Parking your patients

Authors: Caroline Elton 

Publication date:  22 Jan 2013

A junior trainee came to see me recently wondering whether he had chosen the right specialty. There were aspects of his training in obstetrics and gynaecology that he enjoyed, but overall he had a sense that his heart wasn’t in it. Harking back to a rotation during his foundation years in the emergency department, he questioned whether this specialty might have been a better fit for him.

We explored his experience in greater detail, and he remembered that working in the emergency department had actually been somewhat frustrating. It had entailed too much “clerk and park” for his liking, he said. He explained that, although it was satisfying to make rapid clinical decisions in the emergency department, he was also left wondering what happened to the patients if they were admitted to the wards. He wanted to know the end of the patients’ stories.

I took up the analogy. If “clerk and park” was too brief an encounter, what sort of patient parking arrangement might he prefer? Just as options for airport parking range from stopping for a few minutes to leaving your car for weeks, so does the length of relationships with patients in different specialties. Working in the emergency department could then be thought of as equivalent—in terms of patient care—to dropping passengers off at the airport and then driving away.

So would my trainee then prefer the short term “parking option” of a specialty, where he can get to know patients over the course of days or weeks before they are discharged? Or would he be happier with a longer term option—for instance, a specialty where patients have chronic conditions he can treat over months or years?

On balance, he felt that short term patient parking was the best fit. But the length of time patients are “parked” with doctors is only one of many aspects of the doctor-patient relationship that need to be considered when choosing a specialty.

In the conversations I have with trainees who consider changing specialty, one theme is often discussed. That is a preference for being involved in diagnosis rather than treatment. Although many specialties provide opportunities for both, some specialties are more weighted to one phase than the other.

With laboratory based specialties, far more time is spent on diagnostic activities than on face-to-face contact with patients, which might remove the most important source of job satisfaction for some trainees. For trainees who do not enjoy extensive patient contact, a laboratory based specialty may be preferable.

Another crucial issue is patient feedback. I am sure that anaesthetists are thanked by at least some of their patients, and anaesthetists can also be involved in treatment interventions, such as helping patients with chronic pain. But, compared with the opportunities surgeons have for postoperative feedback, anaesthetists are less likely to receive expressions of patient gratitude than surgeons. This difference does not matter for some people. But if a major source of occupational satisfaction is positive feedback from patients, then the type of patient contact inherent in anaesthesia can prove to be problematic.

Of course the nature of the doctor-patient relationship is not the only factor to consider when choosing a specialty. Continuity of care, managing treatment plans, and opportunities for patient feedback certainly do not cover all the relevant doctor-patient facets that need to be explored.

The airport analogy was useful in discussing career options with this trainee. But deciding what to do with your car at an airport is somewhat secondary to the arrival or departure of an aeroplane. On the other hand, getting the nature of the doctor-patient relationship right is likely to be a primary determinant of future satisfaction at work.

Competing interests: CE is an occupational psychologist and head of the Careers Unit at London Deanery.

Caroline Elton chartered psychologist and head of Careers Unit London Deanery, London, UK

Cite this as BMJ Careers ; doi: