Guest post: what we signed up for

I am so pleased to be able to publish this guest blog by River, writer of Hanging Round the Inkwell. She’s a doctor who’s had her fair share of bends in the medical career road, and talking to her is a solace to me. Her reflection is a pithy insight into something every doctor has either thought or been told after a tough day, and bears truths about the realities of being a doctor that the government still steadily refuses to acknowledge.

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“It’s what we signed up for.”

How often do you hear doctors say this? They describe some of the negative aspects of their job and then say ‘but I don’t mind because it’s what I signed up for’. I stayed late again, I missed my best friend’s wedding, I haven’t had a chance to pee in 12 hours, I’m exhausted after working 12 days in a row, I haven’t seen my family in ages… but it’s what I signed up for.

But is it though? Working as a doctor implies certain things. You will, at least at some point, have to be part of providing a 24/7 service which means you may work Christmas day and you will have to work some nights. You will have to deal with sick and dying people. You will have to have difficult conversations. You will have to take on responsibility.

Being a doctor, in and of itself, does NOT mean: having to work 12 days in a row, having to work 13 hour shifts, having to work without a break, having to cope with a workload that would be better suited to three or more people, having to stay late for non urgent reasons (usually on the whim of a senior colleague), having to explain to patients and relatives decisions and management plans made by other people, having to miss significant amounts of family time for a sustained period, having to miss events that are important to you and that you have given rota coordinators notice of. It does not mean having things dumped on you because other people can’t be bothered to deal with them.

So much and so many of the stresses of the job are, we are told, inevitable, part and parcel of being a doctor. We are told that they are what we signed up for. The fact is, for the vast majority of us this just isn’t true. We signed up to help people, to provide healthcare, to do applied human biology. For various reasons, and because of various interests and driving factors. We didn’t ‘sign up’ to be overstretched, to plug ever increasing gaps in an overstretched service, to work unsafe hours.

It would be possible to practice medicine in less relentless ways, and it would still be medicine, and we would still be doctors. Exhaustion and burnout aren’t what we signed up for and they shouldn’t be inevitable.

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It’s as if I’m in the wrong body

After the initial novelty of my non-medical career subsides, and I slip back into every day life, I’m almost surprised how quickly this new situation has become ‘normal’.

Was it really just six months ago that I was trying to decide whether to quit Medicine? Did I seriously stay up all night agonising over my wasted education, questioning my life decisions and wondering how I could live outside of my career?

As unpleasant as all the drama was, life now feel strangely drab without it. My mum and I are now taking advantage of my new-found freedom. She’s been filling my weekends with fun wedding planning, and booking me in to sing at various concerts, which I’m really enjoying. I think she’s actually glad I’m able to do such things now, and it’s nice to spend more quality time with her.

My dad, who I think was deeply affected and disappointed when Medicine didn’t work out for me, and whom I could hardly face for the shame of it, seems to have recovered somewhat too. He grabbed me when I visited last weekend to help him set up a website. He and my mother are renovating a property in Sri Lanka and turning it into a little boutique hotel, which will be aimed mainly at tourists travelling around the Hill Country. Since online business is ‘my thing’ now, it’s nice to know I can use my new skills to help them. I’m also relieved that my relationship with him hasn’t suffered – he still talks to me about his interesting cases, discusses the latest radiological developments with me, and shows me interesting pathologies on MRI or CT scans that he’s reported. I feel like, through him, I still belong to the medical world in some small way.

This is the first time I’ve come close to missing Medicine, but at the same time, I know that I’m not missing it for the right reasons. I don’t yet feel that it’s calling me back – I just miss the familiarity of that part of my identity. It sounds awful, but before, my stressful state of being made sense to me; being a doctor is inherently stressful, and now, although I’ve left the profession, that mindset persists. In fact, I’ve been so highly programmed to cope with pressure that I’m inventing stressors for myself, mostly unintentionally, but partly in a vain attempt to replicate what I have left. I just can’t stop feeling ‘on edge’. The anxiety follows me around like a shadow, and I have to consciously remind myself that no one is going to die. It’s worrying that the NHS makes doctors feel this way – it’s not healthy.

Last night I rang one of my best friends, who is a high school teacher, and lamented a trait that she and I both seem to share: we crave the ‘buzz’. An addiction that started in our school days, the need for achievement has become central to our lives, yet it is horribly unsatisfying. It’s like a hit of heroin – reaching that top grade or winning that prize gives us a fleeting hint of pleasure and pride, but it doesn’t last. In mere moments, the achievement is thrown into the pile of our success and we move on to seek the next high. Combine this trait with a high-pressured, under-resourced job and it’s a recipe for disaster.

Now the buzz is gone. No more cardiac arrests, no more emergency surgeries, no more on-the-spot decisions to be made. I’m not Dr Peach any more, I’m just Peach who’s a marketing manager. I can’t even play the ‘rebel’ card any more, as my family seem to have accepted the change and adapted to it. I feel a selfish longing to be important again, to be valuable, even though as a doctor, I felt anything but important or valued. It’s all so paradoxical, I’m confusing myself. After all, most psychiatrists or dermatologists don’t deal with medical emergencies any more than I do – if I had become one of them, would I still miss the buzz, or would it be enough that I was helping people and changing lives? Who knows. I’m starting to think that, with my current way of looking at things, nothing would ever be enough for me.

I suppose I must learn to be content with life as it is, and to appreciate the wins more. I have now managed to cut my to-do list down to just four things: job, blog, novel and wedding. And if I think about it, life is still exciting. The adrenaline rushes may be considerably reduced in number, but there are plenty of interesting and wonderful things going on, even if they are happening gradually, over weeks and months instead of minutes and hours. I need to change my approach, and since the NHS environment isn’t really conducive to this kind of personal development, perhaps I needed to step out of it in order to grow.

 

 

 

 

 

 

 

The forgotten six thousand (guest blog)

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One of the benefits of writing this blog is that it’s given me the chance to meet other medics who have decided to do different things with their lives. I’m so pleased to introduce this guest blog by theconfusedmedic, a fourth year medical student who has currently interrupted  her studies to pursue other things outside medicine. She currently working as a junior medical writer for a medical communications company and would like to explore medical writing as a career option. She plans to return to medical school in the next year or so to complete her MBBS but beyond that, she’d like to do something outside of practising clinical medicine.

A medical student’s view on the junior doctor contract dispute

Last year, a post on Reddit went viral and this heartbreakingly candid photo of a doctor grieving over one of his patients was shown to the world.

Evidently, the reality of being a doctor is tough. It’s draining, both emotionally and physically. They sacrifice so much of their time and self to help others. The reward can be great; doctors make a huge difference in people’s lives. However, if it goes wrong, they have to pick themselves up and do it all again for the next patient that comes through their door.

The junior doctor contract debate that has come to light over the last several months has angered and frustrated thousands of doctors around the country. The changes to the contract have been widely rejected and deemed unsafe for both doctors and patients. Yet, despite the strikes and protests, news broke recently that the contract was going to be imposed anyway.

The whole medical profession is up in arms yet again, and rightly so. The definition of the word ‘contract’ is: “A written or spoken agreement, especially one concerning employment, sales, or tenancy, that is intended to be enforceable by law.” The key word here is agreement. At no point has anyone agreed and accepted this contract. So why has the government suddenly decided they are going to force it on thousands of employees?

Besides the 50-odd thousand junior doctors in England, there is a significant cohort of people who were never really considered or consulted on the matter of a contract that would dictate their future – they are the 6,000 medical students in England whose voices were overlooked by the government. Six thousand people who will leave medical school and have a job contract enforced upon them that they didn’t agree to.

Amongst my friends and fellow medical students, the general consensus is one of outrage, disappointment, and uncertainty. Outrage at the audacity of the government to go ahead and impose a contract widely condemned as unsafe and unfair; disappointment at the lack of meaningful responses from the government; and uncertainty over what this means for the future of training.

I asked some of my friends for their personal views on the matter and what it would mean for them. Will they complete their foundation training in the UK then leave? Will they apply to do foundation in Wales/Scotland? Would they leave medicine altogether after graduation/somewhere down the line? Or will they stay in the NHS and fight this thing until the bitter end?

The responses were mixed. Some are considering and preparing for alternatives: Wales and Scotland; taking an F3 abroad and playing it by ear; taking the USLMEs. Some are looking for ways out of medicine altogether (I only have to look down my Facebook feed to see events pop up for ‘Alternative Careers in Medicine’ and the like, to know people are considering their options). Some don’t have much choice in the matter of whether to stay or go – the financial investment and ties to family and friends are too strong to consider leaving. And why should they have to?

One common thread amongst medical students is a desire to fight this contract for a better future for themselves, every other medical student that will follow them, and the patients of the NHS. A friend made a good point about how governments will always change and politicians are always attempting to make big reforms; we just have to fight them and stick it out. It took a lot of brave people to keep the NHS running thus far, and it will need a lot more brave people to do the same now.

However, I know for me personally, I don’t know if I could do it. Prior to this contract saga, I had my own personal doubts over a career in medicine anyway and it is looking even more unlikely that I will practice as a doctor. I actually find it quite sad to say because at one point that was what I wanted to do. Unfortunately somewhere along the way, I lost that desire and am currently on a leave of absence to work out what I want to do next. The thing is, it doesn’t surprise me to know that I am not the only medical student who feels this way.

We are incredibly lucky to have, in my opinion, the greatest healthcare system in the world. Sadly, the current government are hell bent on destroying it. The NHS probably won’t be sustainable forever, and it has its flaws, but there are so many more positives about it that we, as medical students, doctors, and members of the public, have to fight for. Medical trainees from all over the world aspire to work in the UK health system, but with the changes this contract will bring, all those highly sought after trainees will go elsewhere. And those that are in the UK already will leave. If practising doctors are considering their alternatives, and medical school graduates like myself are looking at other options, where does that leave the NHS?

It’s easy for the government to sit back and make whatever decisions they want to extend working times, reduce overtime pay, and remove safeguards for doctors. They are not the ones who will have to deal with the fall out. They won’t be the ones who will end up being treated by doctors who are tired, overworked, and damn right miserable about the conditions they work in. That will fall on the general public and all the people who rely on the NHS for their health care.

And it’s just not fair.

Read more from theconfusedmedic

Letter to my MP

Following the advice of the BMA, I wrote to my MP today. The words flowed easily. My god, I feel guilty for leaving and pursuing another career while my colleagues are left in this pile of shit, but I’ll be damned before I stop fighting for them – for us – for everyone.

Dear Ms Creasy,

I am writing to you regarding the junior doctor contract.

I am a ex-doctor. I worked for the NHS for two and a half years before leaving in December 2015. During my time as a doctor, I experienced the extreme pressures that medical staff find themselves under.

I did part of my training in Paediatrics, and I found it especially difficult not to be able to deliver the highest level of care to sick babies and children because we were constantly faced with staff shortages, a lack of resources and management decisions that were not based on good clinical practice, but were simply target-driven, cost-cutting exercises.

My health deteriorated physically and mentally while I worked as a junior doctor. Nowadays, doctors do not have access to the same facilities as they did in days gone by. No accommodation or parking is usually provided for junior doctors, so I often found myself walking home or to wherever my car was in the middle of the night after shifts. As a woman, this can be an incredibly intimidating thing to do – especially since junior doctors have to move around the country so much, so I was sometimes not familiar with the area I was working in.

Food and drink is not provided for medical staff any more, and I often found myself going through shifts without a moment to eat or drink anything. I fainted on shift a couple of times because of it.

Even in the short time I worked as a doctor, I saw and fought against the closure of ‘Doctors’ Messes’ – staff rooms that were often the only place in the hospital to rest, eat and sleep. I worked in several hospitals where I was doing night shifts without any sleeping provisions. If I ever did get a couple of hours to rest, I was expected to either sleep on the floor of an office or try to fashion a bed out of wheely chairs.

When I tell people my stories, they are shocked. I am not the sort of person who demands luxury at every turn, but the denial of basic human needs in the workplace seems absolutely absurd, given that these are the people who need to be able to make snap decisions literally about life or death.

I have been shocked and appalled by the way this issue has been handled by the government. The lies, deceit, spin and slander have completely destroyed any confidence the profession had in the Health Secretary, and the idea of imposition of a contract against the will of 98% of junior doctors, and without soliciting atheir input, is surely akin to exploitation.

I implore you to demand the answers from them that they have denied us. Jeremy Hunt has consistently claimed that doctors will not be working more hours, but how on earth can he simultaneously propose to increase the service to seven days a week without increasing staff numbers or budget? It just does not add up.

I can honestly tell you I am relieved not to be working as a doctor anymore, and my health has finally returned. Although my former colleagues truly love their jobs, I fear this contract will push more and more of them over the edge and soon there will be more like me.

We need people like you to speak on our behalf and put sustained pressure on the Health Secretary and Prime Minister. If this contract is successfully imposed, I believe the future of the NHS will be in jeopardy.

Yours faithfully,

Dr Priyanjalee Perera

Trouble in Paradise: the Type A personality effect

I feel very rested. I’ve just come back from a wonderful skiing holiday in the French Alps, and aside from the terror of voluntarily throwing myself down a frozen mountain, it was a chance for me to relax and reset.

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I did a bit of soul searching while I was away. There’s something about fresh air, white snow and beautiful views that opens your mind to a new perspective, and I’ve been pondering over the fact that I’ve become increasingly stressed over the last few weeks. To make things worse, I’ve been increasing my stress by getting annoyed with myself for being stressed – which is very counterproductive. I was getting snappy with my closest friends and family, and I felt like I was tearing my hair out most of the time. It’s a vicious circle that I find myself in more often than I like – I feel that I should be able to handle everything, and that struggling is a sign of weakness. Now even more than ever, I feel I should be able to handle everything. After all, I’ve just left one of the most intense professions there is, so everything that follows it should be a breeze, right? Right…?

Apparently it’s not that simple. While we were away, conversations with my fiancé and new skiing crew gave me a reality check: I’ve just left my career under distressing circumstances and started working at Dr Morton’s in an industry that is completely new to me without any training. I’m trying to finish this novel that means so much to me, while also trying to work with my brilliant mentor Gyles to help other doctors who are struggling with Medicine. If this wasn’t enough, I’m doing an online course in marketing which demands at least 7 hours a week, and to top it all, I’m trying to plan my wedding. To say I’ve bitten off more than I can chew would be an understatement.

When I left Medicine, people shook their heads and told me that finding a less stressful job elsewhere would be impossible, because every job is stressful in its own way. I never believed that, because to me, the stress that came with Medicine seemed to be on a different level. There aren’t many jobs in which taking your eye off the ball for just a moment could actually kill another human being. I really don’t know how Air Traffic Controllers do it.

But I have to admit that, in a way, it is true. Every job is stressful, but the crucial part of this concept is that every job is stressful for me. Somehow my attitude towards my old job has seeped into my new life. I continue to set high expectations for myself and am constantly seeking approval. I allow myself to feel overwhelmed by the workload, even when my colleagues are telling me I’m doing fine. It’s left me questioning where this outlook on life came from, and how to change it.

Wikipedia defines Types A personalities thus: “ambitious, rigidly organized, highly status-conscious, sensitive, impatient, take on more than they can handle, want other people to get to the point, anxious, proactive, and concerned with time management… high-achieving “workaholics”, push themselves with deadlines, and hate both delays and ambivalence.” Reading this definition made me feel a bit depressed because it pretty much describes me to the letter.

It makes me think back to being an A-level student. All of my peers who got into medical school were, to some degree or another, ‘high-achieving workaholics’. It was inevitable – medical school places are hard to come by. Bristol told us they offered just 250 places per year for 30 000 applicants. To be chosen you had to fight hard. You had to be obsessively hard-working to get the grades and work experience necessary, organised enough to have several different hobbies and ambitious enough to be good at all of them.

I’ve read that who you are and how you think depend very much on the people you surround yourself with. You direct circle of peers unconsciously set your boundaries, so personal, professional and financial success tend to be an average of those who have the greatest influence over you. In medicine, this can be a good thing, because it can mean that standards are held high, but I think it can be fundamentally damaging as well. As doctors I can’t help feeling that we tend to drown a little in our shared intensity, with over-ambition in one feeding the overwhelm of another.

I remember sitting our fourth year exams at Bristol. It was an intense year because it was the year we studied all the sub-specialities. I recall the sheer panic I used to feel, gazing at the huge pile of books before me and wondering where the hell to start. A helpful revision tip from one of our professors was simply to ‘learn everything’.

So there we sat trying to cram the enormity of medicine into our addled brains. What was odd, however, was that it was an incredibly lonely experience. My dad had told me stories of how he as a medical student in Newcastle used to have study groups with his friends and how they used to help each other out. I had assumed that I too would experience this nurturing, communal atmosphere, but the reality was a bit of a shock to me. It felt more like a competition, to be honest. The medical school made it worse by making some of the exam pass marks variable – the grade boundaries were set depending on the standard that year. This was an incredibly unkind thing to do, because it set the students directly against each other. You’d always be hoping that someone else got a lower grade than you so you could have a greater chance of passing.

The only way to be certain you were studying the right things was to do past papers. Everyone gets used to this practice at school because teachers do their level best to get hold of paper for you – however at medical school, past questions were a closely guarded secret, mainly because the board of examiners couldn’t be bothered to go through the rigmarole of writing different questions each year.

There were rumours on several occasions that past exam questions were circulating around some of the students, but no one ever spoke of them directly. If you had them, why would you share them? There was no incentive for student collaboration, and every reason to be secretive. People would lie about how hard they were working, or pretend that they’d ‘done no revision at all’ when you knew they had spent the last week burning the midnight oil face down in a copy of Kumar and Clark.

Not all doctors are the same, of course. I had a Greek SHO colleague in my orthopaedic job called Georgios. He was an incredible person to work with, because nothing ever seemed to frazzle him. No matter how many patients came through the door, or how full the theatre list was, or even how useless the system seemed, he still found time to discuss Greek philosophy with me over a hot drink. His motto, which I still repeat often in my head, was:

“Relax. Have a coffee.”

The Greek accent made it sound all the better!

The stress I feel now is definitely of a different kind. I do want to perform and be successful, but I know that there’s little chance of me doing anything truly catastrophic in my new job. It’s funny because, if I hadn’t been a doctor first, I might have had a very different view of things. I could see how, in a parallel universe, someone as highly strung as I am could easily crumble in the start-up environment. It’s demanding and uncertain, and because I like my bosses, I really want this to work for them. There’s a lot riding on a new business – reputation, money, relationships and sanity – and for the many that fail, it’s a terrible blow.

But having been a doctor, the silver lining is right before me – I just have to remind myself it’s there. The fact is, no one’s going to die if I make a mistake. No family’s life will be destroyed if I have a bad day. I won’t be hauled up in front of the GMC or struck off if I’m too tired to do the job properly. In exchange for that, I have given up the profound wonder of healing and curing the sick, but I honestly feel rather glad of that. I’ve come to see how damaged I am in my approach to life, and am in need of a little self-healing. Life is stressful and demanding enough; adding one’s own unremitting self-criticism and cruelty is really quite unnecessary.

Junior Doctor Cartoon #2

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Yes, I appreciate this cartoon is controversial.

However, let me explain where this comes from. A few weeks ago, I went to a friend’s engagement party, during which I met some people who said that it didn’t matter if all the UK trained junior doctors resign because the NHS will be staffed by a stream of foreign doctors who will be eager to come here and willing to put up with poor working conditions.

When I posted this conversation on the Junior Doctor Contract Forum on Facebook, many people commented on it and agreed with me that this concept was absolutely ridiculous and bordering on exploitation!

It was reported in the Independent today that 90% of junior doctors would resign if the current contract proposal goes through. With the NHS currently dependent on foreign-trained doctors, I can see how this assumption that rota gaps will be plugged by migrants came about. But I have a BIG problem with it. As the daughter of a Sri Lankan immigrant family, I reject the idea of bringing doctors over to work in an unsafe, unfair health system. It’s wrong, it’s backward, and if anyone ever says its to me again, I’ll tell them where to go.

The wonderful Rikki Marr from Hawk and Mouse has once again beautifully illustrated my frustrations in cartoon form. I just want to thank Dr Morton’s for going ahead with this campaign. It’s thanks to them that these cartoons exist. They may be a private company, but their whole focus is to support the NHS through health innovation. They receive no NHS funding and are not NHS affiliated, yet the CEO John Wilkes came in this morning wearing a green BMA badge.

There aren’t many CEOs of private healthcare companies who would do that.

 

 

My Junior Doctor Cartoon Campaign

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The wonderful thing about my new job is that, even though I’ve left the NHS, I can still support my junior doctor colleagues in some small way.

Tomorrow, my former colleagues are going on strike for the second time over the proposed junior doctor contract. Ever since I resigned, I’ve felt painfully removed from their struggle. My voice, that once shouted loudly amongst them, now feels diminished and lacking in authority.

Added to this was the fact that I couldn’t make the protest on Saturday – but it was my best friend’s wedding, so I think I can be forgiven for that!

However, last week, my chance to make a difference came… Our PR Manager at Dr Morton’s asked me for some ideas about how we can get the company involved in the strike. His fantastic idea was a cartoon campaign called ‘A World Without Junior Doctors’. He sent me home to mull it over.

The image above is the first in the series of illustrations that I dreamed up for this campaign, beautifully translated from my head to paper by cartoonist Rikki Marr from Hawk and Mouse. I’ve written a little blogpost on the Dr Morton’s website as well to explain why we’re doing this.

I know that these cartoons will be a marketing stunt for Dr Morton’s, but for me, it’s also deeply personal. I met a Big Issue seller on Friday who saw the green BMA badge that’s still pinned to my coat and cried:

“Ah you’re a junior doctor! Keep doing what you’re doing, I support you. Where do you work?”

When I explained my situation, he said:

“Oh. So you’re not a junior doctor any more then?”

No, I suppose I’m not. I know he was just being friendly, but it hurt.

I thought about it as I was thinking and planning for this campaign, and felt rather nostalgic and sad. Yet here I am, still at the office at 6.30 pm, having spent all day perfecting these images and pushing for publication, and I realise this: I may not be working as a doctor, but the last eight years have irrevocably tied me to Medicine. It will influence everything I do and the way I think for the rest of my life, and that – I believe – is something to be proud of.