Thursday, 8 May 2008

Supernumerary = great responsibility but no power

I was really looking forward to my current post as it was listed as being supernumerary. I thought it would be nice to get some experience in A&E without having too much responsibility for sick patients. I really should have known better and am kicking myself for my naivity now I realise what supernumerary really means in today's NHS.

In theory I am not allowed to discharge any patients without them being reviewed by a senior doctor. This seems like a great idea since I would be the first to admit that I have very limited experience, especially in terms of managing the minor ailments that make up the huge majority of our workload. In practice however this is an absolute nightmare. There are never enough doctors around for this to actually work and I spend an inordinate amount of time trailing around trying to find the registrar so I can discuss whether or not I am allowed to discharge a patient with a broken nail. I just find the whole thing a bit insulting really - there are lots of instances where I don't know what to do with a patient but I would certainly have the common sense to ask and would never discharge someone if I wasn't completely certain it was the right thing to do. The fact that they feel the need to enforce the fact that we can't do anything without a senior review really seems like overkill and implies that we are not capable of knowing our own limitations.

I wouldn't even mind having to have all of my patients reviewed if it wasn't such a battle to get someone else to see them. On numerous occasions I have been on my own in minors because all of the other doctors are with sick patients in majors. It's just completely stupid when you have really simple cases like someone with a UTI or low back pain and you know exactly what to do but aren't allowed to just do your job and send them home. The last time this happened the reg ended up saying that I could just write that they had reviewed the patient in the notes even though they hadn't. This obviously puts them in a difficult situation legally if anything were to go wrong but there really is no other option since the staffing is so horrendous.

I am also not allowed to write prescriptions in minors without them being countersigned by another doctor. I don't understand the rationale behind this at all since I can routinely prescribe morphine etc on a normal drug chart without anyone checking it. It seems like a complete waste of everyone's time for me to have to track down another doctor just so they can countersign my prescription for something like diclofenac or codydramol. The registrars all think it's a complete joke too and have now taken to signing whole piles of blank prescriptions so I can do my work with some illusion of independence.

Working in majors is generally better since I have to spend longer with each patient and therefore see fewer and have to chase seniors to review them fewer times. On a couple of occasions I have been stuck seeing someone really sick on my own in resus though which is extremely scary.

It just feels like whoever thought up the concept of me being supernumerary wanted the best of both worlds. They wanted the safety net of not having F1s discharge anyone or write prescriptions but at the same time didn't want the cost of actually staffing the department properly. I woudn't really mind having no responsibility as it would be a really good opportunity to learn but they need to employ enough doctors so that I'm not having to work independently. On the other hand I also wouldn't mind if they just admitted that I would be doing the same job as an SHO due to understaffing but if this is the case they need to let me have enough power to actually do the job properly.