Nope – A Rant on the Invisible Walls in Medicine

We practitioners are good at a lot of things:

• Making lethal coffee capable of incapacitating a capybara.

• Getting excited over veins at dinner parties.

• Nuking any lighthearted debate about NHS politics.

But one thing we are awful at is sharing.

Whether it’s time, money, resources, or staff—we’re all under the same umbrella cosh of a broken, cash-strapped system. And when someone asks something of us? We resist.

Sometimes overtly. Sometimes with a well-placed sigh. But resist we do.

And it’s not just the NHS. Even in private medicine, when inefficiency rolls downhill, there’s friction. High profit margins and baby-seal fur coats for execs don’t make themselves. The instinct to hoard time, autonomy, or staff crosses sector lines.

I’ve worked up to Specialty Grade in both Primary and Secondary Care (in more than one area of each). And if I had to draw the map of where the real resistance to “sharing” lies, here’s what it would look like.

Sharing Space

Ever worked in a cramped rehab ward or surgical unit? It’s like flat-sharing with five OCD hoarders on amphetamines.

• Want the phlebotomy drawer set up differently? Tough.

• Want a locker in the staff room? Good luck — 98 are taken, and if you fall out with one nurse, you fall out with them all

• Want to eat lunch in peace? Infection control has every surface on lockdown. Enjoy the rain.

Some of this is hyperbole. A lot of it isn’t.

When beds are short — and they always are — the tone of a phone call can change in a heartbeat. Walls become mountains.

Cramped working environments and resource scarcity breed territorialism. When people feel physically crowded, collaboration suffers — not because they dislike each other, but because the system primes them to defend what little space or control they have left.

Sharing Help

We hate asking for help. Some are better at it, but when you really need it? That’s when the invisible wall shows up.

Primary care side: You’ve got a patient breathing weird in front of you in a sort of "looks like death" way but that's hard to convey in medicalese. A queue of late-to-be seen patients are hammering at reception getting twitchy. You speak to a tremulous FY2 asking about your heart failure management for the third time. The Cardiology SpR has already bounced the query for them to solve because they're several inches deep in someones femoral artery and if you keep pushing it, you’ll wait 25 minutes for a consultant. (Spoiler: you will.)

Secondary care side: You’re the lone FY2 on AMU. 16 patients pending. 6 to clerk. One has Type 2 respiratory failure and isn’t responding to nebs. The registrar is arguing with the bed manager, who’s threatening to wear your skin as a suit if you admit one more patient.

Get in their shoes? Sure. But you can't put a fire out from inside the house.

These moments are microcosms of what we more diplomatically call “interprofessional resistance” — moments where collaboration should happen but doesn’t, because the structures make it punishing. Burnout and time pressure become behavioural barriers to teamwork.

Sharing Staff

Since before the pandemic, I’ve been getting daily pleas for cover: GPs, GMED, ED, AMU, medical wards, surgical SHOs—you name it.

They come with subject lines like “Desperate Plea” or “Important Request.” Hit me with that red exclamation mark on an email one more time, and I swear I’ll go feral...

Cross-covering used to mean an extra pair of hands. Now it means “you’re the only FY1 for both wards—enjoy!” Cross-covering for ED or MIUs? Virtually unheard of. I once knew a doc who volunteered to cover ED solely because he was sleeping with a nurse there. Not a recommended tactic.

These breakdowns aren’t just cultural — they’re systemic. Without leadership support and formal training in cross-disciplinary roles, staff are left to guess — or decline — collaboration.

Sharing Time

Time in medicine is both a treatment and an enemy. We might be approaching what engineers would call a “hard limit” on care efficiency (citation still pending), and nobody wants the bulk of the shared timeline dumped in their yard.

It’s like a team trying to eat a 50-foot hotdog:

• The strongest eaters have to go first.

• The anchor at the end needs to be efficient and fast.

• Nobody wants the half-chewed wet bits, so teamwork matters.

But if the GP doesn’t eat enough at the start, the SpR gets overloaded. If the SpR takes on more, the Consultant explodes because they were expecting less to chew. If the Consultant rushes discharge, it rebounds into the GP’s face in a far worse state than before.

Now substitute the Hotdog in this scenario for your Grandmother and it's a lot less funny/edible.

If community teams are already overloaded, the whole system clogs. Time-sharing in multidisciplinary teams rarely translates to true responsibility sharing. Each role is incentivised to do “enough” to pass the baton — but no one is trained to eat the whole hotdog together.

Sharing Information

This should be the easy one.

We’ve got FOAMed, intranet, EPRs. We should be drowning in shared knowledge. But somehow we still operate on a “need-to-know” basis.

I’ve been explicitly told to understate or withhold information to protect:

• Bed availability

• Resource use

• Specialist equipment

• A consultant's true whereabouts from his wife (please, don't ask me about that one)

Sometimes it’s politics. Sometimes it’s just not knowing each other’s roles. Radiology referrals become miscommunication minefields. Team fragmentation leads to each discipline guarding “their” data — not from malice, but from institutional habit.

Until we stop benefiting from opacity, we’ll keep salting our trust with suspicion.

Sharing Experience

“I know something you don’t” sounds cute at 12. At 30, it’s career-threatening.

Specialist silos hoard expertise, afraid someone outside the tribe might screw it up. Hence: Shared Care Protocols — not to share knowledge, but to protect against liability.

There are reasons sharing experience doesn’t happen:

• “When will I use that?”

• “Why is it my job?”

• “How do I find the time?”

• “Can I trust someone else with this?”

• “Who pays for this training?”

All valid. But as Lindqvist (2015) argues, these questions all flow from the same root: systemic mistrust. Until we make transparency less risky than opacity, sharing will feel unsafe.

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This is a rant. There are no perfect answers - I think - this one is definetaly a WIP sort of deal.

Medicine is built on a Potemkin village of self-sustaining silos.

Breaking them could be powerful. But risky.

Stay positive

DW