For the thirteenth year running I have been involved in an induction programme for surgical trainees starting their careers, post foundation training. As I scanned  the computer screen (yes, it happened virtually this year as the last thing we wanted was to take out an entire tier of doctors due to a Covid infection) I was struck yet again by the excellence before me. Possibly the brightest, most accomplished young doctors in the country were sitting in rooms all around the country, waiting for the next stage of their lives to begin. These people have worked hard to get to this position- on top of medical school, Foundation jobs, moving around hospitals every three months, time out for additional work or research or study, many have families, caring roles, other commitments. What they all have in common is a desire to make a difference, a passion for surgery and some trepidation about the future.

Irrespective of where they have been so far – and this year’s cohort came, gratifyingly, from all over the UK, they know the road ahead will be tough. Even without Covid-19, core surgical training is not easy, especially in London where they will be part of a much larger, sprawling team all keen to get to theatre. Hours are long, the work is varied – some of it tedious, other parts terrifying, but underneath all of that, is the question many do not want to ask: “ How will I be treated?”

We try to address this, subtly, delicately, avoiding placing any further fear in them, but also keen not to ignore the elephant in the room.

But the answer is, we don’t know.

Much has changed since I started working in surgical education in 1996. Looking back to those days,  they seem positively Victorian by today’s standards, and I know the profession has come a long way. But it still has some way to go. Waiting for the old guard to retire is not enough; their prehistoric attitudes have often sown the seeds in younger generations; bombastic, critical, even cruel, they reigned in terror not that long ago. We must encourage all new entrants to breathe their passionate humanity across the sector, embracing everyone with their beliefs in equality, fairness, justice and kindness.

Every year we ask our new surgical trainees to tell us stories of a time they thought they may have done wrong, caused harm. Stories that still pester at the edges of their minds, unresolved, preventing them from moving on fully. And every year we are humbled by their honesty, their heartfelt soul searching and reflective capabilities. Every story reveals a culture of self flagellation, personal reproach, each tale told with shaking voice, the rest of the group silent as the grave as they all think, “there but for the grace of god go I.”

And every year the hope that lifts my heart in meeting these amazing people is tempered by the recognition that medical culture in the UK is still far from perfect.

After one moving story this year I asked the narrator how it felt to have told their story.

“It is so good to be heard and not judged,” was the sober reply.

Heard, and not judged.

Four words that can perhaps encapsulate part of the reason for the ongoing difficulties we face when working in or with the NHS. In the pursuit of outcome measures, tick-lists, arbitrary targets and innumerable goals, how often are we, as individuals, heard? How often do we take something with which we are struggling, to someone else? How often do they give us the time and space to talk, to feel, to engage in the kind of mental gymnastics we need to be able to see ourselves and our practice from a different angle? How many people really listen and then, having heard, ask further, follow up, forensic questions to help us to come closer to an understanding? And even if we are afforded the time and space, how many of us feel truly un-judged by our colleagues and supervisors?

How often, if we do manage to tell our stories, are we instead met with solutions, or advice? How often, when we pluck up the courage to tell someone of a mistake, seeking some sense-making of the loop-playing film reel in our head, are we further disappointed? In ourselves, in the other person, in a system that seems incapable of making space for simple human connection?

Perhaps one of the greatest ironies  of all is that the healthcare system cares. The state it is in, here in the UK, starved of resources, forced to focus on  the small gains, bullied, undermined and shamed into a culture of secrecy and pretence, is a shadow of what it could be. Energy is rightly directed to patient care and little more than survival for fellow healthcare professionals. One may be forgiven for thinking that  a career in the NHS would be a nurturing and supportive experience, and it can be, sometimes. But that is not always guaranteed. The irony is that those very skills that form the cornerstone of care are often the skills that are forgotten with newcomers to the profession.  And yet, those skills of listening without judgement – fundamental learning in the early days of clinical education, when applied to each other, can – and do make a world of difference.

The health sector struggles to care as a system. But its individual professionals still can, and they do. So instead of rushing on with the never ending daily task list, the next time you see that someone needs to talk, let them. We are not the totality of the world we work in. We can make a difference, not just to patients, but to each other.

One of the greatest gifts we can give is to listen, without prejudice, to create time and space for another person, to show we care, rather than just to say we do. To hear, and not judge.