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ss triple helix - summer 2017,  The Bleep Never Seems to Stop

The Bleep Never Seems to Stop

  • Registrars may feel stuck in the middle of the healthcare structure - given significant responsibility yet also accountable to their consultant.
  • The battle against arrogance and insecurity may be particularly potent.
  • Christian registrars, knowing their identity in Christ, can think of themselves less and enjoy the freedom of serving God and others.
David Randall reflects on the challenges and opportunities as a Christian registrar

You're with a sick patient in the Emergency Department and aren't sure how best to manage her. You've still got three specialty referrals to see, plus letters to dictate from yesterday's clinic. One of the junior doctors on your team seems to be struggling, and keeps asking for your help. Your consultant doesn't seem to like you and criticised the management of one of your patients earlier in the day. Plus the audit you're supposed to be completing hasn't moved forwards in the last month and your annual appraisal is next week. The bleep never seems to stop.

As a registrar, it's easy to feel like you are stuck in the middle of a complex web of responsibility that makes it inevitable that you will disappoint someone at some point, if not most people most of the time. Forget their standards - you even struggle to meet your own. You look at some of your peers with envy; they seem so calm and sorted as they juggle clinical responsibilities with aplomb.And yet it's not always so dire - just a few weeks ago you made two brilliant diagnoses on one ward round, felt totally on top of all your patients. You were commended by your boss for the calm with which you handled an emergency that developed on the ward. 'Phew', you overheard one of the house officers say as you arrived on the ward,mentioning your name reverentially. 'He's a legend!'

It's not easy to fulfil a role that remains, despite all the recent changes in the structure of healthcare,critical to the running of most hospitals. You are given significant responsibility - and yet remain accountable to a consultant who may have strong views on how they expect you to perform. You have some role in managing a team of juniors, and yet might be acutely aware that you were at their stage of training until very recently. Opportunities to shine for Christ are everywhere. Yet never far away lies spiritual danger: the arrogance that can come from over-estimating your own importance, or the insecurity of feeling as if no matter how hard you try, you will never be good enough.

In his first letter to the church in Corinth, Paul writes to believers divided into factions and rival allegiances to different leaders - 'I follow Paul','I follow Apollos', 'I follow Cephas'. 1 In the first three chapters, he traces out the root cause of the problem: pride. The status they accorded to these Christian leaders was a form of boasting 2 - they were puffed up (the Greek word physio used literally means 'inflated'), 3 because they had associated themselves with one or other of these 'Christian celebrities'. In the same way, in hospitals the big characters - perhaps especially at registrar level - can be boasted of in the same way by their juniors.

In the context of this speculation about the relative merits of these different Christian leaders, with all the potential inherent in such comparisons to fuel arrogance or insecurity, Paul explains how he evaluates himself - and specifically, his gospel ministry. He ignores the judgments of others, and even of his own conscience. 4 He is interested in what God thinks of him. And he outlines the great antidote to both the grandiose delusion that we are the greatest, and the corrosive doubt that leads us to feel perpetually inadequate: in Christ we are justified and accepted, and he accepts the work we do according to the motives of our heart - not according to any human standards of achievement.

Paul writes that God's judgment of our work is based on what we build on (the foundation that is Christ), and how we build (with care and good quality). 5 This should serve to reassure us greatly. We are accountable first of all to God and not those around us, and are judged not on the brilliance of our clinical work but on the motives of our heart. God's resounding judgment is that we are accepted in Christ, and he then graciously accepts our weak and faltering efforts to serve him based on our desire to be obedient - not on any outward measures of success. He then goes on to show the absurdity of boasting in our achievements anyway:after all, he asks, 'What do you have that you did not receive?' 6 For any of us who benefited from a supportive family, a good education, good nutrition in childhood, political stability, good physical and mental health, positive role models, a good work ethic and a keen mind, Paul continues, 'If you[received] it, why do you boast as if you did not?'

Christians have an extraordinary gift that can be of particular relevance to those of us who work as registrars: we are totally accepted by our loving Heavenly Father, and don't need to seek human recognition or approval in order to validate our worth. We shouldn't be puffed up with our own importance, but neither should we be downcast at our own limitations: we are God's children,and he has given us work to do!

Carrying with us this stamp of divine approval,we are set free to serve God in many ways in our work. We can serve our patients, putting their interests first, rather than viewing them as a means of enhancing our own reputation. We can serve our juniors, as we are less wrapped up in our own insecurities, and more able to recognise their needs and support and encourage them. We can honour our seniors, as elsewhere in Scripture we are told to 'obey [our] earthly masters… not only when their eye is on you and to curry favour, but with sincerity of heart and reverence for the Lord'. 7 We can accept criticism, because we realise that our own personal reputation for being right all the time is not important. And we can challenge bad practice, because we have no pretensions that we are any better than anyone else. Indeed, as we gain a reputation for being humble and genuine, people are much more likely to listen to what we say, as they realise we are not engaged in the kind of power games that others might play - we are interested in them, and concerned for their wellbeing, and the good of patients and the wider hospital.

Tim Keller, in his book The Freedom of Self-Forgetfulness, discusses what it means to be truly humble, particularly in the context of this same passage in 1 Corinthians. Humility isn't the false modesty of always telling others how bad we are.Rather, it is about paying much less attention to ourselves, our reputation and our wants, and focusing instead on God and others. 'It isn't so much about thinking less of yourself', he writes, 'as of thinking of yourself less.' 8

In a world obsessed by personal achievement, we can be different. We can stop worrying about ourselves all the time, and how we are perceived, and instead serve God and do the things he wants us to do.

What practical differences might this bring to thelife of a registrar?
  • We can admit when we don't know something, and so ensure that the patient gets the benefit of a second opinion, thus learning from others with more experience.
  • We have opportunities to share the gospel with colleagues, because we invest time asking colleagues about their lives.
  • We form good relationships with everyone on the team, holding the door open for a wheelchair-pushing porter, wiping up spillages with the healthcare assistant, making a cup of tea for an over-worked staff nurse.
  • As far as it depends on us, we don't get into fights with other specialties, because our ego is small and we are willing to back down where needed.
  • We can cope with the mistakes we inevitably make, without becoming aggressive at criticism or broken by failure. Instead accepting personal responsibility, and also suggesting institutional changes that can minimise future errors.
  • We are trusted by seniors, because we tell the truth rather than embellishing or covering-up to enhance our own reputation.
  • We can set a positive culture within a team, challenging poor practice, bad attitude and cynicism by the quiet witness of generosity, and humble words of challenge where needed.

Being a registrar will always be a challenge,but the less we think of ourselves, the more it can be a wonderful opportunity to serve others and showcase God's goodness. Let's work day by day to shake off our egos and our insecurities, and enjoy the freedom of serving the Father in such an interesting and strategic role within the hospital.

David Randall is a Renal/ID Specialist Registrar based in London.
  1. 1 Corinthians 1:12
  2. 1 Corinthians 3:21
  3. 1 Corinthians 4:6
  4. 1 Corinthians 4:3
  5. 1 Corinthians 3:10-15
  6. 1 Corinthian 4:7
  7. Colossians 3:22
  8. Keller T. The Freedom of Self-Forgetfulness. Chorley: 10Publishing,2012:31
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