Back to school

New year and I’m back to (medical) school. I’ve been back since last September but my laziness and forgetfulness means I’m only just getting round to writing about it now!

So I’m back and in my fourth year of medicine. The curriculum’s changed, the medical school dean has left, and there’s no longer the dreaded logbook. The re-start was both (sort of) exciting and nerve-wracking. Having been out for 9 months, my clinical skills were rough around the edges and my medical knowledge probably wasn’t as sharp as it should be. I was lucky enough to start on a rotation that didn’t involve too much learning of brand new medicine; it was actually a good refresher of things I should already know ..which turned out to be not a lot.

The first term was tough to be honest. Trying to get back into the swing of things wasn’t easy. I was back to being a medical student, which was nice as my time was more flexible and I could do what I wanted, but it also meant I had to be a medical student. That meant trailing round after doctors and trying to be useful and learn something. Not always easy when some doctors clearly don’t want you there or think you’re some kind of idiot. That’s the downside to being out for so long – I forgot what being a medical student was actually like.

The usual pre-christmas, mid-winter, stress breakdown occurred sometime in November. I could feel it brewing and it was the same as it was a year earlier: feelings of hating medical school, medicine, and anything related to either. Turns out I was just so desperate to finish medical school, I’d worked myself up into a frenzy. By the time I graduate, I will have been here for a total of 7 years, which is a long time to be in one institution. It’s actually the exact amount of time I spent in secondary school(!) That freaked me out and I wanted to quit. Having had the taste of being financially independent and earning a steady income, coming back was like a balloon being burst. I was desperate to fast forward the next 18 months.

Anyway, I’m back regardless and I’ve got to finish. No more breakdowns (except maybe around exams), just keep ploughing away until my finals this time next year. In almost exactly 12 months time, I will have finished my exams and I’ll know soon after if I’ve passed. Just 12 months to go. 12 months.

Do No Harm

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Do No Harm: Stories of Life, Death and Brain Surgery by Henry Marsh


Henry Marsh is an eminent consultant neurosurgeon who’s career has spanned much of the life of the NHS. Each chapter in his book recounts a surgical case or patient who has made a mark in his memory. Whether it’s because they defied the odds, or because things took an unexpected turn of events, Marsh writes about them with such eloquence and respect.

Littered throughout the book however, are side quips in regards to the slowly changing face of medicine throughout his career. The changing structure of medical training is apparent as Marsh laments the lack of camaraderie because of the constant rotating of the younger trainees. He struggles to the remember names of them as they are repeatedly changing.

The stories Marsh tells are touching and bittersweet. They reveal the difficult decisions that face doctors on a day to day basis. Alongside this is the constant interjection from government forces that are stripping away the doctor’s autonomy and slowly chipping away at the core of the NHS. To me, it parallels what is going on with the state of our national health service right now.

The first ever full junior doctor walkout in the history of the NHS is taking place today. Thousands of clinics and elective surgeries have been cancelled, and consultants are being drafted in to cover A&E and emergency care wards. As annoyed and angry as I would be if I was one of those patients affected, I am still in full support of the strike. This industrial action isn’t just junior doctors throwing their toys out of the pram because they are not being paid enough. It’s for the future of the NHS. If juniors don’t fight it, other healthcare professionals will be targeted next. I can only hope the government take heed to what the medical profession is trying to say. Junior doctors aren’t asking for the world. They are asking to be treated with respect and listened to fairly.

But then again, if they still insist on forcing through a contract that is unsafe and unfair on 50,000 junior doctors and some 6,000 newly qualified doctors come August, the above passage illustrates my sentiments entirely.

My leave of absence

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When I tell people I’m on a leave of absence because I don’t know if I want to be a doctor anymore, I get a number of different responses:

  1. ‘Enjoy your time off – make the most of it!’
  2. ‘I wish I could do the same’
  3. ‘Don’t be silly, this feeling will pass’
  4. ‘Are you quitting medical school?!!’

Telling my parents was the most daunting thing. I had received a job offer as a junior medical writer and was trying to weigh up my options. I was torn between wanting to take the leap and try something new because I was fed up of medicine, or powering through in the hopes that it would get better. I think I’m lucky in that my parents are pretty understanding people. Whilst telling them I wanted time off wasn’t without tears, they seemed to understand that I had thought hard about it, and I wasn’t walking away from it forever.

The reason I was getting fed up was because I didn’t particularly like the job that I was seeing before me. The science side of it is fascinating to me, and always will be. However, the bureaucracy of it all was really putting me off. I didn’t really want a job where time off was potentially scheduled in for me, where there was no guarantee I would finish work at a certain time, or even know my rota far enough in advance.

People might argue that I should have known all this when I considered medicine as a career and I should have been prepared to make that sacrifice. But I disagree. I don’t think any 16/17 year old, myself included, would fully understand what the job would entail. With the recent uproar and public attention drawn to what working as an NHS doctor is really like in the UK, I think any young person considering medicine is thinking hard about it and (hopefully) making the most informed decision they can.

For me, taking this time out has been a great decision. It’s removed the tunnel vision that can take over when you are so focused on just one goal, i.e. becoming a doctor. I’ve had my horizons broadened and know that there is more beyond practicing as a doctor and several paths available to me once I’ve graduated.

I don’t regret choosing medicine. Without it I wouldn’t have had the experiences I’ve had and met the awesome people I know now.  Even if I don’t practice as a doctor when I graduate, I know that with those four letters after my name comes a certain level of skill and knowledge that can be transferable to any job I choose to pursue in the future. I don’t worry about what will happen after medical school because to me, making the leap into the working world was the biggest decision I’ve had to make, and it wasn’t as terrifying as I thought. I do plan to come back and finish my degree (although the thought of it does make me anxious), and I hope that I will return with a new attitude and outlook.

Junior Doctors Walkout

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The BMA confirmed that the second of the two planned strikes would be a full strike. This means that all juniors will be on strike, even those in A&E and critical care wards.

My views on this are simple: this should have happened sooner. I get that there are concerns regarding patient safety but in all honesty, with enough preparation, things should run without any major problems. Yes, there will be disruptions to routine services but patient safety will not be compromised. Patients will be seen and treated by consultants from start to finish and receive the best care available by the most experienced staff.

I believe that this should have happened sooner because the BMA have already given the government enough chances to listen. And each time they spout the same soundbites they always do. Hindsight is a wonderful thing, but I honestly think that if action had been more drastic earlier on, maybe the negotiations would have got somewhere faster. It’s almost April; there are less than five months until this contract gets imposed and we are nowhere nearer to a resolution. I feel that if this contract goes through, it will be much harder to fight. And it paves the way for the government to start moving in on other healthcare professionals within the NHS (they’ve already started with nursing).

I could rant about this forever but it’s probably better for my stress levels if I don’t. It frustrates me that this whole issue even has the medical profession divided because I feel that that is exactly what the government wants. And that is how we, as a medical profession both present and future, lose.

 

Doctors’ Strike 2.0

imageThe second round of the Junior Doctors strike started yesterday. There will be in total three lots of 48 hour emergency care-only strikes over the next month, and I am completely behind each and every one of them. As a member of the public, I’m in full support of these strikes, as everyone should be.

I recently wrote a blog post for a medic who has left medicine and pursued a different career path. I totally admire thedisillisionedmedic for having done what she has because it takes a lot of courage to do it. As doctors, you are selfless by nature but there are times when you have to look after yourself first.

Below is the post I wrote for her really interesting blog. It comes from the point of view of medical students who are in a sort of limbo about the future of their training. It was both sad and anger-provoking for to write as it really drove home how important the issue is not just for the medical profession but everyone who uses the National Health Service.

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.

Is medicine toxic?

I read an interesting article today on the need for change in the culture of medicine.

The idea that one learns best through humiliation is bizarre to me. I’m sure there are fellow students who thrive on that feeling of being challenged and pushed, but there is a certain way of encouraging someone to think outside the box without making them feel like they’re being hung out to dry.

In the past, I’ve had experiences with doctors where if I don’t provide a spot on answer within a second of being asked the question, I’m accused of being a rubbish medical student. I’ve had seemingly funny quips about whether I even attended medical school, which I’ve awkwardly laughed off. Truthfully, in that moment I probably wanted the ground to open up and swallow me whole.

I wish I could say I only speak from personal experience of being on the receiving end of an old school doctor’s grilling, but I’ve seen it happen far too many times to my fellow students. And it’s not a nice experience to watch, let alone go through. Some say that it’s all part of being a medical student. Apparently getting grilled by your seniors is viewed as some sort of twisted rite of passage. One that we all go through to reach the end goal of being able to inflict that pain on some poor soul beneath us.

I exaggarate of course, but reading this article on just how toxic medicine can be made me realise one of the reasons why I felt so demoralised by the profession.

This post is a bit of rant after a discussion over how medical school can quite frankly, be a bitch. But it doesn’t have to be. There are certain stresses to the job that you can’t change: dealing with life and death is part and parcel of being a doctor. However, medics can help make the learning and training less awful by not humilating students and making them feel even smaller than they already feel.

We already know we’re the bottom of the food chain. There’s no need to keep reminding us of how little we are.

Disclaimer: I have actually also had good experiences, despite my moaning. Some doctors know exactly how to push you as a student and at the same time make you feel like you matter to the team. Those are the doctors that are I personally have responded best to. They are the ones who I have walked away from with positive vibes about that specialty. Which is probably why I most definitely do not want to do surgery.

 

The world of work

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Having decided to take time out of medicine for at least the next eight months, I needed to find something to fill that time. Whilst it would have been wonderful to go travelling and disappear to the other side of the world for nine months, the lack of funds and parental judgement prohibited me from doing so. As a result, I had to get a job. Not just any job either but a job that had some sort of relevance, potential for career progression, and would at least help me work out what the hell I want to do with my life.

Through some good luck, I was able to secure a position as a junior medical writer for a medical and healthcare communications company in a pretty short space of time. Medical communications, or ‘medcomms’, is an interesting industry I came across when exploring other options beyond medicine. The role of medcomms agencies is a somewhat intermediary one. They work with pharmaceutical companies to help communicate the clinical trial data of new drugs to healthcare professionals and those outside the pharmaceutical world (mostly with the aim of marketing drugs and making the big bucks for drug companies).

My first couple of weeks in the job have been fairly relaxed. As it’s my first ever full-time job post-university, I think I’m being eased into it all quite nicely. I’ll be honest, there were some periods where I was incredibly bored reading about diabetes, but work has since picked up a little and I’m being given a steady flow of tasks to work on. My work at the moment is mainly putting clinical trial data into a presentable and comprehensible presentation, as well as researching new and interesting studies on diabetes to report.

For some, this job may not be the most exhilarating and life-changing job. But in all honesty, I’ve been more content with the steady 9-5 life I’ve had the last couple weeks than the chaos that was medical school and clinical placements. I’ve been able to enjoy myself in my own time and not have what I call ‘study guilt’ constantly hanging over my head. Things with this job may change: it may get busy and stressful and I’ll come to hate it; or it could challenge me and open my mind to a totally different world of work which I end up enjoying.

I’m just going to see how it goes. At the very least, I’m getting paid.