In defence of the invaluable medical secretary
Opinion
By Jenny Tate, AMSPAR, BA (Hons), LLB (Hons), MA.
Private clinic administrator
I was much amused by Mr Dev Lall’s comic piece in the November issue of Independent Practitioner Today on how one’s NHS secretary should not be allowed to handle one’s private practice.
If it was not intended to be comic, it was, at best, misguided and, at worst, patronising.
Mr Lall’s first mistake is that he appears to be employing the wrong sort of person. He should be seeking to engage the services of a qualified medical secretary, not a private secretary or a PA.
A medical secretary is easily recognisable from her CV, which will state that she holds a diploma from the Association of Medical Secretaries, Practice Administrators and Receptionists (AMSPAR).
This is a two-year, full-time course and requires exams to be passed in medical terminology, typing, health service structures, English and, when I qualified in 1983, medical shorthand at 100 words per minute, as well as the final examinations of four three-hour papers taken in one week in June. A PA does not go through anything like as rigorous a training programme.
Rather insulting
It is rather insulting to the medical secretary, and possibly to the consultant employing her, to say that ‘she is hired with little or no thought’. I can only assume that Mr Lall’s bad experience is a result of not only employing an improperly qualified secretary but failing to interview the candidates properly. On the other hand, it would be easy to land a job working for him.
I was also tickled by his description of the activities that he has observed while strolling past the ‘secretary pool’. He presumably considers himself to be too PC to use the term ‘typing pool’.
How terrible it is that these women are busy doing all sorts of frivolous and unnecessary things that are irrelevant to her actual job of being glued to the phone. Perhaps the solution is to give each woman her own minimally-furnished room, but including, of course, a phone, to which she is locked from 8.30am until 5.30pm and be forbidden to waste time having meal and toilet breaks.
All forms of leave would, naturally, be disallowed. And heaven forbid that she should be able to relieve the stress by discussing problems with her colleagues.
The constant ringing of the phone is a relatively new factor in the life of the medical secretary. When I first started work, the phone rarely rang and, when it did, it was usually an internal call from another department or, depending on the day, from the consultant requesting one’s presence in the clinic or on the ward round.
Invisible presence
Over the years, the medical secretary has become both more accessible and less respected. Her job is vital but invisible. Watch any medical drama on television and you will see doctors, nurses, therapists and all sorts of ancillary staff, but no medical secretary.
She occupies in the medical hierarchy a position analogous to the Victorian governess: she is regarded as socially and intellectually inferior to the medical staff but a cut above the jolly mass of porters, cleaners and catering staff.
Staff and patients assume that she is somewhat dim and needs to be talked to as if she were lacking in basic cognition.
I remember during one orthopaedic ward round, a patient was reading a novel by Joanna Trollope. The registrar, wishing to show off his cultural awareness, groped his way towards a remark about Barchester Towers. When I helped him out by explaining that the two authors were indeed related, he looked at me as if I were a sow that had learnt to dance Swan Lake.
Varied role
The phone calls that the medical secretary has to deal with are not just about appointments.
They can be complaints, inquiries about costs and about the competence of the doctor and his/her areas of expertise, people wanting their results even though the medical secretary is not authorised to give out results on the phone, requests for repeat prescriptions, a query they forgot to ask the doctor in clinic, wrong numbers, queries about transport – I once had to tell someone how to get from Manchester to central London – and anything else that a patient wants to know but is too trivial to ask the doctor.
These inquiries generate work: notes need to be pulled because doctors will not otherwise know who the patient is, messages left, results chased, which means making more phone calls and all sorts of other tasks which take the secretary away from her desk.
In addition, let us not forget that the medical secretary is most poorly-paid of all the professional secretaries, earning considerably less than legal secretaries and PAs, even though her training is more rigorous than either of those roles and the job far more demanding.
There is limited or no opportunity for career progression and she undergoes no continuing professional development. She must carry all the responsibility but has none of the power.
To say that a secretary working in the NHS is not capable of handling private practice is nonsense. The training is the same for every medical secretary regardless of whether she chooses to work in the NHS or in the private sector. But, yes, Mr Lall, if you increase your NHS secretary’s workload by foisting your private work onto her, you will have problems.
Socially inept
I also take exception to Mr Lall’s comment about ‘issues of politeness, education, phone manners and so on’. Some of the supposedly best educated people, doctors included, are among the most ill-mannered and socially inept that I have encountered.
He would do well to bear in mind that patients can be very rude, especially on the phone. They will speak to the medical secretary in a way that they would not dare to speak to the doctor’s face.
It is much easier to harangue an anonymous, disembodied woman on the phone than it is to rant to the man who holds the power to write their prescriptions and sign them off work.
The argument for not using an answering machine does not hold up. It is very difficult to answer every call the moment it comes in. What about those patients who ring out of hours?
Many a Monday morning have I come in to messages left at midnight on Saturday or at Sunday lunchtime. The answerphone is needed to pick up calls when the secretary is busy on another call or is away from her desk.
And it is annoying when people don’t leave a message. Perhaps the solution is to have those NHS secretaries, whose sacking Mr Lall so blithely calls for, sitting by the phone 24 hours a day, seven days a week without breaks. Oh no, that won’t work, because they are not competent enough.
I suggest that Mr Lall gives his medical secretary, if he has one, a much-needed week off and does the work himself so that he can find out exactly what it involves.
I don’t like being told how to do my job. And your secretary doesn’t like being told how to do her job either.