I want to post a question on the FB Group supporting the Junior Doctors over their David and Goliath fight with a juggernaut of blind, self-deceiving or just ignorant, elected members of Parliament. I should say that I am not a fan of democracy because it just does not work. I am of the Benevolent Dictator school of social engineering and control but realise the politicians are a necessary evil in a democracy and whilst the ‘politician’ may be elected or non-elected, their role in life is to try and secure their way. Pick and choose your definition but in this context this seems quite appropriate: “a person who acts in a manipulative and devious way, typically to gain advancement within an organisation.” So when you hear, for example, that the Dean of the Medical School is an astute politician it is not really a compliment!

But whilst you are processing that thought let me introduce the question I want to ask the current junior doctors:

What are you doing when you are at work but NOT on call?
Is this essential work or is it aspirational? Take, for example, record keeping; does the NHS have the wherewithal to process the information? Has it got anybody in-house who understands the complexity but also the potential of creating living, dynamic, clinical databases which are self-reproducing and creating NEW knowledge. This is what I was doing in Leicester in 1984, actually when I was on call. I was the last of an era; as a registrar in the plastic surgery unit I was the highest paid junior doctor in the land. From the same stable came illustrious names like Gus McGrouther, Martin Milling, Michael Early – we were the one in one, non-resident on call junior (middle grade / non-training) staff. Those were the days when training was defined in terms of need and expectation. The registrars taught the senior house officers, the senior registrars taught the registrars, and the consultants taught and learnt from, the senior registrars. The senior registrars were the only ones guaranteed to get a consultant job (eventually), although some occupied that post for seven or more years. It was a vocation not a job, it was training, it was service, but also it was an incredible opportunity to think and dream and to try and make a better tomorrow.

But let me ask, how much time is spent today in the NHS, by junior doctors, creating data? How much time is spent collecting, storing and reporting data? And what is done with that data? And why do I care? Well for those with a sense of history you will know that the first IBM personal computer came on the market at the beginning of the 1980s. What were PCs used for apart from playing Space Invaders?! Word-processing certainly but we were still using the medical illustrations centre to do the artwork for papers and presentations. We had black and white slides produced through a photographic process and we used coloured inks to give colour to the slides. How incredibly different things are now and here I am taking a break from uploading data into a complex Excel spreadsheet using voice recognition software. Yes, I am doing this as part of my PhD looking at big data sets and how we need to combine them to extract meaningful information; my research question relates to the effect of the community on the individual risk of burn injury. This can never be answered by looking at a highly detailed and extensive database looking at all aspects of an individual patient. I need to determine the age-adjusted risk of burn injury from a database, which covers a defined population. The defined population comes from the district of residence field or in the UK the postcode. This is a unique graphical field. I can then use census data to look at the characteristics of that defined population and then start to look for correlations in the trend lines over a ten-year period.

Going back to 1984, I witnessed the completely unexpected and mysterious death of a young boy who had sustained 40% body surface area deep dermal burns from a tragic accident in his home. He fell into a bath and died five days later.

In retrospect Jonathan Ottey’s death was a classic response to a staphyloccus toxin but we did not know that then. It was only the next year that Jim Frame and others first described the association of toxic shock and paediatric burns. Informal inquiry from older members of the burns community said that this was a typical once in the lifetime experience of most burns surgeons; that is to say, very rare but not unknown. So what to do? Basically the idea, based on the prevailing technology, was to create a national burns database and then use the self-interrogating principles of artificial intelligence to ‘grow’ the knowledge. This was not a database for the purposes of epidemiology; this was a clinical database of intervention and response with the intent of producing improved outcomes. But we are still not there and all the data that has been compiled over the years has been filed away in the ‘opportunities missed folder’.

And we continue in the same manner today. In the desperate strive for mediocrity Britain has lost that excitement which we shared 30 years ago. We dared to dream about a better future, no matter how tough things were in the present. But now? What do our young doctors think about when they are at work and not on call? Repaying student loans, studying for exams, alternative employment? How many are actually thinking of becoming involved in making the future, today? What do the principle stakeholders of the industry of healthcare delivery think about the quantity and quality of healthcare delivered by the national institution, the NHS, for the United Kingdom? We have heard about the contracts of employment between the government and the junior doctors but what about the contract of commitment between the junior doctors and the survival of the NHS? An NHS that belongs to the people of Great Britain, not to a few irredeemable and shameless politicians? Let us hear from the dreamers because this is a platform for expression.

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Andrew Burd (Prof)

The Chinese University of Hong Kong.

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