The risks of being a locum

I met a senior casualty nurse lately who told me about the difficulty of doctors in training changing every six months; they had to fit into established routines and practices. The same applies to locum GPs starting at a new practice. Established members of staff, including receptionists, might see themselves as the unacknowledged captain, running the ship. They want no challenge to established practice, especially from a locum GP. There will be occasions when they can be heard perpetrating the lowly status that locums are held in… “Your doctor is away, I am afraid. We only have a locum if you want to see him.” This is where the relationship starts between the new locum GP and the patient.

The secretary or nurse is often permanent and established, protected by employment law as well as by established relationships in the practice. The GP locum is temporary and vulnerable; their reputation is entirely dependent on the answer to the question that the GP principal asks his receptionist on his return: “How did the locum get on?”

The GP locum is temporary and vulnerable

The GP locum needs a reference, this time not from his consultant in hospital, but from the receptionist, patients, and the locum agency. It is rare indeed for the principal to ask the GP locum how things went with the receptionist and patients. And the relationship is not strong enough for the principal to get the truth. “Grand” is an easy answer. Doctors are therefore sometimes more vulnerable than nurses and secretarial staff. And yet the buck stops there.

The GP locum needs a reference, this time not from his consultant in hospital, but from the receptionist, patients, and the locum agency

GP locums may find themselves challenged successfully by established staff around issues that the doctor feels affect clinical practice: “sign this, this, and this,” in rapid and blinding speed. It is understandable, if unhelpful, that the GP who is away, and who has never met the locum, will take the version of history as narrated by his secretary: “the locum would not sign some of the forms”. The principal may be understandably shy and reticent to discuss an awkward issue with the locum, now gone. It is easier to not talk with the locum to get both sides and it is easier not to hire the awkward locum again rather than upset the applecart. Gone is the search for the truth and best practice.

We are all human and we all have bad days, but human upset will cause human error. Medical error is far more expensive and time-consuming than working on all relationships, especially the vulnerable ones. Strange as it may seem, the most vulnerable person is often the doctor.

Dr Paul Heslin is a GP based in Dublin

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