The Twelve Prays of Christmas

So as Christmas time comes around again, it's inevitably a time for reflection as I bask in a work-free Christmas and New Year. The last twelve months have been full of more downs, then ups, a further smattering of downs and another series of ups than I could ever have imagined when I blogged this time last year. Last year I spent the festive season donning my Christmas jumper on the surgical wards over Christmas nights, and then long days over New Year. This year I will be gladly nestled with friends and family, grateful for everything in my world.
So here are my twelve prays of Christmas (yes, I know it should be prayers, but that just doesn't rhyme as well…) - perhaps you have some to share too?

1) Spend more time with family - if you've got one, treasure it. If you're looking for one, give me a call and I'll adopt you into mine.

2) Think the best of others - when life gets stressful, it's easy to think someone's actions are selfish or mean-spirited - I'd like to think everyone is good, and sometimes it's pure insecurity that stops it coming across that way.

3) Be generous always - and I don't mean in a material sense. Be generous with time, friendship and love. Make the effort. Make a phone call. Send a card.  I got my first one this year from work, and I will treasure it always.

4) Put yourself in someone else's shoes and reflect on the view - I really wish I, and others, would do this more often.

5) Drink tea. Often. With friends. Cake is a bonus.

6) Do what you love - la vie est courte. I've just started a research block for the next four months. Big pay cut. Big learning curve. Absolutely LOVE it (and slightly scared about the acute medical job I am doing after that… will I remember how to be a doctor?! Watch this space…)

7) Seek adventures, preferably with friends - a lot of mine are getting married next year. What an adventure! I am seeking adventures abroad, but whatever your definition is, hunt them down and live them.

8) Get a hobby - I followed my resolutions from last year and play in an orchestra; I'm pretty rubbish, but hey ho - so lovely to tinkle out a tune!

9) Be a friend - and by this, I mean checking in on friends, and seeing how they are doing. I hope I am more pro-active about this since January, having realised how much easier it is sometimes to don the world's greatest game face.

10) Find peace - I found mine training for our Team Triathlon, particularly in long swims and runs. I also found it on beaches, and hence will be committing to a wetsuit-free outdoor swim every month of 2014. I've done my November (Northern Irish coast) and December (Tynemouth, Newcastle) swims already!

11) Let others in, and share who you are - I'd like to think I'm fairly open; others have described me as being like Shrek - many layers and it takes a while to find the centre. Bottom line is - be yourself and make room for someone else to learn about you. My biggest challenge, I think!

12) Give yourself a break - if 11) was my biggest challenge, 12) is my ongoing biggest battle. If I make one selfish prayer this Christmas time, it's for me to CHILL OUT and DO LESS.

So I don't know what 2014 will yield but it would be all too easy to look back at 2013 and hate it all. In January, I lost two wonderful friends.  But I remain epically proud of my friend who has surpassed all our expectations with her progress this year. The friends I shared that experience with were just one of the glowing, wonderful things about this year. I survived my first full year as a doctor. I was there to watch two wonderful couples get married. I made new friends, and consolidated lots of old ones.  I swam a mile and ran a half marathon. I have a beautiful baby niece and am blessed by a wonderful family. So count your lucky stars this Christmas and have a good one!

The love is back

Positive. Mental. Attitude.

That, an awesome (in every meaning of the word) weekend in Ireland and a few excellent patients later - and I've got my medical love mojo back.

Kaboom :)

Pure Guilt

With my new-found SWIM empowerment, I have decided to do something extremely non-SWIM-esque, in that it's not particularly sensible.

Next year I will be unemployed. I am not applying for a job. I have no discernible income mapped out. I haven't got anywhere to live. I'm not even planning on being a clinical doctor.

I am crossing the pond and becoming a lab researcher. Some have said this is 'cool' or 'crazy' or 'wow how nerdy'. No matter. Either way, I'll be poor for a year. And I need to fall in love with medicine again.

I remember once watching an episode of Question Time (other TV political debate shows are available) where they were discussing doctors' wages and pensions, and a member of the audience said something along the lines of 'doctors shouldn't be seeking financial gain. They should be doing the job because they want to help people out of a sense of altruism'.

In my opinion, this is the primary motivator of the vast majority of doctors. For myself, it's my raison d'être. You don't go through the high school trauma of applying for medical school, plug through six years at university and commit yourself to a potential lifetime of night shifts and antisocial hours if you don't love it.

But that's why the guilt is so extreme when you realise your love for it has waned. You feel guilty for all the 17-year-olds you know, and knew, applying for medical school who would be desperate to be in your position. You feel guilty for the patients you have met and are yet to meet who still believe that doctors and nurses are these pseudo-heroes. You feel guilty for your colleagues when you have to ask for yet another multi-source feedback which is basically a way of asking 'how much do you like this person?'.  There is a guilt and a fear - what if they knew the truth?

And of course I acknowledge that with this sort of post, I am attracting a barrage of 'you don't know how lucky you are, whining about your job, laughing all the way to the bank'. Let me be clear. People work hard in all kinds of jobs, and I know I am lucky to have one like this. There is certainly no bank laughing. Far from it.

But even in my second year of work, the challenge doesn't seem to be getting any easier.  Just like a blog from a nurse describing her experience of the NHS, I share her concerns and fears. And saying how you feel seems like a sign of weakness. I've done a couple of very long shifts recently, but it doesn't seem acceptable to say 'I'm worried about how tired I am' or similar because you're sort of stating the team vibe and frankly, what's the point? No-one likes a whiner. Senior colleagues perhaps don't see the impact of pure criticism on the junior doctor. To them, they have seen only your sickest patient and have found plenty of holes in your plan. They didn't see the struggle in finding out the story, or getting the blood test or discussing things with the family. You are just another junior doctor. To you, it's stomach-churning confirmation of every fear you had that you're actually not very good.  And all the while you've got the Mid Staffs enquiry (See Francis Report) looming large and you think, if this was my granny, would this be good enough? The fear, embarrassment and panic are all too real in your mind.

I spoke about plans for next year with my best friend from medical school (who is also taking time out), and I suggested this problem of 'falling out of love with medicine' - and there was a sigh of relief down the phone. Thank goodness, he said. 'I feel so guilty for feeling like that, but that's exactly what it is'.

No-one should tread softly about quality and safety in healthcare, but I can't help feeling we've got it wrong from the inside out. I remember after the avalanche thinking that if I channelled anything positive from it, it would be to have more concern for the well-being of my colleagues. Another is to always take at least one positive from every day. There is always something you could do better, and that's what makes us human.

As for the guilt, I'm starting to think it's part of the job. I'm sure this is just a 'down day'. I guess all you can do is your best, keep a smile on your face and, like any relationship, you'll realise there's a reason why you loved it; it just might take a while to find it again.

Come SWIM!

It has begun.

'Oh (cue eyes rolling), what's happened NOW? Big deal, you're a female doctor.'

'I know, I thought so too, but this thing happened at work…'

'Can't you take a joke?' or 'Some people just have those views, we can't change them' or 'you'll just have to put up with it' or 'it's not a problem these days, it's not the 19th century!'.

And there. In one full swoop my ovaries and I have had enough. And some of my friends agree.  I hereby introduce you to: Sensible Women In Medicopolitics and Medicine (SWIM). Because we're not bra-waving feminists, or shouty-shouty whiners; we're just championing the awesome women who have gone before us, and the women we hope to be as we progress up the medical ladder.

The Guardian's list of top 100 women in Science and Medicine is indeed inspiring, but just one click away is the rather more depressing list of occupations where the pay gap is at its greatest - and doctors aren't faring so well. There is nearly a 30% difference in pay between male and female doctors.

I'm guessing but I'm pretty sure a lot of this is to do with many women not ascending up to the upper echelons of the medical command chain. Part of this may be rooted in early experiences of medical leadership. I became involved (heavily) as a medical student with the British Medical Association (BMA), and apart from anything else, it gave me a belief in myself that I previously lacked. When I chaired the medical students committee, I constantly worried that I was letting people down, despite amazing support from all and sundry, not least the BMA.  But at the end of it, I could honestly say I had been myself from start to finish and that it had been something resembling a success.  I realised I had to change my attitude and get positive.

Perhaps as women we lack that self belief? Why?

I think there are two crucial factors in women putting themselves forward. One is the 'tap on the back' - I would never have stood for that BMA post without that prod. Maybe one tap-on-the-back is all it takes, because after that you realise that without throwing your hat in the ring, you'll never get anywhere. Since then, I give everything a go, no matter how insane or beyond me it seems. Often I fail, but sometimes it pays off, and the experience is always valuable.

The other factor is the role model/mentor figure. I think (and perhaps I'm being controversial) there are two types of female role model - the 'look-I-made-it-in-a-man's-world' type, and the 'I'd-invite-you-round-for-dinner' type. I know which I prefer, and I've been extremely lucky already through my thus-far brief medical career to have known or observed many of the latter. It is extremely inspiring to observe women who are intelligent, eloquent and passionate about their subject, but ultimately also still human beings, who have made the most incredible contribution to medicine and science.

That's all very well and good, but what about us kids at the bottom of the ladder? This is where SWIM comes in. We believe in starting early with a positive vibe where leading the troops is concerned. We believe in being positive role models ourselves, recognising that everyone has the potential to be someone else's role model. And frankly we believe in a happy, healthy life and career.

Don't hesitate - become a SWIMer today!

Not sure how 'sensible'… ahem...

Squat your way to work!

Public Health at its finest!

This. Is. Amazing.

The Truth, the Whole Truth and Nothing but the Truth

I spent the first half of this weekend with a legendary friend in Bristol, who puts me to shame every time I see him with his literary and life broad-scope. He waved Intelligent Life, The Economist's side journal, at me as a 'must read', with particular reference to an article on a Brazilian tribe's approach to medicine.

On towards home, and to Papa Purshouse, who is an engineer and extremely squeamish; our worlds rarely collide (apart from a memorable episode during my intercalation when I was doing a module on biomechanics).  So it was with great surprise that his favourite light read, The Economist, was waved in my face soon after rocking up at my parents' doorstep.

And lo, The Economist defined my weekend unexpectedly with the question - How Truthful is Science?

My background interest in Open Access has driven my curiosity into how we read information, and how that information comes to be something you are able to read in the comfort of your home/lab/office. Whilst I learned how to critically appraise and analyse literature at medical school, it's people like Ben Goldacre who have made me question the information in front of me in a more global way.  The cover feature in the Economist this week notes that the vast majority of findings in scientific research studies have been found to be unreproducible, and reiterates what Ben Goldacre has been saying for a number of years about positive result publication bias.  The article notes that reviewers rarely reanalyse the data, and that there is no culture or appetite for data replication by other research groups to validate data.  Peer review on submitting a paper is seen as the gold standard of quality assurance.  And yet, it doesn't seem to be working.  John Bohannon recently tested this theory by submitting a fake article on an invented study - it was accepted by 157 out of 304 journals.

It is funny to reflect on this as a junior medical doctor with research aspirations.  The Economist article is right - one is looking for results. Often, a negative result is seen as a hurdle to overcome rather than a result in itself. I cannot think of many memorable studies I have read with a negative result (apart from the whole bevacizumab 'disease free survival versus overall survival' debacle).  But at my stage, the obsession with publications from those around me is almost suffocating.  Of course, we want to do it properly and accurately. I fear the peer review process as much as the next person. But once it's out in script, it is Job Done.  The idea of going back over someone else's work instead of moving on to the next thing is unthinkable.  In the Economist article, they talk about a lab that offers to validate your results independently - but who pays for this? Individual scientists? And where is the value-added in the system for this?

My key reflection on this is the lack of value on peer review. Peer review is done for free and is an expected part of the job for any established scientist. And yet, on the biography page of most scientists, all that is listed is their list of publications. There is no note about the number of articles they have peer reviewed. In the financial squeeze, scientists have to focus on what will keep them employed - and at the moment, that's research output rather than a really cracking review.

So back to the Intelligent Life article, where a journalist follows a Brazilian tribe and observes their health care rituals. He reflects on how he brings his own prejudices to the situation; how can these methods possibly work? And yet they do. I guess overall, we assume the system we know is best.  But, much like the argument in favour of open access, perhaps we need to think beyond the devil we know to find a more accurate way of answering science's big questions.

A blog-a-plug

I've just discovered this beautiful photo blog created by someone who lost his wife to breast cancer.  The photos are just really beautiful.

The author only writes a few short passages about their life together in his blog alongside each of his photographs, but this little nugget reminded me of something my friend and I talked about when sat in the canteen in a Scottish hospital some months ago.

'Before going to sleep Jen and I used to ask each other what the best and worst part of the day was, choosing to tell the best part last so we could fall asleep happy. The night we came home from the hospital after being told that Jennifer’s liver was failing and she didn’t have long to live, I asked Jen to tell me what she loved most about the day, which we had spent with family and a few close friends. Jennifer thought for a moment then looked through my eyes and into my soul. She said, “I loved it all.” 

http://mywifesfightwithbreastcancer.com/photographs/ 

Today I loved a lot of things; the week has had its moments but I shall tuck those away and think of the lovely parts instead.

Being Thankful

This is NOT a post about female doctors or other such controversies.  This is a post about good and simple things.

Today has been an absolute triumph on many levels.
a) I squeezed in a lovely wee run first thing around my ye olde worlde corner of the world
b) They played Be Thou My Vision in Church. I did not cry! Progress.
c) Exercise numero deux - badminton for the first time since I was about 12.
d) It's raining outside, I'm snug inside, fat jumper on, fire roaring away.
e) I'm going to visit Granny Germany soon.
f) I'm on top of my Masters (which means I'm behind on everything else, but hey, small victories!)

YES! Toasty warm on a rainy Sunday. 

It's Harvest Season so in church today the speaker asked us what we had to be thankful for? So many things, obviously, but it fitted in nicely with my recent 'life refresher'. I have let a few personal and professional things get on top of me in the last few weeks, and just felt sad about a whole bunch of stuff. I guess I'm just used to being able to control my feelings; damn that game face again! And I guess doing the job that I do, when you lose that mental positivity, it's easy to pull yourself down a hole.

Thankfully, I passed that exam, and decided this would be the spring board to a positive K Dog. Because my job is really pretty damn good fun, I get to meet cool people every single day and although I'm not perfect, I'm not a terrible doctor!  This week I had one such patient who reminded me of why it's so awesome. We instantly hit it off, and once I'd done the necessary 'spanish inquisition' of the history and examination, we had some more informal chat while I was taking his blood and getting other things sorted. He had had such an amazing life and I left my shift with a real spring in my step with the tales he had told. In what other job do you get to share so much about yourself, and have so much shared with you? I went to meet some friends later that evening and described how I'd had 'one of those patients who just makes everything worthwhile' and it was amazing to see how they all beamed at the memory of having had such patients themselves.

Obviously that's not what it's always like, but it's those more joyful moments of human spirit that I really value when I get to see them at work. I delivered my first tutorial session this week at one of the Oxford University colleges to a group of new medical students, and although they are at the start of a very long journey, I so desperately don't want them to lose sight of what it's all about. I might be stressed sometimes, miss important family/friend occasions from time to time and be committing myself to another thousand exams in the next few years, but it's a life that I strangely love.

So onwards and upwards. There is indeed much and many people to be thankful for. Hey, I became an Auntie! Coolest. Thing. Ever. 

Great Expectations...?

First of all, just a little thank you to you, whoever you are, who is reading this. I've had a few really lovely messages of late, and it remains a surprise that anyone reads my scribbles, let alone writes to me about them.

Onwards - I had an exam this week but to be honest, I've stopped telling people how I think exams have gone because they are now so fed up of me thinking I've failed when I end up passing.  But for what it's worth, I definitely feel like I left my brain at home on Tuesday, and am already putting another £400 aside for the resit in January. Harumph.

For it is a source of constant amusement to me that everyone thinks 'Ah ha!' - you're a doctor now. You're sorted! Thirteen years at school, another six at uni, boom - you're done, with a job for life. When I told my parents I was doing more exams, they were thinking this was another standard Karin keen-bean moment. Uh oh, no no.  I am not a special case, this is the reality of becoming anything at all other than an SHO (and soz, but I'm not keen to be the go-to cannula woman forever).

Spend most of my time feeling like this...

 But it's basically blimmin scary to think of what expectations there are for the future.  I can look forward to a lot more exams well into my thirties, and revalidation every five years after that. That's assuming I get a job, given that we're approaching a real bottle neck of medical graduates and higher training/consultant posts.  This is before I even THINK about the fact I have ovaries. And it's not just my ovaries; I'm soon to become an auntie and I want to do that properly too.

It's essentially very easy to feel like you're failing by someone else's standards - those who think you're some career-hungry monkey who's just trying to get ahead at the expense of your personal life; those who think you're not all that committed to your career after all; those who judge your frenetic activity and think that's what you want for the rest of your life, when really you're just plugging in the hours now in hope it all chills out later on; those who tell you how to live your junior doctor life - 'make sure you do at least 3 audits and a few posters' - uhhhh when?  Some junior doctors seem to be able to relax about this (mainly boys, I note. Man, I envy you). I'm... working on it.

So I am henceforth focusing on the KP Standard of 'I'm making up my own plan'. I'm hoping to go to America for a year next year to do some research and have already had the full range of complete enthusiasm to wincing in pain at this 'career suicide'.  Well, whatever.  Medicine isn't the one-way-route to lifetime riches that it's perceived to be, it's still a job I love and I'm taking the scenic route to whatever it is that life is going to look like for me longterm, and I know I'm incredibly lucky to be doing a job where I can say that.

The scenic route always makes you feel a bit more travel-sick along the way, and you may burst a tyre or two, but journey's end is always more beautiful. I'll think of that as I head for my resit in January...

How much game face is too much?

If there were an Oxford dictionary definition, it would read something like; 'noun - used to describe the ability to hide one's true feelings and thoughts behind a face that suggests you are neither affected nor concerned by what is happening.'

Doctors are GREAT at game face. I do sometimes wonder whether, personally and professionally, we've got the balance a bit skewed.

Professionally, some would argue 'Game Face' is crucial. On my oncology job, it would have been curtains if I'd fallen apart with every tough conversation or breaking bad news encounter. Yes, these discussions may have been difficult for me to bear personally, but you've still got to get through your shift so that they and the other patients don't suffer.  Further more, it would almost be selfish to imagine that any news you deliver to a patient or their families is more upsetting to you than it is to them.  Your job is to be empathetic but 'the rock'.  I'm now working on the intensive care unit and the emergency admissions unit, and you can imagine the range of traumatic situations one encounters on a daily basis.

For me, all of this has evolved somewhat since losing my friends. Being in ITU has been especially challenging because my friend was in ITU after the avalanche.  I know exactly what it feels like for those families who come in to an environment with all the beeping machines and almost space-like sterility. Someone comes and tinkers with a machine and then walks off again - what were they doing? What does it mean?

This is Una in a nutshell! From her wall at her flat in Edinburgh.

But almost from the start, I have felt that wearing too much of the mask means you lose why you became a doctor in the first place.  People know when you're not being real. No-one is emotionless - and so I have let the controls go a little and have a bit of banter in the more light hearted moments, and, to an extent, wear a little of my heart on my sleeve in the sadder ones.

My game face has also changed personally. I think Una and Rachel always saw their own worth, in a very humble way, and channelled it to bring joy to others; I feel this strength from them at a time where I have found myself really missing them.  Sometimes we should just be honest and not be embarrassed by ourselves.

To value yourself helps you to see the strength and character of others, and I think game face can get in the way of that.  But I also think it gets in the way of seeing what is true, good and right about people.  And whether it's in your personal life or at work, whatever work you do, how can you respect and value someone truly unless you're real with them, and they're real with you?

It's been a tough few months, and maximal game face is the only thing that's saved me in bleak moments.  The other thing is being around 'good people' and you know how I know they're good? Because there's no game face, and we're all honest. Boom. It's tough to define what a 'good person' or a 'good doctor' is, but I'd suggest that's somewhere to start.  So come on everyone, retract that game face a little and you may just be surprised....

Changeover day!

I am totally shattered, but like all junior doctors up and down the country, it's the first Wednesday of August which can mean only one thing - changeover day!

This time last year, I was a bright eyed, newly qualified doc who got really freaked out when someone called out 'Doctor!' and I realised that it was me they were looking at to solve the problem they had.  One year on, I still get a bit freaked out about the fact I'm a doctor, but I hope a little more calm and finesse has entered my game.

But if you get a slightly baggy-eyed Karin coming towards you in hospital, it's probably because I'm not that bright-eyed version of Karin I was twelve months ago. I was on call three times last week, as well as working the other two days. I was at work all weekend. I worked a normal if horrifically busy Monday before doing another 12 and a bit hours on call today. Then.... I moved house, along with all my other doctor buddies. I've been living out of a rucksack for 3 weeks in between house rents, and today moved out proper into my new digs. But that was nothing compared to my friends who finished their shifts and are moving locations completely overnight - the house I was moving out of had two of us moving out and two people moving in, three of us doing so at 11 at night. Most of us have to be at our new jobs between 7-8am tomorrow morning.

But this isn't meant to be a whine.  It was just quite surreal to work for so long, get home late, eat dinner and then say - 'Right - let's move house!'.

I've scribbled in a couple of places about tips for junior doctors, advice on the first day etc.... My top three tips:
1) Eat lunch. And drink water. This is not optional. You can check bloods while eating if necessary.

2) Ask for help. There are no stupid questions for at least 2 months, and actually not even after that. I ask lots of stupid questions, but I'd rather look stupid and know for next time.

3) Make friends, have some laughs and generally get a team going with your fellow doctors, nurses, pharmacists, ward clerks etc. It's the joy of the job and it will make everyone's job easier and more fun.

For me, it was emotional to the last working on the cancer ward. I got my first personalised card; I nearly cried when I was given it!  It is so true that while you don't do the job to get any thanks, and certainly not on a cancer ward where the courage of everyone around you (patients, family, staff) is just overwhelming, it is just so special to think that you might have actually done your job well and had such a personal connection with a person and their family.

Everything I'm about to say is a cliche, but really, the last few months of working on that ward, in combination with losing my friends in January, have made me feel more full of love for life than I could have imagined.  So my actual biggest tip for new doctors? Try and focus on how bloody lucky we are to do a job that has the scope to make some kind of difference to someone's life. 

Not that sort of doctor!

So apart from people often requiring a lot of persuasion to believe that I am, in fact, alas, a doctor, sometimes (often?!) people knowing you're a doctor can definitely be a bad thing...

I am trying to carve some kind of cross-clinical-research type career, and today spent some time on my academic day discussing my project from my research job next year with the guys from the lab. In a lab, a clinical doctor is apparently a bit of a novelty, but I found myself saying 'well, yes, I'm a doctor.... but not that sort of doctor!' - meaning I may have MBBS after my name, but definitely not PhD!

Because in the pure science world, I am even MORE of a baby in terms of knowing what I'm doing than in the medical world.

Lots of words were said that I didn't understand. I tried to keep up in the lab meeting with the different techniques and arrays being used.  In my defence I later went briefly up to the clinical ward where I work day to day and was trying to describe one of the microarrays to one of my medical doctor colleagues, who sighed as he left the office saying 'well, you just go home and enjoy your microwaves, or whatever it is you're doing'....

I know I'm studying translational medicine and all, but it really is like learning another language. It is actually quite a tough balancing act expressing your genuine interest for what is being discussed whilst only having a bit of a clue what it all means, and also accepting that the person talking to you is probably thinking 'what a wally'!

Hence - an evening of reading awaits!!

Fatigue, fess-ups and... fun.

I'm in the middle of an unexpected 12 day work-a-athon pre-Great North Swim, and although I can't complain, the last seven days have definitely been ones where I think - gosh! My job is full on! In the last 7 days:

Number of significant breaking-bad-news encounters - 2

Number of prescribing errors - 1 

Number of times crying - 1 (see above. Everything was fine. Realisation one is fallible is just quite distressing)

Number of antibiotics prescribed - lots

Number of steroids prescribed - as above plus lots more

Number of other specialties who have been grumpy with me - 2 (once justifiably, the other probably not)

Number of ePortfolios that are definitely ready for end of year sign off - 0

Number of hours of sleep - definitely not enough. And progressively less as the week went on. Not on purpose, you understand.  Self-perpetuating cycle of not-being-able-to-switch-off-ness.

Number of hours in the library on my academic day - 10

Number of evenings requiring bolstering by friends - every. single. one.

What a strange existence it is to be a junior doctor... On realising this, I did what any lucky daughter would do and called my MUM.  

Now, my mother is very wise. Nonetheless, I think it takes a particularly wise mother to know what to say when one's daughter comes across as slightly unhinged. Because I do sometimes feel quite messed up about this job and my life and how much I love it and yet how bonkers it all is.  I haven't really worked out how me and my life and my friends and my job all sort of stick together.  The last of these sort of has to be the most important right now. 

And of course, my my mum is right. The first year of a new job is always a bit crazy. Probably the first two or three years, even.  All one can do is muddle through, eat food, sleep and keep yourself sane. 

And have fun along the way, bien sur!

I'm female and I'm a doctor - so what?

The above is exactly what I thought when I started medical school.  I was made aware of the Medical Women's Federation (MWF) and a lot of the issues relating to female doctors seemed quite distant to me; maternity leave... child care... Naively, I thought this was all that mattered when it came to the fact that I happen to be a girl, and frankly, was so far from my thoughts that I thought no more about the fact that I had ovaries and wore make up from time to time.

Then I read a BMJ article saying that there was a 28.6% pay gap between male and female doctors - what?! There is more to this than pure numbers, but the disparities don't stop there.  There are specialties with a particular lack of oestrogen, perhaps surgery being the most well known, but I was also alarmed to read that amongst medical academics (which I would love to count myself among one day) nearly a quarter struggle to return to work, whereas in comparison most men go to a new or promoted position after a career break.

What on earth is going on - did I miss something or are we still stuck in the last century?

I thought about my own (limited) experience as a doctor, and the advice handed down to me about where my career should go.  And it all became clear.

Discrimination feels like it should be really obvious, and that it can't possibly happen because it is so taboo these days.  And yes, sometimes it is subtle.  But often it is so obvious, I feel embarrassed that I haven't said something.  I've had comments about how I look from male senior doctors who have subsequently turned it into a team joke, and banter from another colleague when patients think I'm a member of secretarial staff (no offence intended to the secretarial staff - I just think said patients might find it a bit weird if they then witness me putting up drips, doing ward rounds with patient examinations and prescribing medicines...).  Most career advice I have been given has come with the heavy caveat about the fact I'm unlikely to pursue XYZ career because I'm a girl and off I'll run to have babies.  At the time, these little digs seem so unimportant - it is easy to laugh it off - and you don't want to seem weak and whiny by kicking up a fuss about something that's 'just a joke'.  Because sometimes it is.  And I'm sure any of the chaps I have worked with would be absolutely mortified to think they had caused offence because I'm a girl, or frankly just think it's silly banter.

But do these little chips and inferences eat away, gradually, at women? I don't know if I want to laugh these sorts of jokes off forever.  Heaven forbid I actually do have children one day and then I dread getting a whole other round of 'oh, typical, off you go, leaving us with another gap in the rota...'  And I think if you are told something enough times, you end up feeling like you either have to join the club and become almost masculine about the whole thing, or walk away completely.  That's how women stay away from the board room of many a hospital - it's just not worth the argument.

I'd like to think we can meet somewhere in the middle.  First of all, I refuse to fit the leadership stereotype of stampeding to the front, telling everyone I'm the boss and that anyone who dares to disagree with me is a fool.  I'm going to do it my way, and be an inclusive leader wherever I work.  Maybe that is a 'girlie' way of doing things, but hey - I'm a girl!

And I certainly don't want there to be an end to the fun and jokes on the ward.  But I don't desperately want my legacy to be 'that tall blonde doctor' (which was the latest 'joke' I got to enjoy at my own expense).  No, it's not a compliment. Just maybe check now and again that your jokes aren't stepping over the line, and I'll make it my job to tell you that the line has been crossed.

Maybe I'll feel differently if I'm ever lucky enough to have babies, but for now, that would be enough.

Recent training...

Oxford morning running...

More Oxford morning running...

Bradford-on-Avon --> Winsley running

Oxford Town-Gown 10k running...

With only two weeks to go til our team triathlon starts, we would be ever grateful for your support!

Today a bunch of us ran the Oxford town/gown 10k; a little warmer than we would have liked, and inevitably I brought up the rear, but nonetheless with two weeks between me and a half marathon I was pleased to make it round in less than an hour (just!)

I will post more blog-appropriate things soon, but in the mean time, if you've got some pennies going spare, consider giving them to www.justgiving.com/organisedfun.

Thanks!

K xxx

Get up, Stand up! Why Junior Doctors must lead from the front

Trainee doctors are an often forgotten entity, although we occasionally get some air time as per the Dispatches programme shown last week.  There has also been a recent wave of discussions about daily Consultant reviews and same-standard care 7 days a week, and GMC guidance for doctors about raising concerns.  

Fact is, when you arrive in hospital, you see a nurse, and then you see me.  You may see only me for a while, depending on how unwell you are.  Then you will see a series of other, but more senior, doctors in training.  You will see a consultant within 24 hours, but until then, it's doctors in training of a range of seniority levels who will manage and guide your care unless you happen to be extremely unwell.  Junior doctors look after patients on the ward, with senior input daily and as required.  If someone becomes unwell, junior doctors will often be first at the scene unless it's a cardiac arrest.  Getting your scans, blood tests, referrals etc done will generally be the responsibility of the junior doctor. 

So I'd say junior doctors like myself are fairly 'front line'.  One consultant I worked for described us as their 'eyes and ears' while they juggled their other commitments like clinics and teaching.  Junior doctors are leaders from the moment they do their first ward round (jogging behind the consultant juggling three different folders trying to write, listen and pull the curtain round all at the same time). 

I went to a national leadership conference in Bolton recently - I was one of only three foundation doctors there, and I knew the other two, which perhaps suggests that there exists only a small world of leadership-minded junior doctors.  

Hurrah!  Excellent conference, but where were the juniors?!

And it was very interesting! Because when we sat down and did a group project about solving clinical problems, or clinical governance, or patient safety, or resource management, or human capital, or the work environment, or CCGs..... etc etc..... who provided stories, anecdotes, evidence for what the issues are, and what might be done to solve them?  Ah - enter the junior doctor!  

I'm not trying to suggest there is no role for Consultants or other clinical staff, but if it helps to paint the picture, one of the Consultants there commented towards the end of one discussion that we needed to get juniors involved in these leadership issues because we still believe that change can come, and we're the ones on the ground with the ability to make these changes happen.  

But what changes?  I would describe these as twofold - attitude/cultural, and practical.

1) Attitude/culture - 

We are a new generation of doctor.  We do shift work.  We're expected to be able to do more - there's incredible medicine and surgery out there.  If someone spikes a temperature, or has a heart attack, or has complete renal shut down, there's actually something we can do about it.  We're expected to show our teamwork/publication/presentation-ing skills around a 60 hours working week. But yet we still live in some bizarre shadow of yesteryear that it was 'tougher back then', you should practically fear your consultant and seniors, and any weakness/emotion/personal life issues are almost an question of professionalism.  

Let's show a little love, people!  Yes, it was tough then, but it's tough now, just for different reasons.  Let's support each other and look after each other and, leadership evidence says, we'll be a happier, more efficient, more effective and safer clinical machine.  

2) Practical - 

There are so many on-the-ground practical challenges that remain - the way a 'Take' list is constructed.  The organisation of the blood cupboard.  The sorts of jobs you get bleeped about that might be better placed in a jobs book.  The appearance of the clerking proforma.  We use them every day - if it doesn't work, or it's impractical, let's change it!  

So junior doctor compadres - let us lead from the front, not shirk our duty and hold our heads high - for we are the medical leaders of right here, right now, and not just tomorrow.  We must engage for the sake of improved clinical care and efficiency, and be the leaders we know we are already.  

In the interests of GMC new guidance relating to social media (although I think it's pretty obvious from the side bar): my name is Karin Purshouse.  I am a Foundation year 1 Doctor. 

Look after the pennies and the alcohol will take care of itself

I'm pre-nights.  I've spent 3 out of my 5 days off at some sort of work related teaching/course etc.  I'm a little bit cranky secondary to this.

BUT

I just wanted to have a wee chat about this whole minimum price for alcohol issue that is rather a hot topic in the UK.Read more here...

Genuine confusion from me about why this is so controversial.

I feel before I start, I should lay out my own drinking habits.  I tend not to drink much alcohol, or anything, during the week.  If I went out for a meal, I'd probably share a bottle of wine with someone.  If I go to the pub, I'd have a pint and a half maybe.  I'm no Saint, particularly back in my student days, and occasionally now if I have a really awful day, but I'm generally not that bothered by alcohol.  If prohibition was back tomorrow, it'd be no biggie.

So the main statements against minimum pricing for alcohol seem to circle on an attack on personal liberties and the feeling that this won't make any difference anyway.

On the former - I find this... surprising.  Apparently moderate drinkers will be punished - really?  Under the proposals, the cheapest a bottle of wine would be is still less than a fiver.  I think most discerning drinkers would say that's still unbelievably cheap for 12 units of alcohol.  As one of said moderate drinkers, I do not feel this infringes my personal freedom.

What I see is very much the end that Sarah Woollaston is on about - the bit where people come into hospital and have had their entire lives ruined by alcohol.  In my current work environment, this can be as pancreatitis, bleeding ulcers in the stomach, liver failure... but it can also be an 'aside' part of their health problems, where they have family or employment problems as a result of alcohol.  Withdrawal effects can also be severe and life threatening.  Many have argued that increasing the cost of alcohol won't make a difference and that people will still drink.  I'd argue two things for this.  First, we cannot predict that it will stop people drinking; but surely if there's a chance it will reduce it, that's a start and worth trying.  Second, at the very least, there will be more money to provide the drugs and services people need as a result of excessive drinking.  It also frustrates me that excessive drinking is seen as a 'bad choice' made by trouble makers.  Addiction is an illness that can affect anyone from any background, and as a society we have a responsibility to supporting these people as we would those with any other illness.

I always get a bit depressed when people bemoan a change that might benefit the minority in society.  If this change was going to financially penalise people in a more active way - i.e. more money out of someone's pay cheque or increasing council tax - I would understand.  As it is, I stand to 'lose' as much as anyone in society, and yes, perhaps I'd think twice about that pint at the end of the week.  But for me, that is a price well worth paying. 

Where did all the drugs go?

My annual leave could not have come a moment too soon.  There is only so much energy and motivation in the tank of one junior doctor, and although winter seems to have made yet ANOTHER appearance, training is still going well - the advantage of living somewhere really pretty is that  even when the legs and lungs start hurting on a run, chances are there's something nice to look at while you're expiring! Yet to jump in a swimming pool, but in my defence, the run happens first!

Of course I'm suppose to be doing a bit more of THIS - i.e. reading and writing, which I am currently enjoying in the rather delightful surroundings of an Oxford cafe or three.  I am nerding out to my heart's content over many a tasty cup of coffee.  I'm on nights this weekend so the freedom is shortlived, and yet another celebration is down the pan (sorry, sister, I'll hopefully make your birthday next year!). 

In reality I am doing a lot of THIS - pondering, pen in hand, and trying to get a bit of R and R, something that does not come naturally to me at all. 

As a total aside, I realise my blog has deviated somewhat from its original purpose of my chit-chat about random things going on in medicine from the perspective of one lowly junior doctor type person, and a discussion I had this weekend made me think about this a bit more carefully.  My brother-in-law was asking me about the lack of negative drug reporting and how do drugs come to be available to us anyway?  On the latter - this is essentially what I am reading about in the current module of my studies, but in a nutshell, it's a long, arduous process lined with failure at every step.  Less than 10% of all drugs that start the clinical trial process make it out the other side, and that's the ones that even reach said process.  That amounts to a seriously expensive drop out rate, and a cost which is mopped up by any successful drugs that do pop out.  Think about how much our world has changed since the human genome project - so many possible targets for drugs to reach!  The question is, which ones and how?  Pharma hasn't got that one quite sussed yet, and it's something that everyone's trying to solve - the FDA talk about a 'Critical Path' that should take drugs safely through this process - whether this works remains to be seen.

As for the former, I think I've posted this before but Ben Goldacre's talk on the lack of negative result publishing is well worth another mention.  It's a real problem that pharma-land and the publishers have yet to address.  I'll let Dr G do the talking....

Right.  FDA report reading, here I come.... 

Training starts today!

Realising that doing a half marathon and one-mile swim all in the next four months around my rather antisocial work hours will be a little painful!

.....But this is what it's all about!

I may be on nights this week but training started today for my mega-outdoors-athon in May (Edinburgh half marathon) and June (Great North Swim).  A 7.35km run along the river on day one in the Oxford sunshine :)

I realised looking through my blog that I may have been somewhat cryptic but here's what it's all about.  There was an avalanche in Glencoe on the 19th January and close university friends of mine were amongst those involved.  They were friends not just by virtue of our time at medical school, but also an immense amount of time spent in the hills, bothys, the Irish sea, up to our knees in snow, curled up in a make-shift shelter of moss logs and many more wild places.  Their loss is still not something I can really believe is real, but they were full of so much joie de vivre and laughter that this seems a good way to start living life with them alongside us.

Begging emails of donations to follow!  

About Grief

Grief is something most people experience at some point in their lives.  For most of us, our first encounter with it is the loss of a pet or a grandparent.  For me, it was my grandad when I was 11.  I still remember being the one who picked up the phone that day to hear my dad at the other end of the line telling me the news.

Those who know me will know these last couple of weeks have been more challenging than I could ever imagine thanks to the recent deaths of, and serious injuries to, some of my closest friends ('Tier one', one might say).  The only comfort was that at least I had annual leave that week to be with my friends, to laugh and cry together, and to be able to do things like go on a hospital visit and attend funerals.  

But then, all falls silent.  

The rota waits for no-one, and I was back at work this week.  One email I received this week congratulated me on 'feeling ready to return to work'.  Hmmm.  Was I ready?  Well, my lovely friends wouldn't thank me for sitting on my bum sobbing away, and the good thing about being a doctor is that going to work at least seems to be a useful thing to do.  Work keeps you busy, but it is merely a shield.  The weekend comes.  You go to church.  The first hymn is Be Thou My Vision.  Cue - total meltdown.  

For my wonderful friends, Una Finnegan and Rachel Majumdar, and my other beautiful friend still in hospital. xxx

The events two weeks ago will stay with me forever, but so will my experience of grief itself.  It's like riding a wave, where the ups are tremendous and peppered with joyful memories from the past along with renewed zest for life, but the downs are low, low, and painful.  And embarrassing (who wants their colleagues and peers to see their faces blotched and tear stained?).  When you're riding the wave with other people on the same wave, that's fine.  Crying and laughing in quick succession becomes strangely natural.  The challenge is when those around you are not on the wave, because the event is not something that has affected them.  What does one say? What does one say during either the ups or the downs?  'Keep your chin up' (How very British).  'Work today was the worst thing ever' (hmmm.  Perhaps choose your audience when making such comments).  'I'd feel better by being there for you' (this is ok but not if you're making me feel worse in the process).  Maybe I'm being harsh....

But what has been AMAZING is the love and support from so, so, so many people.  Random messages and emails from people who knew them, who didn't know them, who had a suspicion that I knew them, and every message so kind.  I know it sounds silly but it was genuinely so helpful to know that people were supporting us.  Friends' families opened their doors and gave us somewhere to stay,  food, hugs, a cheesy film to watch and transport PRN.  It has been a tremendously warming experience amidst the sadness of it all.  I can only hope my friends' parents and families have felt this warmth also.  

So I may not know much about grief, but I'll tell you, it's unpredictable and unbearable.  But what joy to know how much you can love someone, and love those around you.  So I'm going to keep loving people, and should the time ever come that someone needs me like I need my friends right now, they are going to feel so loved they won't know what to do.

The Long Winter....

Did Christmas happen?  How on earth is it 2013?!

Christmas was a work-filled affair for me, so it genuinely doesn't feel like Christmas happened at all.  I was working 7pm-8am night shifts the whole of Christmas week, and I'm nearly at the end of a week of 7am-7pm shifts all of this New Years week.

My family were all abroad (parents with my 91 year old grandmother in Germany, sister with her in laws in South Africa).  On Christmas day, I spoke to my sister for about 90 seconds when I was at work preparing for handover.  I ate a slightly weird breakfast of chicken wrapped in bacon with a weird carrot mash and potatoes on my tod before sleeping my way through Christmas day.  When I woke in the evening to go to work, I had mushroom risotto.  That was my Christmas day.

But you know what?  We had a mince pie or two, donned our Christmas jumpers and ... carried on as usual.   Perhaps there are romantic visions that we serenade our patients with a carol or two, or give them all Christmas cake.  But the reality is, it is just like any other night shift without a moment's peace. There really is nothing, truly nothing, to smile about when you have to certify a death early on Christmas morning.  But this is what happens on a night shift, any night shift.  For every patient we saw during that week of nights, you felt awful that this was they were spending the season; after all, all I had to do was turn up to work!

And plus I have a substitute family of my fellow on-call buddies when my biological ones are in absentia.  You come to lean so heavily on your colleagues for a brief conversation, consolation, a giggle, advice....

I am absolutely exhausted now, but I am relieved that I did my best over Christmas and New Year to keep a smile on mine and as many other faces as possible.  The post-Christmas phase has been nothing short of manic, but hey, a smile's contagious right?

I have made two New Year's resolutions - both of which I am already actioning!
1) Have at least one regular hobby (in absence of being free any evening of the week each week - this is temporarily being filled by 'Reading' and 'Eating with friends'.  I'm just finishing Operation Mincemeat - incredible. Even post-nights, it kept me glued the whole 4-5 hours on the train to Newcastle between Christmas and NY.  I am also making the reading of a Sunday newspaper a weekly feature. )
2) Make more non-medic friends.  Evidenced by the fact I am going on holiday with a majority of non-medics at the end of Jan.  And I'm having lunch with a non-medic on Saturday.  You think this is extreme and constitutes unnecessary categorisation on the basis of employment?  Listen, I love my friends.  BUT.  You have no IDEA how dull my chat has become.  I need to broaden my horizons.