Start With Why

Welcome to the elderly medicine ward. My name is Dr Sean Ninan.

I hope you enjoy your time on the ward. You will certainly learn lots. By the end of your time here you will see patients with classic geriatric syndromes, sepsis, malignancy, acute kidney injury, neurological disorders and much more. We will teach you to become very good at assessing patients with delirium, falls, blackouts, immobility, parkinson’s disease, dementia as well as general medicine topics like sepsis, acute kidney injury and acute coronary syndromes. You will learn what frailty really means and what it means to perform a comprehensive geriatric assessment. I expect you to learn about these topics because you will be looking after patients with these problems, but wherever possible, we will try to tailor learning to your chosen career, whether that is general medicine or general practice. If you are going to be a surgeon, paediatrician or something else, then bear with us! It is still important that you learn about geriatric medicine in order to provide a good quality of service, and hopefully you will still enjoy it, and take some of what you have learned into your future career. I also hope that we can convince some of you along the way to join us in geriatric medicine in the future.

I am a geriatrician because I love general medicine and I care for older people. I believe that older people get a raw deal in many parts of the health service and sometimes get suboptimal care if looked after by people who aren’t trained to deal with their complex needs. Older people include some of the most vulnerable members of society. It is important, that we as health professionals stand up for them and care for them. You may see a frail, older person in a hospital nightgown. Take a step back and try to remember that these people are parents, grandparents, husband, wives, brothers and sisters, that many of them have lived rich lives and that they deserve our care and respect, that they are our future selves. When you do your ward rounds, when you take blood or insert cannulas, take the opportunity to talk to them about their lives, their hobbies, their previous jobs, their families. Many of them will enjoy talking to you and you will get a fuller picture of the person behind their illness.

I care about excellence. I believe in delivering high quality care because patients deserve it and because I like to do things properly. If you are casual, or take shortcuts, we won’t get on, so please don’t. It reflects on me and the rest of the team. If you do your best, and learn about some of the things that I have just mentioned, you will enjoy your job more and feel proud of your work. I will be proud of you, as will the rest of the team.

I know that being a junior doctor is hard. I know that at times it can feel thankless. But it can be very rewarding, and on this ward we recognise those who go the extra mile. On the other hand, if you are struggling with anything at work, or if you observe things at work that concern you, then come and see me. I want to know.

Good luck! I hope you enjoy your time here.”

This is (an abbreviated) version of the introductory talk that I intend to give each set of junior doctors that rotate to my firm when I (hopefully) make it as a consultant. Obviously, some of it will include “housekeeping” and “ground rules” but a large part of it is about motivating junior doctors to work well in the team.

I was watching a TED talk by Simon Sinek who was delivering the key messages of his book “Start with Why: How Great Leaders Inspire Action.” (…/simon_sinek_how_great_leaders_inspire_action.html). He explains why he think some people have become great individual leaders, or leading companies, while others have been left behind. They start with why – their cause, their belief. It struck me. He gives examples of people, and companies, who were perfectly competent, as good if not better than their contemporaries, who didn’t succeed because they didn’t inspire belief. He contrasts the fortunes of Tivo, who built an excellent personal video recorder that hasn’t been very successful versus Apple, whose products we lap up and queue for, even when they enter a new market where there are many established competitors. The reason, he says, is that Apple start with why. Their modus operandi is to challenge the status quo and to innovate. The way they challenge the status quo is by making beautifully designed products that are user friendly. Their products happen to be excellent as a result of the why and the how.

In healthcare, you will see organisations outline their visions, missions and goals. These are usually packed full of buzzwords and clichés. They rarely, really, articulate why. On the ground level it is even less common. I have certainly worked in excellent teams, where you can see that people are striving to provide high quality healthcare. Often people lead by example. Often they will tell you “how we do do things round here” with reference to their guidelines and pathways and protocols (all good things, in my opinion, used sensibly). But you rarely hear people say why.

Perhaps, we could argue that individuals who have chosen to be doctors, nurses and other health professionals should be internally motivated. They should be doing the job because they care. And we should. But healthcare organisations are busy places where it is not uncommon for people to fatigue in their motivation or, sadly as we saw in Mid Staffordshire, their compassion.

That is why, if I become a consultant, every time I have a new team, I will start with why.

Everything else comes from there.


Published by sean9n

Geriatric Medicine Consultant Leeds Likes football, disco and onitsuka tigers. Talks about old people on here

4 thoughts on “Start With Why

  1. This is excellent. Well done. One thing to add: Junior Doctors, in your time on the ward (and other) you will come across patients whose B12 Deficiency has been overlooked because B12 assays are flawed and new guidelines are pending. Look out for this complex and common multi-morbidity syndrome because correct treatment can often restore independence. Even the most demented patient may experience a positive measure in quality of life. A diagnosis is equally important to alleviate the unnecessary suffering of for carers. Never be afraid to raise the possibility of this devastating condition with your Consultants, many of whom will need your assistance to keep up to date with the recent avalanche of B12 research and awareness. Thank you.

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