How flexible are you? If you have been doing your Joe Wicks exercises you may now be very flexible as well as fit. However, I was thinking not about your physical flexibility but working practices. We in nuclear medicine are what he Piagest psychologists would call “concrete operational”. There is nothing we love more than a standard operating procedure. In fact such an SOP is the cornerstone of good and safe practice. It helps train new staff members and ensures consistency of results. However, they can become an excuse for ossification of practice. How many times have I heard the phrase “we have always done it that way”. It is a mantra of comfort. We know when we go to work we will be following the SOP like a cook follows a recipe. Any variation brings shrieks of distress “its not on the protocol” and can sometimes induce a state of near panic.

However, we live in strange times. I think that we have come to realise we will not go back to what we considered normal. Before the black death in the 1340s if you wanted to eat you had to work unpaid for 3-4 day a a week for the Lord of the manor. He (and was always a he) would then allow you to scratch a living from a small strip of farmland. The black death killed half the population of Britain and such labour could no longer be relied on. The Lord of the manor now had to pay his worked real money which they could spend in shops. This lead to the rise of a merchant class who would sell things from a new invention called shops. Also people had money to spend on services such as medical practitioners, teachers for their children and no longer had to make their own clothes, shoes etc. The rest as they say is history.

Well fortunately coronavirus will not kill 50% of us but its changes on society may be just as profound. The country is deep in debt, the overall cost of the pandemic to all of us will surpass the cost of 2 world wars. The last time Britain owed so much money was after 18 years of war with revolutionary and Napoleonic France. The resulting social crisis was so severe it resulted in the country becoming urbanised and industrialised with the consequence rise of trade unions, general taxation and the welfare state. Will there be similar changes ahead, time alone will tell. We can see some changes already. Instead of having to go to an office for meetings we can zoom* from our desks or even better home. I do agree hospital IT departments generally still live in a pre-pandemic world. There are dangers; none of us relish spending the whole day on zoom* meetings and just because they may be easier does not mean you should have more meetings.*Other videoconferencing platforms are available

Hospital managers seem to finally understand that attendance is not the same as work. Instead of insisting that you travel into the hospital to do your work it is now seen possible you can, if applicable, work from home. Many departments have found innovative ways to do this. I could never understand why a manager thought it was a good a good idea to get their employees to spend 2-3 hours a day exhausting themselves commuting when they wanted people to be productive. Ah you cry this is not for us. Well yes and no. I do agree injecting and scanning patients means you physically have to be with the patient in the department. However, there is a range of things which do not require you to be in the hospital such as booking the scan, ordering radiopharmaceutical doses, reviewing SOPs, writing new SOPs, doing dosimetric calculations or reporting scans. AGH you are now screaming I need the security blanket of my favourite computer or a special screen or talking to colleagues. All are true but not true every hour of every day.

There is another major issue commuting is killing our planet. Whilst some people would like you to feel guilty about taking a holiday for the average family less than 5% of their carbon emissions are spent going on holiday. The vast majority of transport based carbon emissions is going to and coming home from work. We may not be able to stop commuting altogether but a smarter way of working means we can reduce the work travelling we do. It would be wonderful if we were going to “spend” our carbon emissions we did on things that brought us pleasure not just drudgery. Also why are work patterns built so we expect parents to take children to school at the same time as they need to come to work, it is stressful, results on over use of cars and to be honest is straight bonkers. Why not have work patterns which allow one parent/care giver to start late so they can walk their children to school and the over starts and finishes early enough to collect their children for the walk home. Yes I did write walk. Children do not die if they walk to school. From age 5, I walked over a mile to school and back again every day often chatting with friends. In fact not only do children not die walking to school they may actually live longer.

Then there are clinics. We run clinics in a way that has not changed for nearly 200 years when physicians would only see the rich and in their own homes. In the post Napoleonic world social changes saw the rise of the infirmary and provision of health care to the main population. In 1870 it made sense for the doctor to sit in a room and patients queue up to see him (again at this time it was always a him). However, since than we have had telephones. This device enables us to talk to someone who is not in the same room. Whilst a few brave souls would use this technology including our brilliant Clinical Nurse Specialists before COVID it was generally considered not a proper consultation unless the patient suffered a long commute, had to queue to get into the hospital car park, arrange a bank loan to pay for parking (not in Wales I know), sit in a room with other people some of whom can give you a disease you do not already have (some estimates are that 15% of patients get new infections attending hospital), by the time you see the doctor you are both tired. Then the process takes so long you parking ticket has run out (OK not in Wales) and you need to re-mortgage your house so you can get your car out the car park and have the pleasure of sitting in a stationary traffic jam before getting home exhausted. This is not fantasy as a patient I have known this all too well. Therefore it comes as no surprise that when I ran the Friday thyroid clinic by phone on Wednesday my patients were thankful, happy and communicative. They were not so tired they forgot to ask those important questions. To a person they said how much better it was then trapesing up to the hospital. Of course they did need to come for their scan and treatment but that was all done in under an hour with smiles all round.

Now you are a clever lot. I am sure you have worked out ways to work smarter and more effectively during this pandemic. We have coming up the perfect opportunity of sharing that and in September the BNMS will be running the team innovation prize again. Start thinking what you can share with the rest of us. Remember what the French say “plus de la change”.

Dr John Buscombe

BNMS President