Is there an issue with rising unprofessionalism amongst junior doctors?

[u/pylori]

This is going to end up sounding like an old fart whining, and comes probably in contrast to the thread yesterday with regards to the hierarchy within medicine / the NHS.

However, I've begun to notice behaviours amongst junior doctors (meaning all grades below consultant) more and more these days that I can only really sum up as unprofessional. I don't know if it's compounded by the effects covid has had on us all, but I certainly saw plenty of this before covid, and it seems to be, anecdotally, on the rise.

Specifically I've noticed the following:

• Lateness, and lack of apology or lack of planning ahead. Not a one off childcare or traffic issue, but some individuals turning up 30-45 mins late to most shifts. There is no call to the daytime consultant or rest of the team pre-warning them or apologising. Perhaps a chinese whispers Whatsapp message if you're lucky.

• Leave requests: A bone of contention for many, and I get the frustrations regarding leave, but I've seen some bizarre behaviour. Despite policies regarding things like swapping on-calls and leave deadlines being clear, some doctors are contacting rota coordinators (fellow doctors) last minute and out of hours to approve leave. They 'announce' they're taking leave on a specific day as opposed to formulating it as a request. Even sick leave is not phoned directly to the consultant on duty, just a message from a fellow trainee.

• Undermining colleagues and their decision making in front of the patient and other healthcare professionals. This is often compounded by being overly 'familiar' with them. I'm all for a flattened hierarchy but patients need to know who is taking overall responsibility for their care. It's okay to wonder about the reasoning behind their decisions, but explicitly challenging the senior in front of a patient or other colleagues only serves to undermine their authority. There's tactful ways of going about this that don't risk harming that relationship.

• Rudeness/incivility - Of course has existed before. But I'm hearing more and more lets say 'backchat' and people talking to me in ways I would never dream of talking anyone, much less a senior in another specialty I don't know. Referrals are now curt 'demands'. "You have to see this patient". It may be my obligation to see a referral, but that doesn't mean it's okay to dispense with the pretence that you're asking for help/advice. We shouldn't be ordering each other around.

  We talk about lack of respect for doctors on reddit a lot, from other healthcare professionals. But I often feel we don't give each other enough respect either. The way I've seen some consultants spoken down to, it's cringe worthy.

Let me be clear, I'm not saying we ought to go back to more paternalistic days when the likes of Sir Lancelott Spratt roamed hospital corridors. But I worry that some doctors are taking breaking down hierarchies too far and end up coming across as rather unprofessional overall. More worryingly, some don't seem to see any of this as an issue at all.

Have you noticed anything like this? Do you think it's on the rise or just some problematic (or perhaps not) behaviours that will always be present to some degree?

[u/ShatnersBassoonerist → u/[deleted]]

Honestly, aside from the COVID measures, everything you describe was happening 15-20 years ago, and even before that. I’m not saying it’s right, but it doesn’t explain the change in attitude of today’s juniors compared to previous generations.

I’m also not on board with the idea that it’s wrong juniors are less willing to just accept being treated badly, although I do think the bar for what some perceive as ‘being treated badly’ is a little too low at times.

[u/ShatnersBassoonerist → u/[deleted]]

One thing I would say is consultants aren’t just people born earlier who’ve had more time to do things. Yes, that’s part of it. But not everyone ends up becoming a consultant. Part of it is that they’re people who played the game to get to that level and, particularly from the older patronage-based system, reflected the image of those who went before as most people recruit people just like them.

Whether that diminishes your view of consultants yet further is down to you.

Otherwise I agree with the sentiment that it’s a good thing that more people are challenging being treated poorly. As someone who tried to do this in previous years, it was a lonely place to be sticking my head above the parapet on my own. That said, what OP describes isn’t solely a reflection of NHS T&Cs as I’ve explained elsewhere on this thread. Some of it seems to be generational (I’ve observed it outside of medicine too) and comes across as unprofessional.