Consultant Cardiologist at the Golden Jubilee National Hospital and Physician Executive – Scotland for InterSystems, Dr John Payne, walks us through a typical day, some of the challenges he’s faced this year, and how technology is helping him to juggle the many hats he wears.
How would you describe your job?
My job is slightly strange because I work for two organisations: the NHS and InterSystems. The latter role involves looking at healthcare IT clinical safety issues, working with the InterSystems product team to help make the software safer and better, as well as acting as a general clinical sounding board.
The former is in the NHS and that job has several parts. The first is being a cardiologist in the heart failure/transplant unit at Golden Jubilee National Hospital, which takes in patients from around Scotland. That involves working in the ward and intensive care unit. The work waxes and wanes depending on when I’m On Call, which could be 9am-5pm, Monday-Friday, but could also be an Out of Hours overnight, or at the weekends. It’s not bad for my fitness (which is generally poor!) because I’m often walking back and forth from the ICU to the ward, to my office. I can easily clock up 15,000 steps in a day.
Then I wear another hat, working in clinical governance for the heart failure/transplant unit. We are always trying to be better and learn from past experience. We review and analyse the care we deliver to many of our patients, so that we can learn from mistakes, no matter how small.
Finally, I have a role in imaging, organising and reporting heart MRI scans within a large team of doctors, technicians and nurses.
How would your colleagues describe you?
Some of my colleagues wear blues but I prefer to be in my shirt and cardie, or in one of my many waistcoats. I have quite a few button up cotton waistcoats – they’re great for doctors because you can roll your sleeves up without having to take off your jumper.
What does a typical day look like for you?
I usually hop in the car to drive to work, even though I should really cycle. It’s just too tempting, with the heater and the radio. I’ll usually listen to Radio 2 or 4, apart from when I’m taking one of my four children to school. Then it’s Capital Radio.
Over the past fortnight, our team has carried out five heart transplants, which has kept us busy – we normally only do one every month or so. Depending on transplant activity and patient transfers, my On Call weeks can vary from being steady to being very busy. The patients also vary – some are recovering from transplant and are nearly ready to go home, and some are very sick, having just arrived with severe heart failure.
I’m lucky in that I work with some great colleagues. I’m one of four cardiologists who cover the unit, so there will be many times when I’m away doing other jobs. But everyone on the team always wants to know how the latest transplanted patient or sick heart failure patient is getting on. In the end, you trust your colleagues to do their jobs and touch base with them when you can, to see how things are going.
That could be over lunch where I usually have a bowl of soup in the canteen with some of the team. The Hospital makes its own soup every day and it’s good. Our team often eats together and shares work challenges (amongst other things!), although COVID-19 has made that slightly more difficult – thanks to social distancing, you practically need a foghorn to speak to the person at the other end of the table!
A typical week sees me cycling round in a circle, touching base on the different areas of my work life. It makes for an interesting and varied career and probably reflects the type of person I am – a jack of all trades.
How has the COVID-19 pandemic impacted your work?
Our multi-disciplinary team meetings (MDTM) – where we discuss transplant patients – are an opportunity for team members to have their say. It used to take place in a big boardroom. However, with COVID-19 and social distancing rules, this was no longer possible, so we switched to using Microsoft Teams to hold the meeting virtually. There were some teething problems – both cultural and technical! – but now we have a decent microphone and it’s working well. More team members are joining too because even if they’ve been working overnight and are tired, or they are travelling, they can easily dial in.
We also now have a MDTM where we review cardiac MRI scans. We set that up because of the advent of Teams – which is now widely available in the NHS – and it’s great because an imaging meeting is all about the pictures. Someone can now present a case on the shared screen and we can see everything. We never had an imaging meeting before because my colleagues who report these type of scans are scattered around Glasgow and they were never all going to be able to get to Jubilee Hospital for an hour on a Friday. Now, suddenly, we’ve got a rapidly expanding group of people who are interested in this and we can discuss challenging cases and share opinions and learnings.
Teams has been a big deal, in general, opening up many opportunities, but it’s also been a great help for me personally. It means I can dip in and out of NHS and InterSystems meetings much more easily. I can listen in on the ICU meeting at 2pm, for example, even if I’m somewhere else, to find out how the patients are getting on. I can also do an international call with the InterSystems team without ever leaving my office. I think it’s important to be around and in touch with what’s going on, and Teams makes that far easier.
On the patient side, technology has played a similarly important role this year. The patients we follow up with in our national clinic come from all across Scotland – some have to take a flight to reach us and stay in a hotel overnight. This is not only tiring for the patient but expensive for the NHS and became completely impossible for most of 2020. Many of these appointments have now become virtual and it remains to be seen whether they will go back to happening face-to-face once the pandemic is over.
What is something you’re passionate about right now?
My big thing right now is teamwork. What makes a team work really well together – whether that’s the transplant team, the imaging team, or the clinical safety team at InterSystems. It’s the holy grail for me. How do you get people to support and get the best out of each other? And what stops them working well together, or leads them to work in a dysfunctional way? I’d much rather have an averagely skilled colleague, who is a big team player, than an amazing Lionel Messi figure who has all these skills but is a lone operator, and never tells you what’s going on or asks for support.
What’s the most useful way technology helps you in your job?
Technology, or more specifically, access to patient information, is instrumental in helping the clinical team make difficult life or death decisions. When patients come into the hospital with a massive heart attack, they can be in bad shape and from time to time, the team has to quickly decide whether to offer specialised advanced treatments. Using an online portal, we can view a patient’s files, including letters from their GP and this helps us to build up a full picture of their case, especially if they have not been to our hospital before. If the patient has certain ongoing medical problems, we know that they are probably not a good candidate and would not survive such advanced treatments. Selecting the right patients for a given treatment is important for success and digital health records give us access to patient information when we need it most, allowing us to make the correct decisions quickly.
Hospitals in Scotland are, thankfully, becoming increasingly joined up, which benefits both doctors and patients. Patients are being discharged from Jubilee Hospital to local cardiologists and GPs who are increasingly able to access information around their treatment there. Similarly, if a patient from the Edinburgh area is referred to our unit for assessment, we can access their information using a portal underpinned by InterSystems’ HealthShare platform. The hope is that in the next few years health and social care all over Scotland will have the same functionality, to create a truly integrated, nationwide service.
What’s one thing you’ve learned this year?
If there’s one silver lining to be found in this most difficult of years, it’s that technology has accelerated the journey towards smarter ways of working for medical and nursing staff, and better outcomes for the people we care for. My job may vary greatly from one day to the next. It’s undeniably changed enormously since I first began as a house officer in 1996. But one thing has become increasingly clear to me over the last two decades; data and information have a critical role to play in the delivery of healthcare. It’s this belief that motivates me to work for both InterSystems and the NHS.