So… what do you do? Part 2

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I’m having a bit of a nightmare navigating the delicate social quagmire of speaking to another doctor when you’re a patient who also happens to be an ex-doctor.

It’s always a bit strange being treated and cared for when your job is to treat and care for others, but now that I’m no longer working clinically, it feels even stranger. I was hoping that you, my loyal readers, could give me your opinion.

A few months ago, I wrote a post about the pitfalls of answering the “So what do you do?” question when you’ve just had a massive career change. Now I’m starting to get used to telling my weird I-used-to-be-a-doctor-but-I-left-and-went-into-content-marketing story. Sometimes I even miss out the doctor bit for the sake of ease, but what I’m still finding difficult and slightly bizarre is talking to medical professionals as a patient.

Just after I left medicine, I had to take my fiancé to our local hospital for a minor operation. I remember waiting in A+E, contemplating the mess that was my life, and then we were called into the triage room to be seen by a very nice orthopaedic SHO. I let him explain what was happening, even though I knew perfectly well what my fiancé’s diagnosis was, and exactly what would happen next. Somehow or other, during the conversation I let slip that I was a doctor myself, and the SHO looked surprised and slightly embarrassed as he said:

“Oh! You should have told me before! I wouldn’t have dumbed it down so much.”

I also felt a little embarrassed, but to be fair, my fiancé was the patient, so it was good that he understood what was going on.

But the other day, I went to see a consultant dermatologist. My mum accompanied me, but I was the patient this time. We shook hands and sat down, and he began to tell me about the layers of the skin – first dermatology lesson at medical school stuff -and after debating in my head for a few seconds as to whether I should say something, I remembered the orthopaedic SHO and ventured to interrupt him in what I thought was the politest way possible.

“I’m so sorry to stop you, but I thought I should just let you know – I’m a doctor too.”

Later, however, my mother told me that I’d been rather rude and she’d never been so ashamed of me in her life!

The consultant looked as embarrassed as the orthopaedic SHO, and took a hasty second look at the medical form I had filled in when I had arrived at the clinic. I had written ‘marketing manager’ as my occupation – no wonder he was confused! He then looked at my title – ‘Dr.’ of course. He hadn’t noticed that before. He apologised profusely, but I assured him that I wasn’t at all offended – he hadn’t known, after all.

I felt awful, because he was a nice man and I didn’t mean to make him feel that way. I wondered, as my ears grew hotter and hotter, whether I should have put ‘doctor’ as my occupation on the form instead. It wouldn’t have been strictly true, because I no longer work as a doctor, but to avoid major awkwardness perhaps a little white lie would have been somewhat justified.

I have thought about it many times since. Was my mother right? Was it so very rude to save him wasting time explaining things I already knew ? What if said time wastage had resulted in the consultation ending without my having the chance to ask more complex questions that I really did want to know the answers to? And if I had been inpatient, could I not be forgiven for wanting desperately to get to the point and discuss my treatment options?

I’m going to have to find a solution for this, because there are going to be other times in life when I’ll be a patient. I want to have kids in the next few years, and after the things I’ve seen, there’s no way I’d have them anywhere but a hospital.

So what do I do? Your help would be greatly appreciated as I try to figure out how on earth I, Dr Perera, former junior doctor, am going to explain myself.

Giving up my license to practice

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It felt so cool getting my full GMC registration. In a weird, geeky way it felt like the James Bond part of a medical degree – a Licence to Practice! I was strangely proud and excited.

But today I gave it up.

It was so easy to do – just a simple form to fill on the GMC website, and that’s it. It takes seven years to get that license, and seven seconds to let it go.

I’m still keeping my registration, because for some reason I still feel the need to have a connection with my old profession. I considered renewing my license for another year ‘just in case’, but I can’t really justify the expense as I’m not working clinically and have absolutely no intention of doing so any time soon.

I know it’s reversible. I know it doesn’t make any difference to what I’m doing now, and that it doesn’t take away anything I’ve achieved.

And yet, it still hurts.

It feels like signing the final paperwork in a complicated divorce. I hated Medicine, but I loved it too. As much as we didn’t suit each other, we were together long enough for it to become a huge part of my identity, and I certainly wouldn’t be where I am today without it.

This week, the new F1s take their first fledgling steps in their new jobs, and junior doctors all over the country rotate into new specialties. The turmoil of the last year seems to have had no effect on the numbers of people applying for F1 training – which doesn’t surprise me really. For many it’s their first ever job, and it’s a chance to explore the profession and get a full registration.

I’m floating away from that world. I feel the bonds breaking and the distance widening. I sometimes look back in nostalgia, with that uncomfortable feeling that you were never really right together, but at the same time, you found a way to shift along well enough, and you did have some good moments.

There are times when I catch myself missing it terribly, particularly when I think about how great it was to communicate with patients. I was good at that, and it was the best part of the job. I recently comforted a friend of mine after a scan showed an unwelcome diagnosis, and in her gratitude for explaining things more fully, she lamented my leaving the medical profession, and wished that her doctors were more like me.

It was kind of her to say so, but in reality, when I was working as a doctor I never felt I had enough time to spend with patients to explain, to comfort and to guide, and I was often so exhausted that I could barely muster the energy to care very much. I can only smile at the idea of being a better doctor now that I’m out of the profession, and it makes me ashamed to think of what I was.

I think, having been a doctor, it never truly leaves you. There are some things that, once learned, can never be unlearned. Medicine is strangely addictive in that way.

But I can’t deny that I’m much happier where I am. Looking back and romanticizing my former life simply isn’t sensible, and I am in danger of seeing things through the rose-coloured glasses of hindsight.

It’s time to hang up my stethoscope and move on.

 

 

 

 

 

 

Which way to vote? My 5 main dilemmas…

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I feel like the doctors of this country have had some big decisions thrust upon them in the last couple of weeks. It’s unfair really – just as our country is plunged into uncertainty, the fate of our profession lies at our feet before we even have the chance to process what just happened. New contract – yes or no?

Right now I’m wondering whether I even should vote, given that I’m no longer practising as a doctor, and yet I feel compelled not to waste this chance to contribute to something that will affect so many of my relatives and friends. That’s a choice to make on its own.

And if I do indeed decide to vote, the real choice begins, and the considerations are far from simple.

1. The sheer complexity of Medicine

Part of the problem is that the working life of doctors is incredibly complicated.

Be honest, how many of you really read our old contracts before you signed them? How many of you, like me, didn’t even see a contract at all? In the three hospitals I worked in in my brief time as a medic, I signed just one set of papers.

The only time I actually read the old contract and contacted the BMA was when Queen’s Hospital tried to take the doctors’ Mess away while I was Mess President – at that point I read the terms and conditions word for word, and pulled out everything pertaining to the availability of food and overnight accommodation.

So deciding how the new Ts&Cs will affect day to day working life in the NHS is proving damn near impossible.

2. The LTFT dilemma

Judging by the conversations on Facebook, less than full time training is proving to be a real bone of contention, with many people confused about wording. If we, with our advanced degrees, can’t figure out what it all means, how on earth are payroll going to make sure you’re paid correctly?

In general actually, the wording of the new terms and conditions is poor, to the point where Justice for Health is actually challenging the writing itself.

3. The elephant in the room: pay

In all honesty, I rarely used to query payment issues when I was a doctor – the process of sorting it out was so flipping complicated that I often decided it wasn’t worth it. I also felt like a bad person for talking about money.

Now that I’m removed from Medicine, I can talk about money without feeling guilty or greedy, and I can say with conviction that doctors in this country are shoddily paid for what they do.  This new contract might be cost-neutral, but it does not change that fact. I know doctors in general don’t want to be paid more than they get now though, so that’s probably not a consideration. What I’m saying to doctors is this: you should be.

4. Working hours

I do worry that the new ‘Guardian’ for working hours will turn out to be just as complex. Call me cynical, but accurately tracking and safeguarding doctor working hours is going to be a big job – it will either have to be paid for, or done badly on the cheap. My bet is on the latter.

Say nothing of the fact that LTFT is defined as 40 hours a week; I’m sorry, but in the real world, 40 hours is a full time job. Calling it part time is a very clever way of making ‘full time’ hours ridiculous, and fooling part time trainees into thinking they have a good deal. Does the £1500 supplement make up for that? Well, I don’t mid telling you that, under the old contract, I worked as an LTFT for 40 hours a week, and received just under £20k p.a. pre-tax. Having the supplement would have made my salary marginally less insulting.

5. Brexit

Understandably, for many doctors, our current political mess is making the issue seem even more complicated. Many believe that we’re in enough turmoil as a country as it is, therefore a ‘no’ vote would be unwise. Rachel Clarke has said that no one will care about junior doctors in the fallout of the EU referendum.

What I would say, though, is that politics will always change, and one way or another, our international situation will eventually settle down. In ten years, these politicians will be a distant memory, whilst doctors will still be very much working. The PR and Research teams in my office are predicting massive overhauls in the NHS independent of the referendum, so it’s not really a reason to vote yes.

So, what to do…?

The last consideration on my mind – and it’s not a justifiable reason at all, so I haven’t included it on my list – is the thought of that pesky little fool, Jeremy Hunt, claiming that one reason he’d make a good PM is his ‘ability to negotiate’. If this contract is voted in, I have no doubt he’ll gloat over it and take credit for the whole thing.

It’s not a reason to vote no. But my God, it’s intolerable.

I still don’t know how to vote, or whether to vote at all; but what I do hope is that doctors will vote based on their true convictions, and not because they’re afraid of losing public opinion or of Brexit.

Whatever happens, this is my final message to doctors voting in this referendum: don’t let fear hold you back from fighting for what you believe is right.

 

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.

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 in 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 the doctor in the room any more, I’m just me, and 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.

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 skiing crew gave me a reality check: I’ve just left my career under distressing circumstances and started working at a start up 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 and a cigarette. His motto, which I still repeat often in my head in his gloriously Greek accent, was:

“Relax. Have a coffee.”

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 the team, I really want this to work out.

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.

The Perks of Being a Doctor

A&E

When you grow up in a medical family, you notice how useful it is to know a doctor. Our friends come to my father constantly with their problems; whether it’s for advice, reading a scan or even organising a scan, knowing a brilliant Radiologist like my dad is an exceptional advantage.

My uncle is my dentist. I still feel a bit guilty when we go to his house for dinner and eat dessert in front of him.

Down the road are a married couple. She’s our family’s GP and he’s a paediatrician (and formerly my boss) at the hospital, but they’re old family friends as well. If ever I need advice, both their mobile numbers are on my phone. I don’t feel guilty about his because it means I won’t take up valuable patient slots at the practice. I guess it helps that I’m a doctor myself and tend to know what’s wrong with me already, but it’s just so practical to not have to make an appointment when I know that all I need is a quick chat. That appointment can be left for someone who really needs it.

I remember when I accidentally dropped my brother down the stairs when he was a baby (yes, it was an accident, although my brother now teases me mercilessly about how I did it on purpose, and declares that any mental deficit he suffers from is my fault). After my dad arranged head scan for him, and a paediatrician friend checked him over, they confirmed he was absolutely fine, so I now tell my brother that all his failings are his alone!

It’s not just family and friends. The cleaning lady, the postman, the handy man and even the gardener have all asked for assistance and advice, and my dad has always been very giving of his time to those in need. Cynics call it nepotism, and the GMC has very strict rules about how far you can go as a doctor to treat those you know personally, but I really think society has become so obsessed with this concept of impartiality that they’ve forgotten that it’s human nature to use what you know to help those around you.

Which brings me to what happened last night: over the last week or so, my fiancé has been complaining of a ‘spot’ on the back of his hand. It did just look like a regular spot, but it was hurting him a lot. As the days went by, the area became redder, more swollen and more painful. I treated it with all the over-the-counter things I could think of, but nothing seemed to be working. Last night, when he came home from work, it looked worse than it ever had before, and I was certain it was cellulitis. There was possibly also an abscess, and he needed antibiotics. My fiancé, however, has only just started a new job, and was irritated at the thought of having to take time off work so early. Making an appointment at his GP practice was always difficult, and he had no desire to wait around in a hospital for treatment.

I was at my wits end trying to figure out what to do. My home town was too far away to ask my GP or family for help. If I was still practising, I could so easily solve this problem! Even though you’re not allowed to prescribe for family members, it would have been simple enough to take him along to the hospital and get one of my colleagues to see him. Hell, I could have even lanced the damn abscess myself! As it was, I couldn’t even put a dressing on for him. When I was a doctor, I had access to all this stuff.

I really felt that I was failing him. And yet, I chose this. It’s not my job any more.

Luckily we had a hand from a consultant friend who told my fiancé it was serious and needed immediate treatment. I’m so thankful she called, because I would never have been able to convince him to go to A&E otherwise!

11.30pm. Along we went to Whipps Cross. Funnily enough, we were in and out within an hour. I guess that, with the strike going on, people were staying away from A&E. We were seen by a lovely nurse who made us both laugh. She dressed and cleaned the hand, and gave us the antibiotics and painkillers he needed.

While we were in the waiting room, my fiancé asked me why I was upset. I told him how I felt; that I missed being a clinician. I was so frustrated that I knew exactly what to do and yet couldn’t make it happen. I felt like crying. Medicine was such a huge part of my identity, I didn’t know how to be without it – I didn’t feel like anything without it. I know this sounds melodramatic, but I was tired and frazzled, and seeing my fellow doctors strike earlier had stirred up a lot of emotions.

“Medicine’s not who you are, it’s just something you did for a bit,” my fiancé told me kindly, “You’re more than just a doctor, you know.”

I told him about a doctor I’d met that morning on the picket line of Guys and St Thomas’ hospital. I interviewed him for this blog and he told me about how he used to have anxiety attacks every time he came near the hospital. He pushed through it, however, and is now a paediatric trainee.

I remember that feeling. I remember feeling sick with fear before every shift. I remember having to coax myself out of bed in the morning, just to get up the courage to go to work. I remember the amount of wine I needed to get myself through a run of nightshifts. It wasn’t a healthy place to be, but I felt I had given up too early. Should I have just carried on, hoping one day it would finally be ok? Should I have, as some friends suggested, restarted my antidepressants, just so I could get through my training?

“What are you talking about?” said my fiancé, “You did something you hated for 8 years and now you think you didn’t give it enough of a chance? I never got to see you when you were a doctor. You were constantly tired, and always ill. We never knew where you were going to be from one year to the next, and we couldn’t plan anything in advance because you never knew your rota. You were grumpy and miserable, and you just weren’t you. It’s different, now you’ve stopped; I actually get to spend time with you.”

It was the first time my fiancé had ever told me honestly what it was really like for him when I was working. It dawned on me that maybe my inability to treat his cellulitis didn’t fail him as much as my former lifestyle had.

We walked out of Whipps Cross together, after a free appointment, with two boxes of free medication in our hands. The NHS really is amazing. I definitely took what I did as a doctor for granted – it was my job, after all – but it was incredible, and that’s why it’s so hard to walk away. But looking at the striking doctors from a distance, I can see things in a way that I couldn’t before: even after everything the NHS puts them through, doctors still continue to fight for it, and when you put it like that, their struggle is more poignant than ever.

Striking Doctors and Healthcare Innovations

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I can hardly believe it’s happened. Yesterday, for the first time in 40 years, doctors went on strike. I went out to the picket line at Guy’s and St Thomas’ hospital today to speak to and support the doctors out there. It was incredible how dignified this whole campaign has been. They know they have the moral high ground, because ultimately what they’re fighting for is the future of the NHS.

I have to say, it’s really weird not being one of them anymore. Weakening my bond to Medicine under normal circumstances would be difficult, but with all this unprecedented action going on, I feel like I’ve abandoned my colleagues and my profession when they most need support.

However, it is liberating not to be threatened with legal action and GMC hearings, as unfortunately some doctors have been lately. I feel I can truly speak my mind without having to worry about my career.

With this in mind, I said yes when my friend and mentor Gyles Morrison asked me if I’d spend the strike day with a small private healthcare company that provides advice and treatment over the phone or email. I know there’s a lot of controversy, even within the medical profession, as to how much private and public healthcare should be mixed, and with certain branches of the media so desperately keen for sensations at the moment, a training doctor couldn’t really be seen as being connected with a private company. Even though I’ve left, I have to confess feeling some trepidation as I made my way over to their office in Waterloo today. I could almost see the papers now… ‘Doctor spends strike day at private healthcare company.’ Well, at least she writes her own derogatory headlines…

One of the things this company were doing today was taking calls for free in support of the strike. I spoke with the CEO of the company. He told me that, while working in the city, he found it difficult to get GP appointments without taking time off work.

While I agree with reducing time-wasters for GPs, I know there are many who would say this kind of private initiative undermines the NHS. It’s a tricky one. When I met the founders of Doctify last year, Dr Stephanie Eltz explained how the idea for the online specialist database came from her own personal struggle to find someone who could treat her. She explained:

If you try to innovate within the NHS, you’ll be waiting forever. There simply aren’t enough resources. If you want to develop something new for the NHS, you have to do it outside of the system, and then take it back to the NHS once it becomes successful.

It’s difficult as a doctor to think commercially sometimes. We automatically reject any talk of monetary value, because our priority is our patients of course, and the thought of having to decide how money is spent on them is honestly a bit repulsive. When you choose to be a doctor, the financial side of things just doesn’t come into it.

Instead we let non-medics dominate the world of clinical commissioning and health policy. I met Dr Harpreet Sood, a Senior Fellow for NHS England, and he completely shocked me when he told me that when he arrived, there wasn’t a single clinician at the top level of NHS England. Until it became desperate, everyone accepted this situation. Now, however, we’re left wondering where the hell the £130 million NHS budget goes, and why NHS services are being out-sourced to private companies. The few medics that do exist in that ‘world’ have often turned out to be the rotten eggs – money-grabbing sell-outs who crossed over to the ‘dark side.’

Could the solution be these innovative start-ups, hatched and grown in the private sector until they’re ready to tackle the NHS? I really don’t know. This is a world I am new too and O just don’t understand it yet.

So… what do you do?

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December is the prime time for this question, or versions thereof. With everyone getting together for Christmas and New Year, I knew I would be catching up with friends and relatives and meeting new people, so small talk would be abundant for a good two or three weeks. I have to admit, I was dreading it. I was afraid of their judgement and remarks. I suppose I was also afraid of how I would react to their reactions. I could hardly justify my situation to myself, so how could I justify it to others?

I have always taken it for granted that I could give people a satisfactory progress report. “I’m in year 13” turned into “I’m in year X at medical school,” which turned into “I’m working at such-and-such hospital.” The only variation to contend with was the inevitable follow up question: “Have you chosen your speciality yet?”

Traditionally, the responses I have given to these queries have depended largely on how I feel about the person asking them. With kindred spirits – the people I feel will really listen and might understand my point of view – I am honest, but mostly I’ve just been busy hiding my true feelings about it all these years, even from the people closest to me.

As Christmas loomed, everything seemed so complicated. What was I supposed to say when people asked me what I was doing now?

“I had a quarter-life crisis and quit my job with no plan B, so I’m now officially unemployed and relying on my savings and my fiancé to get by. I have no current certainty or prospects, and not much of an idea about what to do, except a vague plan to write a novel that I’m unjustifiably optimistic about.”

It sounded terrible. I almost wanted to avoid the festive parties altogether to save myself from this humiliating admission. I also felt bad for my parents – when people asked them how I was getting on, they would be having exactly the same problem.

Then, two things happened to me.

The first was deciding to locum after my little visit to the job centre. That gave me something solidly medical to say, and was a relief. “I’m locuming at the moment” is a brilliant answer for those you don’t really want to talk to, and who are just asking you for the sake of saying something. It’s satisfying for both parties and the perfect precursor for a swift exit line.

The other was this: at the start of December, in between dancing for joy and plunging into the depths of despair, I started job hunting on the Guardian website. I found an ad I was interested in for a managerial role in a charity, but being inexperienced with this sort of thing, I was doubtful. I worried that I didn’t meet the criteria in many of the job specifications, because a lot of them stated the necessity for formal qualifications or specific experience. But, as my fiancé told me, job specs are not hard and fast rules. They represent the ‘ideal’, and most companies would rather hire the closest match than wait for the perfect candidate. My career coach has also been helping me to realise the value of the skills and experiences I already have.

So I shot off my CV, not really believing anything would come of it. Then two weeks later, I got a call. The charity had said my application was certainly unusual, but they had loved it. They offered me a telephone interview, and after that, they offered me a formal interview. I’m going in for it next week. Whether or not I get the job in the end, it’s been such a boost for me just getting to interview.

It’s also nice to sing my own praises. It’s not something I got to do much in medicine – it was more about people assessing me. ARCPs are tick-boxing exercises and applying for clinical jobs requires more form-filling and exam-taking than knowledge of your true strengths, skills and weaknesses. It’s just the nature of the medical profession that everybody is presumed to have all the necessary skills for their level. As a result, the thought of doing a non-medical interview is scary. No longer can I rest on my laurels; I actually have to prove myself. It’s made me sit down and think about what I’m really good at, what suits me and what I really want – perhaps for the first time in my entire life.

As the Yuletide approached, I started to see my situation is a different light. Yes, there are things in my current situation that I don’t like, but there is also plenty of potential. This is a really exciting time for me, and I really need to give myself a break. It sounds cliché to ‘have faith in yourself’ and to ‘stay positive’ but these little things can be incredibly difficult to do. I still struggle sometimes, but I’m working my way towards another cliché where I see my glass as half full.

So now, when people ask ‘what are you doing now?’ I have an answer I’m proud of:

“Well, I’m planning to locum while transitioning into a new career. I’ve got an interview with a charity soon for a management role. In the meantime, I’m volunteering for Medic Footprints to help other doctors in their careers – a role that I got because the directors were impressed by an article about their conference on my personal blog. I’m also researching the British colonization of Asia to give historical accuracy to the novel I am currently writing.”

There. Sounds much better doesn’t it? And the best things are: it’s all true, and I can say it to everyone.

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Image from Malla.

Malla is a small business coach and expert at answering this question!

Officially Unemployed

When I talked to my dad about my resignation, it was difficult to bear the disappointment in his voice when he said:

“So, what, you’re officially unemployed now are you?”

He didn’t say it at all cruelly – it was just the statement of the awful truth that hurt. It was qpainfully real.

I hit all kinds of low when I took myself along to the Job Centre before Christmas to register as unemployed. It was my fiancé’s idea – he did it when he graduated until he found his first job, and didn’t see any shame in it.

“You might as well try it,” he said, “You might not get the allowance anyway because you left voluntarily, but it will be a new experience for you.”

So I went along with some reluctance. It was so strange. As I went through the doors, narrowly escaping a dubious-looking guy at the front door who was attempting to sign people up for something, I felt an extreme sense of shame. It’s hard for me to write about it now, in fact. All my hard work and good grades had come to this.

I took a seat inside and waited to be called. They were running late by quite some time, so I had a good opportunity to look around at my fellow claimants. I live in a fairly run-down part of London, so I wasn’t surprised that many of them looked unkempt and down-trodden. We all kept our heads down and avoided eye-contact. This wasn’t a situation that encouraged chit-chat. A loud argument broke out between a claimant and an irate employee nearby. It seemed he hadn’t brought any paperwork at all with him and expected her to simply believe he was who he said he was.

My name was finally called. My assessor was a Muslim lady who did a double take when she looked at my application. She was (quite rightly) astounded that I was a qualified doctor. Why on earth was I here?

“What happened?” she cried.

I began to speak, and as I did, I think I was more honest than I have been with anyone for a long time. I told her how I simply couldn’t face going in anymore. I told her about my illness and how it knocked me. I told her about the anxiety I felt about working as a doctor. As I spoke, the reality of how little I valued myself began to sink in. I felt completely pathetic – a broken woman – crawling along, a shell of her former self. Without Medicine I felt totally worthless.

Her eyes softened as she listened to my story. She then talked me through my options, and told me about the process of claiming the benefit. She said we would need to meet at least once or twice a week, and that I would need to keep a log book, and how I would need to prove that I was trying to get work by signing on to a specific forum and spending 35 hours a week actively looking for work. It felt very demeaning and paternalistic, like I was a prisoner on parole.

At the end of our meeting, she noticed it was my birthday the next day, and asked me if I was doing anything nice. I told her I didn’t really feel like there was much to celebrate this year.

“Oh, don’t say that,” she said, kindly, “Sometimes when thing like this happen, it works out for the better in the end.”

She told me about how she had trained and worked as a dental hygienist many years ago, but something happened that made it impossible for her to practice.

“At the time I thought it was a disaster, but now I realise it worked out for the best. My nephew is quite seriously unwell and is often admitted to hospital, but my brother doesn’t have the time to look after him because he’s a GP. There’s no one else but me who can be there to pick him up from school when he’s ill, or sit with him for hours in A&E. Some of my family still say it would be better for me to go back to my old job, because it’s a better career, but sometimes you just have to look at the bigger picture.”

She told me to go out with my friends for my birthday and have a good time. Despite my desperate state, she saw someone deserving of a celebration, and I will never forget that. The kindness of a stranger can be incredibly touching, and for a moment I had a weird feeling that I was meant to meet this good lady, that there was a reason it was she who saw me that day.

As I walked out of that building, once again dodging the guy with the clipboard, I knew I would not be coming back. I realised that behaving like the pathetic and helpless person I felt I was only propagated the idea, and I was better than this! In some bizarre way, I was living up to the new expectations that were placed upon me: weak, dependant and needy. Other people had given up on me, so now I had too.

I decided I wasn’t going to do this anymore. From now on, I was going to define myself by what I knew to be true. Regardless of whether I would be approved for unemployment benefit or not, I resolved to withdraw my application, and not to take a penny. (Just as well, really, because I was not approved!)

When I got home, I sent off my paperwork to the locum agency. Previously I’d felt incredibly anxious and scared about walking into a hospital again, so I kept putting off applying for locum work. I guess I still feel a bit anxious, but I no longer feel crippled by it. My fiancé laughed when I told him about my change of heart.

“Haha! It’s because I’ve shown you the alternative!” he said, referring to the process of claiming benefits.

I stuck my tongue out at him, and denied it, but he was right. By making me do this, he has shown me a very alternative way of thinking. An alternative where, instead of thinking about what I can’t do, I think about what I can.