Matt Morgan: The medical handover is broken

The most dangerous procedure in medicine doesn’t involve scalpels, or lasers, or even touching the patient. It involves words, sounds, and pieces of paper: it is the medical handover.

Teams huddle together with folded lists or custom PowerPoint slides, leaning on tables or sometimes even sitting on the floor. As critical results are read aloud, all around the team phones are ringing, alarms are chiming, and interruptions fail to be noticed. This is the reality of clinical handovers between excellent staff who are caring for complex patients. Too often, however, what’s said is not heard, what’s heard is not understood, and what’s understood is not done.

Despite safety alerts and published advice outlining evidence based strategies for medical handover, the quality of those handovers remains as variable as the information provided. Handover, like the ward round, is a critical item in a doctor’s toolbox, but it’s seldom formally taught—unlike, for example, the Krebs cycle. The new Medical Doctor Degree Apprenticeship for NHS organisations may be a golden opportunity to weld into doctors’ training these core activities that could improve patient outcomes far more than expensive designer drugs. All too often the theory of medicine can trump the practical aspect of being a doctor.

However, what any emerging model must resist is creating a two tier system that divides us into those with the cognition for medicine and those who deliver it though service. Being advertised as a way to increase diversity in the medical workforce, the Medical Doctor Degree Apprenticeship must not reinforce the “gown and town” divide that already exists between state and independent schools, between certain universities, and between people with different social backgrounds.

Instead, traditional medical education will need to become even more mindful of the practical demands of the job, pairing time dedicated to the Krebs cycle with training based on high quality evidence for the service of being a doctor.

Oscar Wilde and Stephen Fry are among those who have noted that “we are not nouns, we are verbs”—so let’s train others to doctor, rather than just to “be” a doctor.