health, nhs, Uncategorized

Lovely day

It’s that time of year again – changeover week. This changeover, more than others, is a particularly busy time.  It’s when our new FY1’s start.  No longer are they on the wards or in libraries learning the theory. Now it’s time to put it into practice.

It’s both terrifying and exciting!

This year I was again involved in the ‘Preparation for Practice’ course that our Resuscitation team and Simulation Centre organise.  The day takes our new doctors through an array of simulated scenarios using Forth Valley specific paperwork and protocols.

The team involved is huge and varied reflecting the breadth of the expertise involved in caring for our patients and keeping them safe.  What I particularly liked was the involvement of our current FY1’s.  They were brilliant in offering practical tips but more importantly reassurance that it will all be fine. It was also lovely to see how far they’d come since taking part in the same program the year before.

For some though the reality of it all became a bit much. The day came at the end of a long week of induction and shadowing. The scenarios are specifically designed to be as realistic as possible but with an emphasis on a safe learning environment.  However no matter how much you tell yourself the ‘patient’ bears a striking resemblance to your FY1 shadow buddy the situation is real.

There was a dawning realisation that patients don’t behave like they do in textbooks.  They don’t tell you what’s wrong straight away.  You have to work it out based on the clinical exam. You have to have the confidence that you are hearing crackles in the chest and not just the rustle of the sheets on the bed. Then there’s the tests.  Why do they not come back straight away?  Of course that’s assuming you can get bloods off them – some don’t have great veins or are so confused they wont let you near them.

However there’s a sigh of relief when it becomes clear what’s wrong. A plan can be made and treatment started.

In my scenario however our patient didn’t respond to treatment and began to deteriorate.  In real life that happens and it is stressful.  As a doctor (or a nurse) to try your absolute best and see it not working is the worst feeling.  The time that you were willing to speed up to get the person better you now wish would slow down to give you more time to fix them.

One of the objectives of our scenario was how to have those difficult conversations when things are clearly not getting better.  My role was to demonstrate a positive discussion about a treatment escalation plan. Any conversation that involves resuscitation has to handled with great care and sensitivity but always with the intention of doing the right thing by your patient.

After the scenario had finished we had 15mins to debrief and discuss what had just happened.  Pretty much everyone thought they had done terrible.  Of course this wasn’t true but that’s what this particular stress does to doctors and nurses.

In real life what also tends to happen (especially out of hours) is they will be asked to immediately go straight into another high stress situation.  There is precious little time to write up notes never mind reflect on what went well and check everyone, including yourself, is ok.

This kind of chronic stress was something that was never really talked about or acknowledged when I first qualified.  Some twenty years on and induction programs now include sessions on well being and stress management.

As I was writing this Bill Wither’s song came on the radio with the lyrics:

‘When the day that lies ahead of me
Seems impossible to face
When someone else instead of me
Always seems to know the way’

I took this as a sign!

So as our new doctors take to the wards I can’t make the patients behave in a more predictable fashion.  Nor can I take away the feeling of nausea.  I can however ask how it’s going and buy the coffee. So to that end I know it’s going to be – a lovely day…..


health, Uncategorized

Le Freak

I’ve had total writers block this past couple of weeks which is very unlike me.  In the end I decided to write a list of all the things that I’d been involved with including snippets of conversations.  I find even the most throwaway of comments can spark something.

What came out was largely service delivery related.  Or in other words, staffing and rota work.  Most people would agree that taking on any kind of rota is somewhat of a poison chalice.  It did take a fair bit of persuasion to get me to become involved in the junior doctor one.  However I strongly believed (and still do) that get the rota right and everything else will fall into place.

Now I’m not going to spend the rest of this blog talking about rotas.  However it did get me thinking about other areas in healthcare that seem easy on paper but somehow never quite translate to that in real life.

Take ward rounds for example.  Why is it that doctors seeing the same type of patients can take vastly different times?  It’s not like the problem is all that different or the initial results any more complex. The doctors themselves have been through a generic training scheme.  The paperwork is the same.  So what is different and why can’t you standardise them to do the same thing every time?

Simple – you cannot standardise people.

What I have seen over the years is that people do unpredictable things especially when they feel they are being forced into something or being backed into a corner.

And therein lies the contradiction in healthcare – we are constantly being asked to change things in order to standardise what we do.  The more you ask people to change, the more likely they are to resist and nothing changes.

I also think some people actually enjoy treading water because it’s perceived as taking less energy.  And let’s be honest, it’s familiar territory so is less scary.

In stroke I teach that recurrent, stereotypical events are not recurrent TIA’s.  If you think through the pathogenesis and mode of action you quickly realise that it just doesn’t make sense (there is only one caveat to this with a critical carotid stenosis but I digress….). However it takes a big surge of energy on my part to stop this cycle of doing what has always been done, revisit the history, explain to the patient what it might be (including I don’t know) and coming up with a plan.  It also takes a lot of energy, trust and faith on the patients part to work with you in this.  The sense of satisfaction when you get it right though makes it all worth while.

If you take this example and think about how we apply it to other aspects in healthcare e.g. organisational change, rotas, ward rounds – it becomes easy to see why the same problems/issues recur time and time again.

So what do we need to do?  Well if it was that easy I wouldn’t be writing this and the NHS would be totally fine…. I do think it’s a bit like what the quote says.  Don’t moan about the problem or expect it to change.  Stop doing what you have always done. Revisit the issue. Adjust your sail.  See what happens.

You might just be surprised……


health, Leadership

Run the World (Girls)

This week was the Centenary of the Medical Women’s Federation.  Although I couldn’t get to events down in London Izzy Utting, an Edinburgh medical student, had organised an event entitled ‘How to have your cake and eat it….’ With actual cake!196048




I was asked to speak partly due to my role in the MWF (secretary Scottish Standing Committee) but also as someone who has apparently achieved some degree of success as a female doctor.

This I had to smile at that.  ‘Me? You sure about that?’

Preparing for my presentation I couldn’t feel any less inspirational or motivational.  I did seriously debate putting a slide up with:

‘You’ll figure it out’  (drops mic and walks off stage)

Ahead of me were two amazing women Dr Sarah Stock (@evbasedbaby) and Dr Rebecca Heller or Bex (@rebeccalily) talking about their career.  While there were stories of inspirational high achieving women they were both refreshingly honest about some of their life choices and career failures.

Although our talks were prepared independent of each other there was a recurrent theme – Imposter Syndrome.  That nagging irritating voice in your head that tells you are a fraud. The one that causes everyday to be spent in  state of anxiety worrying you’ll be exposed as a charlatan.  I must say I hadn’t actually come across this term until relatively recently but I had experienced all the symptoms.

You see Imposter Syndrome is like a parasite – feeding off your insecurities and self doubt.  It messes with your head so that you are unable to recognise other women going through the same thing. And let me tell you they are.  It’s just it makes you believe that the first rule of Imposter Syndrome is: You don’t talk about Imposter Syndrome.

Bex shared the statistic from an internal report for Hwelett-Packard that men apply for a job when they are 60% ready compared to women who wait until they are 100% ready (Sheryl Sandberg, Lean In). I think this probably tells us all we need to know about its destructive power.  I’m also pretty sure this is why only 24% of Medical Directors are women too (Kings Fund).

So I decided to face mine head on.  A parasite only survives if you feed it. Or in the words of Maya Angelou:


So I stood up and talked about how I had failed. Quite hard to do as a control loving, micro managing perfectionist. That said I made it sound as spectacular as possible – old habits…..

I also talked about what I was lead to believe were terrible career choices.  For example starting a family as a Registrar – something only a handful of people did at the time.  I was also told not to go part time because ‘you’ll never get a Consultant post’.  And for goodness sake what was I thinking about going part time again as a Consultant.  Apparently you’re meant to increase your work load at this point.  Life it seems can wait until you retire.

This is simply not good enough.

So what did I tell these young women:

‘You do what’s right for you at the time’

That means:

  • You will make mistakes – it’s ok you will learn stuff from this
  • You have the right to change your mind
  • Trust your instincts – especially when taking advice.  That person may only have their own interests at heart, not yours.

So can have your cake and eat it?  Yes. Absolutely. And I encourage you to try every single one….

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…..


health, Uncategorized

Living the dream…

Living the dream…..

This weeks blog title was suggested by my former colleagues when I met them for dinner the other night.  We were laughing about how mad I had got when a senior manager asked me ‘How are you? Living the dream?’.  Looking back I think it was meant as one of those silly throwaway comments that the person asking is not really looking for an answer.  Unfortunately it pushed a button and as they say in Scotland I went a little ‘tonto’.  It wasn’t a particularly happy time then.

A couple years later I’m in a different place – mentally and physically. I’m in a different workplace and I’ve also gone part time.  It’s amazing!

So am I ‘living the dream’?  I’m not really sure what that means to be honest.  My dreams are weird at the best of times so I definitely don’t want to be living those! That could be another blog though….

I guess the whole thing is about work life balance although I think that very term will soon be redundant if the current trends in the workforce continue.  I was reading about Millennials (people born between 1980 and the mid 90’s)

The work to live rather than live to work is something that has resonated with me this year. The idea that there should be more flexibility in not only where but how you work.  For example does being at your desk or being seen on the ward after 6pm make you a more productive or better doctor (or any other worker)?  Are you doing it merely to be seen?  Or out of a sense of mouse wheel duty that probably someone else can do?

My new commute is far longer than the 10 minute journey I used to make every day.  It’s now somewhere in the region of an hour or so each way.  And yet I feel more energised and on top of things than I ever did before. How I use my time is different though.  My emails are done on the train.  Any projects or pieces of work are also done on the train.  I do mindfulness at the start of every day which quietens and focuses my brain.  I also like to think time spent staring out the window is a form of mindfulness too…  I get loads more fresh air and exercise which I’ll admit is also a great excuse not to go to the gym.

I finish pretty much on time every day so when I get home that’s me. Work is far away and that part of my brain switches off. Recharging even.  The other part of my brain switches on.  It’s not too dissimilar to the work side its just more fun and more silly.

This week I was at the Edinburgh Festival, the Fringe to be exact. It doesn’t get more silly than a skeleton puppet singing to Frank Sinatra in the rain.  I hadn’t been to the Festival in years and it didn’t disappoint.  While I wasn’t organised enough to get tickets the day was spent wandering the streets watching various street performers and soaking up the atmosphere.

I tried trampolining at Airspace for the first time. The safety video of ‘you may die’ did slightly alarm but I was not put off.  Dodgeball and gladiator style jumping over rotating bars all proved I have no sense of balance. I also seem to reflex squeal when I fall over.  I had thought this was limited to falling off inflatables in the sea but apparently not. It was hilarious fun!

The point of this….?  Living the dream is whatever you want to make of it.  Did my dream include being stressed out my head and blowing up at stupid comments?  No.  My dream is to work hard, make a difference but most of all have fun.