Carly is getting on a bit and is thinking about that next stage. She is finding the rigours and demands of coming in at the weekends and being on call overnight taking its toll. She can do it and she does keep up to date but maybe now is the time to glide down with grace and serenity to work in a different way. She wanted to retain her clinical skills and work but spend most of the year living in Israel. She realised if she could go part-time and annualise this could indeed be possible.
Since she was appointed in 2005, she never did any urgent general paediatric clinics. There wasn’t really any reason, but she just didn’t. Then Covid changed all of that and she found that actually she rather liked these clinics. She even persuaded the managers to change the name. It was previously known as the 10-12 clinic. Patients were only seen within those hours. But this is very limited and what with all the fastidious cleaning of rooms, couches and other equipment between patients during various lockdowns, meant the clinics ran for much longer if face to face. Carly isn’t much of an exponent of telephone or video clinics. There is so much nuance that goes on when meeting in the flesh and the technology often isn’t really up for it. Also, if you were the only doctor seeing these patients, as the GPs weren’t at that time, it really was important to check up on children. Most people felt, including Carly, that the children were the ones who really came out worst in all official measures to mitigate against Covid.
So, early on in the pandemic, Carly saw patients in person at various health clinics. With her trusty bike, she was happy to cycle pretty much anywhere. And parents were loath to bring their children to hospitals which were seen as hotbeds of Covid disease and other dangerous activity. Carly mused that it was a bit unfair that children and their parents had to wait outside on the pavement until their appointment time, even in the depths of winter. But she did see them in person, and it really changed her perspective on the benefits of this type of clinic.
They changed the name to PRAC (paediatric rapid access clinic) which lots of people felt didn’t sound nice. It was rather a harsh name. Not lovely, soft and cuddly. But at least it did what it said on the tin. And one way Carly could increase her hours during the pandemic was to offer to do more of these clinics. It also meant they could be organised at any time of the day. These PRACs played to her strengths as she was very adept at emailing parents during the clinic, if appropriate, and so she didn’t need to bring these children and their parents back to see them again for ‘follow-up’.
This worked really well for the most part and parents really appreciated it. Long before the pandemic she had published on this area and so felt this was an excellent way to offer follow-up. Only very rarely did parents misuse this perk. One parent once sent pictures of her daughter’s stool several times a day to Carly. This wasn’t what was agreed and Carly, not being backwards in coming forwards, and feeling rather overwhelmed by the sheer number of pooey pictures in her inbox, had to explain to the mother that this wasn’t her role. This mother then went to see another doctor and was not allowed any email access. But this was very rare, and Carly has found this way of parents having access to her was seldom abused and meant she can see more patients, as her clinics are not clogged up with follow-ups.
Now Carly is pretty competitive. And Leah, one of the administrators, was a willing participant in seeing who of the consultant body saw more patients. Carly was convinced it was her. So, Leah looked through 15 months’ worth of data. Sure enough, Carly was by far the winner. Most of her colleagues had a new to follow-up patient ratio of about 3:1. This means they see three new patients to one follow-up. Some were as low as 2:1. These were all for exactly the same clinic. Carly didn’t want to show confusing data that compared apples with pears. One colleague was rivalling her with a ratio of 5:1. But she worked out that, whilst he’d been off for many months on sick leave, Carly and her colleagues had cleared his follow-up back-log, and he was basically starting afresh. It was easy to see his ratio falling with every month passing. Carly had a new to follow-up ratio of 9.64:1. Nearly 10:1. Was she pleased? Oh yes. Carly was over the moon. This was because she had an idea, and this would help her case tremendously. And she had to sort this out before her manager, Gordon, left. It had taken a long time to gather this data and once Gordon was replaced, Carly would be back at the bottom rung of the ladder. Gordon was quite a supporter of Carly although not always. He did always laugh when she was up to no good and getting bollocked. This was quite often as Carly finds it hard to behave all the time. He found these instances hilarious, but Carly was keen that he see her serious side.
She prepared an inventory of how much money she saved the hospital by personally having very few follow-up slots. She presented detailed information about what she saved in carbon footprinting by looking at where all 39 patients she saw in five clinics in May 2022 lived. She found they lived a mean of 5.6km and a median of 5.1km. She likes those statistics programmes that easily give you the mean, median and mode. It satisfies her curiosity and aids her memory as she has to keep reminding herself which each one is. Especially as they all begin with an m. But for sure easier than terms used in academic journals such as positive predictive value and false negative. Really, she can never remember them… Surely this will help stave off dementia? She is not really sure why she needs anything other than the entire range (those who live nearby and those who don’t) and the average. Depending on how they travelled to the hospital, Carly summarised their carbon footprint as follows.
If they all came by car (174 CO2 g/km). Total = 38,000g CO2
If they all came by bus (21 CO2 g/km). Total = 4,578g CO2
If they all came by tube (44 CO2 g/km). Total = 9,592g CO2, but the tube station at Archway doesn’t have step free access which is a problem for young children in a buggy or a pram. Of course, if they walked, ran or cycled it would be 0.
She also prepared another paper on how much income parents lost by coming to a follow-up appointment.
Here are her calculations for these same 39 patients. She saw nine babies and she assumed that they were with only the mother who wasn’t working as she was on maternity leave. That left 30 other patients. 15 appointments had both parents attending and 15 only one parent. They lost 3.5 hours of work as parents told Carly for each appointment; they lost an average of three to four hours of work. Carly assumed the pay was £15 an hour. How Carly arrived at this figure is totally open to conjecture. But you have to start somewhere, and it was well above minimum wage (£9.50).
Therefore, the total finance loss on families coming to five clinics in May 2022 is £2,362.50. Additionally, this doesn’t account for the amount of time children are missing school which Carly calculated overall as 120 hours.
Carly had prepared all this information to submit for a national clinical excellence award. But she realised that unless she died within the next five years, then she would be much poorer. Her grandparents all died in their 90s. And both her parents were alive, well and kicking. So, dying within five years was not an option, Carly decided. She did, of course, know that you really cannot be certain about this.
So, she realigned all the data she had collected into another avenue. Giving the data to Gordon who didn’t need to know it was prepared for an entirely different reason. He wasn’t being duped. The data was correct and true. Why collect data and throw it in the bin? That was just plain silly. Carly had started lots of projects and despite being an obsessional completer/finisher, she found some projects did fail. And certainly, Carly can be unsuccessful at applying for things. She has a massive folder on her computer called ‘My Failures (MF)’. Each specific folder is nicely filed within ‘MF’. Sometimes she puts applications in there before being unsuccessful. This could be seen as rather defeatist. But it saves it from being moved there later on. And labelling it as MF, although Carly does hate abbreviations, means she doesn’t need to see the word failures on a daily basis so boldly in her folders.
And Carly also knew, if she was going to work in a novel way, she was best off filing in the forms. So, she persuaded Ben in HR to send her the change of employment forms and duly completed them. She would work flat out in London doing gazillions of clinics during the summer holidays when her colleagues wanted to be off and anyway it was far too hot in Israel where she would live the rest of the year. She filled the form in as accurately as she could. When it came to position number, she cheekily put in she was number 1. Certainly, by the time this part-time job started she would be the oldest in the department. But she did point that out to Gordon, who filled in some random much longer number.
Her clinical lead was happy to support this for up to three years with an annual review to see how things were going. And in Israel, she would have to log on regularly to do the other bits of her job. The NHS is always going on and on about there being novel ways for their staff to retire. And for Carly, and her department this plan seemed to tick the box. It definitely was original. And Carly is all for ‘novel’. That is why she started doing these PRAC clinics in Covid in the first place. To stave off the boredom. At the beginning of the first lockdown there was very little happening with inpatient paediatrics. But parents still had concerns about their children and Carly was able to respond to these in a meaningful and timely way.
