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.

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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, 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.

 

 

 

 

 

 

 

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.