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Wilkommen to my blog - my name is Karin Purshouse, and I'm a doctor in the UK. If you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I'm currently a doctor/research trainee in oncology after spending a year doing research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Thursday, 28 November 2013

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'ĂȘtre. 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.

Saturday, 16 November 2013

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...

Friday, 15 November 2013