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 a small 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 this company were doing today was taking calls for free in support of the strike. I spoke with the CEO 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.

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.

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 really don’t know. This is a world I am new too and O just don’t understand it yet.

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So… what do you do?

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December is the prime time for this question, or versions thereof. With everyone getting together for Christmas and New Year, I knew I would be catching up with friends and relatives and meeting new people, so small talk would be abundant for a good two or three weeks. I have to admit, I was dreading it. I was afraid of their judgement and remarks. I suppose I was also afraid of how I would react to their reactions. I could hardly justify my situation to myself, so how could I justify it to others?

I have always taken it for granted that I could give people a satisfactory progress report. “I’m in year 13” turned into “I’m in year X at medical school,” which turned into “I’m working at such-and-such hospital.” The only variation to contend with was the inevitable follow up question: “Have you chosen your speciality yet?”

Traditionally, the responses I have given to these queries have depended largely on how I feel about the person asking them. With kindred spirits – the people I feel will really listen and might understand my point of view – I am honest, but mostly I’ve just been busy hiding my true feelings about it all these years, even from the people closest to me.

As Christmas loomed, everything seemed so complicated. What was I supposed to say when people asked me what I was doing now?

“I had a quarter-life crisis and quit my job with no plan B, so I’m now officially unemployed and relying on my savings and my fiancé to get by. I have no current certainty or prospects, and not much of an idea about what to do, except a vague plan to write a novel that I’m unjustifiably optimistic about.”

It sounded terrible. I almost wanted to avoid the festive parties altogether to save myself from this humiliating admission. I also felt bad for my parents – when people asked them how I was getting on, they would be having exactly the same problem.

Then, two things happened to me.

The first was deciding to locum after my little visit to the job centre. That gave me something solidly medical to say, and was a relief. “I’m locuming at the moment” is a brilliant answer for those you don’t really want to talk to, and who are just asking you for the sake of saying something. It’s satisfying for both parties and the perfect precursor for a swift exit line.

The other was this: at the start of December, in between dancing for joy and plunging into the depths of despair, I started job hunting on the Guardian website. I found an ad I was interested in for a managerial role in a charity, but being inexperienced with this sort of thing, I was doubtful. I worried that I didn’t meet the criteria in many of the job specifications, because a lot of them stated the necessity for formal qualifications or specific experience. But, as my fiancé told me, job specs are not hard and fast rules. They represent the ‘ideal’, and most companies would rather hire the closest match than wait for the perfect candidate. My career coach has also been helping me to realise the value of the skills and experiences I already have.

So I shot off my CV, not really believing anything would come of it. Then two weeks later, I got a call. The charity had said my application was certainly unusual, but they had loved it. They offered me a telephone interview, and after that, they offered me a formal interview. I’m going in for it next week. Whether or not I get the job in the end, it’s been such a boost for me just getting to interview.

It’s also nice to sing my own praises. It’s not something I got to do much in medicine – it was more about people assessing me. ARCPs are tick-boxing exercises and applying for clinical jobs requires more form-filling and exam-taking than knowledge of your true strengths, skills and weaknesses. It’s just the nature of the medical profession that everybody is presumed to have all the necessary skills for their level. As a result, the thought of doing a non-medical interview is scary. No longer can I rest on my laurels; I actually have to prove myself. It’s made me sit down and think about what I’m really good at, what suits me and what I really want – perhaps for the first time in my entire life.

As the Yuletide approached, I started to see my situation is a different light. Yes, there are things in my current situation that I don’t like, but there is also plenty of potential. This is a really exciting time for me, and I really need to give myself a break. It sounds cliché to ‘have faith in yourself’ and to ‘stay positive’ but these little things can be incredibly difficult to do. I still struggle sometimes, but I’m working my way towards another cliché where I see my glass as half full.

So now, when people ask ‘what are you doing now?’ I have an answer I’m proud of:

“Well, I’m planning to locum while transitioning into a new career. I’ve got an interview with a charity soon for a management role. In the meantime, I’m volunteering for Medic Footprints to help other doctors in their careers – a role that I got because the directors were impressed by an article about their conference on my personal blog. I’m also researching the British colonization of Asia to give historical accuracy to the novel I am currently writing.”

There. Sounds much better doesn’t it? And the best things are: it’s all true, and I can say it to everyone.

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Image from Malla.

Malla is a small business coach and expert at answering this question!

Hitting Rock Bottom – apparently you bounce

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It’s been two weeks since I stopped working. Two weeks sober. What a fortnight I have had…

When I woke up the next day at 8am instead of 6am and had nowhere to be, it felt delicious. The hours of the day stretched out before me, with waves of potential, and to be honest, all I really wanted was to have a break for a bit. I knew I would need time to process leaving Medicine. I didn’t quite anticipate the size of the grief reaction that was about to hit me.

The following Friday, I took myself down to Russell Square where the Professional Support Unit is based. I called them before I left my last job on the advice of the Dean and I really can’t recommend them enough for any doctor in training (foundation or speciality) who is in trouble. They provide all sort of help, from confidential mental health support to career coaching. When I called I had a really interesting conversation with a lady who turned out to be herself a creative – she is a freelance screenwriter who also works on a freelance basis for the Professional Support Unit. They allocated her to be my mentor, I suppose because of our common interest in writing.

We sat down together in a little room with the sunlight streaming in, and we talked. She asked me about my strengths, my likes, my dislikes and my values. And do you know, I found it so hard to articulate those things. After all that communications training, and despite my own quadrilingual tongue, I could not think of a word to say for myself. I panicked internally; how the hell was I going to perform in future interviews if the answer to “what are your strengths?” was silence?

I can’t really say I’ve ever thought much about any of those things. My strength was always my ability to pass exams or ARCPs, my values were insignificant because I was already doing something of such great value, and as for my likes and dislikes, that conversation mainly revolved around the choice between doing medicine or surgery, or between being a hospital doctor or a GP.

My mentor (I will call her ‘Jane’ for the purposes of this) then tried a different tack. She asked me to describe different experiences in my life. She got me to talk about the time I did some voluntary work in West Nepal, and suddenly, talking became a whole lot easier. I could actually appreciate the fact that turning up in the middle of nowhere in an unknown country was pretty brave. I could see that, after being told I was going to be an English teacher but then when I got there, they needed me to be an Art teacher for deaf young people and Dance teacher for street kids, I needed a great deal of adaptability and quick thinking to provide that.

“You’re a storyteller,” Jane told me, “You find it easier to talk about yourself through the medium of stories.”

Deep down, I’ve always known this. I novelise everything because it makes it easier for me to understand and therefore easier to cope with the difficult things in life. I didn’t realise this was a good interview technique.

She gave me some homework to do and I left feeling pretty positive. I realised that now was the perfect time to get to know myself a little better – not with a view to becoming self-centred, but more with the aim to appreciate what’s there already and what isn’t, and to have confidence in my strengths while appreciating my weaknesses. I started to look at my CV, which is very medic-orientated, and tried to see how I could change it to make sense to non-clinical people.

Then the doubt set in.

One day last week, a family member called me up with the express desire to talk about my career. What am I doing now? I’m just lying around at home? Officially unemployed. After all that work, I’m unemployed. So how am I managing financially? Oh, I’m using my savings? Well that’s not very sensible, is it? Am I just going to be a housewife now? Am I going to rely on my fiancé for everything now?

It was so distressing that I couldn’t carry on with the conversation. The idea that no longer being a doctor meant I could only ever be a housewife was ringing in my ears, and I was crying. I tried to rally myself: ‘I will find a job. It might even be a well-paid one, who knows? I will earn my own money and be a useful member of society.’ But it was no use, because when you’re faced with people around you who are baffled by your choices:

“I just don’t understand why you didn’t finish F2! Even if you didn’t want to continue being a doctor in the future, why didn’t you finish F2? It’s bad not to complete things. When you start something, you should finish it. You only had 4 months to go! What are your reasons? What’s your plan?”

These are reasonable questions to ask, and I know the people ask them are just worried about me and want the best for me, but I find it hard to reveal my real reasons because I fear they won’t be taken seriously. I left because my heart was telling me to, and my only definite plan at the moment is to finish my novel while somehow finding my way into the right career. Such delicate and vague ideas are too easily quashed before they blossom, so I protect them from the storm around me by keeping them to myself.

People tell me that I’m just too romantic. I’m just a dreamer. A friend of mine told me all the people she knew who had tried to do something different and had ended up crawling back to their original profession with tails between legs, but she also told me that even if I manage to get another job, it will never make up for the fact that I didn’t finish my F2, because this is the biggest mistake of my life and I will regret it.

It makes me feel panicky just recalling these conversations. I feel like a small child who had done something very bad and is now being scolded, but it is worse, because I don’t have the protection of actually being a small child. I am an adult, supposed to be successful, supposed to be self-sufficient, but all I am is one great big failure.

There it was. That word. Failure.

It’s surprisingly easy to go from niggling doubts at the back of your mind to full-blown depression. It’s a well-trodden path for me, so I know the way down pretty well, and down I went. I felt completely and utterly worthless. The weight of my mistakes and my decisions weighed heavily upon me, and I just couldn’t see how I was of any use or benefit to anyone in this world. I was only a burden on my parents, on my fiancé and all my friends. I was so low and so anxious that I couldn’t even bear the thought of locuming! What was the point of continuing? What the hell was the point of me?

Thankfully, the way back up is also a well-trodden path for me, and what I have found is, when you feel that way, you internalise everything. Paradoxically, you do become self-centred, caught in a loop of negative feedback with you in the middle of it. You break that when you connect with other people, and specifically when you help other people.

On my birthday last Friday, I went to look after my friend, who recently was admitted to hospital, and was coming home to an empty house, as her husband was away in Sri Lanka. I made her lunch and did some jobs for her, and helping her made me feel like a good person again, and she helped me by listening to me and comforting me.

I had just come back from running some errands for her when I noticed some books on her bookshelf. They were her husband’s books about the history of Sri Lanka, written during the 1800s. I could hardly believe my luck! My novel is historically based on the British colonisation of Sri Lanka and here in front of me were books documenting that very period! I asked her if I could borrow them.

I am now sitting on my sofa at home, exactly where I was a week ago, when I was so paralysed by fear and doubt that I felt unequal to everything, but now I have a book in my hand. I’m reading two others at the same time. Researching this topic is exciting! It’s actually fascinating to get a glimpse of what happened and how people lived in those days. My hand alternates between pens and highlighters and I’m brainstorming about how to include all this history in my story. The time passes quickly and I am in my element.

Things aren’t completely OK yet, but this enthusiasm is infinitely better than the despair I felt last week. I still feel really concerned that people will think I’m just bumming around and sapping resources, but I’m beginning to see that worrying myself into a frenzy is just about the perfect way of becoming the very thing I’m afraid of. I am not a failure. As for being accused of being a ‘romantic’ – that’s absolutely correct. Count me with the dreamers, and watch me make a career out of it.

The New Junior Doctor Contract

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A great deal has already been said about the junior doctor contracts row, so I will keep this short.

As the years have passed, working as a doctor in the NHS has become more and more about service provision and meeting targets than about good patient care. As training overhauls like MTAS, eportfolios and the degradation of the firm structure have come to pass, training itself has become more of a tick box exercise. You are no longer rewarded for actually being a great doctor, and can easily work your way up the system by simply looking good on paper. For doctors who care, and who chose the profession as a vocation, this is incredibly demoralising.

The current political storm has revealed the extent of this disillusionment: many doctors are already at the end of their tether. Little things like having night-time resting facilities, access to a locker, or being allowed to park on hospital grounds for late shifts, magnify the more fundamental issues of adequate break times, poor management and punishing rotas. Meanwhile, external opportunities for doctors are increasing, whether it be working abroad, in locum agencies or changing career altogether, the pull to leave the NHS is getting ever stronger. 

In other words: if junior doctors had any doubts about staying in medicine, the imposition of the new contracts will be more than enough to erase them.

The Parental Reaction

I told my parents about my resignation today.

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I cheated. I chose this weekend because on Sunday they’re throwing me an engagement party, and are currently busy with preparations – I was hoping this would be enough to distract them from the magnitude of this revelation, hoping it wouldn’t make headline news. I suppose I also hoped that my engagement would provide something about me for them to be proud of – an oasis in this current desert of my achievement.

I couldn’t do it on my own. I came back to their house in the early afternoon, and several times when my parents asked me how I was, it was on the tip of my tongue, but I was too chicken to say a word. When my fiancé arrived later in the evening, I felt so guilty. My parents were laughing and joking with him, and behaving as one does with someone who is familiar, yet not quite close enough to be treated with the comfortable indifference of family.

They were enjoying a fascinating conversation about the interpretation of Buddhism by different Asian countries when I dropped the bomb. The smile on my mother’s face vanished in an instant, and I couldn’t even look at my father. I felt about an inch high as they expressed concern at my failure to finish FY2 – why couldn’t I stay till April? It’s only a few months away! I could have completed this stage of my training! People change, didn’t I know that? If and when I want to return to medicine, having FY2 would have been so much better. What was I doing leaving without a plan or another job to go to? Not a sensible thing to do. Should have talked to my dad about it first.

Perhaps it was beneath me to resign without consulting them, but genuinely, it was not out of any disrespect for their opinions. I feared telling them – that much is true – but this is a decision I had to make on my own. I can’t keep running to mummy and daddy every time something goes wrong, and then blaming them for giving me advice I don’t like. I am a grown woman and I need to start taking responsibility for my own decisions.

I could tell my dad was deeply affected by the news. He grew very quiet, and that was harder to deal with than spoken disapproval. He asked if I was really not enjoying the job, and when I said I was not, he said it was important that I was happy. He gave me a comforting smile later on, so I knew it was OK.

Still, I felt very emotional. It grieves me to grieve my parents, who have loved me so much and given me everything. While they were setting up the marquee for the party, I ran upstairs and find solace in Jane Austen’s Northanger Abbey for a few minutes. Jane Austen has saved me from many a personal crisis, and if anything she reminds me of the strength of the written word. She will never know how she has saved me, and who knows how many others she has and will continue to save with her wonderful, wonderful books. Though tears were rolling down my nose, I couldn’t help but giggle at her wit and laugh at myself:

“Miss Morland, no one can think more highly of the understanding of women than I do. In my opinion, nature has given them so much that they never find it necessary to use more than half.”

The problem is, I cannot answer any of my parents’ questions. I cannot reassure them at all. I was summoned to see the Dean on Thursday – the doctor in charge of foundation medical education in North East London. I was a bit nervous about seeing her, wondering if she was going to try to persuade me to stay, but she was actually very kind and understanding. She seemed genuinely worried about me, and had the same concerns as my parents. Some of my colleagues and seniors as well do not see this as the wisest move.

There are a lot of well-educated, older, more experienced people around me telling me that what I’m doing is effectively crazy.

Why am I not listening? What the hell is wrong with me?

I don’t know. I really don’t know what I’m doing and I’m not entirely clear on why I’m doing it, but there is a strange freedom in that. It’s almost cathartic to have this aspect of my life fall apart in front of my eyes, like a forest fire burning through the old scrub and making space for the new, green shoots that peep up through the soil when the blaze is over.

Oh dear, maybe I will live to regret this. Or maybe I will realise my true potential. I am good at medicine, but good isn’t enough. Improving my skills just to keep my head above water isn’t satisfying, being bored of learning is deplorable, signing up to tedious projects and audits just for the sake of going on to the next stage is intolerable.

I want to do something I’m brilliant at. I want to be hungry to learn more, I want to stay up till 3 am absorbed so deeply in my work that I don’t realise the time, to speak so passionately about it that I make people think I’m weird. I want to get back to the girl who asked for a French grammar and verb table for her 16th birthday because she was a total geek!

Was that Northanger Abbey quote strangely apt? Have I, for all this time, only been using half of my understanding? Maybe one day I’ll look back at this period of confusion and realise I was simply being ‘clever enough to be unintelligible…’ *

Till then, I live in hope.

*Jane Austen again, of course.

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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.