I resigned from work on the 6th June 2014. Some folk have been wondering why. Below I offer briefly the background to my decision to resign and why it was a matter of more than just principle.
I have worked for NHS Forth Valley as a Consultant in older adults in Clackmannanshire for nearly 13 years. This has been hugely rewarding for me and indeed a privilege to share in the lives of the wonderful elders of Clackmannanshire often in a time of need. The team of which I was part worked with dedication, compassion and professionalism even though at times we had to make difficult decisions due to the demands placed on our service. The support from colleagues in primary care, social work and third sector was greatly valued and our joint-working a source of satisfaction long before integration of services was ever considered.
I also wish to thank my employers for their support, particularly as I faced the steep-learning curve of the non-clinical aspects of today’s medicine and the shifting sands of political mandates and targets.
What follows is a brief account. It is to help explain and perhaps allow wider reflection, including my own. It seems to me that finding the words to express complex matters in writing helps me to “see” better. I am aware that this will be one account, open to challenge as none of us (thank goodness) will have the same view on life.
The factors involved in my resignation were complex. Life is complex after all. The beginnings of all this go back many years when I was faced with a difficult situation. I was concerned that our most elderly were more at risk of mis-diagnosis of dementia. This was at a time of incentivised targets for the early diagnosis of dementia (HEAT target 4 in Scotland) and increasingly I found that elderly patients were being diagnosed with “early Alzheimer’s disease” but in fact did not fulfil internationally accepted clinical definitions of dementia. My concern was that in the late stages of life individuals who would never develop dementia were being told they had it. What was in truth an increased risk of developing dementia was being expressed to patients, families and carers as a definitive diagnosis. My dilemma in speaking out about this was that very few others seemed to share my concerns. This seemed to me to be the case across a range of professions and jurisdictions.
My approach was first to discuss this with colleagues, which only confirmed that my view was that of the minority. I then raised the matter through the appropriate channels of line-management. Initially I was supported in raising my concerns. However this did not last: the most likely reason for support being withdrawn was that I was diverging from the majority.
From that time on my professional life got tough. I wrote an account of my concerns called “Peter’s Lost Marbles” the transcript of which I turned into a short film. This transcript and film were praised by the then Chief Executive of the Mental Welfare Commission and by the then Lead Policy Officer for Alzheimer Scotland. Both these National leads suggested that the transcript should be published in a journal and that the film version be used to encourage wider understandings of the complexities involved in the early diagnosis of dementia.
Dr Peter has one or two marbles left, and written on one of the more brightly coloured ones is the oath he took on graduation: primum non nocere (above all, first do no harm). Yet Dr Peter has found that his medical colleagues, Alzheimer associations and indeed politicians show little inclination to look at this singular marble.
NHS Forth Valley decided that an “External Review” would be held. It was documented ahead of this External Review, by the Medical Director at the time: “but the main concern is with PG [Peter Gordon]”. Increasingly isolated, and not included in strategic meetings to improve “joint working” it was difficult to know how to proceed. Through stress I was signed off by my GP and was off for 6 months. Interestingly having been off once before in 2004 (my only severe depression caused by discontinuation of Seroxat) I found that I was re-defined by some as a case of “recurrent illness”. I have found it very difficult to escape this stigma and my experience has been that my profession is just as likely as any other to see “illness” before the person.
I have always taken a pluralistic approach to science and have been a lecturer in Medical Humanities. I am interested in ethics, professionalism, philosophy and their crucial contribution to the evidence-based medicine that I aspire to follow. It was my interest in professionalism and my concern that medical education was inextricably linked to marketing that led me to advocate greater transparency in financial conflicts of interest. I have pursued this with some determination. I have petitioned the Scottish Government for ‘A Sunshine Act’ and have argued that we should at least have transparency of financial interests equivalent to that which we expect of our parlimentarians.
My experience has been that it is not easy to pursue transparency in the health service. If anybody is interested much of this can be followed here.
The final straw for me was that I no longer felt that my concerns about staffing levels in the team of which I was part were being taken seriously.
I am deeply sad to have left NHS Forth Valley an institution I hold dear. I leave behind many friends, colleagues and special people. My career is now in limbo. But the main reason I write is in the hope of wider reflection and perhaps even a change of culture. I have been honoured and privileged to be part of the lives of the wonderful and inspirational elders of Clackmannanshire. I have learned so much from them all.