Dr Krystyna Walton FRCP
Consultant Physician in Rehabilitation Medicine
The Floyd Unit for Neurological Rehabilitation
Birch Hill Hospital
Rochdale
How did you train in Rehabilitation?
As a SpR in Rheumatology and Rehabilitation medicine. The two were split in 1989. I took up a Rehabilitation post in 1988 that included Rheumatology. When Rehabilitation was recognised as a separate Specialty in 1989-90 I worked fully in Rehabilitation. Rehab training schemes started in 1990-91. There are sub-Specialties in Rehab, such as Neurological Rehabilitation. We see patients as soon as possible after the acute episode and throughout rehabilitation and continuing through the adjustment into everyday life.
What attracted you to Neurological Rehabilitation?
Rheumatology attracted me first. I'm a function type of person. I'm about helping people get on with life. Neurological Rehabilitation is about people with complex problems and needs. No patient is the same as any other. They all have different facets to their personalities and lives. The muscular skeletal training of Rheumatology helps me understand the problems of the neurological rehabilitation patients.
Are there any parts of the work that you particularly enjoy and any that you find less enjoyable?
Team working is essential to the job. Working in a team, being able to contribute and acknowledge the multi-professional skills of the team gives a full picture of what is involved in the work. I also do private sector work - 97-98% NHS or compensation claims funded - on brain injuries; this technical medical expertise complements the Rehabilitation work and benefits the Neurological Rehabilitation patients.
The main problem in the work is finding the right service for the patients when they leave us. There is a split between the Health Service and the Social Service care that doesn't well accommodate the mixed needs of Neurological Rehabilitation patients. It is a matter of negotiating with people who don't fully understand or cannot deliver for patients' needs. This can be prolonged and frustrating.
What is your daily pattern of work?
Every day is different, so shall I take it over the week?
Monday a.m. There is the Rehabilitation Clinic until 2.00 p.m. This covers different neurological problems for new and follow-up patients. Outpatients can be referred from here.
Monday p.m. The afternoon is acute rehabilitation at Hope, seeing ward referrals. Then I'm also involved in the Manchester Strategy for Neurological Rehabilitation.
Tuesday a.m. Here at the Floyd Unit, as today, I'm catching up on administration, doing ward rounds in Rehabilitation and Medical. These are separated out and conducted with junior doctors. Then there are meetings: the once every six weeks audit, the once a month Directorate. Plus inservice training.
Tuesday p.m. Chairing the interdisciplinary team meeting. This discusses patients and formulates rehabilitation goals outcomes measurements and discharge. The team includes nursing staff, physiotherapists, occupational therapists, speech therapists and neurological speech therapists. Then I see any relatives of patients and discuss what we are hoping to achieve.
Wednesday This is a flexible day. Tomorrow there is a case conference about a patient who has become paraplegic for no reason apart from something that occurred when she was young. Psychiatrists are involved and we are trying to get her and her husband into an independent flat. There will also be a discussion about a patient in a vegetative state. Meetings with a manager at Neurological Science…….? And teaching SpRs. In the evening there is a North West academic Rehabilitation meeting which will also give me dinner!
Thursday is my day off when I am going to a Coroner's Inquest at Carlisle.
Friday a.m. I'm meeting with the team at Hope acute unit to discuss Patient Pathways and Electronic documentation. Then there is a meeting with a consultant in the Pain Centre. At lunch I will be attending a lecture.
Friday p.m. The SpR Training Committee is being held at which I'm handing over the Chair of the Committee to my successor.
Monday and Tuesday of next week I'm at a conference in London.
Have you got a family?
Three children.
How do you manage to fit it all in?
They look after themselves very well! My eldest is 17 years old. At first as a trainee I tried part-time working but discovered that I was doing full-time and being paid for only half of it. That doesn't fit with Yorkshire thinking so I went back to full-time hours to get full-time pay for it.
Flexible training is much more structured now and it's monitored carefully. And becoming more so in future. We had a flexible trainee here, but she moved on when her husband moved location. Rehabilitation work is 9 to 5 with weekends off, but with flexibility - we do stay after 5 and see our patients at the weekend if we need to. I'm on call for all Manchester one weekend in seven. We cover the sixteen bed acute unit.
What personal qualities have you found most useful, or think are most useful for Rehabilitation medicine?
Patience. Patients and carers need to be listened to. The patients have cognitive problems and have come through traumatic events. They take time to make decisions and should be given the time they need. Also, there is a need to understand how brain injury affects the whole family. Relatives can become angry. We work with psychologists to understand how people react because it's important not to over-react yourself. Doctors need to get a balanced view. A consultant is the most experienced person, but needs to take into account the views of the nurses and therapists and balance them out. There is also a need to have an eye for detail and to do things in a logical way. Communication is important between team members and with the Social Services. Some of the patients' situations are tragic, which can be draining. You can see yourself in the situation, for example, if the patient is the same age as you and have young families. You need to be able to cope with that.
How do you cope?
Me? I just drink! There's a lot of red wine consumed in our family!
You need to enjoy what you do and get a balance between your personal and professional life.
We have three children and six cats. We used to have seven cats, but the eldest died. We're getting two kittens before Christmas, so then we will have eight cats! And the garden - I grow things from seed. The garden keeps me going in summer and in winter there are the seed catalogues and the conservatory where I can grow things - and the wine, of course!