Inspired by @nas_vascular - here are 25 things I’ve learned after working 37yrs @nhs

1. Helping another human to experience less pain because of something I did is the best feeling in the world.

2. My family neighbours & friends pay my wages. I want to look them in the eye.

3. The @nhs needs better behaviours before it needs more money.

4. Over-treatment costs a fortune. Let it go.

5. You can change more than you think you can.

6. Egos & Empires are enemies of efficiency.

7. Kneel on the floor when you are talking to a kid during a consultation.

8. Patients are people first. They sometimes lie to get what they want - or to avoid what they don’t want.

9. The best and worst managers I have had have been female.

10. It’s no-ones fault we are snowed under. We’ve known about the baby boom since the 1960s - add that to increased longevity, multiple comorbidities, increasing expectation and a falling #nextgen birth rate. What do you expect? Utopia? Nirvana? Or the pressure we have now?!

11. All professions find it hard to let stuff go and have it done better by others. Professional behaviour is human behaviour and it’s often very poor & selfishly protectionist.

12. I can visit almost any country in the world & access my own money using a card in a bank machine. My GP can’t access my full hospital records and vice versa. And I can’t access any of them! In. What. World?

13. We need to stop pretending all things ‘Acute’/‘Hospital’ are good and all things ‘Community’/1° care aren’t. Change the narrative - change the culture.

14. Heath care practitioners who aren’t doctors need to stop wishing they were. Doctors need to stop behaving as though they enjoy that.

15. Rheumatoid patients are the gentlest, least angry people I have ever treated in spite of their often crippling deformities. I’ve often wondered if having to accept such personal physical carnage affects your psyche...

16. Adjacent wards can feel like different countries. Culture is real and generated by everyday behaviour. Bring the best version of yourself to work every day. EVERY conversation with everyone counts.

17. Cleaners are unsung heroes. Thank the next one you meet for making your workplace a pleasant place to be every day.

18. No patient felt worse as a result of you taking 30 sec more to explain or ask if they understand. Equally - no patient felt worse by being allowed to speak during their history taking for 30 sec without you interrupting them.

19. I’ve taken patients home in my own car when the ambulance was never coming. Why would I leave them waiting outside the dept when I locked up to go home?

20. Asking for help from a more junior member of staff isn’t a sign of weakness. I might be head of service but I’m only one person. I can’t do or know everything.

21. Setting up a surgical podiatry unit for 10mths in 2009-10 was the professional highlight of my career. Seeing it close when we couldn’t make it substantive was the professional nadir of my career. Undeterred, we keep trying 9yrs later....

22. Being part of the team that has redefined Podiatry in @NHSGGC over the last 8yrs has been the greatest interpersonal experience of my career.

23. Podiatrists don’t use local anaesthetics way near enough. Tib blocks for blunt VP dissection/ IPK removal; Intermet for neuroma diagnostics; biopsies; surgery; pain relief.... still our most powerful tool!

24. Podiatrists need to accept referrals for ALL foot and ankle problems in their @nhs system. Otherwise we are the F&A experts - but you have the wrong kind of feet

25. Being an advanced practitioner has more to do with decision making leadership and education than technical tasks. What is an ‘Advanced’ task today (eg steroid injection) is an undergraduate competence in 10yrs time.