The forgotten six thousand (guest blog)

confusedmedic

One of the benefits of writing this blog is that it’s given me the chance to meet other medics who have decided to do different things with their lives. I’m so pleased to introduce this guest blog by theconfusedmedic, a fourth year medical student who has currently interrupted  her studies to pursue other things outside medicine. She currently working as a junior medical writer for a medical communications company and would like to explore medical writing as a career option. She plans to return to medical school in the next year or so to complete her MBBS but beyond that, she’d like to do something outside of practising clinical medicine.

A medical student’s view on the junior doctor contract dispute

Last year, a post on Reddit went viral and this heartbreakingly candid photo of a doctor grieving over one of his patients was shown to the world.

Evidently, the reality of being a doctor is tough. It’s draining, both emotionally and physically. They sacrifice so much of their time and self to help others. The reward can be great; doctors make a huge difference in people’s lives. However, if it goes wrong, they have to pick themselves up and do it all again for the next patient that comes through their door.

The junior doctor contract debate that has come to light over the last several months has angered and frustrated thousands of doctors around the country. The changes to the contract have been widely rejected and deemed unsafe for both doctors and patients. Yet, despite the strikes and protests, news broke recently that the contract was going to be imposed anyway.

The whole medical profession is up in arms yet again, and rightly so. The definition of the word ‘contract’ is: “A written or spoken agreement, especially one concerning employment, sales, or tenancy, that is intended to be enforceable by law.” The key word here is agreement. At no point has anyone agreed and accepted this contract. So why has the government suddenly decided they are going to force it on thousands of employees?

Besides the 50-odd thousand junior doctors in England, there is a significant cohort of people who were never really considered or consulted on the matter of a contract that would dictate their future – they are the 6,000 medical students in England whose voices were overlooked by the government. Six thousand people who will leave medical school and have a job contract enforced upon them that they didn’t agree to.

Amongst my friends and fellow medical students, the general consensus is one of outrage, disappointment, and uncertainty. Outrage at the audacity of the government to go ahead and impose a contract widely condemned as unsafe and unfair; disappointment at the lack of meaningful responses from the government; and uncertainty over what this means for the future of training.

I asked some of my friends for their personal views on the matter and what it would mean for them. Will they complete their foundation training in the UK then leave? Will they apply to do foundation in Wales/Scotland? Would they leave medicine altogether after graduation/somewhere down the line? Or will they stay in the NHS and fight this thing until the bitter end?

The responses were mixed. Some are considering and preparing for alternatives: Wales and Scotland; taking an F3 abroad and playing it by ear; taking the USLMEs. Some are looking for ways out of medicine altogether (I only have to look down my Facebook feed to see events pop up for ‘Alternative Careers in Medicine’ and the like, to know people are considering their options). Some don’t have much choice in the matter of whether to stay or go – the financial investment and ties to family and friends are too strong to consider leaving. And why should they have to?

One common thread amongst medical students is a desire to fight this contract for a better future for themselves, every other medical student that will follow them, and the patients of the NHS. A friend made a good point about how governments will always change and politicians are always attempting to make big reforms; we just have to fight them and stick it out. It took a lot of brave people to keep the NHS running thus far, and it will need a lot more brave people to do the same now.

However, I know for me personally, I don’t know if I could do it. Prior to this contract saga, I had my own personal doubts over a career in medicine anyway and it is looking even more unlikely that I will practice as a doctor. I actually find it quite sad to say because at one point that was what I wanted to do. Unfortunately somewhere along the way, I lost that desire and am currently on a leave of absence to work out what I want to do next. The thing is, it doesn’t surprise me to know that I am not the only medical student who feels this way.

We are incredibly lucky to have, in my opinion, the greatest healthcare system in the world. Sadly, the current government are hell bent on destroying it. The NHS probably won’t be sustainable forever, and it has its flaws, but there are so many more positives about it that we, as medical students, doctors, and members of the public, have to fight for. Medical trainees from all over the world aspire to work in the UK health system, but with the changes this contract will bring, all those highly sought after trainees will go elsewhere. And those that are in the UK already will leave. If practising doctors are considering their alternatives, and medical school graduates like myself are looking at other options, where does that leave the NHS?

It’s easy for the government to sit back and make whatever decisions they want to extend working times, reduce overtime pay, and remove safeguards for doctors. They are not the ones who will have to deal with the fall out. They won’t be the ones who will end up being treated by doctors who are tired, overworked, and damn right miserable about the conditions they work in. That will fall on the general public and all the people who rely on the NHS for their health care.

And it’s just not fair.

Read more from theconfusedmedic

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The Perks of Being a Doctor

A&E

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

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

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

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

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

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

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

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

Luckily we had a hand from Dr Karen Morton, founder of online GP service Dr Morton’s. She  told my fiancé it was serious and needed immediate treatment. I’m so thankful she called, because I would never have been able to convince him to go to A&E otherwise!

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

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

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

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

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

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

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

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

 

Click here for an exclusive interview with a junior doctor on the picket line.

Alternative Careers and Wellbeing for Doctors: a Medic Footprints affair…

AwI came across Medic Footprints in a manner perhaps apt for my generation: Facebook. I can’t help being suspicious. In this Big Brother world we now live in, did social media know I’d been desperately googling ‘alternative careers for doctors’ over the last few months? I wouldn’t be surprised if they did.

In any case, I was glad of it. It was an advert for ‘Alternative Careers and Wellbeing for Doctors’, an event which promised inspirational talks by ex-doctors, exhibitions on other career options, career coaching, seminars, workshops, mentorship, advice on health and well-being and plenty of networking opportunities. I jumped at the chance. I didn’t care about the expense of the ticket – it felt like a necessary investment in my future.

Now, since I’ve already resigned, I was a bit worried about going to the event today. I was nervous that it would make me regret my decision. The first talk was to be ‘Do I Really Want to Leave Medicine?’ What if the answer was no? What if someone there presented an opportunity within medicine that I hadn’t considered and wished I had?

Still, I went along with mixed expectations. I soon realised, as is common with me, I had been worrying about nothing…

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The first talk was by Dr Evgenia Galinskaya, founder of Other Options for Doctors.

Other Options for Doctors

Cambridge-educated and clinically excellent, Dr Galinskaya beat off fierce competition to land a registrar post in dermatology. Despite having worked so hard to get there, and outstanding feedback from her colleagues, she found herself missing something in her life, and made the difficult decision to leave medicine to pursue a new life in career coaching.

“Two years later, I don’t make as much money as I did in the NHS, but I have found an inner peace… You have to do what makes you happy.” Dr Galinskaya

She spoke about her emotions at the time she left, and they resonated so strongly with me: guilt about quitting, fear of leaving a steady salary and job security for an uncertain future, a sense of wasting her medical training… It was as if she were taking my current sentiments right out of my mind and giving them a voice. It was hard, she said, to convince those around her that leaving was the right option for her. ‘Once a doctor, always a doctor’ they said.

She even said that she had tried to leave before, but had been persuaded to stay. Her expression of her feelings had been rejected by her peers and mentors. Have I not been through exactly the same thing? When I dared to mention my thoughts about leaving to my educational supervisor earlier this year, I was met with an immediate warning not to waste my education or make rash decisions. She didn’t ask why I wanted to leave, or even consider that it was an incredibly difficult and agonising decision which I have taken literally years to make. Instead she dismissed me with advice that ophthalmology was a good career for a woman.

Anyway, I digress…

In short, Dr Galinskaya was funny, frank, open and inspiring. I knew immediately that I had made the right decision, and my relieved heart opened up to the rest of the day.

There was so much going on. I wished I could have been in two places at once at times, as I wanted to absorb as much as I could.

The Doctors’ Mental Health in the Workplace session turned into a hilarious argument between the controversial and sharp-tongued Psychiatrist Dr Raj Persaud and Dr Andy Heeps, a Fitness to Practice panelist from the GMC. Dr Persaud made some extraordinarily blunt comments about the NHS today – how it stifles creativity and ‘crushes’ innovation while the GMC seek to persecute doctors in the most distressing way possible. He claimed that there was a fundamental difference between those who see being a doctor as just something they ‘do’ as an employee, and those who see it as something they ‘are’. The latter see medicine as their vocation and their calling, and in Persaud’s words, ‘actually give a shit.’ If you’re willing to tow the line and bow down to the rules and regulations put in place by the management, then you’ll be fine in the NHS. However, if being a doctor is something you ‘are’, Persaud claims that your fundamental loyalty lies in providing the best patient care and in pure science – the two things that lie at the bottom of the list of priorities in the NHS. This causes extreme stress in doctors who care.

Perhaps this is a slightly harsh view of the NHS, but it certainly struck a chord with a lot of us who are frustrated with the system’s almost authoritarian demand for obedience and its indifference about what’s best for patients.

Next up was Dr David Perl on his incredibly varied career as a physician, and how psychotherapy transformed him from an arrogant narcissist into a leadership guru. He had some great quotes on his slides:

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The talk about Occupational Medicine by Dr Richard Peters was interesting, as he seemed to suggest that it was possible to find lucrative work as an in-house occupational health practitioner for large private companies without having done any work in occupational medicine within the NHS. I don’t really want to go into the field, but it did make a very interesting point about the difference between the public and the private health world. Dr Peters has built up an excellent reputation, worked for a variety of companies and has a very diverse experience, yet he would never be able to get a job in the NHS as a consultant as he hadn’t gone down the ‘normal’ route. He would have to go back to the beginning, take a pay cut and go through the whole rigmarole of applying to specialty training.

After lunch, Dr Charlie Easmon took us through his story of business success, then failure, and then success again. We met a panel of doctor entrepreneurs who were still working for the NHS and somehow finding the time to develop their businesses. Then Dr Na’eem Ahmed made us all feel humbled with his incredibly moving and impressive presentation about his philanthropic work with his charity ‘Selfless’.

In the breaks I met everyone from medical students considering their first steps, to foundation trainees taking ‘F3’ gap years and registrars contemplating a specialty change. I also met Dr Gyles Morrison, who made a huge impression on me. He had a different take on the guilt many of us felt about ‘wasting’ our medical education:

“Who here did a geography GCSE?” (Several hands go up) “Well why aren’t you all weathermen then?”

It’s true. My friend who did a history degree isn’t an historian, and she doesn’t feel bad about it.

Gyles, a covert artist and musician in his spare time, was a profound reminder that medics are often multi-talented all-rounders with hidden talents. The fact that he left medicine to work in IT and is now an expert in user experience technologies was inspiring enough, but Gyles himself is filled with so much passion and so much energy that it’s truly infectious. He questioned me with a genuine interest about my writing – what’s my novel called? What’s it about? I answered almost with embarrassment, as I currently lack any kind of confidence in my literary exploits. It was the first time I’d really talked about my book with a stranger, and I was touched and reassured by Gyles’ belief in me and his conviction that my plot was a good one.

Speaking of writing, there were two presentations by doctors who wrote poetry and stories in their spare time. It got me thinking, why can’t I do that? Why haven’t I sent of any poems to magazines, applied for any competitions or signed up for open mic nights? It’s because I’ve never considered that I could be good enough to do any of those things, so I’ve never bothered to even try, but in front of me today was living proof that I could be good enough, and people will want to hear my voice.

Other exhibitions and talks I didn’t make it to included army careers, management consultancy, working overseas, medico-legal careers, aesthetic practice, CV management, pharmaceutical work, medical volunteering at festivals, mindfulness, acupunture, yoga… There was something for everyone, and all the delegates I spoke to felt the inspiration and positive energy that infused the Grand Connaught Rooms today.

Afterwards, I spent some time with the founders of Medic Footprints: Dr Abeyna Jones and and Sara Sabin. They had been up since 5.30 am preparing for the event and were understandably exhausted! But I can’t thank them enough for this experience.

Walking away from Medicine was never going to be easy, but the actions of people like Abeyna and Sara make it just a little bit more bearable. Today’s event has given me reassurance that I know what is best for me, faith that I have enough transferable skills to be successful elsewhere, and the belief that maybe, just maybe, I can follow the dream of becoming a published author.

After all, I’m sitting here writing this blog right now.

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The first day of the rest of my life…

I am an ex-junior doctor.

I worked in the NHS for just over two years. I went to medical school for six years. But in 2015, at the age of 26, I resigned from my job. I wrote the post below shortly after I handed in my resignation, and I have been using this blog ever since to document my career journey, and the emotional process of leaving something that had become such a huge part of my identity.

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16th October 2015

I’ve quit my job as a doctor. I can hardly believe I’ve done it, but I have.

Despite all the political turmoil surrounding junior doctor contracts at the moment, and the threat of worsening working conditions, this government’s idiocy is not the only reason I’m leaving.

This has been a long time coming. I never really wanted to be a doctor, but when you’re 15 years old and choosing your GCSEs at school, it’s very difficult not to be influenced by the adults around you who tell you that you’re good at science, and therefore you should do medicine.

I have tried. I really have. I passed every exam at medical school, I got a good job in London, I got very good feedback from my peers, my mentors and my patients – but there was always something missing, and that something ate away at me inside for months on end, killing my passion, fading my colours away.

I don’t know what I’m going to do. I have no plan as such, only a dream to get back into my true loves: creative writing and modern foreign languages. I have no new job lined up for when I finish on December 4th. It is perhaps a little mad to do things this way, with no plan B, but quitting will hopefully give me the impetus to do now what I have been putting off for a very long time.

I want to use this blog to document my journey, and also talk about my experiences as a doctor: the good, the bad, and the terrible. I can now be brutally honest about what it’s really like to work for the NHS – since I’m leaving anyway, I won’t have to worry about losing my job for speaking out!

The NHS can be a brutal and frankly unsafe place to work, and I realised that, without the desire to give up my entire life for his profession, staying in it would be simply too hard. If it isn’t your passion, the huge sacrifices involved in being a doctor just don’t feel worth it.

I have no regrets about my medical career; it was a fantastic experience and has made me who I am today, but it does not define me. The day I leave will be the first day of the rest of my life, and I cannot wait to get started.