A Game of Thresholds - Understanding the Junior Doctors' Strike

A Game of Thresholds

We are all playing witness to the current negotiations between our trade union and the government. We have seen the new deal proposed by the government, which they hope will be accepted. However, there is a crucial lens through which we should view these negotiations, one that is fundamental to understanding the motivations of both sides.

Now the motivation of the BMA is fairly simple. Like most unions, their objective is to advocate and seek better pay and conditions for their members. Any deal proposed by the government will be put to a vote by BMA members and our simple majority voting system means that 51% of the vote is required for a deal to be accepted. The government is well aware of this. 

The BMA began negotiations with a request for a 35% pay increase, justified by the real terms pay cuts to junior doctor wages since 2008. Hypothetically, if the government proposed a 34% pay rise for junior doctors, 1% lower than full pay restoration (FPR), would 51% of BMA members accept this deal? Without much doubt, we can affirmatively say yes. What about 33%? Again, it is highly likely. If we continue to play out this experiment, there will inevitably come a point where the difference between a successful and unsuccessful deal hinges on a single percentage point of pay.

Now no one knows where this figure lies and all of the predictions you see on public platforms are just mere speculation. Nonetheless, this is exactly the question the government is asking itself: How far can we reduce this number while still securing the crucial 51% agreement? 

The current government has inherited a muddied fiscal climate, fuelled by the lasting effects of the pandemic and geopolitical conflicts (and some would add mismanagement and under-investment to that list also). The chancellor has already made a commitment to tighten up spending when appropriate. So we are looking at a negotiation where the parties have competing interests, but are unified by the goal of a functioning health service.

These points show how tactical these negotiations are. Whilst the BMA aims high, for the government it is about strategic concessions aimed at achieving a 51% majority consensus. So to really understand these negotiations we must appreciate the game we are playing, A Game of Thresholds.

Attention Residue

Attention residue refers to the cognitive cost incurred when switching between tasks, as part of your cognitive resources remain on the previous task, even when moving to the new one. 

One might think that switching tasks leads to a smooth transition, but the work of Sophie Leroy tells us that this is far from the case.

Participants in Leroy’s study who were interrupted mid-task and asked to switch to a new task, performed 20% worse on the new task.

So maybe we should be thinking twice before we interrupt our diligent juniors for a TTO whilst they are in the middle of that cannula.

What’s in a Name?

The acronym AIDS (Acquired Immune Deficiency Syndrome) has long been used as a label for individuals infected with the Human Immunodeficiency Virus and it is a term still widely used today. But given its historical connotations and the fact it is loaded with stigma, should this term still be used today? Well there are many professionals who think not, and are advocating the term AHD (Advanced HIV Disease). 

This example raises an intriguing philosophical question about the naming of certain conditions. Should conditions with a fraught historical past be renamed to help society move away from their negative associations?

While one might argue that stigma will not vanish with a mere change in terminology, it is also unreasonable to claim that such a change would have no impact at all, as there are many damaging words that our society has banished from acceptable use, precisely because we know that words have power (we hope you understand why we’re not providing examples!).

Here we visit the branch of philosophy known as linguistics. Language plays a central role in shaping our perceptions and attitudes. The very words we use work to influence how we think about the world and the people around us. Therefore these name changes within medicine work to strip away unwanted or hurtful associations.. 

You might be thinking, "Just what I need, yet another acronym for me to remember…" and medical students might already be gearing up to throw their textbooks at me.

However, it's important to discuss how we name diseases,  balancing their epistemic function (to accurately convey information), with their ethical function (to shape attitudes and perceptions in a humane manner). 

After all, a name is more than just a label; it's a powerful tool that can influence both understanding and empathy. In fact if I’m not mistaken, I believe the old saying goes:  ‘The pen is mightier than the scalpel’...

As ever, our worst enemies are each other. We need unity

“It’s ok to feel conflicted about the deal!”

“I ‘listened’ to a patients chest for a full 10 seconds before realising my steth wasn't in my ears!”

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£10 for Paracetamol ??

I came across an interesting post on X recently that read ‘Stop prescribing paracetamol, it is about 40p in Lidl’. This is true, costs of prescribing certain medications in the NHS are far higher than if the patient went to buy that medication for themselves. But do we know why? 

The NHS has a standard £9.90 prescription charge per item in England regardless of the cost of the actual medication.

The beautiful bureaucracy of the NHS means that when medications are prescribed, there are additional costs linked to admin, dispension and handling of the prescription.