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In Stitches - An Introduction My name is Dr Nick Edwards and I am a doctor working in accident and emergency. I have worked in the NHS for the last 6 years in hospitals up and down the country. I have spent most of this time searching for a word for the feeling you get when you are screaming with frustration on the inside but aren't allowed to express your emotions on the outside. The result is that you end up smiling inanely because that is how I have felt for the last 6 years. Unable to find that word, a few months ago I embarked on writing a book about life as an Accident and Emergency ( A & E) doctor – to show what it really is like. It was a form of literary cathartic therapy, with my own form of ranting and humour. It covers human stories - the upsetting and humorous (such as the Epileptic Society's Christmas party at a night club with strobe lighting). In places, it is very light hearted and witty (my own philosophies on things such as how to be a good patient and my own A&E room 101, as well as definitions of different doctors and medical acronyms) punctuated by serious material. However the most important aspect I am trying to convey is a view on how management and politics pervade right down to front line work. In this way, I hope to increase the interest in the politics of the NHS especially in view of the upcoming 60th anniversary. It is also part of the reason I am working with the NHS Support Federation and other like-minded organisations. The book all started as a blog. It started as a way of expressing my frustrations with the NHS as a system and my concern for the NHS and A&E in particular. Looking back, I was probably a bit naive to just write angry thoughts after I was upset at work. The blog only lasted a couple of weeks before my wife emailed me reminding me telling me that she was eight months pregnant and that I had to get off the computer. I closed the blog and within 24 hours. I had two book contract offers and an interested scriptwriter! I started writing the book in January 2007 and it is basically a collection of short stories about the NHS and my working life. In the month since publication it has sold very well – 7000 copies were sold in the first week. It has appeared in News night, Talk Sport and I appeared in an interview for the Guardian newspapers. I also had an extract published in the Daily Mail. The NHS Support Federation has endorsed it and it is a book that is becoming increasingly talked about in hospitals. It is fast developing the reputation of standing up for the NHS and stating what is truly going on. Essentially, I wrote the book, as I am a passionate believer in the NHS. I am concerned about what is happening to the NHS. I hope that the book will generate debate about the future direction the NHS should take. I am proud to work for it and believe in the ethos and socialised structure of the NHS. Till about 20 years ago, the NHS was run along the lines of collaboration. Despite the under funding, the NHS was very efficient. However, the Thatcher reforms originally rejected by Frank Dobson and Blair but then reintroduced by Milburn (but in a different name) have turned the NHS from being an organisation which works together to becoming a group of separate businesses with little joined up thinking. The organisation became more concerned about targets and accountancy rules than staff and patients. This is so in A&E where the target culture, although initially helped improve things has become the most important factor in management's eyes and is affecting the clinical Independence of staff and our ability to prioritise appropriately. The ethos of the NHS is something we should preserve - the fact that care is free at the point of need is something that should be celebrated. As clinicians our priority is to our patients and not to the shareholder of the company we work for. This is something, which helps us give appropriate and quality care. However things are changing in the NHS. Despite the massive funding increases, which have helped greatly, there have been unprecedented management upheavals. This was the biggest shake up in the history of the NHS. Private companies are profiteering from doing easy operations at the expense of funding which would have gone to local district general hospitals. Hospitals are now competing for business with each other. This is resulting in the inevitable closure of District General Hospitals. The problems are caused by primary health care trusts becoming 'buyers' of services from hospitals that are acting as independent business. But health is not a business that can be run along market forces principles - take the USA for example. What happens if your local hospital looses the contract for knee operations, when there is a trauma case involving the knee - there will be no local expertise and patients will suffer? What I would like to see is the NHS become independent from government - a bit like the Bank of England. An independent board but with a guaranteed income and run along the lines of collaboration not competition and clinical need decided by local clinicians and not top down edicts. From a specific A&E point of view, I am concerned about the way emergency provision is provided in this country - poor out of hours GP services, overrun A&E departments and poor collaboration between A&E departments and the rest of the hospital. I am also concerned about the governments 'reconfiguration programme'. I believe that the current ideas provided by Lord Darzi of super centres are good for the sickest of the sick trauma and heart patients but we shouldn't forget about the vast majority of patients attending A&E for other reasons. The NHS is something I cherish. I never want to leave the NHS but the sheer battle to help patients despite the system and not because of it, strains my sanity (and that of my wife!). I wrote the book, as I wanted to let people know what might and could and is happening to our NHS, but also to show people what it is truly like to work in the front line of a hospital. The book will hopefully amuse the reader and inform those unaware of the reality. I doubt it but hope that someone of influence might read it. The book is available from Amazon and a few book good book shops. Any comments or suggestions or help with publicity please contact me on drnickedwards@gmail.com. Dr. Nick Edwards, November 2007 Back Cover of the Book "Despite the headlines, actually the NHS has just had its best year ever." Patricia Hewitt, Secretary of State for Health, eulogising to the BBC, 22nd April 2006 "Despite what the politicians say, things seem to have gone a bit tits up recently." Dr Nick Edwards, A&E doctor, ranting to his mates down the pub, 22nd April 2006 Dr Nick Edwards is an Accident and Emergency (A&E) doctor working in the UK and a passionate believer in the NHS. However the reforms, political correctness and the Anglo-Saxon culture of binge drinking and fighting and the resulting A&E visits are a strain on his sanity. So to keep up his morale, he began writing down his feelings - a form of literary cathartic therapy - the results of which make up this book. From dealing with cardiac arrests and car accidents, to people with 'Arrest Avoidance Syndrome' and others who hadn't quite read the big red sign above their heads as they walked into A&E, In Stitches paints a vivid picture of what it's really like working at the sharp end of the NHS today. It's funny, it's heartbreaking and it's infuriating. It's also more informative than any government press release. So join Dr Nick Edwards as he describes the frustrations and joys of working in the NHS. The traumas and tragedies, the patients and colleagues and most of all the successes and humour that make up life at the front line of medical care: Accident and Emergency. Note to reader: Ever-conscious of meaningless targets, the author would like it to be known that 98% of the stories contained in this book were written in under 4 hours! Example Extract from the book A sign the world has gone mad? What has had happened to my patients today? They seemed to be getting lost when I sent them for X-ray. I'd given the same directions as normal, there had been no secret muggers hiding in the hospital corridors and as far as I know, no problems with space - time dimensions in our particular corner of the universe. I went to X-ray to investigate. I found it quickly because I knew the way. However, I looked for the signs for X-ray and they were gone. The nice, old-fashioned and slightly worn signs had gone; they had been replaced by a sign saying 'Department of Diagnostic Imaging'. What the hell? I know what it means but only just and only because I have been inundated by politically correct 'shit-speak' for a number of years. What a pointless waste of money; to satisfy some manager, they replaced a perfectly good sign with one that means bugger all to 90% of people. Why don't they change the toilet sign to 'Department of Faecal and Urinary Excrement' or the cafe to 'Calorific Enhancement Area'. Who makes these decisions? Who is employed to do such pointless stuff? Why? Why?? Why??? I needed a caffeinated beverage in a disposable single-use container - management-speak for shit NHS/Happy Shopper instant coffee. I went to sit in the 'Relaxation, Rest and Reflection Room', previously known as staff room. There, the nurses were moaning that tonight one of their colleagues had called in sick and to save money their shift would not be covered by a bank nurse. In A&E, staff shortages can seriously undermine the safety of patient care. I am sure this genius plan was decided by some personnel manager who I doubt has ever seen a patient, cannula or trolley, and therefore is obviously an expert at making nursing planning decisions. We have a hospital that can fund unnecessary new signs, but not replace nurses when they off sick. So, tonight who is going to go looking for the patients when they got lost on route to the Department of Diagnostic Imaging? Related Links Buy from Amazon: In Stitches: The Highs and Lows of Life as an AandE Doctor
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