Originally published in Murmur magazine in 2016
After months of negotiations, strikes, and legal disputes Jeremy Hunt has opted for the so-called ‘nuclear option’, vowing to impose the new junior doctors’ contract against the united will of the profession. The BMA has promised more industrial action, but it looks likely that junior doctors will soon be working under a contract that will prove unfair for doctors and unsafe for patients. What role can we as medical students play in this debacle? As we are not yet NHS employees, we have no paid labour to withdraw, but we can still play a crucial role in the ongoing crisis.
So much of the outcome rests on public opinion; Hunt has to balance his agenda against wavering public support. With so much misinformation being peddled by the press and politicians, it is our job to set out our criticisms of the new contract in a clear and reasoned manner. As a medical student my newsfeed is awash with statuses, videos and images setting out the flaws of the contract. It feels like a current and pressing issue, with almost all commentators rallying behind the junior doctor cause. Yet much of this is an artefact of the way social media works. Social media sites act as an echo chamber, presenting us with views similar to our own while masking the true opinions of a general public who may have a more ambivalent attitude toward the issue.
However, this online activism is not without controversy. In a letter send to British medical schools, the Medical Schools Council reminded students to retain a “professional attitude” when using social media sites, a move which some took as a caution against protest. Though the exact wording of the letter was debated and later clarified, it is clear that the issue of professional image is on the mind of students wishing to protest the contract changes.
Similar tensions arise in clinical situations. As medical students we occupy a strange space between student and young professional, gradually developing into the demanding role of a junior doctor. To the public eye, the line between ‘student doctor’ and ‘junior doctor’ is often blurred, and many patients will quite understandably mistake us for qualified doctors. Whatever our perceived role, we undoubtedly have a responsibility to uphold professional values. On multiple occasions I have had these values thrown into confusion when patients have asked me about my position on the strikes. These situations present a conundrum. On one hand we might wish to generate public engagement with an issue that affects members of our profession and puts patients at risk, but in doing so we can threaten the impartiality that is so central to professional conduct. This can be a balancing act. Medical care should always be provided to a high standard, irrespective of a patient’s political or religious beliefs, and those delivering the care should do so in a manner uninfluenced their own opinions. This is surely the central tenant of treatment under the NHS – free at the point of delivery, delivered without regard to a patient’s worldview or life choices. Yet it is these core values that can be threatened by structural changes that we have a duty to oppose.
Despite these concerns about public support, it seems that the British public are resolutely on our side, with a recent poll showing that 83% of those questioned placed the blame for the crisis squarely on government action. But this does little to allay the situation; the NHS currently faces one of its greatest financial and staffing challenges, leaving many junior doctors demoralised and tempted by promises of better working conditions and higher pay abroad. Our generation of will be the first to enter paid work under the new contract, while being saddled with even greater debt than our predecessors due to increased tuition fees. Current doctors and teaching staff often tell us to think of our first day as a junior doctor. On that day we will continue using the skills and knowledge that we have honed during medical school, but we will suddenly gain a great deal of responsibility. With the threat of poorly regulated and unsafe working hours, this looming horizon can only appear more intimidating.
There are, however, silver linings. As a group, medics often take their impartiality out of the hospital, remaining apolitical and quiet on controversial matters. The issue of junior doctor contracts has ignited debate within the profession, making us better aware of our rights and responsibilities, and more politically aware. There is a feeling that the disputes have fostered a sense of camaraderie amongst junior doctors and medical students alike, which will surely put us in good stead for any future challenges we might face working within an embattled NHS.
Tom Ronan 