MEDICAL WOMAN VOLUME 33: ISSUE 1
INSIDE: How I got here: Dame Carol Black Women At The Top Hilary Cass 100 Leading Ladies Whistleblowing: Dr Kim Holt Charity Focus: Daughters of Eve â€“ Leyla Hussein
I Image thanks to lolography.com
hope all our readers are having a good 2014 so far. Producing this issue has been in quite different personal circumstances, as I now have a wonderful and boisterous baby boy called Zachariah who has been teaching me the challenges of motherhood over the last few months.
In January Dame Sally Davies, the country’s Chief Medical Officer (CMO), suggested that breastfeeding needs to be made more acceptable and women should be allowed to do it in offices. I have taken inspiration from this to an extent. Despite being on maternity leave from my clinical commitments, I was back in my surgery 9 weeks post partum doing some QOF work, have taken my son to a few meetings related to my LMC and CCG work and thanks to the wonders of an electric breast pump was able to attend Dame Carol Black’s Senior Ladies Dinner in January… the fact that he refused the bottle on that occasion is a whole other story, but if women are to equal men in senior positions I truly believe such actions have to be considered ok. Personally there was only so much “baby chat” and coffee/cake consumption with other mums that I could handle. Dipping into work, and producing Medical Woman whilst Zach has been asleep have, for me, been enjoyable tasks. We have a brilliant new team who have been very helpful with this issue. Thanks to Yasmin, Amy and Brooke. We have had some great contributions and feature some extremely interesting medical women. We start this issue on page 3 with Dr Sally Davies the incoming MWF President, who tells us a little about herself. MWF will be sad to say goodbye to Dr Fiona Cornish who has been a personal inspiration and mentor to me over the last few years, however it will be exciting to see how Sally leads our organisation. On page 13 we feature Dr Hilary Cass, who is President of the Royal College of Paediatrics and Child Health. One of the highlights of this issue is “How I Got Here” with Dame Carol Black. Rezwana Akhtar, who is still studying at secondary school, but aspires to read medicine, conducted the interesting interview. An important aspect of practising medicine, and a GMC obligation, is the issue of whistleblowing. On p34 Kim Holt gives us an update on this, and how the Francis Report has affected it. Many thanks to those of you who have written to us, with your support and comments about the magazine. I still see editing Medical Woman as a work in progress, and hope we continue to bring you articles that any female medical doctor in the UK is interested to read.
“A woman is like a tea bag - you can’t tell how strong she is until you put her in hot water.” Eleanor Roosevelt
Sara Khan, Editor of Medical Woman email@example.com @DrSaraK about.me/sarakhan
Contents Medical Woman, produced by the Medical Women’s Federation Editor: Dr Sara Khan firstname.lastname@example.org Deputy Editor: Yasmin Drabu email@example.com Assistant Editors: Ms Anji Thomas and Miss Francesca Rutherford E-mail: firstname.lastname@example.org Junior Editor: Dr Rebecca Say Student Editors: Amy Woods and Brooke Calvert MEDICAL WOMEN’S FEDERATION Tavistock House North, Tavistock Square, London WC1H 9HX Tel: 020 7387 7765 E-mail: email@example.com
Dr Sally Davies,
How I Got Here;
the new MWF President
Dame Carol Black
MWF Officers’ Reports
The Very Important Lady Doctor 23
www.medicalwomensfederation.org.uk @medicalwomenuk www.facebook.com/MedWomen Patron: HRH The Duchess of Gloucester GCVO President: Dr Fiona Cornish firstname.lastname@example.org
Tools to manage stress
Say it, Write it, Tweet it
Working in Sierra Leone
Daughters of Eve
Career Focus: Boys & Their Toys
President-Elect: Dr Sally Davies email@example.com Vice President: Professor Parveen Kumar Honorary Secretary: Dr Beryl De Souza firstname.lastname@example.org
The Mummy Diaries
Top apps for Medical Women
Top Tips for OSCEs
Twitterview: Dr Suzy Lishman
Junior Doctor Competition Winner 33
Honorary Treasurer: Dr Charlotte Gath email@example.com Design & Production: The Magazine Production Company
Women At The Top:
Dr Hilary Cass
Medical Elective: Outer Hebrides 34 13 Book Review:
100 Leading Ladies The Athena Swan Initiative Medical Woman: © All rights reserved. No
This Issue’s Conversation
A Grandparent’s Survival Guide 35
Dr Iona Frock
part of this publication may be reproduced or transmitted in any form or by any means without the prior written consent of the Publisher. A reprint service is available. Great care is taken to ensure accuracy in the preparation of this publication, but Medical Woman can not be held responsible for its content. The views expressed are those of the contributors and not necessarily those of the Publisher.
Contributors SPRING 2014
Dr Kim Holt Whistleblowing pg28
A medical woman you admire/respect: Louise Irvine probably for her amazing campaign to save Lewisham Hospital.
Five favourite things in life: Dr Kim Holt
• Eating out & spending time with my family • National Theatre • Seeing young people with ambition achieve their aspirations • The Edinburgh Festival, • A good gym class.
Dr Hilary Cass Women at the Top pg13
A medical woman you admire/respect: Sheila Shribman, who was our last National Clinical Director for Children and Maternity Services. She had a unique talent for quietly making things happen behind the scenes and letting other people take all the credit, with no interest whatsoever in feeding her own ego. That would definitely not be a man-thing!
Dr Hilary Cass
Five favourite things in life: • Chocolate • Cats • Catch up TV • Country Walks • And most important... Coffee and chats with close friends
Dr Sally Davies About becoming President of the MWF pgx3
A medical woman you admire/respect:
Dr Sally Davies
Dr Anne Kolby, a paediatric surgeon and the first woman president of the Royal Australasia College of Surgeons for her guidance and friendship.
Five favourite things in life: • Spending time with family • Opera • Rugby (Welsh) • Walking • Travelling
Dr Fleur Appleby-Deen Tools to manage stress for female doctors pg24
A medical woman you admire/respect: Dr Fleur App leby-Deen
My dear friend Dr Sara Khan, who always amazes and inspires me with her endless commitment to improving the world and the lives of others while having maximum joy and balance in her personal life.
Five favourite things in life: • My fiancé • Champagne • Organic dark chocolate • Hugging trees! • Sunshine
Rezwana Akhtar How I got here pg20
A medical woman you admire/respect: Without a doubt Dr Yasmin Naqushbandi. She has given up so much of her time to help me and I don’t think I would even have got this far in my journey to medical school without her support. Her giving nature and inspiring words have motivated me to work hard and never give up.
Five favourite things in life: • Education • Drama • D riving although I don’t have my own car yet • My faith • My little sister Jannah
Francesca Saldanha Cover image
A medical woman you admire/respect: It’s hard to pick just one! I have been fortunate to meet and be lectured by many inspiring women as a medical student, including Miss Su-Anna Body (the first mother to be elected to the RCS Council) who reminded us to Francesca Saldanha always “Work hard, play hard” and Miss Helen Fernandes ( the first female surgeon appointed at Addenbrooke’s Hospital where I study). They have incredible passion and determination to pursue both personal and professional goals.
Five favourite things in life: • My family and friends who always make me laugh • Travelling the world • Being creative- dress-making, painting, sculpting • Trying new things • Working towards a career in surgery
Medical Woman | Spring 2014
Profile Background to MWF The Medical Women’s Federation – Working for women’s health and women doctors since 1917. The Medical Women’s Federation (MWF) was founded in 1917 and is today the largest and most influential body of women doctors in the UK. The MWF aims to: • Promote the personal and professional development of women in medicine • Improve the health of women and their families in society The MWF consistently works to change discriminatory attitudes and practices. It provides a unique network of women doctors in all branches of the profession, and at all stages from medical students to senior consultants. We aim to achieve real equality by providing practical, personal help from members who know the hurdles and have overcome them. Achievements: MWF has campaigned for many years for: • the development and acceptance of flexible training schemes and flexible working patterns at all levels of the profession • recognition and fair treatment of sessional doctors in general practice • the need for continuing medical education and a proper career structure for non-consultant hospital career grade practitioners • family-friendly employment policies and childcare tax relief • proper treatment for women who suffer sexual abuse or domestic violence • abolition of female genital mutilation • ensuring the needs of women patients and women doctors are considered in the planning and development of services • ensuring women doctors are active in professional life – MWF members are active in a large range of organisations, including the Royal Colleges, BMA, GMC, Local Medical Committees and Postgraduate Deaneries. Much progress has been made, but much more remains to be done!
Join MWF to boost your CV, confidence and career through to retirement! medicalwomensfederation .org.uk/about-us/join-us
Dr Sally Davies talks... about becoming MWF President
he time is fast approaching for me to take over the Presidency of the MWF. It has been a fascinating experience to be President Elect since May 2012 but I had no idea how fast the time would pass and how quickly my turn would come around. I thought now would be a good time to introduce myself to the wider membership. Welsh born of Welsh parents I can honestly describe myself as a purebred girl from Wales. Leaving my local comprehensive school to go to study medicine at Girton College, Cambridge was a big step and a wonderful, life changing experience. No opportunity was turned down including rowing for the Girton Medics boat. I moved on to Whitechapel, undertaking my clinical years at the London Hospital (not Royal then). The experience gained there was vast and wide ranging as befits such a historic cosmopolitan population. My most important influence was a dynamic and friendly woman doctor who lived across the road. She was following a surgical career in the 1960’s but changed to general practice when she married. Her friendship and support gave me the confidence to think that I could dream of being a doctor. I have never regretted that choice as medicine is a broad field enabling everyone to find a niche that challenges and excites them both academically and practically. My path veered between, adult medicine, paediatrics, general practice and finally clinical genetics in accordance with my husband, the arrival of children and interesting opportunities that arose. I worked and trained less than full time for 20 years before developing a portfolio career including a substantial role in medical education. I would like to dispel one myth, working less than full time is not an easy option. My despair at being described as “only part time” or being told by colleagues that “it must be nice to have days off in the week” provided a constant undercurrent. My career path could not be described as ideal or routine but has meant that I have regularly changed direction and focus ensuring that interest and fascination is maintained. Whilst undertaking my MSc in Medical Education, my school age children were very supportive and constantly reminded me not to leave my assignments to the last minute! My recent sabbatical period in New Zealand was a great experience, working with new people with different cultural and political pressures. Working with MWF has been fantastic with laughter, frustration and pressure to represent women doctors on committees and in front of august bodies. The work of MWF goes on and I feel it is important to take forward the issue of the opportunities and benefits for the NHS, in all four nations, offered by the increasing female workforce and overcome the inequality and perceptions of old. Welcome to the 21st century and changing work practices which will benefit all working in the NHS irrespective of gender or other protected characteristic. As I review my life in medicine and how investigations and therapies have changed drastically over that period, it always strikes me as remarkable that there is such opposition to changing working practices to follow current and more importantly the future needs of the population. Things were not great in the past and we need to help treat the advanced cases of ‘nostalgitis imperfecta’ that abound. Above all, I must acknowledge the support of my husband (an anaesthetist) and four adult children whose encouragement and support I regard as vital in all that I do. I am looking forward to the challenge and mindful of the great Presidents that have gone before. A look at the Roll of Past Presidents reminds me that I am really standing on the shoulders of giants and I will endeavour to lead MWF through the next two years to a stronger and brighter future. 3
MWF Officers’ Reports Read about what the elected MWF Officers have been up to: President Report – Dr Fiona Cornish J anuary 2014 got off to an exciting start with a flurry of activity on twitter and in the newspapers in response to an article by Prof Meirion Thomas, a senior surgeon, claiming that women have a negative effect on the NHS. It has galvanised collaboration between all the women leaders, which must be a good thing. We were quick off the mark to respond and Pulse magazine invited us to submit an article which Dr Sara Khan kindly wrote on our behalf (see page 19), we were involved in a crowd sourced response via twitter and we were also quoted in the BMA newsletter. Dean Royles, head of NHS Employers, has written an article strongly supporting women; his parting shot was “Some people are women. Get over it!” Later in January Beryl and I represented MWF at the Inspiring Women Careers Fair at Basildon Academy. This was one event in a series designed to allow girls, whichever school they attend, to have the chance to meet women from all professional backgrounds and gain first hand insights into different jobs and the routes into them. We had great fun and found it inspiring to be part of this national enterprise, headed by Miriam Gonzalez Durantez. We were in good company with Samantha Cameron, Clare Balding and Tessa Jowell. We encourage members to offer their support to the scheme, www.inspiringthefuture.org I have thoroughly enjoyed working with all the officers and the office staff over the past two years, as it has given me the opportunity to raise the profile of MWF by writing in Pulse and GP magazines when invited. I am most grateful for all the help and support they have given me along with the support off the MWF officers and members. It is hard to believe that my two years as President are almost over. I know that Sally Davies will do a great job when she takes over in May. Honorary Secretary – Dr Beryl De Souza To start the New Year we were delighted to welcome so many new members from all different grade and specialties. We would like you continue supporting us in recruiting new members from all grades. Our prizes and bursaries continue to be as popular as ever and we are ensuring our MWF student and junior members benefit. Keep your eye out for upcoming opportunities! The BMA are committed to supporting women who want to get involved in medical politics. We have many MWF members elected into official positions on BMA committees as well as having co-opted places in branch of practice committees. We encourage you to get involved in committees centrally or locally in your workplace via the LMC (Local Medical Committee) if you are a GP or LNC (Local Negotiating Committee) if you are in secondary care. In this way you can have your say in the provision of education and training and health service provision and receive training too. Finally, we hope to see you at our upcoming conference. The Spring Meeting will take place on Friday 9th May 2014 4
“Diversity and Medical Careers” at St John’s Hotel, Solihull in Birmingham. Speakers include Dr Sarah Wollaston MP and Baroness Sheila Hollins who will deliver The Dame Hilda Rose Lecture. For details of other speakers and to register please visit our website. Later in the year our Autumn Conference 2014 “Healthy Doctors: Healthy Patients” will take place on Friday 7th November 2014. Further details are, again, available on our website.
Honorary Treasurer – Dr Charlotte Gath I have been in the role of Honorary Treasurer of MWF now for the past year and have continued to work to raise the profile of MWF as well as improve efficiency and reduce costs. The introduction of online payments for both the Autumn and Spring Meeting registration and membership subscriptions has increased and expanded MW F’s profile nationally. Continuing to focus on attracting – and retaining – new members remain my and the other Officers’ top concern. MWF’s awarding of grants and prizes continue to attract new members as all but the Junior Doctor, Medical School Prize and Essay Competitions are for members only. This has enabled us to make much higher award amounts to those students who apply. A more detailed breakdown of all the Federation accounts for 2013 and awards is available in the Annual Review and 2013 Annual Report and Accounts. Vice President – Professor Parveen Kumar Last year has been a steep learning curve for me in trying to get a handle on the multitudinous activities of the MWF. I have been very impressed with the vast agenda and the problems that the MWF has fielded and responded to. These have ranged from items picked up from newspapers and journals relating to women and their role in the profession, to the more mundane but equally important issues that women face in their day to day jobs. I am sure Beryl has got hidden microphones in nooks and crannies as she manages to get wind of a lot of issues that don’t hit the headlines! It certainly made me feel that the MWF is an active and very much needed organisation whose influence has spread. What is also remarkable is that all this is run on a small office of very hard working people and the commitment of the officers, led by Fiona… there is also a lot of laughter! I have been busy spreading the word at the large number of lectures/chats that I give around the country and also abroad. Medical students do need help and often need to discuss their future careers and how they can cope with a busy job and a family. They are often too timid to ask in case it means that they are ‘weak’! This, of course, also applies to men as well as women! I hope many have joined as a result of these discussions as they help to inform us as well as helping themselves. Medical Woman | Spring 2014
EVENTS & MEMBERS NEWS MWF Student Representatives: Want to put something amazing on your CV?! We’re looking for MWF student representatives at, Barts, Cambridge, Cardiff, Edinburgh, Nottingham, Sheffield, Southampton and UCL Medical Schools! If you’re interested get in touch! firstname.lastname@example.org
MWF LOCAL GROUPS NEWS LONDON Hobbs Shopping Evening – Wednesday 2nd October
MWF Members News: • Congratulations to Amanda Howe who has been elected as President Elect on WONCA • We were delighted to have the following GP members on the Pulse Top 50 GP’s list 2013 – Dr Fay Wilson, Prof Amanda Howe, Medical Woman editor Dr Sara Khan and MWF President Dr Fiona Cornish. Along with Dr Farah Jameel and Dr Amy Small on the Top up-andcoming GP’s 2013 list.
Dr Fleur Appleby-Deen, raffle prize winner
• Congratulations to Professor Lesley Regan, Obstetrics & Gynaecology, Imperial College Healthcare NHS Trust, St Mary’s Hospital who won the medical category of Woman of Achievement Award from Women in the City 2013.
Dr Rose Clark, 81, MWF member for 57 years and former Scottish Eastern Local Secretary, zip wires across the River Clyde to raise money for Brain Tumor Research – isn’t that just fab!
MWF in the Media: Are sabbaticals still an option for today’s doctors? 4th February 2014 Kathy Oxtoby interviews Dr Sally Davies for BMJ Careers http://tiny.cc/th3mdx
Family friendly workplaces for doctors in training BMJ Careers, 29th January 2014 Dr Beryl De Souza and Paul Deemer http://tiny.cc/ei3mdx
Do the classic specialty stereotypes still hold true for today’s doctors? BMJ Careers 17th December 2013 Kathy Oxby asks our members http://tiny.cc/si3mdx
Dr Fiona Cornish and Dr Sara Khan had the two top read articles respectively of 2013 in Pulse. Patient demand is driving GPs into the ground, Dr Fiona Cornish and The profession must face up to the reality of GP burnout Dr Sara Khan Can women change the culture of the NHS? Guardian Professionals Network, 29th October 2013 Dame Fiona Caldicott talks around the subject of our November Conference title. http://tiny.cc/7i3mdx
Women GPs aren’t hurting the NHS – but old-fashioned views continue to undermine our contribution Pulse, 13th January 2014 Dr Sara Khan responds to Prof Merion Thomas’s article published in the Daily Mail ‘Why having so many women doctors is hurting the NHS: A provocative but powerful argument from a leading surgeon’ on behalf of MWF. (See page 19). http://tiny.cc/bh3mdx
There are plenty of chances to get into the media with MWF – let us know if you would like to be contacted in the future!
OXFORD In November we held a meeting at which Dr Evie Kemp, Lead Consultant in Occupational Health gave a talk entitled “What’s Up Doc?”. The meeting was well attended, including a visit from Charlotte Gath, MWF National Treasurer. The talk provided a most useful account of what can happen when a doctor becomes a patient and the pitfalls that may occur from the use of improper channels of communication. Examples are “Corridor Consultations”, failure of the doctor to be registered with their own GP, and self diagnosis and self prescribing. Dr Kate Chalmers, MWF Oxford Local Secretary and retired doctor. After many years of commitment assisting MWF Oxford Local Group Kate has decided to step down from her role, we thank Kate for all her hard work and in particular organising a spectacular Spring Conference in 2013. We are therefore looking for a new secretary to take care of the local group, organising a few local meetings a year to inspire local women doctors. If you are interested please get in touch! email@example.com
DATES FOR YOUR DIARY: January – May 2014 – MWF Mature Student Grant Awards Opens 9th May 2014 – MWF May Conference, “Diversity and Medical Careers”, AGM (9th May) and Council Meeting, Birmingham (10th May) June – September 2014 – MWF Junior Doctor Prize Opens 3rd June 2014 – Staff and Society Specialist Conference, BMA House, London 4th– 6th September 2014 – MWIA 17th Northern European Regional Conference, Copenhagen 15th October 2014 – Academy of Medical Royal Colleges Conference, “Aging Practice”, Royal College of Surgeons, Edinburgh 7th November 2014 – Autumn Conference, “Healthy Doctors: Healthy Patients” and Council Meeting (8th November)
Say it, Write it, Tweet it
“Say it, Writ SOAPBOX SOAPBOX SOAPBOX SOAPBOX Dear Editor I read with interest this month’s debate topic “is there resentment or preferential treatment regarding maternity leave and other privileges for those who have children?” and was pleasantly surprised. As an Orthopaedic trainee, who currently has no children, I do sometimes feel the focus of organisations representing so-called women’s interests is particularly concerned with our fertility within the workplace. We can fulfil alternative roles to incubators and dare I say it – mothers. Quite correctly in my opinion, the point was made of this being an administrative issue rather than specific resentment towards mothers. Interestingly, my pocket thesaurus gives a wealth of motherly alternatives; all center on kind, loving, devoted, tender and warm adjectives. Perhaps to overcome the apparent hurdle of the simple concept “if there’s a vacancy - fill it” a more fatherly approach needs to be employed. The altogether more authoritative founding, designing, inventing, creating and original approach may give us the vision we seem to be lacking. Although a vocation, healthcare has evolved into a business and if the service we are providing is (choose any of the following or insert your own opinion) unsatisfactory/unsafe/depreciating/ preventing us making improvements/non-profit making then it is the age-old defining factor of the NHS – goodwill is not boundless and is no longer sufficient to carry the service. Investment must be made in staff for the NHS to remain capable
of providing a viable service – this is simple business sense, far from gender specific and is often forewarned. If a male GP goes off sick with stress or a midlife crisis, remaining partners have to pick up the slack or employ a locum. Administration of the NHS has always been short-sighted and perhaps our vocation is no longer wholly to advocate for the patient, but to consider the survival of the system that provides to all free healthcare at the point of delivery and more poignantly has dramatically reduced maternal deaths, improved cervical cancer diagnosis and screening and employs a rapidly increasing number of female consultants. My own mother, ardent feminist and Senior Sister at the peak of her nursing career would concur. Few things make me sufficiently angry to write such a letter, but as women and doctors we need to stop being defined by our gender. We are individuals and professionals. We have fought for this right and I am fascinated that we are now apparently blinkered by an administrative, genderless rota. Given the greater than centennial history of the Women’s Movement that has paved the way to the Medical Women’s Federation and our 21st century lives of what we alone choose to achieve, it is simply outrageous to admit and seemingly accept “this is just how it is!” Dr Abigail Clark-Morgan, Orthopaedic Junior Clinical Fellow, London
Thou shall not doubt oneself in front of the patient: are female medical students less confident than male medical students? As part of my Paediatrics attachment, I was having bed side teaching on the peripheral nervous system. We had talked through the examination and I was first to practice on 4 year old Jake. One consultant and 3 other medical students looked on as I worked my way through the examination. My general inspection and impression of the child got approving nods from my colleagues. Phew! Next up was the actual examination “two people can’t resist...” I recalled in my head. First up: tone. I assessed this correctly and nothing had gone majorly wrong yet. Relief! Power was next. “Ok, so put out your arms up like this and resist me... ok, no, not like that... erm... oh god... I don’t know how to explain it”. 6
My colleagues looked on. The consultant chipped in “tell him to touch his shoulders”. It did the trick and I was able to get through the rest of the examination without too many hiccups. When we had finished, in classic medical school fashion I had to reflect on what had just happened and say something I did well as well as something I could have done better. The thing I did well was “I got through it. I mean I remembered everything”. My bad thing was “I wasn’t good at explaining power to him”. My feedback however, was different. I was told “be more confident. You did everything correctly and didn’t forget anything. I think it’s a girl thing. You doubt yourselves more than the boys”. Medical Woman | Spring 2014
Say it, Write it, Tweet it
te it, Tweet it” My feedback however, was different. I was told “be more confident. You did everything correctly and didn’t forget anything. I think it’s a girl thing. You doubt yourselves more than the boys”. Next up was a male medical student’s turn. He did the examination just fine but there were things that I could pick out that he could have done better and being totally objective my examination was better. But there was a major difference. His confidence. He seemed like he knew what he was doing and when he went wrong or missed something out, he just added it to the end of his examination. If I were his examiner, I would have found it difficult to fault him. He appeared confident and as a patient that inspires confidence and a happy patient makes for a happy examiner and good marks. After the session, I got to thinking: am I really incompetent or
am I just underestimating my own ability which is making me lack confidence? The fact that a Paediatric consultant and all my colleagues told me that my examination was fine, good even, answers the first part. I am not incompetent. So I must be underestimating my own ability. And if I am, is that something that is unique to me? Or are other medical students doing that too? And more interestingly to me, is this something that the female medical students are doing more than their male colleagues? Miss Salma Aslam, University of Bristol 4th Year Medical Student
harlotte Hitchcock@gremlin2c Oct 29 @GdnHealthcare: Dame Fiona Caldicott asks: Can women change the culture of the #NHS? C http://www.theguardian.com/healthcare-network/2013/oct/29/women-change-culture-nhs … #healthcare” they already are! uardian Healthcare @GdnHealthcare Oct 29 Most well-read today: Dame Fiona Caldicott asks: Can women change the culture of the G #NHS? #NHS? http://bit.ly/1g8J4AZ #healthcare Paul Deemer @NHSE_Paul Nov 8 43% of 252,553 doctors are female according to @gmcuk register #mwfconf13 So - yes - women can change the culture of the NHS! atherine Sleeman @kesleeman Nov 8 Some interesting and important tweets coming from the Medical Women’s Federation K conference. Sad not to be there #MWFConf13 L aur @laurevans311 Nov 8 Role models are a vital inspiration! They make success seem more attainable, and sometimes help with the hows. #mwfconf13 PulseToday @pulsetoday Dec 6 Professor Clare Gerada tells Pulse: ‘I think federations are the answer’ WATCH here > http://www.pulsetoday.co.uk/home/videos/the-big-interview/professor-clare-gerada-i-think-federations-are-the-answer/20005262.article… #nhs #health
r Nikita Kanani @NikkiKF Jan 8 The importance of LTFT employees, a twitter sourced response to #MeirionThomas http://www. D nhsconfed.org/Documents/The%20importance%20of%20LTFT%20employees%20to%20the%20NHS.pdf … - please read and RT! ISS @miss_talks Jan 16 ‘Discriminating women is not just unfair, its economic failure to leave 50% of best brains out’ - Dame Sally M #wowlunch14 @WellbeingofWmen omensgrid @womensgrid Jan 16 Medical Women’s Federation responds to claim that having so many women doctors is hurting the w NHS …... http://fb.me/2sX0UZKJO
If you have any burning issues to get off your chest, or news to share, then we’d love to hear from you. Contact us: @medicalwomenUK | MWF, Tavistock House North, Tavistock Square, London, WC1H 9HX firstname.lastname@example.org | 020 7387 7765 www.medicalwomensfederation.org.uk
Conference Review: Patients’ and Doctors’ Safety:
CAN WOMEN CHANGE THE CULTURE OF THE NHS? Dr Bhavagaya Bakshi, GP, ST1, London Patient Safety is transforming the culture of our National Health Service. The Medical Women’s Federation Conference looked at a diverse range of factors affecting patient safety; from the reconfiguration of services, to the restructure of training and education of our workforce, to the wider public perception of the NHS and the pivotal role whistle blowing plays.
r Vicky Osgood, Assistant Director of PostGraduate Education at the General Medical Council caught our attention early on when discussing patient complaints and satisfaction. Interestingly, women receive significantly fewer complaints and are less likely to be brought in front of the GMC for review. Women play a vital role in managing patient experience and expectations, yet women are underrepresented in managerial and leadership roles within their organisations. The Conference explored key characteristics seen to be innate to women, such as compassion, communication and empathy which could account for the differences between men and women. Women now make up the majority of medical students but are still underrepresented in certain specialties, senior roles, boards and academic positions. As Dr Lucy Morse, Obstetrics and Gynaecology trainee explores through her work, we need to change the perception of feminine characteristics, being a sign of weakness or vulnerability but as a strength, key in delivering quality care and changing culture. Dame Fiona Caldicott, Chair of the Independent Information Governance Oversight Panel, unfolded the complexity of information governance, the delicate balance between confidentiality and clinical excellence. She stressed the need for integrated care records to facilitate a single point of access for clinicians to deliver efficient and effective care to patients across a multitude of healthcare organisations. The range of workshops from whistleblowing safely, careers guidance, coaching skills and pensions offered a summary and key tips for all to consider in their careers. The breaks between presentations and lunch offered an ideal opportunity for informal networking and discussions on the conference topics. At the meeting Paul Deemer, Equality and Diversity Consultant from NHS Employers, presented the MWF Family Friendly Awards to the most Family Friendly Deanery, which for 2013 went to Wales Deanery and to Cardiff and Wales University Health Board. Tami Hoffman, Sky News Editor offered a wonderful closing to the event. Her words hit home as she addressed the under representation of women doctors in the media. It was fascinating
to hear that women turned down the opportunity to talk on behalf of their organisation, specialty or on a particular issue due to a lack of confidence and self-belief. Interestingly women commonly would refer to male counterparts as better options, demonstrating that women equally qualified and skilled did not perceive themselves as being equally capable. There is still a need to support and promote gender equality in order to empower women to believe in their abilities. In the current climate we should aim to put patient safety at the heart of every consultation, whether at home, in the community or in a hospital. We need to ensure that patient safety is integral to the culture and work ethic of an organisation. Staff should be motivated and driven and by delivering good quality care rather than targets and monetary objectives. The cost of any compromise is far too high for our profession and our patients alike.
Medical Woman | Spring 2014
Daughters of Eve issue of Female Genital Mutilation, GPs and hospitals only consider the physical effects of FGM such as painful periods, chronic urinary tract infections etc. Therefore, the psychological effects and emotional impact of FGM are ignored. Survivors of FGM require therapy in order to heal, they need a safe space to acknowledge and delve into the effect that FGM has had on their lives, both the physical and emotional. The severity of this issue must be recognised. Women require specialist support in order to heal. This is why I set up the support group ‘Dahlia project’, which seeks to provide help to women who are scarred by their experience. However, such support is isolated and this type of service needs to become widely available to survivors in all parts of the country. Please sign this important petition, which could help prevent girls from being cut: epetitions.direct.gov.uk/ petitions/52740.
Leyla Hussein FGM Activist, co-founder of daughters of eve and Psychotherapist
ackling the problem of Female Genital Mutilation (FGM) has taken up a huge part of my life. I have been an anti-FGM activist for the past eleven years. My work has led me to co-found Daughters of Eve, an organization which campaigns to end the harmful practice of FGM. I am also a trained psychotherapist and community facilitator at the Manor Gardens Health Advocacy Project in North London, which is partnered with the Maya Center Women’s Counseling Service. It is here that I have set up the support therapy group Dahlia Project, for the survivors of FGM. It aims to offer women a safe space to discuss the effects that FGM has had on their lives. Female Genital Mutilation is a complex issue, which involves either the total or partial removal of women’s genitalia for non-therapeutic reasons. This harmful practice is believed to have affected 130140 million women worldwide. So you may be thinking why is such a harmful act committed if there are no medical benefits? Well there are several explanations given to justify this horrendous practice. Girls www.medicalwomensfederation.org.uk
are mutilated in the name of family honor i.e. ensuring that the girl will be marriable. Furthermore it is also believed by many practicing cultures that a woman or girl that hasn’t undergone FGM is “dirty” and is ostracized by society until she is cut and considered “clean”. Female Genital Mutilation violates human rights of women and girls not only immediately after the procedure but also, for the rest of their lives. I only became aware of the scar that FGM had left on my life when I fell pregnant with my daughter. I would become extremely distressed when undergoing vaginal examinations to such an extent that I would blackout. Doctors and midwives were always confused by this reaction. It wasn’t until I met a practice nurse who had also trained as a councilor, asked me “were you cut as a child?” that I began to make the link between my FGM experience and the distress that I experienced throughout my pregnancy and smear tests. Later, I was told that my body was experiencing flashbacks. I am aware of how lucky I was to meet such a nurse. However, not all FGM survivors are so fortunate. Regrettably, when it comes to the
Basic information on FGM World Health Organisation (WHO) classification of female genital mutilation: Type I: Clitoridectomy: partial or total removal of the clitoris (clitoridectomy). Type II: Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. Type III: Infibulation: narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/ or labia majora with or without excision of the clitoris (infibulation). Type IV: All other harmful procedures to the female genitalia for nonmedical purposes, for example: pricking, piercing, incising, scraping and cauterisation.
Managing Upwards! Dr Yasmin Drabu, Deputy Editor Medical Woman
Do you have good ideas that no-one listens to? Do you think you are too junior for anyone to take you seriously? Are you frustrated because you know you can solve the problem but you can’t get anyone to do anything? Are you at the bottom of the heap and feel nothing can be done until you reach the top of the pile?
9) U nderstand the communication style of the person you want to influence and convey it in the form that he/she likes and is likely to retain. A good way to identify the communication style is to watch how he/she communicates with you.
1) Identify your own personal strengths and weaknesses. Ask your friends what your strengths and weaknesses are –they will give you an honest answer. Always use your strengths but recognise your weaknesses and manage them.
10) Spend time gathering information which will help in preparing you to get your ideas across. Don’t bring emotional bias into your information. Bring facts and figures. Never put your own personal credibility at stake by exaggerating the issues. Beware of detail thresholds; some people like a lot of detail, others like little or none.
f you have had any of these feelings – read on. However let me make it clear I am not going to give you a magic solution to solve your problems. What I am going to give you are some ideas to try out and a different way of looking at things, which should help you have productive relationships with your colleagues in your workplace. Try them out and see what happens!
2) D on’t whinge and whine. Don’t bring a problem to the table unless you have realistic solution to go with it. Ensure you take responsibilities for those areas that you can influence. Don’t rely on your boss to do all the work. 3) S how respect to others by turning up on time for a meeting and finishing a meeting on time. 4) Commit to things that you can deliver. 5) Don’t lose your cool. When you are angry or frustrated, say so without added drama or explosion. 6) B e clear about what you want to achieve and what you need. Write it down on a single sheet of paper. Make sure your message is clear. Explain it in one minute. Try it. Doing this will help you crystallise your idea and what you need. 7) Make time for a cup of coffee. Having a cup of coffee/ drink/meal with the person you want to influence gives you an opportunity to talk through your initial ideas and seek feedback in a very relaxed way. 8) Understand the person who you want to influence. Understand his/ her priorities. Check if your idea/ proposal aligns with his/her goal. Modify your proposal so that there is a win-win. 10
11) Take a helicopter view of where you are. Look around dispassionately and see what everyone around is trying to do, especially the person you want to influence most, to get what you want done. This will give you a perspective of what is important to the person you are trying to influence and what are his / her priorities. 12) Identify those around you who may be on the same page and will support your ideas and also those who may possibly be obstructive. Approach those who you think are on the same page as you first and share your idea/ proposal with them and LISTEN to what they have to say. You will get feedback which may be what you expected, and you may get some unexpected results too. Incorporate their ideas and keep them in the loop as you progress. Then work with those who may not be on the same page. LISTEN to what they have to say and try and find solutions to their concerns. 13) Be prepared to consider other options and support them. Give credit where it is due. Don’t bad-mouth anyone. 14) Be prepared to admit to mistakes when they happen and have plans to rectify them as soon as possible. 15) Once you have made progress, take responsibility of doing the key tasks yourself. Ensure that others who are involved are clear about what is expected of them. Medical Woman | Spring 2014
TOPAPPS For Medical Women
by Amy Woods & Brooke Calvert, Student Editors BMJ BEST PRACTICE – BMJ Best Practice is your instant 2nd opinion. Useful for both medical students and doctors this offers key information on the diagnosis and treatment of both common and rare conditions. It is ideal for when you need a recap on guidelines. PREZI – Prezi is perfect for those looking to make their
presentations stand out. Create and edit presentations on the go, and the transition effects will make any audience say “wow”!
TWEETBOT – This app is great for getting the most out of twitter, making it easy to manage multiple accounts, create lists and keep up to date with the twittersphere.
PASTEST – ALMOSTADOCTOR – The perfect aide
memoire for students on placement and junior doctors, this study aid has a fun lego based design and offers a quick recap on a wide range of conditions, and guidance on common practical procedures- Available offline too.
Exam time is fast approaching and this app is the perfect revision aid whether you are studying for MRCP or Finals. The app gives you access to question banks, timed tests and podcasts wherever you are. Weekly progress emails help keep track of how you are improving over time.
MEDICAL WOMEN’S FEDERATION
Spring Conference 2014
& MEDICAL CAREERS
The largest body of women doctors in the UK looks forward to meeting you!
Friday 9th May 2014 – St John’s Hotel, 651 Warwick Rd, Solihull, Birmingham B91 1AT Our conference will explore the diversity in medical careers. There will be a range of speakers and workshops examining different career paths for women doctors; including journalism, politics, management, leadership, charity work and more. Dr Sarah Wollaston MP Prof Sheila Hollins – former President of BMA Dr Alison Walker – Associate Editor of BMJ Dr Henrietta Bowden-Jones – Lead Consultant for Problem Gambling for Central North West London NHS Foundation Trust
Why not submit an Abstract? Deadline – Friday 4th April 2014 You still want more? How about a social programme excellent for networking?! Registration details available at
www.medicalwomensfederation.org.uk MWF, Tavistock House North, Tavistock Square, London WC1H 9HX Email: email@example.com Tel: 0207 387 7765
Twitterview MWF @medicalwomenuk with Dr Suzy Lishman, Vice-President of the Royal College of Pathologists & author of ‘A History of Pathology in 50 Objects’ @ilovepathology
When did you join Twitter and how often do you check it?
I joined in 2010. It depends how busy I am, what I’m doing and who I’m with – some days I check every hour, others not at all
What attracted you to medicine?
I come from a medical family so it’s what I grew up with – I liked the science & problem-solving as well as the caring aspect
Did you make any sacrifices for your career?
I’d say compromises rather than sacrifices. I’ve worked a huge number of hours but love my job and have a supportive family
What has been your greatest achievement?
National Pathology Week – encouraging pathologists to talk to the public. Aim was 40 events but over 3 years there were 1200
Who/what has been your biggest inspiration?
My mother. She brought me up to believe that I could do anything I wanted and that being a girl made no difference
What has been the best year of your career and why?
Every year is better than the last so I’d have to say 2013! I love meeting people and being asked to do new things
How have you engaged the public in pathology and what can others learn from you? A: @medicalwomenuk Developed resources to make it easy for pathologists to fit public engagement into their busy lives. Anything is possible!
What would you consider as your greatest contribution in your role at the Royal College of Pathologists? A: @medicalwomenuk Changing perceptions of pathology and pathologists and encouraging thousands of others to do the same
How/why did you get involved with promoting Pathology to the public? A: @medicalwomenuk It was a neglected aim of @RCPath. As most junior officer I volunteered to take it on as exams & research were already taken
What advice can you give our members on getting into leadership roles? A: @medicalwomenuk Have confidence in your abilities. Put yourself forward and give it a go. @TheKingsFund courses are brilliant
What does it mean to you to be recognised as an Inspirational Woman by the HSJ? A: @medicalwomenuk It’s lovely to be recognised and encourages me to keep going – but my real work is for patients at @psh_nhstrust
Where do you see yourself in 10 years? A: @medicalwomenuk Still working as a pathologist, trying to make a difference in healthcare & talking to anyone who’ll listen about pathology!
As a woman in the medical profession, have you experienced discrimination? No. I’ve had to work hard, stick up for myself and get on with things but I don’t think that’s because I’m a woman
What advice would you give a female medical student/junior doctor about developing her career?
Look for opportunities to learn and gain experience. Medicine is team work – appreciate the people you work with
How have you encouraged medical students into your specialty?
I teach, give careers’ talks, hold workshops, lab tours, presentations and have developed booklets for others to use for NPW [National Pathology Week]
Why did you decide to work for your Royal College?
I was in the right place at the right time. I was looking for a new challenge and Assistant Registrar post came up
How do you keep a work/life balance and keep up with your family and friends? A: @medicalwomenuk I try to be organised. It helps that pathology’s family-friendly. Family help with events as assistants, models, guinea pigs
What do you do to relax? A: @medicalwomenuk Spend time with my family, read, run (@parkrunUK), plan holidays, visit art galleries and eat
Q: @ilovepathology Name someone you love to follow on Twitter and why? A: @medicalwomenuk @GrangerKate because she has done so much for others and is truly inspirational. Everyone should read her books. Q: @ilovepathology What have you gained from being a Member of MWF? A: @medicalwomenuk The chance to meet many inspirational women and a better understanding of the challenges that some women face in medicine.
Medical Woman | Spring 2014
Women at the Top In this feature we profile medical women who have demonstrated reaching a senior position within medicine...
WOMEN AT THE TOP Dr Hilary Cass – President, the Royal College of Paediatrics and Child Health
Name: Dr Hilary Cass, President, the Royal College of Paediatrics and Child Health Born: 19/02/1958 Lives: North London Medical School: Royal Free Hospital School of Medicine Speciality: Paediatric disability & Medical Education Place currently works: Evelina London Children’s Hospital and RCPCH First Ambition: To be an archaeologist. Enthusiasm waned abruptly after reading various sensationalist accounts of the ‘curse’ of Tutankhamun, at which point medicine seemed an altogether safer option.
Dr Hilary Cass is President of the Royal College of Paediatrics and Child Health (RCPCH) and Consultant in Paediatric Disability at Evelina London Children’s Hospital. Prior to taking up the Presidency, she has had a series of roles in medical education, including Director of Medical Education at Great Ormond Street Hospital for Children and Head of School of Paediatrics for London. She has also had several other NHS management and policy roles, as well as being a trustee of a number of children’s charities, most recently Whizz-Kidz.
Other Career Related Interests/Roles: Although my main clinical role is in paediatric disability, I have become increasingly interested in paediatric palliative care because we have growing numbers of children with life limiting conditions, and many, when at home, are technologically dependant. If we push forward the boundaries of medicine, we have to be able to follow through and give optimum care for life, not just on intensive care or while pursuing heroic lifesaving treatments. Challenges along the way: Believing in myself! Every school report about me said ‘lacks confidence’, although people look incredulous if I say that now. When you train to be a doctor you have to start donning an outgoing persona like a cloak, and eventually you learn to feel confident in that skin. Success breeds success, and each role I took on equipped me with the confidence to take on another until suddenly I was College President and still didn’t know if I could be that person... until I started. Rewards of your role(s): Being able to meet and work with ordinary and extraordinary people from around the UK and internationally. I get the chance to talk to junior doctors, MPs, health and voluntary sector leaders, parents, journalists, and the inspiring young people on the RCPCH’s Youth Advisory Panel, to name but a few. I learn something from every one of them. My days are incredibly diverse – stretching from workforce pressures and standards of care to public health issues like plain tobacco packaging. Inspirations/influences: My inspiration comes from two sources: Our trainees; they are both the front line and the future of our specialty and they always tell it how it is without being influenced by the politics. And our Youth Advisory Panel; they are the future of our country and... they always tell it how it is without being influenced by the politics. Quotas for senior positions for women in healthcare – yes or no? No. Just transparency of appointment process. ADVICE Do’s: Know your principles and stick to them. Imagine yourself in your next job and imagine it really can be yours. Retain a sense of humour. Trust your instincts. Believe in yourself. Continue to drink wine and eat chocolate (moderately). Don’ts: Dwell on things that go wrong; I think women are worse than men at going over and over how we might have done things better. Learn from the glitches and move on! How to get there: If an opportunity looks interesting – go for it. It’s no good being in the right place at the right time if you don’t make the right move.
100 Leading Ladies Nancy Honey Photographer, London 100 Leading Ladies is a photographic project by Nancy Honey capturing the portraits of 100 influential senior women in Britain, and it features MWF members. We are pleased that Nancy took the time to describe her project for Medical Woman…
n my own lifetime I have witnessed a profound shift: from little girls imagining their future as marriage and children to the now total belief from childhood that a woman will grow up to have a career outside the home. In my photography, I have always been interested in charting these female journeys and I believe that, now more important than ever, it is important to celebrate the achievements of the women that have reached the top – in some cases against the odds – in the professional fields that enrich our society and hear their voices of experience. When I was an emerging photographer, balancing my career with mothering two young children, one of my heroines was Eve Arnold, the highly successful photojournalist. So when I saw she was going to be giving a talk near my home, I was quite eager to attend. I knew she had a family and a career, so I hoped she would address how she was able to manage them both. She didn’t mention it. After her talk, I realised that this question was so important to me I couldn’t leave the hall without Medical Woman | Spring 2014
100 Leading Ladies
asking it. Tentatively I raised my hand. Her answer was abrupt, as if to quickly put a stop to my line of questioning. ‘That subject,’ she said, ‘is too painful to talk about.’ This is how 100 Leading Ladies was born. Over the past 18 months, I have photographed 100 of Britain’s most influential senior women, from all walks of life. Former Times journalist Hattie Garlick interviewed them, asking them the questions that everyone wants to know. The result is a living history that celebrates a range of extraordinary achievements whilst bringing to light the steps these women took to get where they are today. Among the 100 Leading Ladies are well known public figures like Germaine Greer, and Tessa Jowell as well as those who are admired by their peers in their respective fields, like Averil Mansfield, the UK’s first female professor of surgery. There are politicians, scientists, restauranteurs, CEOs, authors, Britain’s oldest working super model and much more. Many of them are the first women in their fields. These candid interviews position individual personal struggles and triumphs against the backdrop of a remarkable era of change. The project pays tribute to the role models who have helped transform the perception of what is possible for women to achieve in their lives and comes at an opportune time. Though it is clear that the attitude towards women and work has vastly changed during their lifetimes, they are all agreed that there is still much work to be done. As the public eye finally begins to Carol Black
100 Leading Ladies take note of the gender discrepancies that continue to exist at the core of many professions, the challenge of how to change this culture has taken centre stage. Though varied in their diverse views, the collective warmth and wisdom of these women provides an invaluable resource for a younger generation of leaders, from complex issues that range from navigating an all male boardroom to juggling a successful career and family. One of the fundamental messages of the project is the urgent need to encourage young women to realise their full potential early on and bestow them with the confidence to forge their own long and successful careers. As these women demonstrate, the opportunities are there if you choose to take them. ALL THE DOCTORS INCLUDED IN THIS PROJECT ARE MWF MEMBERS: Carol Black, Dame Carol Black DBE, FRCP, Eminent doctor and member of many consulting boards Sheila Hollins, Baroness Sheila Hollins, Professor of the Psychiatry of Learning Disability Parveen Kumar, Professor Parveen Kumar CBE, Consultant physician gastroenterologist and editor Kumar and Clark’s Clinical Medicine Averil Mansfield, Professor Averil Mansfield CBE, UK’s first female professor of surgery Jane Anderson, Professor Dr Jane Anderson, Doctor & researcher in the field of HIV. Chair of the British HIV Association
To see more of the project please visit: http://www.100leadingladies.com and http://tiny.cc/g78mdx to see the 13 portraits and interviews that have been acquired by the National Portrait Gallery. Avril Mansfield
Medical Woman | Spring 2014
The Athena Swan Initiative
THE ATHENA SWAN INITIATIVE Dr Peggy Frith, Deputy Director of Clinical Studies at Oxford University Medical School
he Athena SWAN (Scientific Women’s Academic Network) Charter is a national initiative which recognises commitment to advancing women’s academic careers in science, technology, engineering, maths and medicine (STEMM). The Charter, launched in June 2005, recognises the vital importance of adequate representation of women in what is still a male-dominated area, believing that science cannot reach its full potential unless it benefits from the talents of women and men equally1. At Oxford University, with eight pre-clinical and thirteen clinical departments contributing to the large Medical Sciences Division, the implications of Athena SWAN are considerable. Interest in the project was fuelled by the clear link with vital funding, though initial responses from heads of departments varied from ‘this is long overdue and of course we should do it as quickly as possible!’ to ‘what happens if we don’t take part?’ After the Divisional launch, each department identified a team to formulate their approach to the challenge of collecting accurate data and canvassing balanced opinion from a wide range of members, both women and men, from research students to Head of Department. Teams include both administrators and academics. The teams have been supported centrally by a full-time post-doc researcher with experience of the Athena SWAN process from another Oxford Division, already committed and with bronze and silver awards under its belt. The work involved is considerable – approximately equivalent to a major grant application – but the response so far has been positive, and departments have both supported and competed with each other to meet the deadlines set. To fail to get an award would be detrimental to the needs of others, and the target is silver for all departments by the 2015 round of NIHR applications. It is particularly important that the process is endorsed at the highest level, within the Departments and Division, so that Athena SWAN appears regularly for discussion, on the agenda of senior meetings. Consultations have yielded opinions on topics ranging from nursery provision and reintegration after maternity leave to representation and decision-making. At Oxford, after the most recent round of awards, two departments have been awarded silver, and ten bronze, with nine units due to make an application in the next round. Each department derives its own action plan with objectives that are measurable and dated, and so progress can be monitored. A bronze award shows that the department has identified key areas for improvement and that their action plan is appropriate. Progression to silver entails both some implementation of the plan and showing that things have improved as a result. Dame Sally Davies is the first woman CMO of England. Asked what she has brought to the role, she cites ‘emotional intelligence’, and says being encouraged to try new things was a great enabler in her career so that when faced with opportunities she’d ‘hold my nose and jump right in’. She has taken risk after risk in her career and found it ‘scary’ at times2. She is also Chief Scientific Adviser for the Department of Health and in 2006, developed the National Institute for Health Research
(NIHR) which now has a budget of £1billion. Each of the UK’s eleven designated NIHR Biomedical Research Centres is awarded funding to support the recurrent costs of patient focused research, determined by the nature of its research activity and the anticipated impact. In 2011, in response to a direct challenge from Dame Sally, the NIHR stated that for future competitive funding applications it does not expect to short-list any NHS/University partnership where the academic partner has not achieved a silver award of the Athena SWAN Charter3.
What can MWF members do in support of this important initiative? Clinical academics can actively participate and identify areas for action within their own ambit. They can express a positive interest at all levels and ask questions of their academic colleagues and institutional leaders to ensure that Athena SWAN is kept high on the agenda and that progress is made. All members can network with others to emphasise the importance of this opportunity, and to support the work involved. They can ask to be updated with progress and they can help celebrate gains, for both men and women. Departmental heads at Oxford University, after a year of effort, have given a positive to very positive response, finding the scheme has revealed much about the working relationships and views of colleagues, both men and women. Relatively small yet important steps have already begun to make a big difference. Such steps have included considering the gender balance of invited speakers and of images on the departmental website, the timings of meetings within family-friendly hours, balanced work allocation and the transparency of appointments. There is much still to be done, but this is an impressive start. The challenge now will be to keep up the momentum, especially with those slower to engage in the early stages. This is a major opportunity to make some fundamental changes which will improve the quality of working life of men as well as women, at all levels of an academic career. It will also in the longer term benefit the whole population, reliant on the outcome of bio-medical research, and it is a marvellous opportunity to engage more with areas of particular importance for women’s health. The next two years could be an important turning point, in many respects.
References 1. Athena SWAN website October 2013, www.athenaswan.org.uk/content/charter 2. King’s College London website October 2013, www.kcl.ac.uk/iop/news/records/2013/ March/Inspiring-Women.aspx 3. NIHR website October 2013, www.nihr.ac.uk/infrastructure/Pages/infrastructure_ biomedical_research_units.aspx
THIS ISSUE’S CONVERSATION:
In January a prominent surgeon, Professor J Meirion Thomas wrote an article in the Daily Mail titled:
“Why having so many women doctors is hurting the NHS: A provocative but powerful argument from a leading surgeon.” The medical community was aggravated by it and a number of responses were made. Below is the MWF response, followed by a response by Medical Woman Editor Sara Khan that was published in the GP news website Pulse (www.pulsetoday.co.uk)
The Medical Women’s Federation Response:
e are astounded by the article written by Prof Meirion Thomas in the Daily Mail entitled “Why having so many women doctors is hurting the NHS: A provocative but powerful argument from a leading surgeon”. It is unfortunate that such a prominent surgeon continues to propagate such a backward view in the 21st Century. It is well recognised that having women as part of the mainstream workforce is key to the success of organisations. Organisations that recognise this and provide the flexibility in their workforce plans to ensure that they keep this talent pool are those that are successful. Prof Meirion Thomas is right that female doctors do take time out to have babies and some opt to work part-time. Women should not be penalised for this, just as men (including him) are not penalised for opting to go into private practice or pursue managerial posts which reduce their clinical commitments. It is well recognised that female doctors are more caring and have fewer complaints than their male colleagues. Women in hospital medicine have to pull their weight just like their male colleagues; however it is impossible to give continued care to patients with the EWTD in place both in primary and secondary care. However, there are systems in place to ensure patient safety and good standards of care which need continued improvement. We need to continue to identify new and innovative ways to improve this system, rather than have such a negative approach as portrayed by Prof Thomas. The changes in the medical workforce have been recognised for a long time, however creative solutions are needed and it is important for women to take up leadership roles and the Medical Women’s Federation strives for this by encouraging
women to “lean in” to these roles by giving support and mentorship. It is unfortunate that Prof Thomas is part of a (decreasing) group of men in senior leadership positions who to date have not had the ability to look forward and work with women to provide the solutions required. Prof Meirion Thomas’ concern about General Practitioners training is unfounded and shows a lack of an ability to work as a member of a wider team of the NHS and sadly shows a lack of respect to other professionals. His concern about lack of integration of primary and secondary care is also out of touch with the new clinical commissioning groups having secondary care doctors on their boards. Women who chose to study Medicine gain their places on merit, Research supported by MWF has identified that doctors choose their specialty based often on role models who they have worked with. It is important for our present (mainly male) medical leaders to ensure that they are respected as role models so that there is recruitment of these highly intelligent women into those specialties that Prof Thomas has shown have a low level of interest by women. Most women are more committed to NHS work and not private work and hence give more back to the NHS. What women need to stay in the medical workforce is good role models, creative support from the Royal Colleges and the NHS to enable them to progress in their careers and if they wish to carry out their family commitments, to have the career flexibility to do so. The Medical Women’s Federation seeks to ensure that support is available at all levels of training for women in the medical profession and to enable women to achieve their desired outcomes.
Medical Woman | Spring 2014 2013
Debate The following response was originally printed on pulsetoday.co.uk on 13/1/14:
Women GPs aren’t hurting the NHS – but old-fashioned views continue to undermine our contribution
rofessor Meirion Thomas’s diatribe against female colleagues shows some parts of the profession still need convincing that women doctors can work just as well as men, argues Dr Sara Khan Last week there was uproar in some parts of the medical profession, after the prominent surgeon Professor J Meirion Thomas wrote an article in the Daily Mail titled, ‘Why having so many women doctors is hurting the NHS: A provocative but powerful argument from a leading surgeon’. He described the feminisation of the medical workforce, arguing that it was having a ‘negative effect’ on the NHS and claiming that ‘most female doctors end up working part-time – usually in general practice – and then retire early’. In the same breath he claimed he was a feminist. When I read Professor Thomas’s article, I can’t deny I felt outraged. I’m currently on maternity leave, and when you spend all day with a nine-week old baby you have a lot of thinking time. I felt disappointed that a professor from my alma mater, Imperial College, appeared to be so out of touch and yet felt confident enough to voice his old-fashioned views in a well-known newspaper. It is demoralizing to think that there could be many doctors with a similar lack of understanding of the changing culture and the efforts to achieve equality – and I wonder what the patients who read his opinions think? ‘In general practice, part-time working and job-sharing have an effect on patients,’ he wrote. ‘They can deprive them of continuity of care, which is the service they most value.’ Professor Meirion Thomas is right, of course, that female doctors do take time out to have babies and some opt to work part-time. However, women should not be penalised for this, just as men are not penalised for opting to go into private practice or for pursuing managerial posts, which likewise reduce their clinical commitments. The last time I checked, it’s only women who can have babies! I work parttime with respect to my clinical sessions (six a week), but combining this with my management responsibilities as a partner, as well as my work within medico-politics and commissioning, is extremely demanding. If I did more than this, I would burn out. With European Working Time Directives in place it is impossible to provide absolute continuity of care to patients both in primary and secondary care.
“Please can we remember: it is 2014. The female of the species isn’t going anywhere.”
However, there are systems in place to ensure patient safety and good standards of care, and these are always being improved and refined. My patients feel they get continuity of care and, while I will take six months out this year to have my first child and look after him, I hope they are satisfied with the locum I have employed to temporarily take my place. I don’t feel I am short-changing the NHS if I take 12-18 months maternity leave over a 40-year career. It is well recognized that having women as part of the mainstream workforce is a key to the success of organisations. Those that provide flexibility in their workforce planning retain the talent pool of women and reap the benefits. The changes in the medical workforce that Professor Meirion Thomas describes have been recognised for a long time, and creative solutions are needed. He suggests that we need to persuade women to ‘lean in’, using Sheryl Sandberg’s phrase, but the MWF and countless other organisations have already been supporting women to do this for years.
A change in culture Professor Thomas’s concerns about the cost effectiveness of training women to work as GPs suggests a lack of ability to work as a member of a wider team of the NHS and sadly shows a lack of respect to fellow healthcare professionals. Given that the NHS is currently under attack as evidenced almost daily in the British media, it would be nice to see some solidarity rather than such negative views. I’m pleased to be a member of the Medical Women’s Federation, which seeks to ensure that support is available at all levels of training for women in the medical profession and to enable women to achieve their desired outcomes and overcome any obstacles. It is vital we support women doctors so that their potential is fulfilled. We know there is evidence of a lack of women at senior levels, and Professor Thomas has clearly shown that we need a change in culture so that there is diversity across specialties and within leadership. Please can we remember: it is 2014. The female of the species isn’t going anywhere.
How I got here
How I Got Here DAME CAROL BLACK Dame Carol Black is Principal of Newnham College Cambridge, Adviser on Work and Health at the Department of Health, England, Chair of the Nuffield Trust, and Chair of the Governance Board, Centre for Workforce Intelligence. Interview by Rezwana Akhtar, year 13 at Tower Hamlets College, East London. Rezwana has applied for Medical School this coming year. Why did you choose to study medicine and become a doctor?
I came to medicine late I was almost 26 when I started first MB. I had a history degree and a qualification in medical social work. I wanted to work more with people and I just thought medicine was a really good people subject. I shared a room at university with a medical student when I was doing my history degree and that must have influenced me. So was it a big jump from history to science?
It was a huge jump and it was very difficult. Also at that time, British universities did something called first MB where you could do an equivalent of you’re A-Level at university in a year and so I got a place to do that. Of course if you didn’t pass that you couldn’t go on to second MB. And, so, that’s how I got into Medicine. What do you think is the one thing you can get from medicine that you cannot from any other profession?
I’m not sure that that’s a good question because whatever I would have done, there would’ve been things I would’ve got from that and I don’t think there is just one thing you can get from Medicine. When I was a clinician, I obviously thoroughly enjoyed and got a huge amount from patient interaction. When I was a medical director, it was quite different, I got a huge amount from planning services. Research gave me something different. I don’t actually think any way there’s one thing in medicine and I don’t think it wouldn’t matter whatever you did, there would be something very special about it. What do you think are the most important qualities a good doctor should possess, and do you think that has changed over time?
No, I think it’s what patients want of doctors, which is the most important question to ask. They want to be able to trust you. They want to be respected. They don’t want to be talked down to. I don’t think those sorts of things have changed at all. I think what has probably changed is that Medicine is no longer so hidden from the public, it’s much more transparent and accountable. Patients ask many more questions, they are 20
more demanding. So I think some things have changed. But it’s all about your professionalism and integrity, I don’t think that has changed. How do you think it’s become more transparent?
Because organisations have demanded that of us. I think because of technology such as the internet, information is much more available. So, in a way, it had to become more transparent. You can go on the internet and find a huge amount about anything now. And so, Medicine has become much more open than it was many years ago. Who is the most memorable person you have worked with and why?
I think for me it goes a long way back. A woman called Marjorie Tate. She was the warden of the hall of residence I lived in, in Bristol while I was a History undergraduate. And then when I did Medicine, she was one of the wisest, the most supportive women I’ve ever met. But equally quite firm. Hugely stable and supportive. She’s the woman who I think of still, even though it was many years ago. Why did you choose to specialise in rheumatology?
Well, rheumatology chose me, I didn’t really choose it. I wanted to be a liver doctor. And I was a houseman doing the Professor of Medicine’s house job. I said to him I wanted to do liver medicine and he said “you can’t do liver medicine, you can’t do gastroenterology Carol It’s too full, there are too many people doing it”. And in those days you often waited as a senior registrar for 10 or 12 years to get a job. It was awful. I was trying to get a consultant job. He said “Go away and you can come back and discuss your career with me when you’ve found a part of medicine that isn’t full, and because you’re 8 or 9 years older than everybody else, because you started medicine late, you need to find a specialty where you can move to the top quickly.” And so I found rheumatology. So rheumatology was not that advanced then?
Well, the subject wasn’t popular, so it wasn’t over full. That was its great attraction. And indeed the things that have made Medical Woman | Spring 2014
How I got here
rheumatology much more attractive was the developments in radiology and the developments in immunology and therapy. Those have given it a much more interesting edge and some very good research to do. Do you still have clinical commitments?
No, I don’t. Now I am the Principle of Newnham College, Cambridge, I do expert advising to the Department of Health, England and I Chair the Nuffield Trust. What has been most challenging in your career?
I think probably the two really challenging times were when I had to change from History to Medicine. That was hugely challenging, but also, when I was finishing at the Royal College of Physicians as President and I got the job as National Director for Health and Work. I mean, I was not an occupational health doctor, I knew nothing about the business and I had to acquire a whole new lot of skills and knowledge. How did you move into leadership positions, and is it something you aimed to do or is it something you fell into? (i.e When did your role change from following to leading?)
I wasn’t planning to, I didn’t go into Medicine thinking, one I want to look after a very rare disease like scleroderma and build up a national service for it. I never thought I’d be a medical director until somebody suggested it to me and said you’d be a very good one, we’d like you to do it. I would never have put my name forward. I would never have put my name forward for the Council of the Royal College of Physicians had somebody not suggested it to me and subsequently for Clinical Vice President and then President. In a way, I thought these things were good ideas when people discussed them with me, but they weren’t on my list of things to do. But each time I did something, it showed me I did know about leadership, I could be a leader. It made me more confident to have a go at the next thing. When I became National Director for Health and Work, even though I didn’t know much, I thought I had enough skills to make it work. You were the 2nd ever female President of the Royal College of Physicians. What barriers did you meet and do you think this has changed in recent years?
Well of course, it was quite a male dominated environment. It had to be. Men were most committed, they chaired most things. So I guess I felt, perhaps it wasn’t true that I needed to prove that I could do it. That I could be good at it. That a woman could do the job so easily, well at least, do the job as well as a man. And that it didn’t matter whether you were male or female. So I suppose it was really showing that I could Chair the Council, that I could do all the things that needed doing in the College. That I could meet the judgements and do it well. Once I’d got into the job, I sort of felt that people forgot I was a woman. They looked at me as the President of the College of Physicians. And I imagine now there’s so many more women on Council. It feels quite different when you go in there. www.medicalwomensfederation.org.uk
I believe if you want good quality healthcare, you have to look after your staff just like if you want to build a Rolls Royce engine, you have to look after the people who build it for you. And although everybody says, “Our staff are our greatest asset,” I believe we have a long way to go in the Health Service, before we value everyone. In February 2013, you were listed as one of the 100 most powerful women. If you could change one thing in medicine right now, what would it be?
It would be the care we take of the health and wellbeing of the staff who run the NHS.I believe if you want good quality healthcare, you have to look after your staff just like if you want to build a Rolls Royce engine, you have to look after the people who build it for you. And although everybody says, “Our staff are our greatest asset,” I believe we have a long way to go in the Health Service, before we value everyone – the porter, the cleaner, the technician, the person who cooks the meals, the manager, the nurse, the doctor. And I think if I could change one thing, I’d start with the people who do the work. And do you think there is any particular aspect that is lacking at the moment?
One of the first things I’d turn my attention to is ensuring anyone who manages anyone in the health service, whether they’re clinically qualified or a manager who has qualified without a clinical qualification – I would have all of them trained and educated in people relationships and management. I’d have them understand what makes for good staff engagement, what helps people’s positive mental health and I’d think we’d have a much better health service. What do you consider your biggest achievement?
From each part of my life I would pick one. If you took my clinical career, I would say my biggest achievement there was to improve the care quality and to a certain extent the mortality 21
How I got here of patients with the rare and horrid disease, scleroderma. I was able, over 25 years, to actually work with a lot of very good colleagues to set up a service for a rare disease. In the Royal College of Physicians, I would say the work I produced on medical professionalism because it has been quoted and used and built on by so many people. So, I’m really proud, I suppose is the right word, and pleased with the work I was able to do. I had the pleasure of working with some fantastic teams to do that. You mentioned scleroderma as a rare disease you have specialised in, can I ask why you chose to learn about that particular disease in such great detail?
Early on in my career, I looked after a young woman of 26 who came in with scleroderma. And when I asked my boss, as I’d never seen it, how do we treat it, what could we do, he said, there’s nothing that can be done, she’ll be dead in three weeks. And I couldn’t believe it, here was the Professor of Medicine telling me there is nothing we can do. And then I asked if he knew anything about scleroderma and he said that nobody knows much about it and it’s such a complex disease, so nobody really wants to look after it. So I thought right, here we are. Just out of interest, has anything improved regarding scleroderma?
Oh yes, definitely. We can diagnose the disease very early. We don’t stop it completely, but we certainly can slow it down. Which is a great deal. Why do you think you have been so successful? I think I’m adaptable and flexible in the way I approach people and I like to be collaborative. I think all of that helps when you’re trying to get used to doing things. If you’re going to be a leader, you’ll get people who will follow you, you can’t do it all yourself. So you need to understand how to make people work together and want to do things that they don’t necessarily think they wanted to do. You have to be able to really spend time talking to people, getting them into the right place. I think I’m very resilient and I think that matters hugely. I don’t give in very easily, and I think I work very hard. I think that’s some of the things and I’ve been very fortunate in the people who helped me. So I think it’s been a mixture of things. What obstacles have you faced along the way?
Oh, people who want the status quo. People who don’t wish to change. Dinosaurs. Really the biggest obstacles have not been structural. They’ve been, definitely, people. To change their minds, not to dig their heels in. Occasionally, it might have been a financial obstacle, but mostly, it’s been human beings. Do you feel you have maintained a good work-life balance alongside your many achievements; and if so what are your top tips for maintaining work/ life balance?
I never call it work/life and I dislike those words, I call it work/ home, because work is part of life. Well, there would be lots of people who’d tell you I’m a workaholic. I’ve loved every bit of work that I have done. But I also do lots of nice things and go 22
to the theatre and go to the shops, go for long walks. Unlike the last weekend when I had to work all weekend. So I would say its variable depending on the demands of my time. If you were thinking of applying to medical school now, would you and why/why not?
Well I would. I think medicine has gotten far more exciting. I wish I were a medical student now. When I trained, there was only an X-Ray and an ultrasound. The number of tests we had, the number of branches of medicine I could have gone into, were much more defined and limited. I couldn’t have carved out a career for myself, let’s say in medical ethics or clinical management or some of the sub-specialties that are now there. Why would I not do it? Five things you need to become a successful leader within medicine:
Firstly, I think leadership qualities aren’t defined to medicine. 1. I think if you’re going to lead in anything, you need to know you’re subject matter. I don’t think people will follow you, work with you, look up to you if you are not highly competent in the thing you’re trying to lead in. 2. I think you have to be able to listen to people. If you can’t listen to people it would be very hard to be a sustainable leader. 3. You’ve got to be able to build trust. None of us will follow anybody we don’t trust. 4. I think you’ve got to be able to take the bad things with the good. There will be times when it feels awful. There will be people who will try and put you down or try to harm you. You’ve got to be really resilient. 5. Personally, I don’t think everyone will say this, but you’ve really got to have a sense of humour. But I don’t think any of these things are peculiar to medicine. Do you have any regrets?
No. Well, actually, I regret that I didn’t do medicine as my first degree, sometimes. Do you use any of the skills you gained from your history degree within medicine?
Well, yes and I now love history, I hated it when I read it. I hated it. Why did you choose to do history if you hated it so much?
When I was at grammar school I had a crush on the history master. Yes, he was wonderful. I went in to history thinking he wasn’t married at the time, even better! But he married the domestic science teacher. Much to my grave disappointment. What I really liked was Mr Morton, not the subject. So I chose to do history, and I’d always done very well at it at school. When I got to University, I think it would’ve been alright, had it been about people. Because I think people change the world. And it was very much about constitutions and battles and I lost my way very quickly. And I disliked my tutor. So I played around, became President of the Student Union and did all the things you shouldn’t do. Although it gave me an experience of life. Medical Woman | Spring 2014
THE VERY IMPORTANT LADY DOCTOR Dr Karen O’Reilly, GP & VTS Programme Director, Hampshire
Oh dear I’m so important to all and sundry, patients dear They need me every moment to consult and to be near. My Partners need me too, to have a laugh and have a groan Receptionists to give advice, to sign a script and take the phone. The manager is seeking me to sign a cheque and fill a form. The Midwife wants to tell me more how little Frank was born. The Health Visitor is waiting to tell of Frank’s poor mother more A really squalid bedsit and a high depression score. The cleaner wants me now as she really must get in To hoover up the floor and empty out the bin. The Practice Nurse is waiting quietly in the wings “Please take blood from Mr Smith and check a few small things” The District Nurse is sighing “have I not seen Mabel yet?” “Her blisters have all burst and the bed is soaking wet!” Now the Chemist’s on the line with a query on a script. I feel as if my brain into treacle has been dipped. The Secretary’s waiting she can’t understand my tape. “I really must be clearer when my letters I dictate.” On line 2 waits Social Services with an urgent “if I will?” Please come now and see Jack Rogers at his house with the Old Bill. They’re there to try and help as poor Jacks gone quite A.W.O.L. They’re worried if they leave him he’ll be as risk and hence the call. They think I must assess him now; a section 3 might be required. Has anybody noticed… the doctors getting tired. Thirty coffees later, several smiles and several groans A very tired doctor will make her own way home. And there at home she’ll find four men await her too But with love and understanding to help her make it through The sadness and the upsets that her fellow humans bring To her as “their doctor” be they patient, foe or friend. And so the day is over, just one day in one long life, The doctor turns to mother then to cleaner, cook and wife. And she wonders if each day if one human heart she’s touched, Then all the aggravations will have been worth so very much. www.medicalwomensfederation.org.uk
Tools to manage stress for female doctors Dr Fleur Appleby-Deen, drfleur.co.uk, Co-Founder- Healing Doctors, London You have probably read many articles about stress during the course of your career as a doctor. Maybe you take them seriously; maybe they do not inspire you. Suggestions such as taking breaks, trying to get a walk in at lunchtime and minimising caffeine are all important, effective methods to help manage the stress response. However, as a female doctor, stress is an increasing problem and requires more specific stress management.
s women we have clearly shown that we are every bit as capable as men in the workplace. What many of us have lost however is the power that dwells within our feminine essence. Our emotions, intuition, empathy and ability to relate to others are some of our greatest assets as doctors, yet we are likely to bury such skills in the following of such masculine structures like guidelines and protocols. Of course such structures are necessary, helpful and essential for safety, but we could become even better as doctors if we allow ourselves to harness those more feminine qualities too. After all, being a doctor is not just about Science, it’s about people. As women, we understand people. We have far more mirror neurones than our male counterparts, which allow us to tap into the feelings of our patients with greater ease. That’s a serious advantage that we are not allowing, not trusting and brushing off as ‘unprofessional’. Furthermore, I think that denying these qualities within ourselves makes women more prone to burning out, because we our not living an authentic expression of who we are. Before I started to help people with burnout, I used to work in hospital medicine. After 3 solid weeks in A&E I developed an unknown illness, which was eventually diagnosed as Chronic Fatigue Syndrome or ME/CFS. This condition, whilst not fully understood yet, is characterised by a maladaptive stress response. I have since recovered and become a bit obsessive about stress, its effects and prevention. So trust me when I say these suggestions are powerful and essential if you want to have a good life and not end up as a dried up, burnt out bit of your former self. 1. BREATHE – Obviously you breathe all the time, but conscious breathing, as we practice in yoga, is a whole new ball game. Inhaling stimulates the sympathetic nervous system, while exhaling stimulates the parasympathetic. Try taking 10 deep breaths into your belly now (actually do it), making your exhales double the length of your inhales. This directly lowers your heart rate and blood pressure. You will also feel calmer because conscious breathing keeps your awareness in the present moment, not in the future or the past. 24
2. EAT AND DRINK – This may be obvious, but how often do we skip lunch and drink coffee when our bodies really want hydration through water? Have some protein rich snacks like nuts and a bottle of water on you and make sure you eat every 3-4 hours, especially on a long shift. Being too busy to eat makes you much more likely to have problems later on. Find the time to prioritise the health of your body and brain so you can do a great job for your patients who trust you. 3. RESPECT YOUR CYCLE – Now I know we aren’t meant to let ‘women’s problems’ get in the way of our ability to excel in the workplace, but how many of us feel the heaviness and chaos of our hormones affecting our work? Maybe we berate ourselves for such inconvenience and consider it acceptable to dose up on analgesia and override our exhaustion, but there is the potential to do ourselves some harm here. We are likely to be less kind to the people we work with and for and we lose the potential to take the opportunity to reflect and go inwards. We are not men; we are not the same every day of the month (and yes our partners and male colleagues are certainly aware of this!). Whilst I don’t suggest you skip work on such days, you can make the choice to slow down, ask a bit less from yourself and try to carve out some opportunity to lie down when possible, close your eyes and show yourself the kind of love and nurturing you would show your patients. 4. STRETCH – The stress response involves blood flow increasing to muscles, but we rarely fight or run these days in response to our physiological mechanism. So our muscles get tense and tight, resulting in bad posture and pain, often in the lower back and shoulders. As a Yogi I obviously would advise everyone to get to around 3-4 yoga classes a week, but there are some stretches you can do easily in a corner of the ward or in your surgery. Neck rolls – slowly roll head a few times in each direction. Shoulder rolls – circle shoulders backwards, then put fingertips on shoulders and circle elbows, and then make big circles with the whole arm. Medical Woman | Spring 2014
Chest stretch – interlace fingers behind you and squeeze shoulder blades together, then interlock fingers in front of you and stretch between shoulder blades. Forward fold – with bent knees fold your torso over your legs and hold onto your elbows for 5-10 deep breaths, releasing your neck as you do. Shoulder opener – reach arms overhead, interlock fingers and push palms up to ceiling for a few breaths, then reach over to each side, stretching the waist and the poor squished up psoas. 5. MEDITATE – No longer just for hippies, meditation and mindfulness are gathering huge popularity as people realize what a difference it makes. There is evidence that those who meditate regularly feel calmer, clearer, happier than they did before. It also increases productivity and efficiency. Brain too busy? That’s exactly why you need it. Sit still and close your eyes. Take 10 deep breaths. Let your awareness settle on the centre of your chest or your navel. Just sit and observe. Your mind will probably kick off and you will realise how many thoughts are whizzing around. Just watch the thoughts, and name them ‘thought’ as you watch. Twenty minutes a day is amazing, but even 2 minutes will help when done regularly. 6. DEVELOP YOUR INTUITION – You may dismiss intuition as nonsense. If you do, please skip this section. If you know deep down that you have a sense of intuition, practice using it. Follow hunches; ask the questions that pop into your head even if they seem weird. As a woman you can do amazing things with this ability to sense and it gets stronger the more you listen to it.
7. DARE TO DREAM – Remember how you felt when you got into medical school and a whole world of possibility opened up before you? It felt amazing. That part of you is still in there, longing to make a difference to people who need you. So maybe you have lost a bit of that fire amongst the exhaustion, exams and audits, but it’s still there. Studies show people who are committed to some greater purpose are much more resilient than those who don’t. Being a doctor is not just a job, it’s a calling. Find a way to reconnect to that mission of yours and burnout will ease its way out. 8. FEEL YOUR FEELINGS – In the West we are very good at talking about our feelings but not so good at actually feeling them. When you next feel afraid, angry, sad or overwhelmed (which may well be every day), take a pause and breathe deeply. Try to really experience what you are feeling in your body and respond with a loving thought like ‘It’s ok for me to feel this. I am safe. I am ok. I completely accept myself as I am’. Allow the feelings to pass through you. Repressing emotions in the long term leads to depression and anxiety. Feel your feelings now and you will be far healthier for it. 9. AFFIRMATIONS – The thoughts we tell ourselves have a powerful effect on our nervous system. Let go of expressions like ‘I can’t’ and ‘I should’ and replace them with simple messages that empower you like ‘I am good enough’, ‘I can do this’, and ‘I trust myself’. Don’t wait until things start overwhelming you, which they inevitably will. Learn how to communicate with your body and actually take care of it. Then it will take care of you and you can be the kind of doctor you always wanted to be.
Amongst the highest maternal and child mortality rates worldwide: working in
SIERRA LEONE Dr Sian Cooper, Post Foundation Programme, North Central Thames deanery www.freedomfromfistula.org.uk
natural break in medical training comes between completion of the foundation programme and commencing specialist training. It presents an excellent opportunity to take time to consider specialty choices, experience other cultures and see the world. As medical professionals, we are in a privileged position of being able to work anywhere in the world. In addition, our skills are much appreciated in low-resource settings, not just clinically but also to capacity-build and help train host nationals. I wanted to work in the developing world as it would give me an opportunity to develop my knowledge and skills and broaden my clinical experience. Organising my trip was straightforward. A friend suggested I should consider Sierra Leone. My initial rebuff contained references to the film ‘Blood Diamond’, civil unrest and a dubious safety profile. However, further research opened my prejudiced mind to applying for a job there. After a Skype interview, it was down to the practicalities of organising comprehensive insurance and vaccinations. Luckily, the organisation I was going to work for proved to be very efficient, and planning for the trip was straightforward. Nestled amongst a backdrop of luscious tropical beauty in a country still feeling the effects of a civil war that ended more than 10 years ago, Aberdeen Women’s Centre (AWC) is a centre of excellence providing healthcare for the poorest women and children in Freetown. In a country recently named the third most dangerous country for a child to be born in and for a mother to live, the Centre strives to reach the underprivileged. Led by a formidable mixture of international and national staff, its tripartite services include maternity, family planning, and a paediatric clinic. Perhaps its greatest accolade is the comprehensive obstetric fistula care. Maternity services are reserved for the poorest women. Antenatal care comprises screening, education and safe delivery in the labour ward. I had my work cut out. The children’s’ outpatient clinic treats over 1000 children per month. A dedicated and tireless team of Sierra Leonean nurses face Africa’s biggest killers, such as malaria, typhoid, pneumonia, diarrhoea and vomiting. The work is emotionally taxing. In a typical morning, I saw a boy with 30% partial thickness burns from an open fire, a crying mother wanting to know if there was anything to do for her post-meningitis brain damaged child, a child so malnourished, it was too weak to cry, and Burkitt’s lymphoma amongst the ubiquitous malaria cases. The inevitable sadness of working 26
Medical Woman | Spring 2014
“Fear of the unknown, fear of change and fear of doing something different nearly prevented me applying for this job. ”
in a resource-poor setting, however, is tempered with the joy of helping the most desperate and poor children, and seeing the majority get better after simple interventions. Our feeding programme transforms wasted, lethargic children into bouncing and playful kids. Coupled with maternal education, it’s one of our most successful interventions. Gentle but persistent education of one mother convinced her to feed her child, who she believed was a chameleon. Such cultural beliefs run deep. Lastly, running outreach clinics in the slums amongst the shacks, litter and wandering hogs will be hard to beat in terms of job satisfaction. The fistula centre is famed and draws patients from across West Africa. A typical natural history of fistula is described in Catherin Hamlin’s book. A young girl grows up in the provinces. She is married off young and becomes pregnant. Her body is not mature enough to safely deliver without help. However, tradition combined with prohibitive fees in hospital mean that she will attempt to deliver at home. Her labour may stretch on for days until the baby finally dies, leaving permanent damage to the girl’s pelvis.Because of the injury, she will continuously leak urine or faeces, and will be rejected by her family and husband. Picked up by the AWC outreach team, members of her community will often know of this woman begging or living alone in destitution. Bedraggled, malnourished and weak, these girls are treated like outcasts by society. Despite legal restrictions on minimum marriageable age, it is culturally accepted that some girls are groomed by older men and married off as young as 13. One patient was brought in by a relative who took pity after she had been tied, crouching, into a hessian sack and left in a corner to soak in her own urine and faeces for 18 months. Obstetric fistulae are the cause of the majority of the injuries; however some are also caused by sexual trauma. After admission, the women are given a bed, food and washing facilities to begin the process of recovery. At the AWC, both staff and patients share from the same cooking pot. However, the recovery process is not just physical. Counsellors onsite spend time tending to the psychological trauma these women have suffered. They are taught practical skills and learn how to make items to sell. Under the watchful eye of the ward matrons, by living, working and eating together, the women gain the social support and acceptance that they had been denied. The women sit in the courtyard and watch as their sisters walk into the pre-operative room ready to start a new life. Each patient’s stay culminates in a weekly ‘gladi gladi’ ceremony. She is given new, clean, colourful clothes and leads thanksgiving singing and a dancing procession. The sisterhood celebrate with an www.medicalwomensfederation.org.uk
exuberant dance to the beat of African drums. Even the women who limp from footdrop can usually stand to join and dance with unfettered joy. The woman is now given another chance at life as she goes out into the community. She has new, clean clothes and a sense of worth and dignity. But she is given responsibility too; she is an ambassador for the good work of the AWC and it is her right and duty to spread the word and find her sisters whose lives too could be changed for the better. Fear of the unknown, fear of change and fear of doing something different nearly prevented me applying for this job. However, the satisfaction of using your medical training to make a difference to the poorest members of a developing country is worth that initial step. Whether you’re feeling the burnout of the NHS treadmill, or looking for your next challenge, I couldn’t recommend working in a resource-poor country more highly to re-light the fire of why you went into medicine in the first place. 27
Whistleblowing Dr Kim Holt, Consultant Paediatrician and Founder of Patients First www.patientsfirst.org.uk @PatientsFirstUK
Has the issue of whistleblowing been solved following the Francis report? Sadly the answer has to be no. All of the cases that I am aware of which have been reported, have ended in trouble for the whistleblower. Rather than look into the concern, the individual is ignored, brushed aside or targeted in some format to ensure their silence. It is not the raising concerns itself that is the issue, it’s the response. When I was preparing to write this piece I hoped that one year after the publication of the Francis report1 I could be optimistic and confirm that the system was now safer for health professionals raising concerns. But, as I write this, a number of cases are battling their way through legal processes that are not designed to hear patient safety concerns, including recent attempts in Scotland to gag a Consultant Psychiatrist. For those who are still slightly mystified about gagging clauses, a report was issued only last week2 confirming that there has been misuse of public money in some cases, including mine (page 9) to suppress information related to patient safety. After so many years of being treated as a troublemaker it is very heartening to have senior politicians voice their anger about the lack of oversight from the Treasury in this regard. In 2013 David Johnstone and I proposed a truth and reconciliation commission to examine past cases of whistleblowing3, to allow an opening up of this matter and to enable the harm that has been caused to both individual whistleblowers and patients and families to start to heal. It would require a willingness to listen and learn from mistakes, and possibly reinstating some health professionals. Until this happens, many of us don’t think that real learning will have taken place and it may still be unsafe for health professionals to persist in raising their concerns. Dr Jane Hamilton, a consultant perinatal psychiatrist, has risked sacking by speaking openly to journalists about attempts by her employer, NHS Lothian, to gag her4. This case is currently sitting with the Cabinet Secretary in Scotland and campaigners call for a public inquiry to ascertain whether investigations into her concerns were fully independent and whether managers have been trying to misrepresent the truth. Unfortunately Patients First hears regularly of this. We have compiled a summary of the types of retribution that can happen to staff entitled; “the lifecycle of the whistleblower”5. Whistleblowing is tied up in employment law because of the Public Interest Disclosure Act (PIDA). In employment disputes where there is some compensation that can be legally offered, the sum is agreed between two sets of lawyers. In cases of unfair dismissal this sum is capped at around 60,000, but in cases proven to be whistleblowing, the sum is uncapped. However, the amount offered depends upon whether an individual is deemed still able to 28
earn etc, so the amount awarded is based upon the loss of earnings, in theory. It is a hard lesson to learn that anybody, however great a surgeon, however caring a nurse, can potentially be paid off, if the lawyers agree a sum. I found this very hard to hear. But the person who signs the agreement is the individual concerned, and a number of us have refused to sign such documents. Only by refusing to capitulate and walk away can we bring patient safety matters into the open and try to get them addressed. One of the challenges for the individual who raises concerns and finds him or herself in trouble is making sense of the situation. We are professionally bound by our codes of practice and, as such, we know that we should raise concerns when resources or systems or even clinical colleagues cause concern and might impact upon patient safety. So when suddenly the organisation turns against us we are surprised, shocked, in denial, distraught, scared, and often are left feeling isolated. Patients First are enabling people in this situation to connect with each other, to share experiences, to learn and understand how whistleblowers feel and what support helps. We are collating real life historic and current case studies to build our evidence for lobbying to MPs and, if necessary, the media. For anyone who is really worried about staffing resources or systems there is some excellent guidance written by Roger Khan and Shazia Khan6 on how to raise professional concerns. This can be downloaded from the Public World website. www.publicworld.org It is possible to navigate the challenges faced by raising concerns, without ending up in trouble. It is important to seek help and advice early on from trusted colleagues or those who have “walked the walk”. As such a growing network of health professionals in Patients First are willing to offer a one off telephone call and signpost to places for support and advice, but we continue to urge caution and document every concern, despite the fact that professionally we should not be suffering as we do with backlash and threats. 1Francis,
R., Final Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013. 2 Accounts, C.o.P., Confidentiality clauses and special severance payments, C.o.P. Accounts, Editor 2014, House of Commons: London. 3Holt, K., & Johnstone, D. Time for truth and reconciliation in the NHS. Health Service Journal 2013 September 19th 2013]; Available from: http://m. hsj.co.uk/5060343.article. 4Ross, D., Doctor risks sack by going public over whistle-blowing, in Herald Scotland2014, Herald newspapers: Scotland. 5First, P. The lifecycle of the whistleblower. 2013 January 26th 2014]; Available from: http://www.patientsfirst.org.uk/?p=775. 6Kline, R. and S. Khan. The Duty of Care of Healthcare Professionals. 2013; Available from: http://www.publicworld.org/projects/duty.
Medical Woman | Spring 2014
BOYS & THEIR TOYS? Miss Joanna Higgins ST6 Trauma and Orthopaedics, Wessex Deanery
Trauma and orthopaedics has historically been labelled a “boys specialty”, requiring strength, muscles and a taste for expensive toys. Although there may be some truth in this, as a female orthopaedic registrar, I believe there is a lot more to the specialty than the stereotypes may suggest.
o let us first dispel the myths: physical strength, in a small number of operations, can be an advantage but is usually overcome by resilience. Contrary to popular belief, brute force is never required, just skill, a little muscle and a degree of finesse. Strength of mind is perhaps more important. A love of toys, expensive or otherwise, is not an unreasonable stereotype; it is an implant and kit heavy specialty and the toys are fun. A good understanding of biomechanics, basic science, engineering and technology is desirable and a significant proportion of our curriculum centres on these. Industry plays an important role in trauma and orthopaedics and simulated application of the implants and kit is used in training. The results of the fixation or implant are immediate and feedback through x-rays can be gained instantly, unlike any other specialty where interventions may take months to have an effect. Quality of life for our patients is hugely improved and their pain dramatically reduced, which is satisfying for all involved in their care. Trauma and orthopaedics can be exciting and fun, yet at times very demanding. The surgeon needs a toolbox of personal attributes to deal with the different situations often faced, both from patients and staff. The patients cover a huge range of demographics, from the schoolgirl with a monkey-bar related forearm fracture, to the deaf elderly gentleman with painful, longstanding osteoarthritis of the hip. It certainly keeps us on our toes; every patient is different, whether trauma or elective, and each have a story to tell. To be part of that story can be humbling and the often sensitive and varied nature of treating these patients is of great importance and should never be undervalued. I think this is generally done well in orthopaedics and unfortunately is not often recognised as a feature of the specialty, or those working within it, yet it certainly should be. The team within which the trauma and orthopaedic surgeon works is incredibly diverse and is perhaps unlike any other department. It is truly multidisciplinary and close working relationships are often formed with all members of the team. Highly stressful events, patients and staff who test our human emotions regularly, light hearted situations and run-of-the-mill days all combine to ensure that our personalities are continually challenged and moulded. As a doctor, there surely is nothing more attractive than a varied specialty with the chance to meet many different and colourful characters, to reduce pain and improve quality of life, to be tested to our limits, challenged by technology, and build a career which rewards our individuality. So, now that you want to be an orthopaedic surgeon, how do you do it?
Application to orthopaedic training posts has always been competitive. In 2011, 102 posts were available in England, of which 94 were filled. The competition ratio was 7:11, and unpublished figures for 2012/13 were comparable. Currently recruitment is national with ranking based on person specifications. From core training programmes or otherwise, the appointment to an ST3 post is based on a number of factors – there is an application form with scoring system, points attributed for criteria such as prizes and presentations, publications and audit, teaching experience, courses, outside achievements and operative numbers2. Through shortlisting, the candidate is invited to an interview. The format often comprises a portfolio station, clinical scenarios and communication skills. Technical skills were introduced in 2013 as a pilot station and validity assessments are ongoing. The specialty remains predominantly male, but as the workforce changes, more women are interested, and are pursuing a career in trauma and orthopaedics. In 2009, 4% of consultants in the specialty were female (95 out of 2264). However in my training region alone, the number of female trainees is now at 25%, indicating that perhaps this relationship is changing. Once appointed to a rotation, the training structure involves 6 years (ST3 –ST8) gaining experience through the various subspecialties and participation on a general trauma on-call rota. Both elective and trauma is covered yearly and competency assessed through workplace based assessments with clinical and educational supervisors. An Annual Review of Competency Progression (ARCP) is performed to ensure adequate training, progression, operative exposure and to highlight any deficiencies early. In order to complete training an “exit” exam is required, in the form of the FRCS (Orth), prior to the award of certificate of completion of training (CCT)3. Personally, trauma and orthopaedics is the only specialty I would choose time and time again. It is an exciting, advancing and sociable specialty which suits most personalities and lends itself well to some diversity, in fact, probably needs it. Female trainees add a different dynamic to a department and my experiences have been entirely positive. That is not to say that it is always conflict free and that all female trainees experience the same, but those female doctors with an interest, some resilience and a commitment to a craft specialty should certainly not rule it out when making their career choice. 1http://www.cfwi.org.uk/publications/trauma-and-orthopaedic-surgery-cfwi-
medical-fact-sheet-and-summary-sheet-august-2011/@@publication-detail 2 http://www.boa.ac.uk/Publications/Documents/Proposal%20for%20
The Mummy Diaries
T he Mummy Diaries
Laura Pugh, Medical Student, University of Nottingham
The glass half full approach to being a medical mum…
“I have shown my children that they can do anything, and be anyone, if they work hard.”
hose of you who attended last y e a r ’s Autumn Conference will know that I was lucky enough to have the opportunity to give a presentation. This focussed on some of the attitudes I have encountered from other healthcare professionals to being a medical student with children, and the fact that these attitudes have often been negative, especially when coming from other women, and even other mothers. The conference was a fantastically warm environment for my first, nervous presentation, and I left feeling inspired and encouraged by everyone I spoke to. On the train on the way home, full of all the positivity of the day, I started letting go of some of those negative attitudes I have encountered, and thinking more about what makes being a medical mum such an amazing experience, and how it benefits me, and in turn my future patients, and even my children. I have two boys, age 6 & 8 years old, and two step-children, age 13 and 16. I joined the Graduate Entry Program at Nottingham University at the age of 31 and am now in my final year. When people ask me what prompted me to do medicine at this stage of my life, I jokingly call it a ‘thrisis’ – a turning-30-related crisis about my life. However, in truth, age and motherhood had got me to a point within myself, where I finally had the confidence
to think – ‘Yes, I could actually do this’. As a shy teenager more interested in reading Shakespeare than science, being a doctor never crossed my mind when I was doing A levels, but a lot has changed since then, and when I found myself in a bit of a career wilderness, somehow it seemed the obvious choice. (To me anyway – to others it was perhaps a little less ‘obvious’!). Since I made that decision to apply I have never looked back, it was one of the
two best decisions of my life. The other was to become a mum. And contrary to popular assumption, these two roles do, in my view, combine well. Obviously, if you take a doctor with children, and a doctor who does not have children, they can both be equally good doctors. However, there are many ways I feel being a mum has helped me to be the best doctor that I can be. There are some that are easy to think of – for example, when Medical Woman | Spring 2013
The Mummy Diaries dealing with children in the hospital, I have practice in the communication skills needed. I know what they might be getting up to at school, or what cartoon they are referring to. Also, my experiences helped me a lot during my Obstetrics rotation. But what was going through my mind on the way home from that conference were all the more subtle ways that being a mum has changed me, and how they have impacted on me as a future doctor. • Work/Life Balance – I can honestly say that having children helps rather than hinders when it comes to finding a work/ life balance that I’m happy with. This might seem counter-intuitive, but having children means that 9 times out of 10 when I finish my shift I go straight home. When I get home, there is no question of me working, because the kids are doing what kids do – demanding my time and attention – and rightly so. I switch off from medicine the second I enter the house. The best piece of advice I was given by another student mum when I started was to treat the course like a 9-5 job, and unless exams are looming that is what I do. These means I am… • Focus – Time management is key to being successful, at work and at home. Whether I have classes or not, I get to the hospital between 8-9am and I leave at 5-6pm, and any non-timetabled periods are spent working in the library. I haven’t got the luxury of thinking – I’ll do it tonight instead – and that works for me.
Previously I was a real procrastinator, and would put things off again and again – having children means I can’t do that now. • ‘Mature attitude’ – this is a phrase I hear a lot from tutors when they have to comment on my performance. I like to tell myself this has nothing to do with my age, but is down to the fact that I stay calm in most situations. If motherhood does anything, it makes you realise you can cope with most things life has to throw at you, and that after a really bad day, you can get up and start again, which can be a very useful trait in the hospital environment.
• Non-judgemental – when you have children it can often feel like the whole world is judging you and your parenting skills (and you’re coming off pretty badly). That feeling really stuck with me and made me much less judgemental of others, something very important in being a good doctor. As women, I think we are a pretty judgemental group on the whole, and I am very conscious of tackling that within myself. Reminding myself of times when I have felt judged as a mother helps me to do that every day. These are just a few of the ways that being a parent has impacted on my experience as a medical student. Obviously there are challenges, and I am very lucky to have such a supportive husband and family around me, without whom this would all be extremely difficult (never say impossible!). It’s also important to note that as well as my home life impacting on me as a student doctor, my work has also impacted on the way I view my home life. It becomes very easy to appreciate what you have at home, and just how lucky you are, when working in the hospital environment. I hope that I have shown my children that they can do anything, and be anyone, if they work hard, and that life can take many paths – you don’t have to plan it all out from the age of 16. I also hope that having a happy and fulfilled mum will help them be happy and fulfilled in turn. And really, that’s all anyone wants for their kids.
JOIN US! You can now pay for membership and events on the MWF website! So, what are you waiting for? Pass this magazine onto your friends, family and work colleagues, it’s about time they took advantage of what MWF has to offer. Become a member at: www.medicalwomensfederation.org.uk
WHAT YOU GET FOR YOUR MEMBERSHIP FEES: MEDICAL WOMAN – Our in-house magazine is issued twice a year in both paper and online formats. GRANTS, PRIZES AND BURSARIES – for both Students and Junior Doctors. SUPPORT WITH AWARDS – we are a nominating body for ACCEA and give support with individual applications from women. We also nominate Medical Women for the Women in the City Award and the Woman of Achievement Award. NETWORKING OPPORTUNITIES – we hold small networking events in our local groups and hold 2 national conferences a year.
MWF is a supportive community which will help boost your CV, confidence and career through to retirement!
OBJECTIVE STRUCTURED CLINICAL EXAMINATIONS Brooke Calvert, 4th year Medical Student, UCL Amy Woods, 2nd year Medical Student, St Georges (Student Editors of Medical Woman)
1. Don’t Panic! Take a deep breath, gather your thoughts and think through how you are going to approach the task.
2. Do smile! First impressions are important and if you project a confident and friendly manner you’ll find it easier to relax and you’ll score bonus points with your simulated patients.
3. Practice, practice, practice Practice on your friends, your family and most importantly: on real patients on the wards. Make the most of any bedside teaching to refine your skills and get feedback from doctors on the ward.
4. Don’t neglect your communication skills Practice history taking on the wards and make the most of clerking opportunities in clinics.
5. Leave the last station behind you Everyone will have good stations and bad stations. If one station doesn’t go as well as you’d hoped-draw a line under it and approach the next station afresh.
6. Be prepared Research the skills that your medical school expects you to know each year, make sure you’ve covered all the subjects your University can assess-and don’t miss out any of the more unusual stations such as statistics.
7. Mix it up Utilise different resources so that you can get the most out of them-there are some excellent video resources you can watch such as Macleod’s on You-tube.
8. Invest in a good book It can be very useful to look at example mark sheets and practice role-plays with your peers.
9. Know your strengths and weaknesses Whether it’s dealing with difficult consultations, aseptic technique or an abdominal exam-tackle it head on until you feel more confident.
10 Enjoy it! It certainly makes a change from sitting at a desk studying and you might find yourself having fun in the process.
Medical Woman | Spring 2014
Poetry Junior Doctor Competition 2014
JUNIOR DOCTOR -
THE GAME CHANGER OF THE NHS Ms Mehreen Ahmad, Core Surgical Trainee Year 2 Plastic Surgery, Birmingham Children’s Hospital, Birmingham The floodlights switch on, the crowd jeers, The air is gravid... promising..., And charged with emotion, The noise is lurid, difficult to hear ones thoughts, The doors open and the teams run into the field, It is apparent tonight, like any other night, it will be a good game, Fear, Illness and Disease exchange meaningful looks, Led by their captain, Death, the Challengers are determined, New members have joined their team tonight, Stress, Tiredness and Hounding, The opposing lineup is getting bigger with every play, But the Champions stand strong, With Courage as his Striker and Resolve as the mid fielder, The Junior Doctor knows he must win this one over, Amidst the roars of the troop, a bleep goes off, And the game begins... It is going to be an exhaustive night, The Junior Doctor moves towards the goal, Entwining in and out through the foes, Not letting anyone catch up with him, Weariness tries to drag him down, Ailment surrounds him , Sickness tries to shudder him, But the Junior Doctor fights them all, And makes his way to the goal now, So close to winning, Almost there, When Death halts him, Its an arrest!! Cries of 2222 fill the air, Fear closes in, Dimness tries to enfold him, The junior doctor tussles now, Not able to see the goalpost, Can’t give up now, Can’t lose this one now, The Game is on, He turns around expectantly, Help has arrived and the Junior Doctor makes a pass onto her, Support passes the buck onto the Senior, And the Junior Doctor sees Hope, Senior to Hope, Hope to Junior Doctor, The buck is being passed too fast and too strong for the opponents, ‘Come on Junior Doctor!! Come on! You can do it!!’ Senior cries out Only the Junior Doctor can change the game now, He makes a run for it, Attempts a pass... And it’s a Goal!!!!!!!! The crowd roars!!! The noise is deafening! The Junior Doctor strikes again!! Its a game. One-nil for NHS v opponents, the Champions v Challengers Only until the next bleep goes off...
A medical elective in
The Outer Hebrides Ruth Kirby 4th year graduate Medical Student, Warwick Medical School
take every opportunity to escape to the mountains and search for crags to ascend or secluded tarns to jump in. I relish the freedom of wide, open spaces and would like to combine my passion for wilderness with my medical training. I hoped a medical elective in the Outer Hebrides experiencing remote and rural medicine would allow me to develop my clinical abilities and understand the challenges unique to island medicine. I began with a general practice in Stornoway, the largest town of the archipelago. I had opportunities to practice core clinical skills, such as phlebotomy and childhood immunisations. I took my own clinic on two mornings, which allowed me to develop my professional relationship with patients and to direct consultations as I believed appropriate. Feedback from these sessions highlighted areas for improvement and things to continue developing. I joined two of the practice partners on home visits into remote areas on the east coast of Lewis, where many of the patients speak Gaelic as their first language. I soon got used to walking into people’s homes without knocking and searching rooms in the house until finding the patient (usually in front of a peat fire). I became aware of the strong cultural and religious beliefs of patients living on Lewis. It was important for me to not only respect these views, but to use them in some situations to guide medical management. This developed my attitude towards guidelines, in seeing each patient as a true individual and moulding their treatment around their situation, for example if they had limited family help or wanted to make minimal decisions regarding their illness. The highlight of my time on Lewis was a day spent with the search and rescue team based at Stornoway Airport in the ex-RAF hanger. The team is made up of paramedics, pilots, winch men and a doctor. Seconds after my safety briefing on the helicopter with a paramedic, Simon, a loud siren called signalling that a job had been received: two fallen climbers on Skye. 34
Twenty minutes later as we arrived over a headland on the north coast of Skye, casualties were spotted and the winch man was lowered down to complete the primary survey. We circled high above until he gave us the signal to land and we jumped out with a stretcher to join him. I assisted in the care of the casualties, and following stabilisation we brought them aboard and flew them to the hospital on Skye, where we handed over to A&E staff before flying back to Stornoway. For the last three weeks of my elective, I joined a GP on South Harris, where he has worked independently for the last 24 years. Leverburgh practice is a dispensing practice and serves approximately 580 patients. Home visits make up 40% of all consultations due to an ageing population, but also difficulty in accessing the practice due to the remoteness of some homes. The nearest hospital is at least 90 minutes by ambulance, and it could take 30 minutes for an ambulance to arrive from the nearest base at Tarbet. I learnt how this is crucial in deciding when to send a patient to Stornoway hospital, if it’s appropriate (the bumpy journey could worsen the condition) and when it’s essential to have the patient flown to mainland. During my time on Harris, I built good relationships with patients, both in their homes and at the practice. They presented with the same medical problems as those in urban areas, but the GP may take on more management usually directed by a specialist. A strong example of this is end of life care in terminal cancer patients who would rather stay on Harris in their last few months instead of going to Stornoway or mainland where more specialist care is available. I had the opportunity to train with the Leverburgh lifeboat crew on two occasions and assisted in a rescue mission to save two sheep on a cliff ledge….we failed due to a strong swell but I believe they succeeded a few days later. I believe I saw a snapshot of how general practice used to be; one family doctor treating an entire community. He treats every patient as if they were the first of the day and takes the time to visit patients at any time of the day or night. I believe this experience will change my future career in that I will strive to achieve this level of trust with my patients, and to know each patient individually with a good understanding of their views and preferences. I did not want to leave these beautiful islands and friendly people but hope to return one day... Medical Woman | Spring 2014
A Grandparent’s Survival Guide Sheila Martin and Dr Lis Paice
lot of people have asked me why I wrote a book about grandparenting. That’s interesting, because when I was a postgraduate dean, no-one asked me why I wrote about educating doctors. And when I trained to be a coach, no-one asked why I wrote about that learning journey. Is it that grandparenting is seen as an instinctive role that needs no special preparation? A journey that needs no guide? I used to think that about teaching and about coaching. I’ll admit that I didn’t think seriously about grandparenting until I was asked to take on significant caring responsibilities. I was all ready for babysitting and the odd sleepover, but hadn’t quite digested the fact that these days many mothers go back to work full time and full time childcare is unaffordable for all but the very well-off. I was still working myself and hadn’t expected to be asked to provide day care for my grandchildren. Once I had agreed to take on the role of carer one day a week for two small children, it occurred to me that I was now responsible for one-seventh of their physical, emotional and intellectual development. No light responsibility! I consulted my older sister Sheila, herself a grandmother and a Montessori teacher, who had spent her life looking after other people’s small children. She was full of wisdom about respecting the children, keeping them safe and helping them grow. I also spent time informing myself about new things to watch out for (did you know the risk those washing machine capsules present for toddlers? It just takes one bite!) I refreshed my knowledge about sick children. It was another learning journey and one I wanted to share because it was so fascinating and so much fun. Each of my six grandchildren taught me something new. All the games described in the book were played and developed with them. The other day I found the two oldest children playing with the ‘Granny book’ propped open in front of them, carefully following the instructions for a game they had invented themselves. We tried not to write about obvious things that any sensible grandparent would know, but concentrated on whatever had come as a surprise to one or other of us. And we collected lots of stories from our friends and family, so that the book is more a sharing of experiences than a didactic text. We loved writing it and are thrilled that other grandparents (and a few Mums and Dads) seem to have enjoyed reading it!
Prof Lis Paice, doctor, coach and writer
Review This book is a small handy-sized paperback packed full of useful information. It has a single page of contents all colour coded, with each chapter being only a few pages long and colour coded to match, so that when you reach for it in an emergency, it is easy to find your way around. Indeed you would reach for it in a crisis, whether physical, emotional or medical, because just about everything terrible that could happen to you as a Grandparent is covered in this book. Appropriate advice is given for every eventuality, whether it is the splitting up of the parents, them moving away from you, you moving in with them, or taking over total care if the worst happens, heaven forbid. It manages to be reassuring as well, stating that an accident is no more likely when you are in charge as when with the parents, emphasising the importance of safety. There is a lot of sound advice about discussing everything first, being clear about what is expected including important financial aspects, and maintaining good communication with the parents at all times. I liked the personal touches that were added, with examples, to illustrate each point. As a new Grandmother 3 years ago I would have welcomed this book, but with a second Grandson 6 months ago I still found it a good read with lots of practical advice. There were some brilliant ideas for keeping children entertained, while maintaining a routine, going out every day, and including ingenious games to play on a rainy day. I liked the section about looking after yourself as well-it’s very important to be a fit Grandparent. I appreciated the insistence throughout that the parents’ wishes are paramount, and your role as Grandparent is to support and not criticise, unless you think the child is at risk. I was surprised that NHS Direct was mentioned, but not the 111 Service that is replacing it in many areas. It was a little wordy in parts, particularly the First Aid section, which could have done with more diagrams in the CPR and choking sections, for example. Possibly £9.99 is slightly expensive for a book of only 104 pages. These are small criticisms though and in conclusion it is a practical and sympathetic survival guide which I would be happy to recommend to patients and friends, who are becoming, or are already Grandparents. Dr Jennifer Langdon, GP Principle, Maidenhead, Berkshire
A Grandparent’s Survival Guide to Childcare by Sheila Marlin and Dr Lis Paice is published by Bloomsbury Publishing. It is available from http://www.bloomsbury.com/uk/grandparents-survival-guide-to-child-care-9781408193457/ Or on Amazon http://www.amazon.co.uk/Grandparents-Survival-Guide-Child-Care/dp/1408193450/ref=pd_sim_b_1
OBITUARIES DR DOROTHY MAY BLAIR BEGG (NEE WARD)
MARY “MOLLIE” MCBRIDE MBE
Born: 27th August 1928 Died: 2nd December 2013 MWF member for 50 years
Born: 01/01/1928 Died: 18/11/2013 MWF member for 32 years
She cured in a motherly spirit! Dorothy Ward was one of the early women medical graduates, qualifying in 1950 at Glasgow University. Having spent the early years after qualification in bringing up her family, by 1970 Dorothy was a Principal in General Practice in Glasgow, a post which included Maternity Care. In support of her particular interest in the health of women and children she soon became active in medical committees there, and also on committees of the British Medical Association (BMA), General Medical Council (GMC) and of the Medical Women’s Federation (MWF). She also became a tutor at Glasgow University Medical School and a Trainer in General Practice. An MWF President from 1983-84 she was initially a member of the Scottish Western Association, she became a member of its International Sub-committee and the UK representative (National Coordinator) of the MWF in the Medical Women’s International Association (MWIA). She was voted onto the MWIA Executive in 1987 and organised International Congresses around the world on behalf of the MWIA on four occasions. Her husband Dr Thomas Begg, a consultant physician in Glasgow, usually came with her and they were very generous with their hospitality on these occasions and ensuring that everyone was happy during the tours. Dorothy became President-Elect of the MWIA in 1989 and President from 1992-1995. Her inauguration took place at the first MWIA congress in Central America, which was entitled “Health for All Children”. During her time as President she represented the MWIA at meetings of the World Health Organisation (WHO) and the World Medical Association (WMA) conferences and lobbied governments on Women’s and Children’s Health Issues. She had passion for this which included writing articles, chairing meetings and workshops on this important topic. Alongside her working commitments she researched the history of the MWIA travelling to Philadelphia and London to look through material and her finished effort was published in 2010, at the age of 82, with “They Cured in a Motherly Spirit: History of The Medical Women’s International Association”. Following a stroke in 2011 her health deteriorated and she was unable to travel any longer. She is sadly missed by her family, friends, staff in the MWF office, and members of the MWF.
General Practitioner Chester (b 1931; q University of Liverpool 1954), died from heart failure 12th November 2013. Mary “Mollie” McBride (nee Gregson) retired after 42 years in National Health Service in April 1996. After qualifying with Honours from Liverpool University in 1954, she spent most of her career as a general practitioner. First in Liverpool, then as an assistant in a rural dispensing practice in Cheshire, moving on to start the first Health Centre in Chester and finally five years in the East End of London when she served twice as Honorary Secretary of the Royal College of General Practitioners. Within her portfolio she also had sessions in Psychiatry and Occupational Health with Marks and Spencer’s and Debenhams. She was a member of the Local Medical Committees of BMA for 18 years and was an examiner for Royal College of General Practitioners. She has been a member of two Regional Health Authorities in Merseyside and London and has had the honour of being Provost of both the Merseyside and North Wales Faculty and the East London Faculty of RCGP. She was awarded a MBE by Her Majesty the Queen in the 1980s for her services to primary care. Her main interests were practice organisation including audit, training of practice staff, occupational health and the future of general practice, particularly in deprived areas. She undertook the primary care input into the Tomlinson Inquiry. Retiring at 65 she returned to Chester and in 1997 she became Honorary Secretary of the Medical Women’s Federation. Her hobbies were bridge, gardening, the Chester Civic Trust and croquet. She was delighted to be awarded a diploma as a coach for croquet. Latterly Mollie was involved with the Macular Society, who support people with macular degeneration. She also was actively involved with the Samaritans. She leaves four children and seven grandchildren. The Floral tribute on her coffin was in MWF colours. Mike McBride, Son
RECENT MWF MEMBER DEATHS: • DR JANET JEFFERSON MBE, 02/06/1916 - 01/06/2013, Northern Ireland Member. Awarded an MBE in 1991 for services to handicapped children. MWF member for 57 years. • DR SHEILA CROMWELL, 01/01/1950 – 07/09/2013, London, MWF member for 64 years. • DR HELEN SAPPER, 1965-2013, London, MWF member for 50 years.
Medical Woman | Spring 2014
Dr Iona Frock
Dr Iona Frock In this issue we meet Iona’s Mother... Dr Catherine Harkin, GP, Scotland Illustration by Laura Coppolaro
The icy silence in the car showed no sign of melting in the heat of Iona’s frustration as she drove fruitlessly round and round the hospital car park. “Of course,” her mother snapped, “if you’d been on time to collect me.” “Mum, please don’t start,” said Iona wearily, “We had a terrible morning, I told you about that lady collapsing, now just help me look for a space...” A snort from the passenger seat suggested that her mother was not convinced. Retired Paediatric Histopathologist Professor Jean Forth-Bridges was a woman for whom the word “redoubtable” might have been invented, and age had not diminished her sparkling intellect or taken the edge off her razor-like tongue. The steely gaze that had caused legions of medical students and junior doctors to shrivel with fear was roving contemptuously over the car park and the glossy white building beyond it. “Don’t know what they were thinking of when they built this place. Looks like a supermarket. Now when I started work the old place smelt of disinfectant and vomit like a proper hospital, this is just...” Oh, here we go, thought Iona, the good old days. When nurses were trussed into stiff and uncomfortable uniforms and ridiculous starched hats and children spent visiting hour standing in the corridor because they weren’t allowed into the wards. When junior doctors lived in tiny hot rooms above the kitchens to be wakened at 5 a.m. by the clashing of pans and the skittering of cockroaches www.medicalwomensfederation.org.uk
disappearing back under the lino. Professor Forth-Bridges was fond of holding forth on the easy life that today’s doctors had compared to her own generation and how disappointing it was that Iona had not chosen a hospital career, and the sight of any kind of clinical building always set her off on those wellworn tracks. “I am not “just a GP” mother, it’s really hard work and it is a speciality in its own right you know – oh, there’s a space.” Running the gauntlet of defiant smokers by the main door, they hurried into what nobody seemed to have found it tasteless to call the “departure lounge”, the central area where patients and relatives meandered around waiting for transport or buying gifts for the wards. Iona uttered a silent prayer that this time they might be seeing a consultant who had not been taught by her mother as they rushed into out-patients. “Hello, dear,” said the receptionist, looking surprised, “Can I help you?” “My name is not “dear” barked the professor, “and I have an appointment with Dr Ladysmith.” “Oh. Did you not get our phone call? I’m afraid he’s had to cancel today’s clinic, we’ve sent you another appointment...” As the air rang with the sounds of her mother’s displeasure and words like “incompetent” and “idiots” and “complaint” bounced off the walls, Iona reflected that there was a silver lining to every cloud. Even if they had to do all this again in a week or two, at least she’d had the afternoon off. 37
MEDICAL WOMEN’S FEDERATION
Autumn Conference 2014 Friday 7th November 2014
Friends House, 173 Euston Road, London, NW1 2BJ
HEALTHY PATIENTS The conference key note speakers will focus on doctors and patient’s health and wellbeing. Our key note speakers are: Dr Clare Gerada
THE LARGEST BODY OF WOMEN DOCTORS IN THE UK LOOKS FORWARD TO
Practitioner Health Programme, Chair of NHS England’s board for transforming primary care in London
Dr Debbie Cohen Senior Medical Research Fellow, Institute of Primary Care & Public Health, Director of Individual Support Programme, Cardiff University
Dame Rosemary Rue Lecture: Professor Jane Anderson Consultant physician, director of the centre for the study of sexual health and HIV and honorary senior lecturer at Barts and The London
...More speakers to be announced!
OUR S WORKSHOP ON HOW WILL FOCUS EALTHY TO HAVE A H ODY MIND AND B TICING WHILE PRAC MEDICINE
Why not submit an Abstract? We will be welcoming abstracts under the following categories – Education and training, Health and Work-Life balance, Audit and research, Management and Leadership.
Application forms will be available from June 2014.
You still want more? We will be holding social events excellent for networking! Registration details available at
www.medicalwomensfederation.org.uk MWF, Tavistock House North, Tavistock Square, London WC1H 9HX Email: firstname.lastname@example.org Tel: 0207 387 7765