I’m doing a Livestream about Doctor Guilt!

REAL Reflective Practice for Doctors: GUILT

Forget your e-portfolios for a moment. Reflective practice might be a mandatory training requirement, but rarely does it give doctors the opportunity and skillset to truly process the emotions that surround their work. And with concerns in recent years over the confidentiality of those reflections, it can feel like being authentic and honest is not an option.

That’s why I’m doing this livestream – to practice some real reflection, i.e. take a deep dive into the mental, emotional and spiritual realities so unique to the medical profession. And on Monday we’ll be looking at the theme of Guilt.

Date: Monday 6th April 2020

Time: 7.30 – 8.15 pm

Place: The Disillusioned Medic YouTube channel

Guilt a familiar feeling to a lot of doctors (me included…) but now, in this unprecedented situation, ‘doctor guilt’ is taking on new forms… Are you self-isolating and feeling guilty for not being there for your frontline colleagues? Beating yourself up because you can’t be faster, cleverer, less exhausted than you are right now? Perhaps you’re a retired doctor feeling bad for not coming back, or not helping as much as you think you should be? Or maybe you feel you don’t deserve the public support and generosity being shown at this time?

Join me as we explore:

  • Why doctors experience guilt and how it’s different from other professions
  • The impacts of guilt on our personal and professional wellbeing
  • How we reframe those narratives in a more healthy way

SPECIAL GUEST: I’ll be joined by Dr Amrita Sen Mukherjee, a GP with a special interest in Occupational Health, Wellbeing and Positive Psychology. She’ll be sharing her own perspectives on how doctors experience guilt, as well as her research around the powerful impact of positive emotions.

Hope to see you there! Just click on the link above to join 🙂

20 tips on what to do if you want to quit medicine

With everything that’s been going on lately with Covid-19 – the insane rotas, the failure to protect staff, the appalling lack of leadership and the battlefield the NHS has turned into, I’m not surprised that we’re now seeing doctors seriously considering a change of career.

As much as the political rhetoric tells us we’re ‘all in it together’ and that camaraderie in the health service is back, it feels like too little too late. So many brilliant, hard-working doctors out there are feeling lost, exhausted, and just plain fed up. 

When I first considered quitting medicine, I found the whole idea deeply distressing, and I felt really alone. I didn’t know where to start, what to do, or even how to find out more information. It also felt like such a taboo to even talk about my feelings – socially isolating, you might say… (Too soon?)

Anyway, in honour of my old colleagues, and anyone else out there who has doubts, I’ve updated my guide for what you should do if you’ve had it with medicine.

*                          *                        *

1. Find some head space

As much as our beloved eportfolios bang on and on about the importance of ‘reflection’, working as a doctor rarely gives you the chance to actually reflect on your life. I got my chance to do this completely by chance – in October 2015, I was called up for jury service, and as all those who have done it before will know, you spend a lot of time waiting around. The hours I spent sitting in a tiny room outside the court with a bunch of strangers forced me to think, and in the end, the inefficiency of the justice system served me well, because five days later, I wrote my resignation letter.

Whether it’s getting away from normal life for a while, or talking to someone who’ll respond to your concerns objectively and not critically, spend some time exploring your doubts and feelings.

2. Know that you don’t have to leave medicine outright

I’ve had doubts about medicine since my first year of medical school, but one of the reasons I held back from doing anything about it was that I genuinely didn’t realise that you could be more than a doctor.

It seems like such an obvious thing to me now that I’ve done it, but the medical schools rarely tell students how they can diversify their careers. As a medical student, you’re led to believe you’re on a non-stop train to consultancy. You start to believe medicine is all you’re trained to do, all you know how to do, indeed all you can do.

But it’s not true. I’ve discovered that you can get off the train. You might change trains and go via a different route. You might ditch the train for a while and drive a car to the next station, where you get back on again. I’ve met people who have had several career breaks over the course of their lives, doing both medical and non-medical things. For these people, their experiences have enriched their lives and have actually helped them when they have returned to their medical careers. Don’t believe the old-school naysayers who will tell you that career breaks will damage your chance of making it in your chosen field; if you do something interesting that will help you grow as a person, it can only be beneficial.

Here are just a few examples of incredible doctors, some still practising, some not, who have diversified their careers:

Abeyna Bubbers-Jones, Founder of Medic Footprints, the largest organisation in the world that focuses on diverse careers and wellbeing for doctors

Evgenia Galinskaya, Production Associate, Coulter Partners (Life Sciences)

Gyles Morrison, Clinical User Experience Designer

Lafina Diamandis, Founder of Eurekdoc, amongst many other things

Stephanie Eltz, Founder of Doctify

Kishan Rees, Founder of WatMed Media

3. Remember who you were

While on jury service, I went out for a drink with one of my dearest friends, who happens to be an old teacher of mine. She taught me French at high school and we stayed in touch after I left. Whenever I see her, I feel a strong connection to my high school self: the girl who was a brilliant linguist, but didn’t appreciate or realise it at the time; the girl who loved poetry and prose better than covalent bonds and the Krebs cycle; the girl for whom English, French and German held such a fascination, that studying them hardly felt like real work.

My wise friend listened to me so understandingly, and told me of her own search for happiness in life, and suddenly the right thing to do became blindingly obvious to me: I didn’t just like languages – I was madly and irrevocably in love, to the point that life without some linguistic aspect would always feel incomplete.

So who were you before medicine eroded the passions you once had, and drove out the hobbies, interests, talents and little personality quirks that once gave life that spark?

4. Ask yourself: is it medicine or is it the NHS?

This notion came from an unexpected corner: my dad. Although he expressed doubt as to the wisdom my leaving the profession, he made a very pertinent point: debate is important when you’re making big decisions, and while the medicine referendum was going on in my head, my dad represented the ‘stay’ campaign.

Working for NHS England can make it very difficult to like medicine at times, and it can be really hard to know if it’s medicine itself that is making you unhappy, or whether it’s just the system. Would it change things for you (if we’re ever allowed to travel again…) if you were working in a different country? Could a different speciality, part-time work, or a year or two abroad give you that sense of perspective? What about the private sector? It’s a taboo subject I know, but you’d be surprised to know that even junior doctors can find roads into it. The co-founders of Doctify, Drs Stephanie Eltz (mentioned above) and Suman Saha, set up their independent health tech platform partly because they felt stagnated in the NHS, and setting up a business has been their way of getting that spark back.

It’s a really hard question to answer, but I guess, if you don’t ask it, you never look into it.

5. Do your homework… in the right way

If you’re like me, you’ve probably spent hours googling thing like ‘alternative careers for doctors’, and seen unhelpful lists of other careers that are vaguely related to medicine. But I stopped when a friend of mine, Dr Evgenia Galinskaya (also mentioned above), who used to be a Dermatology reg, told me not to do this. (Her exact words were: “stop googling alternative careers for doctors!”)

Those lists are bullshit written by people who have only a vague idea of what the job market actually looks like. You are not limited to those lists. When was the last time you sat down and thought about what you wanted to do? Years of medical school and postgrad training give you a plethora of skills, but it can make medics forget that they have other facets to their personalities. Give yourself the chance to rediscover your natural skills, weaknesses and goals.

It might not come straight away, because you aren’t used to asking yourself what do I actually want. But it’ll come in time. Finding your sense of purpose and direction is a journey – start it now.

6. Evaluate your own health

The GMC estimates that 10-20% of doctors suffer from depression at some stage, but more recent studies suggest that the real figure is much, much higher than this.

Of course, not every doctor who questions their career will be experiencing either mental or physical health issues, but I think the risk of this happening is greater, because changing career just isn’t something we do. As I said before, it’s classically been a bit of a taboo – you work so hard and invest so much personally; leaving could naturally make you feel that a lot of time and effort has been wasted. Then there are the wishes of your family or colleagues, and their investment in your career, plus the horrible, awful guilt many doctors feel about leaving. When all of this was added together, for me, it made the misery so intense that I honestly began to wish I could go to sleep and not wake up again.

Please don’t feel alone if you find yourself struggling. You know what the signs and symptoms are; if you were your own patient, would you be worried? Don’t suffer in silence: contact the Professional Support Unit in your Deanery or NHS Practitioner Health. Or reach out to support wellbeing groups on social media like Tea and Empathy. Or get yourself a licensed counsellor or therapist – again not something doctors do, for some reason.

Physical health is also an important consideration. How is being a doctor affecting your body? Do you have a condition or disability that, if given more attention, could allow you to continue practising? Doctors are really good at feeling guilty and ‘weak’ compared to their colleagues, and therefore not asking for what they need. But knowing your own body is not weakness, and you’re allowed to be a human being.

7. Get yourself a person

Even if it isn’t health support that you need, people who are having a career crisis generally could use a little help. Having someone who specialises in careers guiding you, such as a coach or a mentor, was a critical part of my successful transition out of medicine.

When I was considering leaving, I contacted the Professional Support Unit in the London Deanery. They gave me four free career coaching sessions (that was five years ago – I’m not sure what they provide now). I was linked up with a coach who wasn’t a doctor, but a writer by profession. She did all sorts of things with me, like personality tests, a CV overhaul, a skills analysis, non-medical interview practice and lots more. As she worked with me, it became a bit clearer to me why medicine wasn’t the right career for me.

My mentor was (and, in fact, still is) Dr Gyles Morrison (mentioned above). He left medicine about a year before I did, and was therefore able to relate to me in a very specific way, as he knew exactly what I was going through. His support and advice became a lifeline to me as I felt my way through a strange, new, non-medical world.

That was an informal mentorship, but there are also a lot of professional career coaches, life coaches and mentors out there who are themselves ex-doctors and now specialise in helping other doctors. If you find someone whose ethos and coaching style resonates with you, this could be a very worthy investment.

Formal or informal, having a person to specifically discuss these issues with you can bring you empathy and new perspectives, as well as helping you to set goals and holding you accountable to them. Remember, engaging a coach doesn’t mean that you’re definitely going to end up quitting medicine – it just means that you’re exploring your options.

If you’re interested in mentorship with the Disillusioned Medic, click here.

8. Explore opportunities to take time out

For you doctors with a specialty training number, it could possible for you to take an Out of Programme experience (OOP). This can be related to training, research, or something completely non-medical altogether. They can be hard to get, but they are definitely worth exploring. I’ve met many OOPers, Azra Chang being one of them. Like her, many have stepped out of medicine into something completely different, like management consultancy or health policy. I don’t think a single one of them regrets doing it, for the experience has allowed them to learn something totally new. Some don’t return to medicine, but some do, and from my experience, those who do feel empowered to come back on their own terms.

9. Network your socks off

Doctors – especially junior doctors – are not used to the concept of networking. Generally, you know where to find the people you need (even if they’re not always available!) and as jobs in the early years are dished out using some strange algorithm that puts the SJT on a par with six years of med school, you don’t really need to get out there and meet people in order to find work.

However – and I cannot emphasise this enough – this is not how it works outside medicine. Meeting people and knowing people can mean everything. I’m not talking about nepotism; it’s more about being in a position to take opportunities. How can anyone become your mentor, your new boss or even business partner if they don’t know you exist?

I’ll give you an example: my mentor Gyles walked past a health tech start up’s PR stunt one day, and stopped to ask them questions about what they were doing. The Head of PR ended up introducing him to the founders of the company and they paid him for some UX consultations. Some months later, I met Gyles by networking at the Medic Footprints Alternative Careers and Wellbeing event and he became my mentor. Gyles then asked me to assist the same company in another PR stunt they were doing, and I just went along out of curiosity and to be helpful. In the process of doing this, I got to know their Head of PR and I guess he saw something in me, because the company then called me in for an interview and hey presto, I become their new Head of Content and Marketing.

When I left that job, I met the CEO of my next company at a GIANT Health event. I heard him speak, loved his perspective on the way companies hire, and went to talk to him about it afterwards. He gave me a job on his marketing team, but because the company was a management consultancy, I learned about the consultancy world and then I became a consultant myself.

So there you have it: go to networking events and careers fairs, be curious and keep your eyes and ears open. You never know what you’ll discover one day.

10. Get on LinkedIn

This ties in with networking, and is a must for medics who want to explore new professional territory. Make yourself a profile, put some effort in and make it look good. Write a decent bio about yourself and put up a good, professional-looking photo of yourself. You can go further by putting up blog posts as well. 

Another benefit of networking is finding that peer support. When I first started discovering the alternative careers sphere, meeting other people who thought differently was just the most inspiring and comforting experience.

11. Think about when you’ll be in a good position to leave

It’s not a nice subject, but I used up a lot of the money I had saved working as a doctor while I was unemployed. It didn’t feel great – especially when I  was considering unemployment benefits – but I felt it was a necessary investment in myself. I was extremely lucky to have the support of my fiancé as well.

Dr Roger Tackley made headlines when he left his post as a Consultant Anaesthetist to open up his own hair salon. A career change is always a financial burden, but for him, setting up a new business at the same time made it even more challenging. However, he told me that he was so glad he took the plunge, and his advice to anyone who has a passion to do something alongside a medical career is to give it your best shot. He said it’s a good idea to experiment and sample it before swapping careers, and to make sure that you are secure enough to survive if it doesn’t work out.

12. Remember that the door is always open

Dr Lafina Diamandis (mentioned above) is a testament to how varied a doctor’s career can be. She took several career breaks to try different things, including setting up her Boutique Property Services in Spain, and founding Eurekadoc, the only UK publishing house dedicated to printing ‘niche’ career guides for doctors. In December 2015, it was she who organised the ‘Medicine: Stay or Go?’ conference. Lafina went in and out of medical practice, and is now returning again to complete her Paediatrics training. So if someone tells you that once you leave, you can never come back, ignore it; it’s simply not true.

And even if you do leave and tell the GMC to well and truly fuck off, a global pandemic might end up pulling you right back in (case and point: yours truly).

13. Free yourself from guilt

When I spoke to Dr Sabine Fonderson, CEO of HelloDoc, about switching careers, getting rid of the guilt thing was her number one tip.

I too was racked with this terrible feeling, but Gyles put it this way for me: if you did a degree in history, would you feel guilty about not becoming an historian? Probably not. Yet doctors continue to feel this sense of shame and guilt when they consider leaving medicine. I felt like I was letting everyone down and I felt that I owed the NHS all the money spent on my training.

Do remember, though, that the government subsidises every single degree in this country – medical students might get a bit more, but the difference is not as big as people believe. Also think of all your fees, exam costs, the free overtime you do, the quality improvement projects, the audits, the teaching and everything else you do completely out of your own pocket and your own time. You’ll probably find that the NHS owes you more than you owe it! Also your value is not just monetary – you are more than just a pay check. The fact that you’re a doctor makes you extremely valuable to other sectors – health policy, for example, like Dr Harpreet Sood. People who harangue you for wasting taxpayers’ money are ignorant of these things and therefore not worth listening to. 

Ultimately, you have to do what is right for you. If you are miserable, you and everyone around you will suffer, including your patients.

14. Turn down the volume of negative influences

It can be hard to avoid negativity. When someone close to you expresses a strong aversion to the idea of a career change, it can make it very difficult to make the call. I also had a bad experience with my educational supervisor, who simply told me I was wasting my life. 

Having said that, I did notice, particularly in the wake of the junior doctor contract fiasco, that more and more senior doctors are willing to talk about the realities of working in medicine than they were before. I was surprised at how, as well as those consultants who have urged me to go back, there were a considerable number who were open to discussion about other careers and who helped me – by providing references, for example.

At the end of the day, people will always have an opinion about what you should do with your life, but I now try to take advice only as it empowers me.

15. Learn to talk about yourself

Often I find that doctors who are leaving medicine are not very good at talking about themselves. Any professional confidence they had within medicine suddenly evaporates, and they don’t know how to communicate their skills and value to non-medics. They also often suffer from an aversion to boasting that is so severe that they’ll often downplay their talents.

This makes sense in the strictly hierarchical medical world – if you talk yourself up, chances are you’ll get put straight back in your place by your seniors, or worse, you’ll be asked to do something outside of your competency. Also, you don’t really need to say very much to another doctor to communicate your level of expertise. For example, if you were to say that you were a Paeds ST3, another doctor would have a fairly good idea of your professional aptitude just within those two words.

Not so in the non-clinical world. People won’t hire you or partner with you unless you’re able to explain why they should, so start prepping that elevator pitch. Your coach or mentor can help you with this.

16. Create a non-medical CV

Medical CVs are only understood by people within the medical field. They often are extremely long, due to the level of detail you need to go into about the competencies you gained in every post.

Non-medical CVs need to be short (two pages max), snappy and to the point. There will almost certainly be a number of superfluous details you need to get rid of, and until you reach a certain level of experience in a non-medical field, you will almost certainly need to tailor your CV to every position you apply for.

Also, don’t assume that your medical degree will open every door for you. People will often tell you that a medical degree is a ticket to anywhere, but this is a misconception.

It is true that, as a doctor, you will have a range of transferable skills. You will likely be very adaptable, fast to learn, flexible and extremely diligent. But people won’t necessarily understand that, or have the ability to see how you’ll fit into their team.

Remember, most people have no idea what doctors actually do, and they often have weird assumptions about the kind of people we are and the kind of capabilities we have.  

I’m not saying this to dishearten you – remember, you ARE much more than just a doctor, and you DO have a number of transferable skills, whether you know it yet or not. I just want to prepare you for the probability that you will meet resistance, and therefore have to ‘sell yourself’ in a very particular way. It is undoubtedly true that medicine has opened up many, many doors for me, and I wouldn’t be where I am today without my MBChB. It just didn’t necessarily happen in the way that I expected.

Again, ask your coach or mentor for help.

17. Stop thinking so big

Now this might seem counterintuitive – what could possibly be bigger than leaving medicine?! You NEED to decide EXACTLY what you’re doing with your life now, right? You NEED to have a new pathway to success mapped out with precision, to know IMMEDIATELY what your new purpose is, what your career progression is gonna look like, what your salary’s going to be, what you’ll be doing in two years, five years, ten years. How are you going to do GOOD in the world, make a name for yourself, make a difference, make up for the fact that you left the most NOBLE profession of all?? Oh God, it’s overwhelming! Maybe you’ll just crawl into a box and think about it later…

I understand. This was me, once. I felt like I needed to have all the answers, and it didn’t help that people around me were asking me what the hell I was doing with my life. But if you think too big, you’re only going to feel more stuck. This is a gradual process, so take it one step at a time. You’re probably not going to land your perfect dream job tomorrow. But you can go to that art class, you can read that book, you can attend that webinar. The small steps will lead to big ones – just be patient.

18. Explore

This ties in a bit with my last point. Doctors are really bad at exploring. For many of us, having been on a conveyor belt ever since we were in our late teens, we never actually had the time to experiment. It’s almost like you got married when you were 15 and never had the chance to date. You never kissed any frogs, never had a fleeting romance, never figured out what you like and don’t like, never spent a year with that guy you knew deep down was a mistake, but hey, it was a mistake you needed to make.

I think it really boils down to fear. Medicine always gave me a goal to work towards, no matter what stage I was at. To suddenly be without that very specific goal made me feel like I was wandering around aimlessly. I had jobs that I didn’t like but had to stick out for a while, jobs that didn’t really seem to be going anywhere, and periods of not really knowing what to do. These things acutely stressed me because I felt like a massive failure all the time.

But I realise now, they were all an important part of me learning about what I liked and what I wanted to do. Let yourself explore.

19. Don’t presume you have to do a Masters

Because medicine requires us to have formal training for everything and demands proof of it before we even set foot on the wards, doctors often make the incorrect assumption that, if you want to go into new field, you’re going to have to retrain. And most frequently in my practice, my mentees talk about doing a Masters degree.

However, in the non-medical world, academics are not the be and end all of everything. There are plenty of fields where your experience, your personality and your talent (as well as knowing the right people) are the primary drivers of your success, and I would argue, are more important than your qualifications. This is a bizarre concept for a lot of newly escaped doctors, and it can feel quite uncomfortable at first.

Now I’m not saying that you should never undertake another formal qualification – I’m just saying that timing is important here. Often, doctors put themselves under huge pressure, as I said above, to ‘decide’ what their new life will be, and this drives them to looking at expensive degrees they have no idea whether they’ll actually enjoy or find useful. It’s basically like medicine all over again.

So pull it back a bit – start by building your skillset on a smaller scale. It doesn’t matter if you don’t know what you want to do yet, or even if you’re not sure you’ll leave medicine yet. Just start looking at things that interest you. If you think you might want to set up a business one day, read some business books. If you think you might be interested in health tech, maybe do a coding course and see if you’re into it. There are so many resources out there, including free webinars, courses and educational platforms. Use those research skills and start researching what you’re into!

Once you have an idea of that, you can step it up – find a more in-depth paid course, get a ticket for an event in that area, geek out about it a bit more, and talk to people who are in it. Perhaps you’ll even get a job in your new field of interest so you can explore it a bit more.

And one day (not always), there might come a point where you realise that, to take this further, it might be useful to do that degree. You might realise you’re really interested in management consultancy for example, and to work for the Big Four, you’re going to need an MBA. At that point, you’ll be ready to take the plunge and spend that £10k. Or you might find a completely different route into your chosen field without doing a degree – there is almost always more than one way of getting where you want to go.

Example: I’m a strategic marketing and communications consultant. My clients are small to medium sized enterprises and they pay me a pretty decent day rate. And I don’t have any sort of marketing degree.

20. Get ready for a massive personal learning curve

Before I left medicine, I didn’t realise how ‘doctor-y’ I was. It was in part because I’d been institutionalised by the NHS, and infantalised by a management culture that still speaks to you like you’re a toddler even if you’re in you’re a highly trained specialist in your thirties. But it was also partly because I’d never actually experienced the outside world myself. I had ideas and presumptions about it that turned out not to be true, in both good and bad ways. Certain prejudices and suspicions turned out to be unfounded, whilst in other areas, I realised I was desperately naïve.

And the spiritual growth! Blimey, I was not expecting that. I mean, I realised that leaving medicine would impact my emotional and mental health, but I really had no idea how it would change my entire outlook on life itself! It’s perhaps a rather hippy-dippy thing to say, but my soul has changed. And changed for the better.

It will take you a long time – months, maybe even years, to rewire the neural pathways that are keeping you stuck right now. And to be quite honest, it might sometimes be really painful. But if you embrace the process, it’s worth it. Bloody hell, it’s worth it.

*                          *                        *

I hope this article has been helpful to you. Just remember, you’re not alone. In medicine, always being in the same environment can make it difficult to see the bigger picture, but take it from me – there are other options out there, and there’s no harm in looking!

Wanted: Leadership in the NHS

I’ve been going round in circles this week.

I’ve spoken to a lot of people. Including the Guardian, ITV News, my mentor and old friend Dr Gyles Morrison, my therapist, my husband, my friends, my dad, my whole fantastic community of ex-doctors, and some fellow coaches. I’m like a decision pendulum – one moment I’m so sure I’ll go back, the next moment, I’m certain of the opposite.

I even flipped a coin last night – and then again. And again. (Best of three!) And then I got the email informing me that my licence to practise had officially been reinstated (not because I had definitely decided to return, you understand – they did this automatically). Fuck. Way to pile on the pressure, GMC.

Here’s the thing that’s bothering me at the moment though…

We’re hearing about things changing. There are reports of PPE supplies finally slugging their way to the frontline, and today that testing for frontline workers has been started (no doubt because of the amount of media coverage that myself and other healthcare professionals have been pushing for in order to raise this issue – sad that it had to come to that, but hey, not surprising).

We’re also seeing the nation express gratitude towards the NHS like never before. I joined in on last Thursday’s Clap For Carers round of applause and it was truly moving. It’s also incredible to see that already, over 700 000 volunteers have joined up to help support care efforts, and uplifting to hear reports of restaurants dropping food off at hospitals for staff, and businesses giving up their time and space to help support staff.

BUT – there appears to be on thing that has not changed. One incredibly critical thing: leadership within the NHS.

From up and down the country, I’m hearing reports from friends, former colleagues and on social media groups about the culture of bullying, blame and sheer managerial incompetence that is pervading the health system, even at a time like this: F1s being bullied for wanting to wear PPE; PPE protocols changing every five minutes, causing mass confusion; SHOs being yelled at for raising PPE concerns; consultants being threatened with fitness-to-practise tribunals if they refuse to see a patient on the grounds of inadequate PPE; retired doctors being charged GMC fees before their licence is returned… The list, no doubt, goes on.

You know something is seriously wrong when the Lancet – The Lancet one of the most impartial scientific journals known to the medical profession – call this situation a ‘national scandal‘.

Last week the Doctor’s Association spoke of how they feel like ‘cannon fodder’. All I can say is, thank goodness for the Doctor’s Association, because if they didn’t speak up, no one would. The BMA is being deafeningly quiet, now that there’s nothing in it for them, and my friends on the frontline tell me that managers have warned them that if they go to the media to discuss their local situations, their careers will be damaged. Professional blackmail, how classy!

I’m not scared for myself. If I go back (and that’s still very much an if), the system will have little power over me. What are they gonna do, strike me off? Be my guest! They’d be doing me a favour! I have no intention of returning permanently, and therefore I can’t be threatened in the same way.

But I’m angry. This, more than anything, is a time where great leadership is essential. And I can tell you, from my experience in the management consultancy world, that great leaders make the welfare of their employees an absolute priority. It’s not rocket science. As Simon Sinek said, if you look after your staff, they will make your customers happy, which in turn will make your shareholders happy – in that order.

And in these times, this leadership principle is even more critical than ever, because we desperately need NHS staff to be well cared for, not just so they can be there to run the health system, but also because if proper infection control measures are not adhered to, they risk spreading the virus even further! This snide, small-minded, power-centric attitude is killing people in real time.

This was always going to be a challenging time – no healthcare system in the world was ready for Covid-19 – but in war, it’s not necessarily the biggest army, or the army with the most guns who wins. It’s the army with the best strategy, the best tactics – in other words, it’s the army with the best leadership. And shitting on your troops is not exactly a shining example of that.

To get the best out of your men, they must feel that you are their real leader and must know that they can depend upon you.

General of the Armies John J. Pershing, U.S. Army

Slapped round the face by Reality

It turns out I didn’t need to send that email after all.

Less than 12 hours after I posted my last blog about how I was debating over whether to tell the GMC I’ll to return to the NHS in this time of coronavirus crisis, I got an email from the GMC informing me that, because I had relinquished my license within the last three years, I would be included in their first round of callbacks.

I had completely forgotten about this. I knew about the three year thing from hearing it in the news, but as I stopped practising five years ago, I assumed I wouldn’t be in included. But I had totally overlooked the fact that I didn’t immediately give up my license to practice! I, in my infinite wisdom, kept a hold of it for two years after I left ‘just in case’.

I guess I simply wasn’t ready to let go at the time I left, which is fine, but the consequence now is that going back into the fray seems a far more real possibility – one step closer to returning than I had anticipated.

Pretty soon after that email dropped, a Whatsapp group of fellow ex-docs was set up and buzzing. They, like me, have a LOT of questions about how this would work, what exactly we would be expected to do, and how on earth we would do it safely. And they, like me, feel a deep resentment towards the GMC and the NHS about their treatment of doctors. Thanks to section 18a of the Medical Act (1983), it would seem the powers that be reserve the right to dig their claws into us long after we’ve told them where to go.

I’m sorry if I sound mean-spirited. I still do intend to help out in any way that I can, and any way that is safe, but I think the reality of this situation has just really hit me the last 24 hours. I’ve been in emergency mode the last few days just trying to keep things together as my family self-isolates, so I haven’t really had time to process what’s going on. But when I got that email, it was like reality slapped me rounf the face. Today I’ve just felt so tired and ill, as all of my repressed emotions welled up inside.

Everything has changed. In the last two weeks, I – like so many other self-employed people and business owners – have lost almost all of my clients. Two weeks ago, my business partner and I were busy creating a new podcast that we were absolutely loving, and that felt like the perfect project for us. Now, she and I are now both in full time mum-mode as schools and nurseries shut down. I loved my job – I loved it. And now, for the forseeable future, it’s gone. And in its place is the prospect of going back to a profession I didn’t feel I belonged to and a job that I hands down hated. People are being so kind and telling me I’m being selfless and brave for being willing to go back, but I don’t feel selfless or brave – I mostly feel anxious, scared and resentful. Meanwhile, the world as we know it is falling apart around us.

Of course, there are many things to still be grateful for – health, friends, family. And I am mindful of all that, but after a conversation with my best friend today, I realised we need to make space for grief as well as gratitude. One of my favourite perspectives on gratititude is the idea that, when practised too early, gratitude can make us feel guilty for the pain that we do have. When we are too precipitate to make meaning out of suffering, we suppress the grieving process that is so critical to our emotional well being. We shouldn’t take it so far that we end up depressed, obviously, but the paradox is that allowing ourselves to embrace our pain and be present with it actually leads us to a healthier and more authentic form of gratitude.

So this is me making space for that grief. So many things are changing, and change is hard, and right now, most of it sucks. I miss my old life. And I’m terrified of what the future holds.

It’s funny, even just writing that paragraph is helping me to feel more positive. Maybe in coming days I’ll be able to write a reflection on everything I am thankful for. But right now, I need to sleep. A war is coming, and if I’m gonna go in, best get some rest.

The Call of Covid-19

Photo by Hush Naidoo on Unsplash

Never, ever did I think I would ever see the day that I would consider returning to medicine.

For the last five years, I’ve been thanking my lucky stars that I got out. My whole life has been completely tranformed – I am happier, healthier, professionally more fulfilled. Indeed, my work as a careers mentor for doctors is all about fighting what I see as an inherently abusive system that treats doctors without humanity, restricts their personal growth, and traps them in a state of obligation by effectively decimating their sense of self-confidence and worth. I am the Disillusioned Medic, for crying out loud!

And yet here I am, my finger hovering over the Send button of an email to the GMC, telling them I am willing to come back. As Covid-19 sweeps across our societies, condemning health services to a swift descent into crisis and taking healthcare workers with it, it seems inevitable that the time will come that extra support will be desperately needed.

We’ve heard today that the government is proposing emergncy legislation that would allow them to call retired doctors back. Of course, there are many issues with this plan – namely that a significant proportion of retired doctors will be in the age bracket most at risk from the novel coronavirus. When I first heard about it, the thought that immediately came to my mind what that I am essentially a retired doctor, but young. I realise that youth is not a complete protection, but would doctors like me be a safer option if (and, probably, when) the call goes out?

And then there are the issues of indemnity, revalidation… I’ve joined a Facebook group called Covid Returning Doctors Support which is keeping an eye on the situation, and it seems that temporary licenses to practise could be granted under emergency circumstances without having to go through revalidation, and NHS indemnity might cover people like us. I guess in this situation, rules might have to be bent, but I still can’t shake my sense of suspicion and distrust of the GMC. I would be completely unsurprised if, after this is all over, the GMC, in all their scape-goating goodness, were to pin failures and deaths on returning volunteers. It’s sad to have those thoughts, but given what’s happened in the last few years with doctors like Chris Day and Hadiza Bawa-Garba, I certainly am not the only one. Trust has been so broken down that I’m not sure even an apocalypse can bring it back.

I won’t deny, there is a sense of thrill at the thought of returning to the frontline. It’s similar to the naive anticipation I had when I was applying to med school, but now it’s mixed with real memories of things I liked about medicine – little things I was good at, like getting cannulas into tricky veins. Would I still be able to do that? It’s been five years since I did any sort of venepuncture, let alone any oher clinical procedure… On one hand I feel the need to offer the precious skills and experience I have, but on the other, I worry that it’s simply been too long. Would I be too rusty to be of use? Would I get in the way, or make things worse?

And what about the risk? We’ve all heard about the appalling lack of PPE and testing for healthcare professionals. We also don’t yet know why this virus seems to be killing young and otherwise healthy hospital workers… I’m a mother now, and it’s scary.

Of couse, it’s all still hypothetical – for now. The proposed legislation is due to be debated in Parliament next week, but the way the projections for this outbreak are looking, I can’t see the UK going into the peak of the curve without needing back-up from the ex-doctor community. I have a statistician friend who is currently working flat out on a report that will project the number of critical care beds we’re going to need, which in turn will influence the estimated number of clinicians needed, so it shouldn’t be long now. (Incidentally, are scientists not amazing?? I hope our species appreciates them more after this.)

I am struggling with the feelings of duty and obligation – the very feelings I worked so hard to rid myself of when I left, the very feelings that once left me with so much crippling guilt. And yet, when I see my friends and former colleagues post on social media about the unthinkable challenges they face and their bravery in doing so, I feel compelled to help. As Emmanuel Macron declared, this is war. And doctors are on the frontline.

I hated practicing medicine, and it definitely is not the career for me. That is not going to change. But this situation is so utterly unprecedented – a threat to human life like never before – so even if I could ease the pressure in some small way, it might be worth the risk.

My finger continues to hover…

Doctor Me First

I got interviewed on a podcast!!!

Maybe it’s a bit sad to be as excited about this as I am, but as much as I’ve had kind people telling me that my story has inspired them, it still takes me a bit by surprise that people actually want to talk to me about my journey.

So when Dr Errin Weisman, US based physician and fellow career coach for doctors, reached out to me on LinkedIn, it gave me a bit of a thrill because Errin is the host of ‘Doctor Me First’ – the podcast that showcases the issues that female physicians face in modern medicine and the ways in which they’re taking their lives back and diversifying their careers. I’m a fan of the show, so it was so exciting to talk to the woman who created it all.

“I just don’t think medicine should be a full time job nowadays. It’s so demanding and so exhausting that I think we should ALL be doing this part time and supplementing our lives and careers with other things.”

And when we finally did connect, it was incredible to see the similarities between our stories. It’s a fact that doesn’t surprise me, but our American counterparts experience a great many of the struggles that NHS doctors face here. They too are dealing with stress, burnout, exhaustion and being generally stomped on by the system.

Errin told me her story – how she felt like there were days when she could barely get out of her car, days when she would be counting the minutes just to get through the day. It resonated – she might as well have been describing my own life as a doctor. One thing she said to me that really stood out to me during our first conversation was this:

“I just don’t think medicine should be a full time job nowadays. It’s so demanding and so exhausting that I think we should ALL be doing this part time and supplementing our lives and careers with other things.”

It blew my mind. Because it’s just such a simple idea, and yet, what a difference it would make if that were actually the case!! My god, if I had been encouraged, nay obliged by my Deanery to balance my work in medicine with other work in a refreshingly different field, or travel, or hobbies, or just time with my loved ones, I may not have left. At the very least, I certainly wouldn’t have left in the spirit-sapped, soul-crushed state that I did.

When Errin later invited me to feature on her podcast, I was a mixture of delighted and really nervous (!), but she’s a lovely person and a very generous interviewer. Despite some technical difficulties, and me wanting to claw my own teeth out at the embarrassment of hearing my own voice, the episode turned out great. If you want to have a listen, I’ve popped the links to the major platforms below. And while you’re there, check out the other episodes of her podcast because there are some great stories there of other female physicians doing unusual and brilliant things with their careers and being generally badass.

I think the most important thing that I gained from my conversations with Errin was a sense of real vindication about what I do. Of course, I was already proud of my work as a mentor, and I get so much fulfilment from it, but there’s always that critical little voice that comes both from within and from external sources… The accusation that I’m making the NHS recruitment crisis worse… That I’m actively helping to dismantle our healthcare system by helping doctors to get out of it.

Well, screw that. Doctors are human beings, and human beings are not disposable fodder that can be used to prop up a system that is utterly failing them. I believe every person has a right to work that fulfils them. In an ideal world, we would all get that sense of joy from our jobs, but since we don’t, I have no shame in getting people out of a job that, for them, is doing the exact opposite.

Apple podcasts: https://podcasts.apple.com/us/podcast/144-exploration-with-dr-anjalee-perera/id1445688396?i=1000465128449

Spotify: https://open.spotify.com/episode/3KwwPcmM4uU1J7qVMkQi4k?si=lp8i0XvfS8WQ8QGEhNcelQ

Stitcher: https://www.stitcher.com/s?eid=67216456&refid=asa

The Disillusioned Medic is BACK!

Hello and Happy New Year!

It’s Anjalee here, the Disillusioned Medic, and I am delighted to say that I am BACK! After a long leave of absence, I’m going to be writing more articles on this blog, as well as creating some videos and podcasts too, so watch this space!

So why the return now??

When I wrote my last post in August 2017, I really felt like I’d made my peace with my medical life. This blog had served as a place for me to vent all my pain, resentment, guilt, and a whole host of other less than pleasant feelings about my time in the noble profession. I had moved on, and was looking forward to the next stage.

“Things we lose have a way of coming back to us in the end, if not always in the way we expect.”

And it was a busy couple of years! I launched my own business consultancy, got a regular column in a business magazine, started a podcast, and – my greatest achievement – I’m the very proud mother of a beautiful daughter. It seemed like my doctoring days were well and truly behind me… but some things have a strange way of reappearing in your life. What was it Luna Lovegood said? “Things we lose have a way of coming back to us in the end, if not always in the way we expect”…

Becoming a mentor

Back when I started writing the blog, a lot of doctors got in touch with me to tell me about their own situations and ask for advice or to hear more about my experiences. This was lovely for me, of course, but it also made sense – I was keeping myself in the career-transition spotlight, after all. But what surprised me was the fact that this continued even after I’d stopped writing – even when the weeks, months, years of inactivity passed by, the blog was still drawing visitors. The questions kept coming and the doctors kept calling. I was doing so much informal mentorship that eventually I felt compelled to set up a proper mentorship programme, and before I knew it, I was coaching career-questioning doctors on a regular basis alongside my other work!

I realised there was so much NEW stuff to say, and though it’s been slightly delayed as I’ve been on maternity leave, I’m so excited about using this platform again to open up all those discussions.

It’s funny, when I left medicine, I worried so much about not making a difference in people’s lives anymore – of not doing something truly worthwhile. But I look back now and realise I should never have got so worked up about that. My journey through the business world since leaving has allowed to me understand what my true strengths really are. I see now that I love to listen to people. I love to be there for them in times of distress, to witness their grief, to hear their stories, to show them other possible paths, and to share those of my own experiences that might help to guide them. Whether that’s for senior executives of corporate bodies in my consultancy work, or for doctors feeling as lost as I once was in my mentoring role, I have found the work that lights a fire beneath me. I have discovered a sense of purpose that I never had before.

At the end of my very last blog, I said:

‘The slight irony is that, the thing I loved most about medicine was the interaction with patients, and that was the thing that was most difficult to find the time to do, given the vast pressures we were under. Now, having left medicine, but still having the title of ‘doctor’, I have the time and the ability to listen to sad things without becoming sad myself. People tell me stuff they wouldn’t tell other people. They trust me and ask my advice, but really I think it’s just being heard that does the most healing.

Being a doctor was an honour and a privilege – I have always believed that, even at my lowest moments – but now I realise it’s still a privilege. For the people I coach, I am often the only person in their life with whom they can be truly open. Knowing I’m a doctor builds a sense of trust and confidentiality. And for me, the skill of listening to the most difficult moments of a person’s life, taught to me by the many patients who shared their stories with me over my clinical career, has become a cornerstone of my practice.

We all go into medicine with that clichéd, if slightly vague desire to ‘help people’ – but that doesn’t mean that being a doctor is in only way we can help people. My purpose in life is greater than my job, and though the path to finding it might not have been exactly smooth or painless (this blog can attest to that!) – my god, was it worth the journey.

Farewell from the Disillusioned Medic

August 27th 2017

Dear Readers,

This will be my last entry on this blog – for a while, at least, anyway. I guess I’ve said everything I needed to say. I am heart glad and grateful that there is such thing as blogging in this world, because this outlet was a veritable lifeline during what was a very dark time, and your loyal readership and kind words have helped me so much.

I had a lovely conversation this week with Dr Sally Graddon, as ex-doc like me, who found her own happiness as a life coach, and as we spoke, it was funny, poignant and rather moving to find that the our emotional experiences of leaving medicine were practically identical. We talked and laughed about the guilt, the uncertainty, the pain, the loss of identity, the shift in universe and the bitter regret, before both agreeing that it was totally worth it and that we were far happier and more fulfilled now than we were before. Pain is an excellent teacher.

Life for me now is so different, but good different. It isn’t easy – in fact, it’s often frustratingly unpredictable, but mostly I find that exciting. It keeps me on my toes, and suits me far better than the ‘conveyor belt’ feeling I talked about before. They say you make your own luck, and I think to a certain extent that is true. I have been continuously astounded by the opportunities that apparently keep landing in my lap, or the incredible experiences I seem to just fall into, but they happen, I guess, because I put myself in a position that allows them to happen, and don’t shy away from them when they come along. I’m still working things out, but I’ve given up putting a time limit on that – I don’t need to make an overnight success of myself. I don’t need to prove anything. I don’t need to justify my choices to the world and, more particularly, to myself. I can just be proud of being me – even if that ‘me’ is sometimes irrationally romantic!

I used to have lots of regrets about medicine, but I don’t anymore. I have had the extraordinary privilege of working in a profession that gives you a perspective on life and a sets of skills that most people never have access to. There was the good – the strength of the human spirit; the camaraderie of this tribe of beings that share your odd little world; the gentle and unobtrusive wisdom of the older generation; the miraculous victories over the seemingly impossible, like getting a young lad with schizophrenia to finally see that his mum was trying to do what was best for him, rather than trying to kill him.

There was the bad – the long, slow exhaustion; the coldness where there should have been kindness;  the unbearable, fatal cruelty of child abuse, violence, and an uncaring system; of dying mothers and brains riddled by dementia; of yellowing alcoholics despairing of the lives they lost; of good people in the worst situations.

I got to spend time with people from walks of life that someone of my background would never normally have done. I don’t know many people in my conservative, middle-class circle who can say they’ve had a heart-to-heart with a man whose face seemed to be almost crumbling due to his heavy meth consumption. I don’t know anyone else who’s been given origami flowers made out of NHS kitchen roll by a middle-eastern refugee, after sitting with him post night shift to listen to the horrors he had witnessed. And without medicine, I’d never have had a very, very long laugh with a heroin addict, whom I simply could not cannulate in the antecubital fossa because he’d injected so many times that his veins were shot, and who subsequently went on to show me, the doctor, where the best spots on his femorals were!

And I have to say, there’s pretty much nothing that grosses me out anymore. When you’ve had to scrape stinking pus off an STI-riddled foreskin, you end up with a pretty strong stomach.

I won’t say that it changed me entirely for the good, because that wouldn’t be true. There were negative effects on my character as well – for example, medicine makes you good in a crisis (a few nights in A&E will teach you that), but it often left me nerve-wrackingly anxious in general life. It taught me to grow up extremely fast, but it also made me bitter and cynical in many ways, and I started not to like the person I was becoming. It added colours to my box of metaphorical paints, but left me without the energy or the inspiration to use them, so life became rather grey and faded. It brought out the selfless in me, but also the self-neglect.

To paraphrase that song from ‘Wicked’, I couldn’t say if I’ve been changed for the better, but I do know that I’ve been changed for good.

I feel so honoured to have been a doctor. Even the bad stuff was good in its way, and I think of our time together with pride, and with peace. Who knows if our paths will cross again, but even if they don’t, that part of my life will stay with me. It will remind me that there is still so much to learn, and that, while I think I know myself ever so well, there’s probably something waiting right round the corner that will shock me into realising I don’t know myself at all.

The slight irony is that, the thing I loved most about medicine was the interaction with patients, and that was the thing that was most difficult to find the time to do, given the vast pressures we were under. Now, having left medicine, but still having the title of ‘doctor’, I have the time and the ability to listen to sad things without becoming sad myself. People tell me stuff they wouldn’t tell other people. They trust me and ask my advice, but really I think it’s just being heard that does the most healing.

I accept now that it is possible for me to help other people without being a clinician. I think I was always meant to heal through words, rather than operations and prescriptions. My old med school professor was right – I didn’t really belong there.

Funny old thing, life, eh?