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.

[merrymouse]

Of course, you could ban all female doctors, and you still wouldn't be able to fill every hospital with Lancelotte Spratts.

Rather inconveniently, wives have all sorts of jobs these days and cannot be relied upon to provide child care and warmed slippers at the end of the day.

[InionEile]

If the problem is the junior doctors' unwillingness to work longer hours under the suggested changes, then why would that be the fault of women with families? Most junior doctors - I am guessing - are between 24-30 years of age? Only about 60% of college educated women have children and most who do wait until they are 30+ so doctors under 30 working limited hours is only tangentially linked to the issue of women working flexible hours for family reasons. Nice way to confuse the two issues and blame the feminists though.

[LadyStoicIsBack]

Inion The guess is wrong I'm afraid (not tho for one second do I concur with Lawson's nuts view)

A junior doctor is ANY doctor who is not yet a consultant, so not the 'junior' that the junior doctor misnomer implies.

They are the people who take your appendix out; the ones in A&E that see your child; the list is bloody endless. And do I want an over-worked and over-tired doctor performing surgery on me or my DC? No I fucking don't.

I want one who is recompensed properly and not operating at near exhaustion levels, and I don't give a flying fuck if they have a willy; tits; or indeed both!

Lawson is an A-grade twat IMHO...

[Nottsmove16]

It wouldn't be uncommon to be a junior doctor until becoming a consultant at 37-38 yrs old.

[EdYouKateShaun]

I would rather be seen by a doctor / nurse midwife / dentist who works part-time (male, female, parent or not) and enjoys a more satisfying work-life balance than any of the above working full-time and frazzled.

[BoboChic]

It isn't in anyone's interest to have doctors who are routinely frazzled from overwork, but it isn't economically viable to train large numbers of doctors who will spend a significant part of their careers as part-timers.

[ChristineDePisan]

I agree with both EdYou and Bobo. But these things have a cost. If we think that the protections that women enjoy in other professions eg to take a year on maternity leave and request flexible working should be extended to those working in the NHS (and I think that is the right thing to do!) then we also have to acknowledge that there is a cost and impact of this. Sometimes it is the UK taxpayer who picks up this cost, rather than just private business.

I don't think we should pretend that there is no impact from the increasing number of part-time workers (whether that is a 40 hour "part time" week or otherwise), but we can also say that we are happy with it and look to the Government to conclude negotiations with the BMA in a sensible way

[treetrowle]

I work for a commercial organisation (everyone uses it and knows it ) and we like our hours flexible as possible (for men and women).

not because it's PC or fluffy but because it actually makes sense and because it attracts the best and most intelligent people and they tend to be the most innovative and productive (and yes our company performance reflects that).

the modern family has changed - it's no longer one breadwinner and one little woman.

any sensible organisation must reflect that for its employees, or die.

One senses the self-loathing and that Lawson only got his role as a pathetic serial opinion-spouter because of his family connections, unlike the many doctors who got their roles through hard work and commitment (and some even have those vagina things too).

(incidentally, why is it always whiny little men who have never served in the military or worked as a doctor who have strong opinions on both the armed forces and the NHS?

"if i was in the nhs this is what i would do" .

Sorry pal, you're not though, you're just a pathetic middle-aged little hack behind a laptop screen, although I am sure when you need treatment some "lady doc" will be happy to indulge you)

#supportourdocs

[Want2bSupermum]

I posted on the other thread and think we have a huge issue with poor leadership and underfunding.

There is a small increase in cost by having PT employees but that is borne by universities who qualify doctors and by medics themselves who earn less while having to pay for the same training etc. There is no excuse and the article shows how desperate our politicians are to dismantle the current system.

[mamadoc]

There is so much wrong with this opinion I hardly know where to start.
It's not so much that it's offensive to women Drs it's offensive to all women.

Plus it is really old news. I had a blazing row with a male consultant about the 'feminisation' of medicine 10 years ago based on a comment by Dame Mary Black I think. I called him out on his twattish views and got told not to speak to him like that if I want to get on.

Newsflash: working part time is not just for women in the 21st century. Family responsibilities should be shared and I think that the new ability to share parental leave is a big step towards a much more equal division of labour. Increasingly my male colleagues are taking that up and both working 3 or 4 days is starting to be normal. Which is exactly how it should be.

Many Drs are married to other Drs ie they both have similar career prospects, earning power and skills to give the NHS. Exactly why should it be the female dr who makes sacrifices to bring up DC is very unclear to me.

We don't need to stop these terrible women infiltrating the bastions of male power we need to make things equal and let everyone work part time if they want to. We can fill the gaps by the simple expedient of training more Drs. There is plenty of demand. It's just that the government caps places artificially.

[BoreOfWhabylon]

I've been a nurse for 40+ years. I remember the days of the Lancelot Spratts only too well.

The femnisation of the medical profession is the best thing that could have happened to it. It humanised it.

[BoreOfWhabylon]

i

[BeaufortBelle]

Interesting you speak of equality mamadoc. Does that explain why so many doctors I meet walk in and say hello Mary, I'm Dr Bloggs. Equality my foot. If the average medic cared a jot about equality they'd walk in and say hello Mrs Belle, I'm Dr Jack Boggs. They are always so taken aback when I extend a hand, smile and say how nice to meet you Dr Bloggs, I'm Mrs Belle. Do they not teach about treating other humans as equals rather than subordinates at med school. Serious question by the way.

[Want2bSupermum]

Here in the US I'm always addressed as Mrs and it's only because I am friends with my obn that we call each other first names.

I'm in accounting, at big4 and it's interesting that salaries have stagnated for the past decade while the number of women has increased dramatically. Now men are in 'finance' which is better paid.

As for working hours, I don't think it is healthy for any doctor to work 70 hours a week over a sustained period. I think a cap of 50 hours a week is about right along with all hospitals having 24/7 childcare facilities for their employees and patients. They do it here at my local hospital and I think its a wonderful addition.

[ABetaDad1]

Beaufort - are you a surgeon and hence expect to be called Mrs?

I believe in normal conversation a Dr is always called 'Dr xyz' as correct form but it depends on where you work and the relationship between 'Dr' professionals and other employees. Do female 'Drs' say 'hello Mary' as well.

Drs I meet are usually terribly conscious of their status and people around them - in both a good and bad way.

BoreofWhabyLon - I happened to hear on TV this morning that a shop manageress in Greggs was on an annual salary of £20k. I read last week on the 'Junior Dr' thread a newly qualified junior Dr is on a basic salary of £22k before extra payments but undoubtedly works longer hours.

That I think is the measure of how far junior Dr status has declined.

I agree about the 'Lancelot Spratt' issue but feminisation all too often comes with lower pay and status.

[BeaufortBelle]

Of course I'm not a surgeon but if someone addresses me by my first name I don't expect them to expect me to use their title. Dr Bloggs/Mrs Belle, Jack/Mary. Same if the doctor is female. It's an equality issue. If a doctor wants my respect I expect to be afforded the same courtesy or at least asked if my first name may be used. And if the doctor doesn't want theirs used then no, they may not use mine because I am not their subordinate. Casual mores work both ways. The doctor is not my friend and therefore they should not assume they may address me informally - it is, is it not a professional relationship.

[ABetaDad1]

Beaufort - sorry I was trying to work out the social context of where you get called 'Mary and they get called 'Dr xyz''.

If the 'Drs' are assuming that because you are a woman you are an office junior when in fact you are a 'surgeon' that is very bad form and I suspect that happens a lot.

On the other hand, if you are a patient I would always expect them to call you Mrs out of politeness and recognition of the Dr patient relationship. I think it would be presumptuous to use first names.

If you work at a GP surgery I think the convention is usually the Drs' get called 'Dr xyz', but everyone else gets called by their first name. That's what happens at mine between staff when talking to each other.

Are you an NHS manager? Not sure what the convention is in those circumstances. Do male managers who are not 'Dr' also get called by their first name in the same social context as you or is only women that get called by their first name?

[BeaufortBelle]

I'm talking about the patient doctor relationship where I am the patient. I have seen three doctors this week. One a&e Dr, one registrar and one GP. Both hospital doctors used my first name, telling me they were Dr something. The GP used my first name, had Dr x on the door and the staff referred to him as Dr x. I don't k ow what his first name is. It's a genuine question, why do doctors and their staff feel it's,appropriate to address patients as subordinates in what should be a professional relationship. I think it's quite important in the context of equality within the NHS culture. I am a patient, being a patient does not make me subordinate to a doctor - neither does it make me superior by the way. Why does a nurse refer to Dr x when talking about them but refer to the patient by first name or without a title. Do nurses think patients are less important than doctors? How much does the NHS spend on equality and diversity and yet all this goes on?

[Treats]

I'm not in the NHS but it always frustrates me that p/t working is demonised (by men, usually) as a Bad Thing and Expensive. In my own career, it's often worked out very well, because my employers got to have someone taking 100% responsibility for a specific and specialised area of work while only having to pay 80% for it. This was when I was head of finance at a small business, working 4 days.

Part time working might create a bit of a headache wrt scheduling, but it can be a lot more flexible. If there are two people working 20 hours a week, instead of one working 40, then you don't need to have everything screeching to a halt when that one goes on holiday. Even better, one or both might be able to increase their hours in the short term when things are hectic - in-built additional capacity.

There's lots of examples of p/t working being a benefit and it's about time we all started talking about it instead of allowing these myths to proliferate.

More power to the #ladydocs.

[madsaz76]

beaufortbelle you are right to ask to me referred to as Mrs if that is what you want.

There's a lot of role confusion in the NHS. I always introduce myself as "hi I'm Mad Saz, one of the consultants " - about 30% of patients will at some point then call me nurse or ask when the doctor is coming. If I am really on a roll they a dress themselves to the male medical student who is about 18 years younger than me.

I always introduce the whole team and try to explain their role too - I feel uncomfortable with people randomly standing around and patents not knowing who is who.

Generally people are very respectful. I always start with Mrs Smith and change if I am asked to "call me Ethel".

However doctors introducing themselves as Dr X isn't neccessarily about equality but more the way they have ended up doing it to try and avoid confusion. It's really difficult.

I would generally say that doctors are generally nicer than they were when I first qualified and some have further to go than others. My first job was an old school 1 in 4 on call wih some 100+ hour weeks.

I was so exhausted I would walk into stationary objects and had total compassion fatigue. I reckon there several patients I was probably uncaring, indifferent or unpleasant too. I hated my job and hated myself.

The changes to pay with the penalties around hours saved me and many others. I've worked full time and still long hours for 16 years and delayed my family because I was worried about not being here for my kids.

I now work 1 in 8 weekends (and about 52 hours a week ). It's really dissapointing to me to find that I delayed till I felt I could do motherhood some justice only to be told that:

A) I'm not doing enough weekends so the slight advantage of waiting potentially being taken away
B) it was actually bloody hard to conceive at this age - essentially I nearly totally Cocked up and put career in front of my life
C) the NHS failures are apparently my fault for being female despite working as hard as anyone else for years

One thing I dislike is people trotting out other issues with the NHS when an issue like this is raised. We know too well across the NHS bad stuff happens but it's jot the fault of juniors doctors or women.

I put a lot of time into improvement - I'm a CQC specialist advisor and have worked with major organisations about communication, safety and improvement. But I don't want to be accused of being the problem when I am working so hard to try and improve against the odds.

DH wants to move to new zealand. Right now the only thing that stops me is my 92 year old father. I need to be here for him but it's for him and others like him that I believe in an NHS even when misogynistic idiots and government officials wih privatisation agendas attack it.

[BoboChic]

I too am puzzled by the NHS convention of addressing hospital patients (inpatients or outpatients) by their first names when consultants introduce themselves with their surnames. Here in France doctors call me "Madame" which is easy and inoffensive.

[Want2bSupermum]

My main issue with the NHS is the waste. I just called my Dads GP surgery. He never tells them what's going on so I call up to tell them. New process is that I now book a telephone consult with the GP. It's a waste of the GPs time. I'm only going to tell the GP what I told the receptionist so write it on a note and stick it on their file. I don't want to discuss my fathers health as that's between him and the doctor. It's stupid mismanagement like this that makes a doctors day longer and wastes lots of money.

[BeaufortBelle]

Madsaz, don't get me wrong, I don't mind my first name being used but I expect to be addressed as equal to any person who works in the NHS.

Want2BSupermum. I wouldn't phone them, I'd write a short letter, proof of delivery and keep a copy. Quicker for you and them and you have proof it's been done.

You sound marvellous btw and I don't think the criticisms about part-time working are aimed at people like you.

It I difficult, however, to listen to doctors complaining about the fairness of the new contract in isolation when such outrage hadn't been heard from medics about issues that directly affect patients.

My experiences of the NHS are largely limited to my own family but it is a concern that it is so hit and miss. I reckon over the last 35 years as an independent adult there had been poor care for every episode of excellent care. 21 years ago every midwife whinged that they were overworked and under paid. It's hard for the public to tell what is the truth or otherwise. From my perspective though, I think the public was treated with more respect, especially by nurses and other staff a few generations ago. I can't imagine nurses calling my grandparents anything other than Mr and Mrs.

We also have a home in France and from my limited experience public health care is delivered there to a much higher standard, not least from a pastoral perspective if that is the right word to use. It is just less "right on" and more respectful. When privatisation is mooted it is always the U.S. That is mooted but there is much to be learnt from the Continent.

[BeaufortBelle]

Apols for all the typos

[mamadoc]

I can't speak for everyone but I 100% refer to my patients as Mr/Mrs/Mrs x and to myself as dr y unless invited by them to do otherwise (some people ask to be called by their first name).

I do not encourage patients to use my 1st name but I don't see this as in any way snobbery or pulling rank just a signal of a professional not personal interaction eg I refer to my daughters teacher as Mrs x and I expect her to do likewise.