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……


Leadership, nhs, Uncategorized

Everything is awesome

I have always considered myself a positive and naturally optimistic person but several events this week sought to test that.  To be fair some were truly awful. However there were some things that, in my opinion, restored an equilibrium.

The first was the news story about mental health as championed by William, Harry and Kate:

I quite liked the honesty with which they talked about the British ‘stiff upper lip’ culture. This is such a ridiculous notion when faced with the tragedy of losing your mum at such a young age.  There is no silver lining or looking on the bright side.  It’s just bloody awful and should be treated as such.  That said I do think how they have channelled it into something good is remarkable.

They are not the only people who are able to do such things.  Look around and you’ll see people from all walks of life trying to create something good from terrible circumstances. It could be running a marathon for charity or volunteering.

There are parallels with our daily NHS life.  Recently I helped one of my trainees complete a near miss incident form. There was no harm and the patient and family were informed. The main thing from my perspective was to identify exactly what went wrong and more importantly how to make sure it doesn’t happen again.

The process of documenting failure is, by its nature, long, depressing and overwhelming negative.  There is no way to make it a positive experience for anyone. What you have to do though is pick everyone up and somehow turn it around. It’s a difficult one to balance as you want people to feel empowered to make a change but equally you’re trying not to diminish the mistake in the first place.

I believe we managed to achieve this balance.  A plan was made and over the next few weeks I am optimistic we will have something in place that ensures this particular incident will not be repeated.

Which then brought me to this quote that I saw the following day on my twitter feed (thank you @johnwalsh88): C91f2UvW0AAZKbu.jpg-large

This to me is much more reflective of who I am nowadays. I think it’s what we should all be to be honest. So with the glass half full I would argue that for every situation you hope for the best but plan for the worst.  To me that is about having plan A, B, C, D etc etc

This philosophy is reflected in a postcard I have on my wall at work that says ‘Failure is not an option’  It’s from the Apollo 13 mission. It makes me smile every time.  Now you may think I am deluded or living in denial but I agree with the statement. Failure is not an option.  You just haven’t found the option that works.  It is true of the NHS and in life that you will need to try out many different options until you find the one that works.

So on that note I go into another week with my eyes wide open, optimistic that it will be a good one. If it’s not, well, that’s just a chance to try out Plan B…





Reach for the stars….


Today I went to space, well sort of.  I went to the IMAX at Glasgow Science Centre and immersed myself in the awe inspiring ‘A Beautiful Planet’.  Filmed by the crew of the International Space Station it gives a first hand account of what life is like in space.  Now while I really should’ve been impressed by the science of it all, I have to confess what really took my breath away were the views of Earth.  I have always appreciated the beauty of our planet (I may be into triple figures with photos of sunsets….), but there is something quite special when you see it viewed from space.

Major Tim Peake then came on to talk about his experience of living on the ISS for 6 months.  I had followed this particular mission avidly so it was lovely to see and hear him talk in person.  Earlier this year I’d had the opportunity to hear Commander Chris Hadfield’s experience as well.  What struck me was that while they both spoke with enthusiasm and passion, it was also with a pragmatism I found really refreshing.

There was a question asked of Tim Peake about how to become an astronaut. His reply was to emphasise that while aiming to be an astronaut don’t loose sight of doing something that you really love in the meantime.  The implication being that while it could be a foundation to future space travel, becoming an astronaut should not the sole aim.  In Chris Hadfield’s book he talks about the limited number of people who are chosen to train as an astronaut.  Even then you’re not guaranteed to go to space after years of training.

There was no hint of regret about it though.  Obviously they both got to go to space so I guess that worked out for them.  That said I genuinely got the sense that even if they didn’t go to space they knew they would’ve still contributed to something important. Something that matters. Something bigger than themselves.

So as I re-calibrated my brain and headed back to Planet Earth I thought about this.  At work we are to be ‘person centred’ and think about ‘what matters to me’.  Our children are being taught at school to be ‘successful learners, confident individuals and responsible citizens.’  This is all good stuff but I have some concerns. Increasingly the talk is about the person alone. We don’t talk about the person in the wider context.  How does that person fit into the family or what do they contribute to the community?

I worry that by being so person centred we will loose the ability to see beyond ourselves.  There will be no shared sense of meaning.

Just as my brain was becoming weighed down by the gravity of these thoughts I was reminded that ‘we’re all just motes of dust here for a twinkle of time…’

I work with many people whose main aim in life is to make others better.  They do this because they love what they do.  Promotions and projects will come and go.  Most will disappear into the ether of time however what will remain will be the people.  So make it matter!

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” 

Maya Angelou


Shine on you crazy diamond

This week two encounters rattled my happy equilibrium of recent months. For most of the week I wasn’t able to fully articulate why and I hate that!

There was no drama.  No heated exchange of words. In fact there was nothing particularly special about either situation to cause a dark cloud to drift across the blue sky of my world.

On both occasions I felt like I’d become a more rubbish version of myself.  It was like the light had been dimmed and my energy diminished.  I began to doubt myself and was slightly less self assured in what I said.

What the hell was going on? This wasn’t me.

The more I wrestled with the why the more irritable I became until I had primed the beginnings of a downward spiral of negativity.  Helpful advice from friends fell on deaf ears.  Even the icy cold slap in the face of ‘Let it go’ was not enough to bring me to my senses.  I do love to ruminate but even I was boring myself on this one.  ‘Urgh – get over yourself woman!’

For whatever reason the idea of kryptonite entered my head and I found myself googling it. There is A LOT of information about a substance that isn’t even real.  Did you know that there is more than one colour of kryptonite for example?  I thought it was just green but apparently not.

It seems that Superman requires the sun to power him up like some kind of flying solar panel.  Kryptonite blocks this process. I felt like I was onto something deeply profound…. ‘so if I just google How does Superman defeat kryptonite? I’ll have this all figured out. Brilliant!’

Minor problem – there is no answer.  Balls.

The following day the fabulous Olwen Williams (@OlwenOlwen) tweeted this:



It dawned on me that the source of my kryptonite originated from the middle of the chart.  I had come across this concept before during a leadership course.  Various people/studies have looked to psychoanalyse those working in the NHS.  It seems each healthcare group has a unique personality profile.  In fact it turns out 98% of doctors, nurses, managers etc are all uniquely the same.

I remember one such person commenting in a proud fashion that after 30 years the NHS had finally turned them into one of the 98%.  I was dumbfounded that someone could be proud of that.

My profile is consistently not in the 98% and to see it illustrated in such a way was my light bulb moment.

I’m nearly 20 years a doctor and in that time I have struggled with conforming to the perceived norm.  I have been consistently told to change.  I have been told ‘we don’t do things that way’  that I am a ‘new broom’ wherever I go.  I have also listened to some who talk of being the 2% but their actions would suggest otherwise.  I have also heard the same people talk of their support of the 2% only to put up barriers at every turn.  It has been a confusing and at times, lonely place to be.

What I have learned and what I say to other two percenters  is to ‘keep being you, keep doing what you do because you are awesome!’.  There are others out there.  We’re pretty easy to find. Just look and invariably you’ll see our light…..









You cannot be serious……..

So this week was the 15 year anniversary of one of my favourite films – ‘Legally Blonde’. The film follows Elle Wods as she goes to Harvard Law school to Unknown-1win her boyfriend back.

The film at first glance might draw assumptions of chick flick froth and to be fair the first 15 minutes do little to dispel that idea. However watch on and you see that below the superficial pink sparkle are themes about discrimination, prejudice, leadership and haberdashery.

My own personal take is that it is mostly about the multi faceted nature of being female and what it’s like living in a world where you are immediately judged by how you look.  What you say is similarly judged and compartmentalised – Bossy, Ambitious, Part Timer or worse of all Nice.

The film takes me back to the days when at high school the deputy head (who was female) told me several times that ‘Medical School is very competitive. For every one place there are ten others vying for it. You are highly unlikely to get in.’

So when I got 3 conditional offers I was told again that is was ‘highly unlikely’ I would get in.


Like the skimming stone of time not much appears to have changed.  Today I’m a Consultant Geriatrician working in the NHS. The barriers and obstacles remain but they are more covert.  So the film got me to thinking about resilience.

Its about choice.

You can chose to be miserable and mired at work or you can choose to do things differently.  To put this into some kind of tangible context its worth remembering that for the vast majority of us working to, lets say 65, we will spend approx. 35% of our lives in work. Or as one study quoted ~110,000 hours.

Are you really going to be that unhappy for that length of time?  I see many of my older colleagues coming back to work after their official retirement.  It also makes me wonder about my colleagues who tell me that they just want to retire and have a life. It makes no sense!

Now, to be clear I’m not talking about being sunshine and rainbows all the time. Our job at times is hard, stressful and utterly demoralising.  It is also the most amazing, satisfying and interesting job a person can do and that is why I love it!

There can be prejudice or assumptions that comes with being that positive person in such a negative environment  I was once told that it ‘must be hard being the team cheerleader all the time’. You may be judged as caring less, presumed to be less knowledgable and frankly just not serious enough.

This could be demoralising if it were true and you allow people to project their issues on to you.

But the world needs cheerleaders. Individuals who make being the tough days that little bit better. Smart, fun, serious – multi faceted.

2, 4, 6, 8 who do we appreciate?


Holiday, Uncategorized

For once in my life….



Holiday time has finally rolled around. Plans ahoy!  However the unplanned stowaway was Mr Virus.

Now, many will be familiar with that feeling ~24hrs ahead of the out of office button being pressed that something is brewing.  You might be mislead into thinking that its just the rushing around pre hols but be vigilant people.  I can confirm that it is in fact your immune system checking into the first class lounge as it prepares to leave for the Caribbean.

You however will be oblivious as you naively continue your plans for ‘quality family time’ complete with a world breaking effort in creating Kodak moments that all your friends and family will be jealous of.  Complete with Facebook and Instagram posts without filter – because you’re that amazing!

Then Mr Virus hits. Without realising it you have become the 5 star holiday home it had booked the year before.

Now usually I spend quite a bit of time fighting the uninvited visitors. It ain’t pretty and usually I loose. The battlefield ends up with me being exhausted, mood in my boots (I really am the most terrible person/mother/wife/friend/daughter etc etc). I would drag myself back to work with that feeling of ‘why did I bother?’.

This time I almost repeated the 10 year cycle of non learned behaviour then something magical happened. I gave in.  For once in my life I surrendered. Right at the start of the fight.

In doing so I won.

I can’t say in all honestly my recovery was quicker or less vile.  It was however a much easier process. I let the hideous thing run riot for the best part of a week.  I was almost in the third person watching it. I indulged in my guilty pleasures – reading newspapers cover to cover and watching property programs. A particular favourite being the ‘A Place in the Sun: Winter sun edition’.  I’ve travelled the world this week judging and passing comment on everything and anything. The pool is too small. The beach is too far to walk to. Its not south facing.  Two bedrooms, are you kidding me? I need three.

After my pseudo foreign trip I was fighting fit and able to witness the spectacle that is Beyonce.  The talent, the work ethic is enough to put us mere mortals to shame.

We held a moments silence without realising that at that moment we were silent to the unfolding horror that was the Dallas shooting. And suddenly my brain was struggling to make sense of the world again. Except this time there was no virus, no delirium to explain it away.

I’m not going to get into a commentary about life in the USA.  I know very little about these things to be credible.  What I do know is that violence is not the answer. I feel the frustrations – why do people act/behave in that same way they always do?

As Martin Luther King said:


So as I go into my second week of holiday I will indulge in the luxury that is my family close. The friends I treasure near. I will pray. I will continue to shine.

For once in my life I will just….. Be.