The power of invisibility

Having been back at work for a few weeks now, I have worked out a new rule:

The more senior a staff member is, the less likely they are to look through or ignore a person in uniform.

This was particularly shocking for me to experience first-hand, as I went from "doctor" dress one Friday to "uniformed staff" dress on the very next Monday. Suddenly I went from a person who you would look in the eye and smile at on the way past, to being part of the wallpaper.

One thing that I have noticed is that the more senior staff members will still talk to me (without knowing I'm a medical student, although that shouldn't matter) but many of the interns and junior registrars will look straight through me, and one has even rolled her eyes when I show up to do a mobile x-ray. Seriously. She asked me to be there. I was pleasant and professional. She rolled her eyes. Somebody clearly has issues.

I know that this is a generalisation, and there are many junior staff who will talk to everybody they work with. It is just something that I really noticed between one "work" day and the next.

Somewhere over the rainbow . . .

. . .there is a mysterious place that is free of all of the farce and nastiness that goes on in the hospital system.

Sometimes when I am drifting off to sleep at night, I like to imagine this place in my head. It is a special place. Some would even call it magical.

All that glitters is gold. There are unicorns, pixies and elves in the woods on the hospital grounds who are seen by everybody, not just those who have gone for 30 hours without sleep. In the middle of the night they clean and wax your cars and procure you healthy take-away food when the hospital cafe is closed at dinner-time, and surround everybody entering and leaving the hospital with a wondrous cloud of pixie dust and cheerful applause.

When you ask a more senior member of staff a perfectly reasonable question, they look deeply into your eyes, give you an honest, in-depth answer, and then thank you for your hard work and effort. Whenever you turn a corner, you will often see consultants shaking hands with the cleaning staff and wards-people for the tireless work that they do.

The medical students are well-trained, hard-working and prepared for every situation, due to the top-notch training and mentoring that has been invested in them by the staff who have sufficient time set aside each day for this important task. They feel like a valued part of the team, and love coming to the hospital. They look forward to graduating and coming back as interns, knowing that the training that they have received will stand them in good stead to step up to the role ahead of them.

When a patient has just had their life saved and they thank the doctor, the doctor replies, "Thanks, Mr/Mrs Smith, don't just thank me. It was a team effort!"

In the operating theatres, the surgeons and the anaesthetists all get along really well. Everything runs on time, the teams are prefectly co-ordinated, and when there is an emergency case or equipment malfunction, nobody gets angry and attacks the nearest helpless minion. They all just nod, smile and say, "Oh well, these things happen, let's make sure the urgent cases get done first and then we'll take it from there."

The doctors value the nurses, the nurses respect the doctors, and the nurses don't take out their frustrations on everybody else. It is a wonderful place, where everyone who walks through the door knows that it take much more than doctors and nurses to care for patients.

The patients are all seen promptly, treated as individuals and experience excellent care due to the large number of qualified staff allocated to look after them. Nobody ever slips through the cracks.

Nobody ever assumes that psychiatrists are crazy or aren't real doctors. The surgeons go home every night at 5pm to their happy families. The other staff know that anaesthetists do more than sit in the corner and play sodoku, and are applying passive attention as well as working hard behind their drapes and machines. The pathology staff are seen as a valuable part of the team, and everybody comprehends what they do. The radiology department is loved by all, everybody understands that you can't fit three patients into the CT scanner at once no matter how urgent they all are, and people appreciate the valuable skills and years of work that have gone into the expertise of the radiologists.

People understand that certain test results can't be received instantly because of the time required to do them. Everybody knows what all those other people in strange uniforms who aren't doctors or nurses actually do. The small amount of administrative staff who are required are extremely competent and get everybody's pay right the first time.

Usually by this time, I have drifted off into a blissful sleep, where nobody ever throws instruments in rage, yells at me for broken equipment, rolls their eyes when I show up to perform a test that they actually requested or tells everybody (right in front of me) that I am a moron and they could do my job easily when it took me an entire 4-year degree to become qualified. One can only dream . . .

"Suitable ward attire"

I am very happy to be getting away from a profession in which we are required to wear a uniform day in and day out, but this introduces the option of personal taste and preference. Generally making your own mind up can be an area in which some people seem to struggle.

In a recent lecture we were told that we were to look, act and dress the same way as the real doctors in order to fit in and give patients confidence in our ability. Having worked with real doctors for several years, I am not quite sure how to take this. You see, real doctors get it very very wrong as well.

I have seen a young female doctor in a tight designer dress with fishnet stockings and killer heels. In the emergency department. I would have loved to see how she went if all hell broke loose.

I have seen another female consultant wearing a low-cut top and tight leopard-print miniskirt. She could have gotten away with it if she had worn the ensemble once, but it was a regular outfit, clearly in her pile of "workwear". I doubt this would pass for suitable student attire, but you could argue that you were dressing like a real doctor.

The men don't quite seem to get it as wrong as the women, probably because it is hard to get it so incredibly wrong when you get to wear men's clothing. Your average clueless male can get away with a striped collared shirt with navy pants or jeans (on the weekend) and not put anybody offside.

However, I have seen a male doctor running around the hospital with clothes that looked strikingly like the uniform of a male nurse. His pants were the same colour, his shirt was the same colour (although obviously not hospital-issue) and a lot of nurses run around with Littmann steths around their necks these days (as does everybody, it would seem - even the vet students at uni!) so that didn't even make a difference. However, seeing as how most male nurses tend to get mistaken for doctors I doubt it would have caused him any issues.

Milk & Two Sugars has already written a great post on student-wear in the hospitals, so I won't repeat what she has said. However, where we are in the world, a lot of our female doctors run around in business pants and dress shirts that don't need ironing, and for me this is an incredibly attractive option! There is also the issue of the cost of a nice collared shirt for women - the same brand of shirt with the same material for a woman will cost twice as much as the same shirt cut for a man. Not cool.

However, you won't catch me dead wearing a leopard-print skirt or fishnets anywhere, so I think I am pretty safe. Better to concentrated on becoming the best doctor I can be without spending energy fixating on clothing. If I do fixate on clothing, it will be in a happy way. :)

A scary thought

Today I while at work I had a scary thought. I was talking to one of the nurses, and he told me that they "keep the good interns and registrars in the loop and the bad ones out of it" when it comes to many aspects of their treatment of the patients.

While this must make life difficult for the junior doctors who have been perceived and branded as "bad" and may not always be ideal for patient care, my thoughts after hearing it were a little more self-centred, and I wondered:

How do I avoid being one of the "bad" doctors and become one of the "good" ones?

Having been on-hand when it makes a hell of a difference, and being a person with high standards of work for myself, I really want to know whether there is an actual attitude, demeanour or set of skills that can make somebody "good" as opposed to "bad"?

Is it really fair to label somebody "good" or "bad"? They are all at work, and trying, although in every profession some people try harder than others.

Should I stop thinking about this and just try my hardest and know that it is the best that I could have done? I have been told that the enemy of good is better. I've seen things turn from a reasonable outcome to a very bad one because a doctor with high standards just kept trying. Sometimes things just go pear-shaped and it is just one of those things that happen, even with the best doctor imaginable.

The only answer I could think of is that I should simply try to do the best that I can, to remain a resonable human being, and to take each day as it comes. And make sure I don't get confused with the names of all of the drugs. They scare me, too.