In keeping with the cardiac theme of this month’s newsletter, I was reminded of a fascinating episode in my early career. In 1970 I was appointed to a Residency Training Programme in London, Ontario, Canada. I had applied for this as I was confident I was not going to get any of the really top training jobs in the UK and a student flatmate of mine had got such a post and recommended it. The appeal of going abroad and doing something different was very powerful!
One day I was the duty junior hospital doctor in the teaching hospital and working on the intensive and coronary care units. Whilst in the unit, an alarm went off and the staff could see ventricular fibrillation on the cardiac monitor. The nurses rushed to get the defibrillator and I went to the patient and searched for the femoral pulse – an instinctive reaction to any cardiac emergency. The nurse in charge shouted ‘stand clear’ as she prepared to defibrillate. To my amazement, I could feel the pulse very easily and I shouted stop – she was about to ignore me until I was able to make it clear to her that the patient had a normal pulse! The lesson is that we must always make use of whatever technology is available to us – but that such technology may not be infallible!
Moving on in my career I was appointed to a consultant post at Northwick Park Hospital which had a Demonstration Centre in Rehabilitation Unit. These units had been recognised by Sir Keith Joseph – (who became one of Mrs Thatcher’s key ministers) as offering leading-edge rehabilitation either in practice, education or research. Indeed, it was one of the few hospitals in which a rehabilitation department had been clearly planned prior to its being built. One of the leading services offered was that of ‘coronary rehabilitation’ which was led by the head occupational therapist – Elizabeth Yates 1. In this chapter Elizabeth was ahead of her time – she noted many employers having an attitude to encourage patients to take early retirement and a reluctance to employ people with coronary heart disease. ‘This can be counteracted in two ways. Firstly a return to work should be as early as possible (6-10 weeks depending on the severity of the infarction and its associated complications). Secondly, the employer should be included as a member of the extended remedial team whenever possible’. All are now agreed that the employer is an intrinsic part of the rehabilitation team.
I had clean forgotten about this as the Thatcher government wound down all employment rehab services including the excellent coronary rehab programme at Northwick Park. I think this resulted from a very flawed decision made in the early 1990s that all government actions relating to employment should be organised by the Department for Work and Pensions (or its predecessor). The Department of Health said ‘yippee’ so that money spent on RTW services could be channelled elsewhere!
Indeed, the Civil Servant who represented the Department of Health on the British Society of Rehabilitation Medicine Working Group on vocational rehab (which published its report in 20002) in 1999 resigned from the group with the words “My minister won’t have any truck with this work nonsense”!
Perhaps next month will have happier reflections!
Trustee and Past-Chair, VRA
(1) Yates E. Coronary rehabilitation. In: Frank AO, Maguire GP, editors. Disabling Diseases: physical, psychological and environmental management. First ed. Oxford: Heinemann Medical Books; 1989. 98-112.
(2) British Society of Rehabilitation Medicine. Vocational Rehabilitation – the way forward: Report of a Working Party (Chair Frank AO). First ed. London: British Society of Rehabilitation Medicine; 2000.