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

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.