30 March 2023

The introduction: "Good evening, Sister. I'm your SHO for this shift." The response: "You…? You're old enough to be my grandad." (I'm not.) And, "You look more in need of medical care than half of the patients." (I didn't.) Followed by: "Don't be insulted, but I'm going to move the arrest trolley a bit nearer to you." (She did.)

So began my contribution to strike cover. In case you are worried about the ward sister's approach, I know her well, having worked with her for years and this type of good-natured interaction with someone you respect is one of the reasons we come to work.

The experience made me realise how the role has changed. I spent most of my time working alone, interacting with a variety of inadequate, unlinked, non-intuitive IT systems.

I understand that much of this has been put in place in an attempt to improve patient safety, provide accurate records and audit trails. But I seemed to spend more time proving I was doing the job via cumbersome software rather than actually doing it.

The laws of unintended consequence have come to play in our trainees' working lives. A move to safer electronic systems and shifts to enable safer working hours has resulted in a reduction in continuity, a loss of the team structure with an increase in bureaucratic burden.

Although pay is a key factor in the decision to strike, it is unfortunate that, from a media perspective, this seems to be the focus. In reality, the dissatisfaction amongst junior doctors runs much deeper than pay and reflects poor working conditions and deteriorating patient safety.

A recent opinion piece in the BMJ by Jennifer Darlow, an ST7 in paediatric haematology (and a previous Crucible Prize winner), comments, "…the strike is symptomatic of a deeper sense of exasperation after years of working in an exhausted system that seems to have little respect for patient safety or the welfare of its workforce." I wholeheartedly agree and await BSH's forthcoming study on staff well-being with interest.

I'm pleased to report that HEE has agreed to support ten specific paediatric haematology training numbers. Paediatric haematology has had longstanding recruitment issues. Many people have contributed to this successful outcome, not least BSH members Drs John Grainger and Beki James, who have put years of effort into highlighting the problems and lobbying for change.

Back to the subject of IT, there has been a lot of media focus on the OpenAI tool, ChatGPT. As we have two excellent speakers discussing potential roles for AI at next month's ASM, I thought I would investigate. I had hoped ChatGPT might write this month's message for me. It appears I can't shed this task just yet. The tool is more likely to help with A levels than writing your PhD thesis. Dipping my prosthetic toe in the artificial water, so to speak, I posed a series of questions:

  1. Explain UK population demographic changes and how this could impact healthcare provision?
  2. Why is haematology the most interesting medical specialty?
  3. Will AI replace doctors in the future?
  4. Now I'm 60, should I get a tattoo?

The first question elicited a competent narrative if a little low on facts and figures. Following the second query, I was presented with a response that would certainly have satisfied me had the question been asked at a consultant appointment committee.

I was reassured that ChatGPT felt that although AI tools would be a useful adjunct to medical work, they would not replace empathy and human touch as a crucial part of any doctor-patient interaction.

As for whether I should get a tattoo, I was given a balanced list of reasons for and against with the reminder that getting a tattoo can have relationship consequences for those close to you. I asked my wife about this, and she agreed with ChatGPT, helpfully pointing out that if I needed to ask her this question, the problem wasn't artificial intelligence; it was any intelligence. Decision made.

So, what is the point I'm trying to make here (other than the fact I clearly shouldn't get a tattoo)?

It seems we are potentially on the brink of an Industrial Revolution-scale change with the rapid developments in AI. It will undoubtedly have an impact on medical training, working lives and the delivery of healthcare. Indeed, I note that the New England Journal of Medicine will be publishing an AI-focused journal from 2024. On the other hand, despite the huge potential for benefit, our NHS IT infrastructure seems more of an impediment than a facilitator (or at least it is in my Trust).

How do we bridge this gap? What, if any, is the role of BSH?

Later this year, we will be looking to establish our next round of strategic aims. Is it too soon to be considering such matters as part of our three-year plan? If you have any thoughts on this subject, I welcome them.

Finally, congratulations to our newly-elected BSH Secretary, Guy Pratt, and Trustees, Cathy Burton, Shankaranarayana Paneesha, and Huw Rowsell (appointed for a second term). I am certain their contribution to BSH will be significant.