Look out! Tigers on the horizon!

Yesterday afternoon we went to see a play at Hampstead Theatre called Tiger Country, written and directed by Nina Raine.

We actually saw the very first version of this play in 2011 when it was produced at the same theatre causing their first full house and queue for returns tickets… it’s that good. Full houses again this run for the new version which is much longer indeed with several new scenes although some old ones were remembered.

The star of this play is Indira Varma playing the lead Vashti – a surgeon – who is struggling to become a Consultant  in a world where she is a perfectionist – and her attitude to her juniors is considered bullying but in a man, she claims would be perfectly acceptable strong management.  She feels that being a female surgeon is tough – she needs so be so much more than any man and of course, is not included in the coterie who drink and socialise together.

The play is set in a struggling and over-worked hospital where the doctors work out their stress in different ways  but very few leave    the medical profession – in the booklet that accompanies the play a Consultant Physician is quoted as saying ‘to walk away from the medical world .. is more akin to changing religion than changing jobs’ and quotes a colleague as saying ‘If you’re not stressed, you’re bored’.

One character in the play, a very junior doctor, has to learn to cope with the stress of diagnosis with insufficient time and too few staff. A doctor can cause death, she feels, with a wrong or mis-diagnosis, and so she struggles to work through all the potentials with her colleagues lambasting her attempts to get everything right. Yet getting it wrong can be disastrous – your patient may die.

With medical errors come complaints too, and in the US this would lead to many cases of doctors being sued and thus a very high insurance premium for them. As we, in the NHS, don’t pay for treatment, court cases are much rarer. Yet the Internet and freedom of information and well-informed patient means more complaints than ever – doubling in the last five years. There are now many law firms specialising or offering specialised service for medical complaints and even the NHS has to explain very clearly indeed how to make a complaint.

I have made a complaint myself against a hospital and in return got a very long and detailed letter explaining how they were going to change procedures so that what happened to me, didn’t happen again – but no compensation of course!

According to a Govt report (http://www.hscic.gov.uk/catalogue/PUB14705/data-writ-comp-nhs-2013-2014-rep.pdf)

  • Total number of all reported written complaints in 2013-14 exceeded 175,000 the equivalent of more than 3,300 written complaints a week and equivalent to 479.1 per day.
  • Total number of all Hospital and Community Health Services (HCHS) written complaints has increased by 4,990 (4.6%) from 109,000 in2012-13 to 114,000 in 2013-14.

The figures below demonstrate where some of these complaints are made and what was complained about.

nhs3 nhs2 nhs1

Yet the 2 items that most cause the General Medical Council to bar doctors from practicing are:

  1. having sex with a patient; and
  2. taking drugs.

Being incompetent is amazingly hard to prove and thus rarely a cause  for disbarment.  Yet the stress of being a doctor remains high – as the suicide figures show. “over 20 doctors committed suicide between 2005 and 2013. All of them were under investigation for malpractice. Many of those who killed themselves were suffering from alcohol problems or depression. (http://rt.com/uk/216319-uk-doctors-suicide-report/).

In the US (http://www.insidermonkey.com/blog/the-10-highest-suicide-rates-by-profession-331520/#ze7DBlaVXwyBtiSM.99 ) “Those professions which demand high skills and long hours, and put a lot of pressure on the worker, have elevated suicide rates,”
“Physicians are at the top .. because being a doctor is one of the most stressful professions you can choose. But stress in not the only factor that amounts to this sad result. As health-care workers, physicians are more likely to succeed in committing suicide because they have access to drugs and know the correct dosage and administration to apply. Moreover, physicians tend to be more reluctant to seek medical help if depressed.”
Overall, positive expressions came from people as they left the theatre, but it is long and can be depressing as the play explores the stress – but please don’t believe it is a truly accurate portrait of all hospitals in the NHS. It is fiction after all…

We all gave it 4-5 stars!

See also various reviews: http://www.theguardian.com/stage/2014/dec/21/tiger-country-review-remarkable-snapshot-health-service

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