A few did come into work to help provide a safe level of medical cover and care for the patients.
This article is not written to justify or write for or against the strike.
When a strike is called, plans are put in place by the unions to support those that strike, but no thought seems to have been given to those who choose to work, whether they are union members or not.
This, then, is my personal reflection as a senior clinician on the wider fallout of the junior doctors' strike action, how it has affected me, and what I have learnt from this exceptional situation.
summaryWhen junior doctors down tools, someone has to pick up the work. There was an expectation from employers, the BMA, and the public, that a safe level of care would be provided. Ironically, this resulted in two things happening that the BMA is generally opposed to. Firstly, that consultants had to act down, and secondly, that Physician Associates (PAs) had to take on a greater role (which they did very well). Colleagues covered the night on call (we were fortunate we had a newly appointed consultant and an ST7 on at the same time over night). Consultants worked with PAs to cover wards, and those trainees that came in were allocated generally to the take, although a few were on the wards.
preparationOnce we knew the date of the strikes, I challenged a number of junior doctors, and one just laughed when I asked about patient care!
My initial response was one of anger and disbelief that members of the medical profession could take such a callous approach and disregard for those they were trained to care for. This was reinforced by the approach of BMA consultants, who backed the action while also demanding extra payments for working their normal hours. The BMA Consultants Committee were watching from the sidelines to decide whether to call consultants out and ensure maximum disruption to services. But this would only be a disruption to those that could not afford to pay for other providers. As Christian doctors, we remembered that we are called to care for the sick, vulnerable, and poor.
As the strike days grew closer, I became more angry, anxious, concerned, and nervous about covering the clinical service. Worried about my ability to manage hyperacute patients without a medical team to support me, and the possibility of attending a peri-arrest or cardiac arrest (something I had not done for 20 years). How would we support patients and their families, and just keep them and the staff safe? On reflection, this was me suffering moral distress. Knowing what was right, but being unsure I would be able to provide the level of care my patients need and expect.
I felt let down by the attitude of some of my team. It enhanced my sense of abandonment. It has engendered a feeling of mistrust between my team and me.
Three days of covering gaps, plus the days before hand-learning new skills resulted in a backlog of administration for clinical and managerial staff (some of whom stepped back into clinical roles).
return to workThe team returned to work, on the morning of 16 March. A lot of the feelings experienced on the twelfth, the day before the strike, returned on the evening of the fifteenth. How would I respond to the junior doctor working with me? Would the ward round be as effective as it had been with a PA? Did I want to have a trainee on the ward round? Fortunately, the ward round was not heavy, and I knew most of the older 'outlying patients', but the working relationships were not the same.
reflectionThe weekend before the strike involved a lot of soul-searching, a lot of prayer, and finally realising that there was no way I was going to manage on my own. Philippians 4:13 reminded me that, 'I can do all this through him who gives me strength'. And remember, Paul is writing this letter whilst chained up in prison in Rome. 1 Thessalonians 5:16-18 says 'Rejoice always, pray continually, give thanks in all circumstances; for this is God's will for you in Christ Jesus...Roman's 10:12 says 'the same Lord is Lord of all and richly blesses all who call on him'.
We can only have God's contentment when we have left our troubles at the foot of the cross; God takes our troubles away, so that he may dwell in our hearts (Ephesians 3:17). In John Bunyan's Pilgrim's Progress, as Pilgrim approaches the cross, the straps holding his worries, troubles, and sins on his shoulders are loosened and as he reaches the cross, they all fall off and are taken away forever. But only if we let Christ do this for us. Recalling God's promises to me, I was able to lay my worries and concerns at the foot of the cross as I drove in to work at 5:30 on Monday 13 March and feel God's peace that passes all understanding; the peace that can calm our spirit and then bring contentment is waiting for us. How often do we struggle to achieve it because something is holding on to us. In my case, it was the anger, frustration, disbelief, and feeling of abandonment by my colleagues, no matter how justified they considered their actions.
recoveryFor working relationships to return to any degree of normality, two things need to happen: a reaffirming of God's peace, and the ability to forgive those that have caused us pain.
Firstly we need to keep claiming God's peace; learning to rest in his arms and be content in what he provides. Accepting that true contentment can never be acheived without God, and that contentment, and ultimately peace, will only be found when we accept that God's grace is sufficient for us, and God's power through us is made perfect because of our weakness and failings.
We should be content because we have been adopted into God's family. We are small and insignificant, yet he has sought us, and by his grace taken us in, grafted us onto the vine, the vine which is Christ. So long as we stay with him, we will continue to thrive. Then we will receive the peace that Christ offers. That is the peace that we cannot find from the world. The world cannot offer it to us, only Christ can, and at what cost to him.
Secondly, we need to be able to forgive. In the framework that Christ provided when asked how we should pray, we are to ask for forgiveness as we forgive others. Being able to forgive has both physical and spiritual benefits,,, taking away the burden of carrying grudges and anger and allows us to approach God. In Ephesians 4, Paul writes that we should put all bitterness, frustrations, and anger away, not letting the sun go down on our anger. And in the Sermon on the Mount, Jesus exhorts us to be peacemakers. The writer to the Hebrews urges us to, 'Make every effort to live in peace with everyone and to be holy; without holiness no one will see the Lord. See to it that no one falls short of the grace of God and that no bitter root grows up to cause trouble and defile many.' (Hebrews 12:14-15)
what have I learnt?As it says in Ecclesiastes 1:9, 'there is nothing new under the sun'. Have I learnt anything new? Well, no. Has God reminded me of his promises? Yes!
So, as I return to work, back to face the storms of life and the NHS and its many problems, I need to keep turning to Christ, accept and rest in his peace that will bring contentment, being aware that 'The Lord is trustworthy in all he promises and faithful in all he does' (Psalm 145:13), and later in verse 16, 'You open your hand and satisfy the desires of every living thing'.
The Lord is near. Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus. (Philippians 4:5-7)
David Smithard, Consultant in Geriatric Medicine at Lewisham and Greenwich NHS Trust, Visiting Professor at the University of Greenwich & Triple Helix Editor