RCP vice president for Wales: rainbows | RCP elections | a view from west Wales

February is LGBT+ History Month and I have been reflecting on how we as physicians should be embracing inclusivity. How can we best support our colleagues as allies, especially at a time when we are all under huge pressure? How can we truly understand how our colleagues experience stigma, discrimination and hate crime? The outpouring of support for, and from the LGBTQ+ community following the recent conviction of three people for the homophobic murder of Dr Gary Jenkins in Cardiff should remind us of the need to care for each other and call out any abuse.

I’m delighted that there are two RCP fellows from Wales standing in the upcoming elections. Dr Hilary Williams, regional adviser for south-east Wales is standing for Council while I am one of the seven candidates for RCP president. More information on the elections is on our website.

For the next few months, we’ll be featuring guest blogs from our regional advisers in Wales. They will provide a different perspective from around the country as we begin the huge task of learning from the past 2 years and rebuilding the post-pandemic NHS.  

I’d like to welcome Dr Sam Rice, regional adviser for south-west Wales, and consultant physician in diabetes and endocrinology at Prince Philip Hospital in Llanelli as the guest blogger for February.

Dr Olwen Williams OBE
RCP vice president for Wales
Consultant in sexual health and HIV medicine

West is best | Days off unplugged | Bridging the privilege gap | Red status

In my opinion, west Wales is the best place in the country to live and work, and I struggle to understand why we are not overrun with physicians wanting to come here. The hospitals are welcoming and have a real community feel. Like everywhere, yes, there are the day-to-day issues of heavy workload versus limited resources, but the communities we serve are lovely and people very much appreciate what we do for them. My colleagues here are phenomenal, dedicated and hugely knowledgeable. Having worked in many places in Wales (and further afield) I have no doubt we are delivering the highest levels of care. We also have some fantastic tertiary services and clinical leads, and we are all on a first name basis. Conversations around more difficult clinical cases are easy to access and are invariably helpful.

However, it is not all about what we do at work. Life in west Wales is so closely linked to the most beautiful countryside. Being out in it is always so rejuvenating. My short drive to work takes me past wild horses, with views to Devon on my right and Pembrokeshire on my left, then along the Loughor estuary, with only a single set of traffic lights between my house and the hospital. I can cycle the journey in less than an hour and live under an hour’s drive from five district general hospitals in south Wales. A few years ago, I took a visiting Australian doctor to Three Cliffs Bay in Gower, and he was, without exaggeration, flabbergasted. He had no idea that such amazing places existed in Wales. If you do see any jobs you might be interested in around here, I would advise you to consider them. A life here is amazing.

Days off unplugged

One of the well-discussed positive outcomes from the past 2 years has been the development of virtual working. For those of us providing care in rural communities, the gains can be considerable: for a single clinic, I calculated that I have saved 1,000 kilometres in travel. Of course, virtual clinics are not clinically appropriate for everyone, and like many, I am conscious that a virtual review is not as comprehensive as a face-to face consultation.

However, more than this, I have become increasingly aware of the blurring of boundaries between work and home. There has been a creep in this direction for some time now that work emails are available on our phones, but now I have a home office set up to look at patient results, write and sign letters, and attend meetings both locally and nationally. This means my working day starts earlier and only finishes when the last question or email comes in.

So many of us are working like this now that I feel it is becoming the norm. Putting an out-of-office message on does not stop the email from pinging on your phone. So, what I am saying (to myself as well as those reading this) is that we do need to work harder at unplugging ourselves. Put the phone down, turn off the computer and try not to reply to emails until Monday morning. Maybe even avoid sending emails outside out of normal working hours and remember to be mindful of your colleagues who are on annual leave. After all, we must find time to get out and enjoy the Welsh countryside.

Bridging the privilege gap

I have had a privileged upbringing. My mum’s family moved to the UK from eastern Europe after the second world war, but I have always considered myself to be British and Welsh. I went to a small primary and then a comprehensive school in north Wales, but at the age of 13 I went to the most amazing private school in England supported by a bursary. So yes, I’m white, male and privileged.

Given my background, I have often wondered how well I associate with the people that I see in my clinics, mostly held in a district general hospital in a post-industrial town in quite a deprived area of south Wales. Over the past decade, I have worked with colleagues to develop a series of educational films for people with chronic conditions. People are more likely to change their behaviour if they trust the person delivering the message; however, I worry about my background being so different to my patients’ upbringing and whether I’ll still be able to make that connection with them. For me, this underlines why it is vital that we in Wales increase capacity in our medical schools and fill these spaces as best we can with people who have grown up in our towns and villages. They will be more likely to stay and may well be more effective doctors.

Red status

Finally, I’m on call today. For the past 3 months, my hospital has been permanently on red. Every morning I receive an email: there are no CCU beds, no stroke beds, no ITU beds. There are three wards full of patients who are medically fit to leave hospital. On top of this, at least one doctor per shift is likely to be affected by COVID-19 isolation rules – maybe they have it, or their child has it. Hospitals nearby are in a similar situation. During my last on call, the hospital to the west asked to transfer seven patients while we were on full divert for the hospital to the east for a couple of hours. I’m sure my cortisol levels are going up just writing this down.

However, this is not what I am here to think about today. Today, I am here to focus all my attention, knowledge and experience on the people that come through the hospital doors needing care. What does the history suggest? What do the tests indicate? What is the diagnosis? What other tests and specialists are needed? Can the person be safely discharged from hospital? Yet I cannot let the information I receive on hospital pressures influence what I do for the people who come under my care today. I’m good at this but I know I don’t get these decisions right all the time. My discharge rate should be influenced by what comes in rather than anything else, shouldn’t it?

This change in focus, from wide to narrow, from regional and hospital to individual, and then back again is a skill that physicians need to develop as they progress from specialist trainee to consultant, and it is not something that I have seen acknowledged in leadership or training meetings, or by hospital management. Nonetheless, we physicians do it every day, subconsciously or otherwise.

I’d better get down to the admissions unit.

Dr Sam Rice
RCP regional adviser for south-west Wales
Consultant physician in diabetes and endocrinology