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.

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Striking Doctors and Healthcare Innovations

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I can hardly believe it’s happened. Yesterday, for the first time in 40 years, doctors went on strike. I went out to the picket line at Guy’s and St Thomas’ hospital today to speak to and support the doctors out there. It was incredible how dignified this whole campaign has been. They know they have the moral high ground, because ultimately what they’re fighting for is the future of the NHS.

I have to say, it’s really weird not being one of them anymore. Weakening my bond to Medicine under normal circumstances would be difficult, but with all this unprecedented action going on, I feel like I’ve abandoned my colleagues and my profession when they most need support.

However, it is liberating not to be threatened with legal action and GMC hearings, as unfortunately some doctors have been lately. I feel I can truly speak my mind without having to worry about my career.

With this in mind, I said yes when my friend and mentor Gyles Morrison asked me if I’d spend the strike day with ‘Dr Morton’s’, a private healthcare company that provides advice and treatment over the phone or email. I know there’s a lot of controversy, even within the medical profession, as to how much private and public healthcare should be mixed, and with certain branches of the media so desperately keen for sensations at the moment, a training doctor couldn’t really be seen as being connected with a private company. Even though I’ve left, I have to confess feeling some trepidation as I made my way over to their office in Waterloo today. I could almost see the papers now… ‘Doctor spends strike day at private healthcare company.’ Well, at least she writes her  own derogatory headlines.

One of the things Dr Morton’s were doing today was taking calls for free in support of the strike. I spoke with John Wilkes, co-founder of the company. He told me that, while working in the city, he found it difficult to get GP appointments without taking time off work. Lining patients up in a waiting room is convenient for GPs and saves money for the NHS, but paradoxically, it costs the economy money. Especially when you consider the report by the NHS Alliance and the Primary Care Foundation last October, which estimated that a quarter of GP appointments are unnecessary.

While I agree with reducing time-wasters for GPs, I know there are many who would say this kind of private initiative undermines the NHS. It’s a tricky one. When I met the founders of Doctify last year, Dr Stephanie Eltz explained how the idea for the online specialist database came from her own personal struggle to find someone who could treat her. She explained:

If you try to innovate within the NHS, you’ll be waiting forever. There simply aren’t enough resources. If you want to develop something new for the NHS, you have to do it outside of the system, and then take it back to the NHS once it becomes successful.

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

It’s difficult as a doctor to think commercially sometimes. We automatically reject any talk of monetary value, because our priority is our patients of course, and the thought of having to decide how money is spent on them is honestly a bit repulsive. When you choose to be a doctor, the financial side of things just doesn’t come into it.

Instead we let non-medics dominate the world of clinical commissioning and health policy. I met Dr Harpreet Sood, a Senior Fellow for NHS England, and he completely shocked me when he told me that when he arrived, there wasn’t a single clinician at the top level of NHS England. Until it became desperate, everyone accepted this situation. Now, however, we’re left wondering where the hell the £130 million NHS budget goes, and why NHS services are being out-sourced to private companies. The few medics that do exist in that ‘world’ have often turned out to be the rotten eggs – money-grabbing sell-outs who crossed over to the ‘dark side.’

Could the solution be these innovative start-ups, hatched and grown in the private sector until they’re ready to tackle the NHS? I don’t really know. I’m not in a position to say that.

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

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

ohne arbeit

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

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

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

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

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

The “Bristol Promise”

the bristol promise

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

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

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

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

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

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

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

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

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.