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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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

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.

 

 

 

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 ‘Dr Morton’s’, a 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 Dr Morton’s were doing today was taking calls for free in support of the strike. I spoke with John Wilkes, co-founder 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. Lining patients up in a waiting room is convenient for GPs and saves money for the NHS, but paradoxically, it costs the economy money. Especially when you consider the report by the NHS Alliance and the Primary Care Foundation last October, which estimated that a quarter of GP appointments are unnecessary.

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.

The Dr Morton’s team that if this model takes off, as I’m sure it will, because there will be a huge demand for it, it would be great if the NHS could adopt it. In the meantime, they attempt to ‘take the stress out of the NHS’ by providing care for those who can afford it, while leaving the free service to those who can’t.

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 don’t really know. I’m not in a position to say that.

All I can say is this: the other Co-founder of Dr Morton’s, Dr Karen Morton, is an Obs and Gynae consultant, and works on the business alongside her NHS work. If the NHS does need to collaborate with the private sector to survive, I’d much rather those decisions be taken by a caring doctor on the front line like her, than those who are driven by financial gain alone, and those who – in the words of Dr Sood – have never set foot in a hospital.

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!

The Dangers of Ego: how medicine became my self-esteem

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The other day, I was on my way to the Royal London Hospital to discuss my resignation with the Dean of my Foundation School, when a man going past on a bicycle stopped next to me.

“Are you lost?” he asked, with an accent that I recognised to be Sri Lankan. I turned away from the map and looked at him, and his features confirmed our common heritage.

I explained I was looking for the hospital, and he pointed me in the right direction, but before I could get very far, he began to tell me all about the amazing pastor at his church, who apparently had died, visited hell and heaven, had a chat with Jesus, and come back to earth again. I suppressed a smile as he asked me if I had time to chat, and said I was in a hurry. He then asked me why I was going to the hospital. I obviously didn’t go into my real reasons, but the moment I said the words ‘I’m a doctor’, he looked at me with such awe, as if I were the one taking return journeys in and out of the afterlife.

It’s not an uncommon reaction. Although the medical profession is much less revered now than it was twenty years ago, people are generally still impressed when you tell them you’re a doctor. “Wow! That’s incredible! You must be clever,” they say, or “I couldn’t do what you do.” As for my Asian relatives, particularly the older generation, I represent the ultimate achievement.

When I think about how hard I’m finding it to leave medicine, I can’t help but admit that part of it is losing that massive ego boost. The moment you qualify, you are seen almost universally as intelligent, selfless, noble, caring and respectable. Another bonus is the fact that people have a basic understanding of what it is you actually do – as opposed to the non-vocational folk like my fiancé, whose job description of ‘business consultant in macroeconomics and econometrics’ is vague at best, and downright confusing at worst. I don’t have to justify myself as a good person because my occupation automatically confirms that. I save lives. I help people. I took an oath to devote my life to healing the sick. What kind of person breaks that promise?

The “Bristol Promise”

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When I think of how amazing and necessary the work of a doctor really is, it’s hard to validate my existence without it. If I am ever one day shipwrecked on a desert island, I’d have gone from being someone you’d definitely want to keep alive to someone who can be eaten without any great consequence.

The funny thing is, when I step back and look at it objectively, I can see quite clearly that Medicine is not the only ‘noble’ thing to do in the world. Our intricately connected society relies on the collective effort of many, and we all can influence the world around us for the better in our own way. The problem is, these things are not always recognised  in the same way that being a doctor is. In this world where money and fame is more celebrated than anything else, medicine is still holding on to respect and value by the tips of its fingers, whilst the actions of good teachers, parents, farmers, legal aid lawyers, emergency service personnel and countless others fall by the wayside.

I used to dream about working as a doctor in Africa or Asia with Médecins Sans Frontières, providing healthcare for the poorest and most vulnerable. When I started to become unhappy in Medicine, this dream was the only thing that kept me going, but I realise now that my desire to be of service had become tainted with selfishness. I wanted to make a point, to show that I am a good person, but there’s something paradoxical in the truth about this: if you do something you hate for the sake of being good, resentment will poison any happiness you gain until you can’t do it any more. But if you use something you love to do something good, the happiness you gain will motivate you to keep doing it, and the good you do will be tenfold. The line between selfishness and selflessness suddenly doesn’t seem so clear.

These next few months are not going to be easy, I know. I have already experiences the sneers and sometimes just plain disbelief that I would ever dream of giving up Medicine, and I’ve barely told anyone in my family about it yet. I dread my next trip to Sri Lanka, as there the judgement will be even more severe.

However, I am coming round the idea that my self worth isn’t quite so dependent on Medicine as previously thought. As my best friend once said, “I don’t love you because you’re a doctor – I love you because you’re loyal and kind, and always there for me.”

I am still determined to help people, but perhaps being obsessed with a goal in actually more of a hindrance than a help. After all, my literary inspiration, Jane Austen, didn’t write her books with a view to helping me, but she has. Her books have been my joy and comfort in many a dark moment – one of many unexpected echoes of her quiet, modest life that she will never know. I’m sure if she were alive today, she would tell me to chill out and take myself less seriously.

Perhaps she’d tell even me to listen to Bertrand Russell, who I believe once said:

“One of the symptoms of an approaching nervous breakdown is the belief that one’s work is terribly important.”