The whole patient

Zoomed in image of faceless person wearing a stethoscope and white coat
By Luke Blair     17/05/2024

“She was so apologetic. She said ‘I’m sorry I was crying.’ ”

I am listening to the Senior House Officer (SHO) discuss this afternoon’s list of cardiothoracic patients with three colleagues.

The patient is in her twenties but has already had to undergo lung surgery for cancer. Today, the team has better news for her, but she has had a physically and mentally challenging few months and still has “a journey ahead of her.”

At that moment, the SHO’s bleep goes off and he needs to call a senior colleague. “I will look into it,” he promises the consultant who called.

Constant interruptions are all part of the shift for the SHO, with whom I am spending the afternoon to try to understand what being in one of these junior medical roles means, in a specialist hospital like Harefield.

This particular SHO is aiming to specialise in cardiothoracic surgery – that is, dealing organs in the chest cavity such as the heart and lungs. Eventually, he will then choose between either the cardiac or thoracic side. 

Today, he is covering ‘short-day’ thoracic patients. At Harefield, that means taking care of a significant number of people with lung cancer.

The surgical SHO is also a junior clinical fellow, which means he conducts research and teaching alongside his clinical duties of a house officer. He also has surgical training on designated ‘theatre days.’ 

Of course, we all remember the stories and TV dramas about SHOs working heroically long shifts as part of their training to become fully-fledged consultants. Since the thinking behind back-to-back shifts has been largely discredited (they were established by a famous doctor who it turned out had been addicted to cocaine), the hours are far more manageable. But my SHO still works long days.

“I’ll make sure to arrive at seven fifteen and tend to work to seven thirty to about eight o’clock in the evening. And when I get home, I usually need to study for assessments, work on my Masters, or do research. In fact I have a big exam coming up.”

“It’s a shame – I would like to spend more time with my two-year-old niece – but it’s a privilege to be here.” Such dedication. And still just 27.

“Do you want the patient to have anti coagulation?” We are back in the room or, technically, the ‘Board Round,’ at which all 30 plus patients on the current thoracic list are being discussed with a multi-disciplinary team comprising the SHO, the registrar, and advanced nurse practitioners (ANP).

They study their screens intently. Each patient is represented by a bewildering combination of medical acronyms, data from test results, and drug dosages, together with images of scans.

The team appear to speak in code and yet, through focus and teamwork, the list is gone through at some pace. Every patient is checked, assessed, approach agreed, and then processed through the system.

There is no doubt the electronic management of patients through the labyrinth of NHS care has been made easier with the introduction of a single patient record system, recently installed at Harefield in line with the wider Trust. Where once many multiple systems were used, now there is only one. It is unarguably more efficient.

But my SHO – youngest and therefore by definition the most digitally literate in the room – has a perspective that belies his years. He knows electronic systems are not, in themselves, the answer to good care.

“It’s important to see the patient with your own eyes, or you are just seeing the test, not the patient. What we do is not just service delivery, it’s holistic. You need to see the whole patient. The word ‘care’ is important. If a patient needs two minutes, we will give them two minutes. If they need fifteen, we will give them fifteen.”

I am struck by this, and the way the team talk about their patients. Behind every set of figures and data is a person, first and foremost, with all the hopes and fears that comes with their particular reason for being in Harefield Hospital.

“I believe in her. She is doing what she said she would do. I’m determined to see her walk out of here,” says the ANP, of another patient. A great many of the patients are, or have been, smokers. Reference to the habit crops up again and again. Not surprisingly my SHO has not only never smoked, but is a keen runner.

From Board to Ward. We leave our colleagues to visit a man in his seventies who has already had one part of his lung removed via keyhole surgery, and is now in for further treatment. 

He has smoked for 50 years, his daughter explains, consuming 20 roll-ups a day. “But now I’ve been off it – well, on and off it, for six months,” the patient himself adds in an oddly cheery, strong northern accent.

The SHO examines the patient, explains what the new procedure will involve and shares a joke. Patient and daughter both laugh. As we leave, the daughter says to me: “We know that Harefield is a very good hospital. They’ve looked after him really well.”

I talk to the SHO as we finish the afternoon. It must be difficult, I say. I’ve seen you managing difficult, emotional conversations with patients. It must be tiring.

“Your attitude sets the course of the day. You see a lot of sadness and pain. But you also get to tell someone they don’t have cancer or that their heart is a lot better. That’s one of the best parts of the job,” he says.

The ability to see his patients as whole people is the key, here. It helps him gain a wider perspective as an SHO, to see beyond the data, and see beyond his long days of work, research and study. It also helps to keep him motivated.

“Just being part of this every day is an honour. I feel lucky to do what I do.”

[Note from author 10 days later: happily, all the patients mentioned here underwent successful treatment and are now recovering at home.]