Letter to my MP

Following the advice of the BMA, I wrote to my MP today. The words flowed easily. My god, I feel guilty for leaving and pursuing another career while my colleagues are left in this pile of shit, but I’ll be damned before I stop fighting for them – for us – for everyone.

Dear Ms Creasy,

I am writing to you regarding the junior doctor contract.

I am a ex-doctor. I worked for the NHS for two and a half years before leaving in December 2015. During my time as a doctor, I experienced the extreme pressures that medical staff find themselves under.

I did part of my training in Paediatrics, and I found it especially difficult not to be able to deliver the highest level of care to sick babies and children because we were constantly faced with staff shortages, a lack of resources and management decisions that were not based on good clinical practice, but were simply target-driven, cost-cutting exercises.

My health deteriorated physically and mentally while I worked as a junior doctor. Nowadays, doctors do not have access to the same facilities as they did in days gone by. No accommodation or parking is usually provided for junior doctors, so I often found myself walking home or to wherever my car was in the middle of the night after shifts. As a woman, this can be an incredibly intimidating thing to do – especially since junior doctors have to move around the country so much, so I was sometimes not familiar with the area I was working in.

Food and drink is not provided for medical staff any more, and I often found myself going through shifts without a moment to eat or drink anything. I fainted on shift a couple of times because of it.

Even in the short time I worked as a doctor, I saw and fought against the closure of ‘Doctors’ Messes’ – staff rooms that were often the only place in the hospital to rest, eat and sleep. I worked in several hospitals where I was doing night shifts without any sleeping provisions. If I ever did get a couple of hours to rest, I was expected to either sleep on the floor of an office or try to fashion a bed out of wheely chairs.

When I tell people my stories, they are shocked. I am not the sort of person who demands luxury at every turn, but the denial of basic human needs in the workplace seems absolutely absurd, given that these are the people who need to be able to make snap decisions literally about life or death.

I have been shocked and appalled by the way this issue has been handled by the government. The lies, deceit, spin and slander have completely destroyed any confidence the profession had in the Health Secretary, and the idea of imposition of a contract against the will of 98% of junior doctors, and without soliciting atheir input, is surely akin to exploitation.

I implore you to demand the answers from them that they have denied us. Jeremy Hunt has consistently claimed that doctors will not be working more hours, but how on earth can he simultaneously propose to increase the service to seven days a week without increasing staff numbers or budget? It just does not add up.

I can honestly tell you I am relieved not to be working as a doctor anymore, and my health has finally returned. Although my former colleagues truly love their jobs, I fear this contract will push more and more of them over the edge and soon there will be more like me.

We need people like you to speak on our behalf and put sustained pressure on the Health Secretary and Prime Minister. If this contract is successfully imposed, I believe the future of the NHS will be in jeopardy.

Yours faithfully,

Dr Priyanjalee Perera
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Junior Doctor Cartoon #2

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Yes, I appreciate this cartoon is controversial.

However, let me explain where this comes from. A few weeks ago, I went to a friend’s engagement party, during which I met some people who said that it didn’t matter if all the UK trained junior doctors resign because the NHS will be staffed by a stream of foreign doctors who will be eager to come here and willing to put up with poor working conditions.

When I posted this conversation on the Junior Doctor Contract Forum on Facebook, many people commented on it and agreed with me that this concept was absolutely ridiculous and bordering on exploitation!

It was reported in the Independent today that 90% of junior doctors would resign if the current contract proposal goes through. With the NHS currently dependent on foreign-trained doctors, I can see how this assumption that rota gaps will be plugged by migrants came about. But I have a BIG problem with it. As the daughter of a Sri Lankan immigrant family, I reject the idea of bringing doctors over to work in an unsafe, unfair health system. It’s wrong, it’s backward, and if anyone ever says its to me again, I’ll tell them where to go.

The wonderful Rikki Marr from Hawk and Mouse has once again beautifully illustrated my frustrations in cartoon form. I just want to thank Dr Morton’s for going ahead with this campaign. It’s thanks to them that these cartoons exist. They may be a private company, but their whole focus is to support the NHS through health innovation. They receive no NHS funding and are not NHS affiliated, yet the CEO John Wilkes came in this morning wearing a green BMA badge.

There aren’t many CEOs of private healthcare companies who would do that.

 

 

My Junior Doctor Cartoon Campaign

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The wonderful thing about my new job is that, even though I’ve left the NHS, I can still support my junior doctor colleagues in some small way.

Tomorrow, my former colleagues are going on strike for the second time over the proposed junior doctor contract. Ever since I resigned, I’ve felt painfully removed from their struggle. My voice, that once shouted loudly amongst them, now feels diminished and lacking in authority.

Added to this was the fact that I couldn’t make the protest on Saturday – but it was my best friend’s wedding, so I think I can be forgiven for that!

However, last week, my chance to make a difference came… Our PR Manager at Dr Morton’s asked me for some ideas about how we can get the company involved in the strike. His fantastic idea was a cartoon campaign called ‘A World Without Junior Doctors’. He sent me home to mull it over.

The image above is the first in the series of illustrations that I dreamed up for this campaign, beautifully translated from my head to paper by cartoonist Rikki Marr from Hawk and Mouse. I’ve written a little blogpost on the Dr Morton’s website as well to explain why we’re doing this.

I know that these cartoons will be a marketing stunt for Dr Morton’s, but for me, it’s also deeply personal. I met a Big Issue seller on Friday who saw the green BMA badge that’s still pinned to my coat and cried:

“Ah you’re a junior doctor! Keep doing what you’re doing, I support you. Where do you work?”

When I explained my situation, he said:

“Oh. So you’re not a junior doctor any more then?”

No, I suppose I’m not. I know he was just being friendly, but it hurt.

I thought about it as I was thinking and planning for this campaign, and felt rather nostalgic and sad. Yet here I am, still at the office at 6.30 pm, having spent all day perfecting these images and pushing for publication, and I realise this: I may not be working as a doctor, but the last eight years have irrevocably tied me to Medicine. It will influence everything I do and the way I think for the rest of my life, and that – I believe – is something to be proud of.

 

 

 

The Perks of Being a Doctor

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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.

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.

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!

Officially Unemployed

When I talked to my dad about my resignation, it was difficult to bear the disappointment in his voice when he said:

“So, what, you’re officially unemployed now are you?”

I hit all kinds of low when I took myself along to the Job Centre before Christmas to register as unemployed. It was my fiancé’s idea – he did it when he graduated until he found his first job, and didn’t see any shame in it.

“You might as well try it,” he said, “You might not get the allowance anyway because you left voluntarily, but it will be a new experience for you.”

So I went along with some reluctance. It was so strange. As I went through the doors, narrowly escaping a dubious-looking guy at the front door who was attempting to sign people up for something, I felt an extreme sense of shame. It’s hard for me to write about it now, in fact. All my hard work and good grades had come to this.

I took a seat inside and waited to be called. They were running late by quite some time, so I had a good opportunity to look around at my fellow claimants. I live in a fairly run-down part of London, so I wasn’t surprised that many of them looked unkempt and down-trodden. We all kept our heads down and avoided eye-contact. This wasn’t a situation that encouraged chit-chat. A loud argument broke out between a claimant and an irate employee nearby. It seemed he hadn’t brought any paperwork at all with him and expected her to simply believe he was who he said he was.

My name was finally called. My assessor was a Muslim lady who did a double take when she looked at my application. She was (quite rightly) astounded that I was a qualified doctor. Why on earth was I here?

“What happened?” she cried.

I began to speak, and as I did, I think I was more honest than I have been with anyone for a long time. I told her how I simply couldn’t face going in anymore. I told her about my illness and how it knocked me. I told her about the anxiety I felt about working as a doctor. As I spoke, the reality of how little I valued myself began to sink in. I felt completely pathetic – a broken woman – crawling along, a shell of her former self. Without Medicine I felt totally worthless.

Her eyes softened as she listened to my story. She then talked me through my options, and told me about the process of claiming the benefit. She said we would need to meet at least once or twice a week, and that I would need to keep a log book, and how I would need to prove that I was trying to get work by signing on to a specific forum and spending 35 hours a week actively looking for work. It felt very demeaning and paternalistic, like I was a prisoner on parole.

At the end of our meeting, she noticed it was my birthday the next day, and asked me if I was doing anything nice. I told her I didn’t really feel like there was much to celebrate this year.

“Oh, don’t say that,” she said, kindly, “Sometimes when thing like this happen, it works out for the better in the end.”

She told me about how she had trained and worked as a dental hygienist many years ago, but something happened that made it impossible for her to practice.

“At the time I thought it was a disaster, but now I realise it worked out for the best. My nephew is quite seriously unwell and is often admitted to hospital, but my brother doesn’t have the time to look after him because he’s a GP. There’s no one else but me who can be there to pick him up from school when he’s ill, or sit with him for hours in A&E. Some of my family still say it would be better for me to go back to my old job, because it’s a better career, but sometimes you just have to look at the bigger picture.”

She told me to go out with my friends for my birthday and have a good time. Despite my desperate state, she saw someone deserving of a celebration, and I will never forget that. The kindness of a stranger can be incredibly touching, and for a moment I had a weird feeling that I was meant to meet this good lady, that there was a reason it was she who saw me that day.

As I walked out of that building, once again dodging the guy with the clipboard, I knew I would not be coming back. I realised that behaving like the pathetic and helpless person I felt I was only propagated the idea, and I was better than this! In some bizarre way, I was living up to the new expectations that were placed upon me: weak, dependant and needy. Other people had given up on me, so now I had too.

I decided I wasn’t going to do this anymore. From now on, I was going to define myself by what I knew to be true. Regardless of whether I would be approved for unemployment benefit or not, I resolved to withdraw my application, and not to take a penny. (Just as well, really, because I was not approved!)

When I got home, I sent off my paperwork to the locum agency. Previously I’d felt incredibly anxious and scared about walking into a hospital again, so I kept putting off applying for locum work. I guess I still feel a bit anxious, but I no longer feel crippled by it. My fiancé laughed when I told him about my change of heart.

“Haha! It’s because I’ve shown you the alternative!” he said, referring to the process of claiming benefits.

I stuck my tongue out at him, and denied it, but he was right. By making me do this, he has shown me a very alternative way of thinking. An alternative where, instead of thinking about what I can’t do, I think about what I can.