different hours. That means I can see a doctor anytime between 7.30am and 7.30pm and get (generally) good quality care.

I don't know much about the finance side of the new contract, but I think the potential to increase doctors working hours is scary (as a patient). Of course doctors make mistakes (being human and all that), but surely that would only increase if they're working longer hours and are hence more tired.

[BeaufortBelle]

I agree. But it isn't about society's standards. It's the expectation amongst doctors that they may address the patient informally whilst expecting the patient to adress them formally. If a doctor calls me Beau, I expect him or her to introduce themselves as Jack or Jane. It is simply discourteous to use the patient's first name whilst expecting that patient to use Dr Bloggs. It is an equality issue because I am not subordinate to my doctor/any doctor - nobody is. I call my daughter's form teacher Jane, it's what she prefers; she calls me Beau - we are therefore equal - and treat each other as equal because we are both human beings entitled to mutual respect. I would never call her Jane and expect her to call me Mrs Belle because I would not treat her as my subordinate. I have never had a teacher use my first name and expect me to call them Mr or Mrs and I think you have missed the point there. But you and I would get along because you would call me Mrs Belle, as indeed you should if you expected to be called Dr Mamadoc or even Mrs Mamadoc.

As I have said, twice in the last week a doctor has said "hello Mary, I'm Dr Bloggs". They have both been taken aback when I have said quite charmingly, "hello Dr Bloggs, I am Mrs Belle". Why should they look surprised when it is merely putting down an equality marker because they have overstepped the line and the way they have addressed me has implied they regard me as their subordinate? I don't mean to labour the point but this isn't a familiarity, putting at ease issue, it's about the embedded insubordination of the patient by people who think they are in some way superior to their client. I simply do not understand the entitlement.

If

[mamadoc]

There was recently a thread where people expressed outrage at their children's teacher referring to themselves in person or correspondence as Mr/ Mrs x and many people felt it was silly to use a title, too formal and the teacher should expect parents to use their first name. To me that is awful and I could not bring myself to do it but it seems standards are changing in the NHS and in wider society

[mamadoc]

I think it's a bit of a red herring though really.
People in coffee shops and double glazing salesmen want to refer to me by my first name now. It is just the way society in general is going not an NHS or Dr specific issue.
My patients are generally older and my assumption is that we are all more comfortable with Mrs x and Dr y but some younger patients would find it laughable to be referred to as Ms x and some of my junior colleagues routinely introduce themselves as firstname surname without any title and don't mind patients using their first name. There is no longer any universally correct way to do it as long as you do introduce yourself, clarify what your role is and are polite.

[BeaufortBelle]

Absolutely mamadoc. MNet doctors always say this but it absolutely doesn't happen in real life. I am happy to call a doctor Dr x but not if they call me Beau because it indicates there is no mutual respect. Why does it happen in the NHS. At my local fracture clinic make patients are called in as Mr; women are called by first name, last name. It's outrageous!