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Three Medic Behaviours That Could Be Hurting the NHS · MSKMag OutLoud

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  Three Medic Behaviours That Could Be Hurting the NHS,
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  written by Glenn O'Humeral.
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  SPEAKER_00: The NHS is under super enormous pressure.
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  SPEAKER_00: Staff are walking,
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  SPEAKER_00: patients are waiting ridiculous amounts of time,
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  SPEAKER_00: and services feel harder to deliver than ever.
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  SPEAKER_00: Why?
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  SPEAKER_00: Not enough funding?
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  SPEAKER_00: Debatable.
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  SPEAKER_00: An aging population?
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  SPEAKER_00: Definitely a contributor.
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  SPEAKER_00: Political decisions that make you want to scream into a pillow?
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  SPEAKER_00: God, yeah.
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  SPEAKER_00: If only we had more doctors, more nurses, more beds, more stuff.
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  SPEAKER_00: But what about how we use the workforce we already have?
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  SPEAKER_00: Billions are funneled into recruitment drives and shiny tech,
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  SPEAKER_00: yet in the shadows,
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  small cultural habits might be quietly draining the system
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  every single day.
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  Now,
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  I'm going to bravely approach one often untouchable topic that
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  needs a wee tickle.
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  SPEAKER_00: Medics are brill, aren't they?
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  SPEAKER_00: Highly trained, hugely valuable, and often super dashing,
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  SPEAKER_00: But as lovely as they are, they shouldn't be untouchable.
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  Now,
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  I've set this up nicely,
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  so let me tentatively whisper that concern of mine.
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  SPEAKER_00: In medicine, there are some patterns of behaviour that go unchallenged.
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  SPEAKER_00: Could they be contributing to the problem?
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  SPEAKER_00: OK, I've said it, so let me see how far my bravery will take me.
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  SPEAKER_00: 1.
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  SPEAKER_00: Clocking in late, leaving early.
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  SPEAKER_00: Picture this.
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  SPEAKER_00: A patient has an 8am appointment.
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  SPEAKER_00: They got up early,
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  SPEAKER_00: skipped breakfast,
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  SPEAKER_00: battled parking,
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  SPEAKER_00: which is as expensive as a weekend in Amsterdam,
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  SPEAKER_00: and arrived on time.
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  SPEAKER_00: By 8.15, they're still waiting.
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  SPEAKER_00: Why?
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  SPEAKER_00: It's the start of the day.
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  Maybe the doc started at 7.30 and one of the first patients was
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  super complicated.
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  SPEAKER_00: Or,
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  SPEAKER_00: takes a bravery pill,
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  maybe it could be because the doc's tennis lesson overran and
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  they've only got to
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  SPEAKER_00: work at 8.10.
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  I'm being jovial,
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  of course,
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  but I'm leaning tentatively towards a serious point.
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  Some docs seem to be stretching things like this,
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  rocking up rather late and leaving early.
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  SPEAKER_00: Maybe it's the odd one or two,
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  SPEAKER_00: but if it's not,
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  SPEAKER_00: do we need to start questioning why it's so easy to be so liberal?
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  SPEAKER_00: And let's be honest, other staff notice.
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  SPEAKER_00: Nurses who have been at handover since 7.55,
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  SPEAKER_00: physios who can't leave until their last patient's safe,
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  SPEAKER_00: junior doctors terrified to leave until the job list is cleared.
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  SPEAKER_00: When seniors slide in at 8.10 or sneak out at 3.30,
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  SPEAKER_00: what does that signal to colleagues and patients?
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  If the public saw how casually we treat 15 minutes at the start
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  of a list,
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  they'd be horrified.
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  It seems that when accountability rests with an operational
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  manager who lacks
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  SPEAKER_00: authority and a consultant lead who might also be a peer,
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  SPEAKER_00: a bit too much flexibility might be on offer.
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  SPEAKER_00: After all, you ain't going to have a go at your golf buddy.
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  SPEAKER_00: I'm not calling for a culture of micromanagement,
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  but I am calling for a system whereby holding people to account
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  is attainable.
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  SPEAKER_00: Two, no accountability for best practice.
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  SPEAKER_00: Variation from best care happens.
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  In fact,
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  I'd argue that it's a good thing,
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  but it shouldn't be like all the fucking time.
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  SPEAKER_00: Subacromial decompressions,
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  SPEAKER_00: SADs,
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  SPEAKER_00: trigger point injections,
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  SPEAKER_00: scopes on NANDs,
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  SPEAKER_00: it's a bit much,
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  SPEAKER_00: isn't it?
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  SPEAKER_00: If I could set a KPI for trauma and orthopedics,
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  SPEAKER_00: it would be the ratio of scopes to NANDs per year,
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  SPEAKER_00: and you'd want to be going for one in a hundred.
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  SPEAKER_00: I joke.
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  SPEAKER_00: I think.
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  SPEAKER_00: I'll mull it over.
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  SPEAKER_00: But I do wonder how much outdated practice like this is costing the NHS.
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  SPEAKER_00: Probably enough to hire an extra nurse for A&E.
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  SPEAKER_00: And it's not just about money.
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  SPEAKER_00: It does suck.
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  SPEAKER_00: Imagine being sat on a pain management waiting list for two years.
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  Two years of losing physical and mental health and the prize at
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  the end is an
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  SPEAKER_00: intervention that barely works.
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  SPEAKER_00: I do have empathy for medics here.
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  SPEAKER_00: I assume that by the time a patient gets to that point,
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  our medical colleagues assume that they've had a great journey
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  of care and maybe
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  SPEAKER_00: through a place of empathy,
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  SPEAKER_00: a Hail Mary is worth it.
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  SPEAKER_00: Did I assume too much there?
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  SPEAKER_00: I'll assume I did.
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  SPEAKER_00: Then there's the impact on the flow of the entire system.
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  SPEAKER_00: Every unnecessary arthroscopy is not just £1,500 down the drain.
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  It is also a patient waiting three months longer for their
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  diagnostic colonoscopy.
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  SPEAKER_00: Opportunity cost is the bit that stinks.
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  SPEAKER_00: Outdated practice isn't neutral.
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  It actively blocks innovation and slows access for those who
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  really need it.
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  SPEAKER_00: So what do we do?
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  Well,
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  what if instead of tracking DNA rates,
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  we openly tracked adherence to best practice?
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  SPEAKER_00: Could transparent national data give managers clarity,
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  SPEAKER_00: patients reassurance,
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  SPEAKER_00: and clinicians stronger feedback loops?
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  SPEAKER_00: Shine light on those blind spots?
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  Give ops leads,
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  commissioners,
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  and the public something to really dwell on?
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  If we put in as much effort to tracking adherence to best
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  practice as we do DNA
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  SPEAKER_00: rates,
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  SPEAKER_00: we might just strike gold.
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  Honestly,
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  the amount of time spent on monitoring DNAs is so incredibly
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  demoralising.
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  Saving an extra four appointments isn't going to make the
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  difference in our mates.
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  Saving an extra four appointments isn't going to make the
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  difference that our mates
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  SPEAKER_00: in the Department for Health seem to think it will.
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  SPEAKER_00: My mate Wes Streeting sitting on top of that tree loves a statement.
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  SPEAKER_00: So here you go, pal.
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  SPEAKER_00: I've sorted it for you.
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  SPEAKER_00: Remember when you were warming up number 10 for Farage?
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  SPEAKER_00: Vomits in own mouths.
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  SPEAKER_00: Three, protecting roles instead of using the workforce we have.
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  My mate we're streeting,
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  sitting at the top of the tree,
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  loves a statement.
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  SPEAKER_00: So here you go, pal, I've sorted it for you.
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  SPEAKER_00: Remember me when you're warming up number 10 for Farage.
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  SPEAKER_00: Vomits in own mouth.
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  SPEAKER_00: 3.
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  SPEAKER_00: Protecting roles instead of using the workforce we have.
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  SPEAKER_00: Does the NHS have a workforce problem?
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  SPEAKER_00: Probably.
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  Could it be less of an issue if a door was open for ACPs,
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  APPs,
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  ANPs to stretch themselves?
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  SPEAKER_00: Like, why aren't ANPs allowed to see spines in emergency departments?
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  SPEAKER_00: Genuinely,
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  SPEAKER_00: I'm asking because at the Mo,
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  SPEAKER_00: I'm worried it's because the docs don't fancy them to do a good job.
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  SPEAKER_00: I hope I'm wrong, but I'm worried I'm not.
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  SPEAKER_00: And why are spines treated like pastry cooking?
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  SPEAKER_00: 90% are dead easy,
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  SPEAKER_00: unlike baking and meal fuel,
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  SPEAKER_00: which is actually really hard to do,
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  SPEAKER_00: as I found out on a really bad date.
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  SPEAKER_00: Other health systems are already embracing this.
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  SPEAKER_00: In the US, ANPs run entire spine triage services.
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  SPEAKER_00: In Australia, physios lead ED fracture clinics.
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  SPEAKER_00: The Netherlands hand advanced practice nurses far more autonomy.
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  SPEAKER_00: And guess what?
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  SPEAKER_00: The sky doesn't fall.
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  SPEAKER_00: If anything,
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  morale improves because otherwise talented professionals who
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  feel boxed in
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  SPEAKER_00: eventually leave,
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  SPEAKER_00: which ironically makes the workforce shortage even worse.
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  SPEAKER_00: Then you've got primary care.
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  Over recent years,
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  I've heard many GPs describing almost unmanageable workloads.
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  SPEAKER_00: I listen to them on social media, in their lunch breaks and on podcasts.
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  What I hear sounds grim,
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  but when I've looked a bit deeper,
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  the same issue lives there too.
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  If you're a service user or a commissioner and your GP practice
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  has a mega grim
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  SPEAKER_00: waiting list,
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  SPEAKER_00: have a browse at how many ANPs or FCPs they have in their practice.
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  SPEAKER_00: It's often not enough.
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  SPEAKER_00: The question I'm asking,
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  SPEAKER_00: I guess,
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  SPEAKER_00: is,
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  SPEAKER_00: are medics,
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  SPEAKER_00: if my suspicion is correct,
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  SPEAKER_00: making things harder for the NHS by protecting territory?
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  SPEAKER_00: Final thought.
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  The NHS doesn't need another leadership framework or an inbox
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  full of wellness emails.
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  SPEAKER_00: It needs accountability,
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  SPEAKER_00: shared responsibility,
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  SPEAKER_00: consequences when behaviours undermine patient care.
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  SPEAKER_00: That means calling out when people rock up late and leave early,
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  SPEAKER_00: refusing to defend outdated procedures that don't work,
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  SPEAKER_00: sharing clinical decisions with the professionals trained to make them.
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  SPEAKER_00: This isn't about undermining doctors,
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  SPEAKER_00: it's about holding everyone to the same professional standard.
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  SPEAKER_00: Because each small behaviour – a late start,
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  SPEAKER_00: a pointless scope,
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  SPEAKER_00: a protected territory – has a ripple effect.
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  It means longer waits,
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  wasted money,
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  burnt out colleagues and real patients missing care.
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  SPEAKER_00: The NHS will not be saved by frameworks or slogans.
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  SPEAKER_00: It will be saved by courage.
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  SPEAKER_00: The courage to have awkward conversations,
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  SPEAKER_00: to challenge behaviours that feel normal,
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  SPEAKER_00: and to share the load across the whole workforce.
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  SPEAKER_00: Medics are a core part of the NHS,
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  SPEAKER_00: but if you're clocking in late and ignoring guidance,
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  SPEAKER_00: you're making things worse.
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  SPEAKER_00: And if that makes you uncomfortable, good, it should.
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  SPEAKER_00: Maybe the real trick is easier than meal fuel.
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  SPEAKER_00: Turn up, use best practice, share the load.
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  So perhaps the real questions are,
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  is there an issue with accountability in medical circles?
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  Why do the NHS governance streams seem apathetic toward
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  scrutinising outdated practice?
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  SPEAKER_00: And seriously, how do you actually make a good meal fuel?