Take yourself back in time. It's 3 am. You're an SHO in obstetrics on your first night on call covering the labour ward. Your registrar's doing an emergency section and your consultant's tucked up in bed.
Something happens that you can't handle, so you bite the bullet and decide to call the boss.
(10 minutes of ringing later)
"Hampton Lucy 212"
"Hello, is that Mr Adams?"
"Hello, it's Dr Hammond here."
"Dr Hammond. Your senior house officer."
"How did you get my number?"
"Um switchboard. We're on call this evening."
"Are we? (Pause) What seems to be the problem?"
"I'm at a delivery now and I can't quite remember "
"Spit it out, man!"
"Is it the baby or the placenta that comes first?"
"Oh Lordy it's so long since I did one. Just give the mother which ever one's better looking."
OK, I'm exaggerating (a bit), but a friend of mine doing paediatrics used to phone his consultant at home and – whatever the problem – he was told "You'll just have to fly by the seat of your pants". Such is the nature of hospital training, but there are a few enthusiasts out there determined to change the system.
Step forward Chris Bulstrode, a professor of orthopaedic surgery in Oxford, who has dedicated his career to the task. Professor Bulstrode's motivation comes from his own experiences as a trainee.
An elderly woman came in with a fractured neck of femur (broken hip) who needed emergency surgery. He didn't have a clue how to do it, so he phoned his senior colleague for help.
"I explained that I'd never done an operation before. He swore for 10 minutes and after much argument agreed to come in.
"An hour later, he burst into the operating theatre, still in his suit, put some gloves on, made his incision, pinned and plated the broken hip, dropped his gloves on the floor and said, in front of all the theatre staff, 'Don't you ever ****ing call me at home again'. It was the most humiliating experience of my life."
A quarter of a century later, and Bulstrode has pioneered HOTS – the House Officers' Training Scheme – which gives new recruits structured training each week on specific topics.
He admits that many of his ideas come from general practice, such as protected time for training, and one of the topics covered is 'Ringing a Consultant'.
So, in case you ever have to do it, again, here are the guidelines:
- Do not take at face value the comment "Just call me any time"
- Try to sort the problem out yourself
- Discuss it with the nurses and your peers
- Take the problem to your immediate superior
- Does your consultant like to be presented with the problem or the solution?
- Brevity and clarity are everything. Limit information to "need to know"
- Never bowl him an SEP (Someone Else's Problem)
- Don't wait until a problem requires an immediate, urgent decision
- Finally, find out what time your consultant goes to bed!
Of course, the success of your call depends not just on your presentation but also on the attitude of the consultant.
Professor Bulstrode ambushed a group of fellow Oxford consultants with a group photo of house officers and asked them (a) to identify their house officer, (b) to give either their first or second name and (c) to name one thing about them that distinguishes them as a person.
Three-quarters failed all three tests. Clearly, hospital training has a way to go to catch up on general practice.
- Dr Phil Hammond is a GP and author of Trust Me, I'm a Doctor (Metro, £9.99).