health, Uncategorized

This girl is on fire….


I’m going to make a big assumption that many reading this didn’t watch ‘The Insider’s Guide to the Menopause’ this week…. Am I wrong?  Well I hope that by the end of this blog I can persuade some of you to watch it on iplayer.  It was excellent.

I like Kirsty Wark. I like her straight forward, matter of factness way in dealing with a subject that still has a bit of an ‘ick’ factor to it.

It is this ‘ick’ that has prevented little in the way of conversation about something that every woman will face at some point in their life. I previously wrote about my experience of being diagnosed with ‘Primary ovarian failure’ at 38:

I was amazed at just how many woman got in touch to say thank you for writing it.  As much as I was deeply touched that some wanted to share their story, I felt quite sad that they couldn’t talk about it more openly.

Trying to get people to ‘talk about menopause’ is a monumental task.  Having heard some of the stories I began to see that for some menopause is this huge, invisible load that is dragged around all day, everyday.  It seems to be in our DNA that while it happens you don’t discuss it and you move on with your life.

Kirsty Wark talks about a film where basically the woman turns to dust and dies.  Very rarely is this stereotype of older women challenged.

Until recently I’m ashamed to admit that my own perception of women’s health wasn’t all that great either.  To my mind you grow up, have kids, sort of disappear for a bit then come back as an old person – possibly with grandkids but definitely with arthritis.

The invisible woman is something that I’ve been thinking about a lot since I had my diagnosis.  This is a time when women should be taking back control not losing it.  Goodness knows you cant control any of the wonderful symptoms that comes along with menopause but you can be a voice.

I also wonder at what age women should be educated about menopause?  We have sex education for our children with the focus on sexual health and pregnancy but there is very little in the way of education about women’s health as you age.  Why is this?  Even though I’m a doctor and we did obs & gynae at medical school I had little clue.  This made me feel even more stupid at a time I wasn’t exactly feeling fantastic in the first place.

I should say that in my opinion education shouldn’t be limited to just women. All men have some kind of relationship with women whether it be family, personal or professional.  I think it’s really important that they are educated as well.

My only quibble with the program was that it was a stand alone, 1 hour documentary.  There was so much in it that any one of the topics could’ve been an episode in their own right.  I don’t know if there are plans to make a series from this but I sincerely hope they do. In doing so we can really start a proper conversation…..


nhs, Uncategorized

Human touch…


When you’re asked to give a presentation on something they tend to come in runs.  Some are easier to prep and deliver than others.  For example I’ve spoken about delirium on many occasions. Usually I just need to tailor the format and content to suit the audience.

This time I’ve been asked to speak about social media and its role in medical education to colleagues at the Scottish meeting of the British Geriatric Society. The meeting isn’t until 3rd March but starting to prepare early is always a good thing.

It’s a bit difficult to know how to pitch it to be honest.  There will be some who are active users but just as many who view social media with an element of both suspicion and derision. It’s also the last session of the day which is always a bit of a tough gig.  Usually by the end of any conference my concentration is waning and all I’m thinking is ‘Can I get home ahead of the traffic?’ I suppose given the topic it shouldn’t matter when I’m speaking.

Getting down to business though, if social media thrives on discussion and sharing, then why was I trying to prep this talk by myself? I decided to turn to the ‘Twitterati’ and ask this question:


Of the 23 replies I received, there were only a couple of negative comments, although you could argue I was somewhat preaching to the converted.

One of the themes coming through seemed to be its role in developing resilience. For all we talk about team work in the NHS there is a degree of silo working that still occurs. It’s not always through choice but usually as a result of time and geographical limitations. Social media, in particular Twitter, manages to breakdown these barriers.

I also presented a very rough draft of my talk at our departmental meeting. I figured there’d be a good mix of people from which to gauge opinion.  Of course, any talk about social media relies on connectivity. Working where I do however, is like working inside a nuclear bunker with its lack of mobile signal and WiFi.

We talked about it rather than engaging with it – not ideal when trying to promote its educational benefits. The lack of WiFi is already a contentious issue and not just with staff and students. Many patients also don’t understand why they can’t just connect. This lack of connectivity can make a hospital stay seem longer and more lonely.  The current vogue for single rooms in new build hospitals only perpetuates this.

There is an advantage to patients being able to get online to look at resources relevant to their illness or condition in real time.  Although I always ask if they have any questions on my ward rounds the ability to look online (or ‘Google’) may further improve the persons’ hospital experience. It would also allow me to signpost them to various websites.

To my mind you then have an educational ward round that meets the needs of everyone, not just the doctors or nurses but also the patients and their relatives.

Technology and social media may blur the lines between virtual and real life but the basic human need for connection will remain the same. In my opinion it is this that makes social media and medicine so intertwined. And so necessary……

education, nhs, Uncategorized

Man (or woman) in the mirror….


Last night I went to see the Lego Batman Movie – it was hilarious! Like most multi layered kids movies there was something for everyone.  The main message however was around reflection. Just incase it wasn’t obvious the soundtrack included Michael Jackson’s ‘Man in the Mirror’ just to hammer the point home.

So as I start the week as faculty on the RCPSGlasgow Clinical Education Certificate course, reflective learning was very much at the forefront of my mind.

The course itself is targeted at all grades from FY2 upwards and across the medical and dental community.  We had 12 delegates on the course predominately dental and surgeons.  The aim is to teach several aspects of clinical education including things like the clinical environment, techniques on delivery and feedback. Throughout the course reflective practice is incorporated at every opportunity.

One of the big questions on the first day was how do we turn superficial learners into deep reflective learners? Or to put it another way how do we facilitate the transfer of learning from the classroom to the real world?

It prompted a fair bit of discussion.  There was general agreement that we should be moving away from didactic teaching to a more applied, problem based learning.  This isn’t exactly a new concept. Quite a few medical schools have done this already with varying degrees of success. Most agreed that at undergraduate level a balance needs to be struck but how do you incorporate reflective learning? More to the point what are you reflecting on at this level?

So mulling on this we moved to the postgraduate world where the problem seems to be the other way round.  I had previously commented that in my experience doctors ‘expect to be taught’. There are teaching programs across the specialties with defined learning objectives delivered by senior medical staff in a lecture style.  Departmental teaching is also pretty didactic (with the odd bit of discussion at the end, usually Consultant lead).  Even conferences are turn up, sit down, listen, tick your CPD box, move on.

Where is the reflection?

Now I appreciate that CPD diaries and e-portfolios do ask us to reflect ‘what did I learn?’ but do they really capture those practice changing moments? Or is the reflection merely dictated by the predefined learning outcomes?  Do I really care at the end of the day…?

I think proper reflection should at its heart have continuous professional development and patient safety. There is the process mapping and dissection of a clinical skill or scenario.  What I like to call the mechanics of learning.  I think though what we struggle with in the medical profession is the softer side.  For example we spoke about different learning styles.  To some a this was a revelation in itself.  Are you a visual or an auditory learner? Do you operate in the cognitive or the psychomotor domain?

For me the discussion brought out other thoughts. I came to the conclusion that I need to come out my comfort zone and use learning techniques that I find hard.  If we believe that education should be taught through the learner perspective I think I might be disadvantaging them by only using techniques that come naturally to me.

And so this is why I love education at the end of the day.  It has the power to challenge preconceived notions and learn new skills but most of all it has the power to refresh the mind.


‘If you want to make the world a better place

Take at yourself and then make that


(nah nah nah nah nah nah nah nah nah….)’


‘Choose your future. Choose life.’


Over the last few weeks I’ve had conversations with several of our middle graders about their career path.  They’ve spoken candidly about uncertainty and doubt in their choices.  There’s a sense of feeling rushed into career decisions.  There’s also the perception that once you’re on that path you can’t change.

Our junior doctors are feeling trapped.

I’ve talked before about how training has changed even in the time I’ve been qualified.  However even by the end of my PRHO year I felt that I should have a vague idea of what to do.  The options put to me were not that great.  I was not a ‘high flyer’ so a medical or surgical rotation was unlikely.  I also wasn’t academically minded so research was out too. My choices were go to Australia or get on a GP rotation.

Back in the mid 90s general practice was thought of as the career choice of women wanting to be part time and/or have families. Nor was it a speciality that many got excited about. Now before I alienate all my GP friends and colleagues that was not how I viewed it but it was how many saw it back then.

I wanted to become a GP as I was attracted to the diversity of work it had to offer.  I was however a little hesitant about going straight into being a GP registrar with only a year of medical experience.  I worked in rural Northumberland doing a 1 in 4 on call and Saturday morning emergency surgery.  We weren’t part of a co-operative so all the out of hours were managed solely by the practice.

It was one of the hardest jobs I’ve ever done.  There was no learning curve per se – it was a straight up line.  It was however where I learnt about perspectives, the patient/doctor/carer agenda and safety netting.  It’s also where I learnt I did not want to be a GP. I didn’t think it was the right fit for me.

However bearing in mind what I said earlier I felt I had little option but to continue doing jobs that might get me to the end of GP training.  At the back of my mind I also wondered if it could help get me on a medical rotation.  So I went freelance.  I resigned from the rotation, moved to Glasgow and started doing a variety of jobs.

I look back on this time with great fondness. I like to call them the ‘faffing about years’.  In that time I did jobs in several different hospitals in Geriatrics, A&E and General Medicine.

I toyed with Cardiology as a speciality but research put me off.  It wasn’t until some 4 years later I thought about Geriatrics.  I think bringing that degree of life experience and professional maturity really helped.  I’d never considered Geriatrics before.  I brought with me a wealth of understanding that stretched from primary care to the ED and into the rest of secondary care.

So as I listened to people talk at a recent education meeting how ‘broad based training’ is simply wasting time and lacks focus I became a bit depressed. I found myself  back in 1996 and our Dundee Medics review. It opened with the now infamous monologue from Trainspotting.  It was given a medics spin though:

‘I chose not to choose life.  I chose something else.  I chose medicine’  

Choose your future indeed but perhaps that ought to include time to faff. Try out different specialties, see what one fits. Choose life.