Medical Woman – Issue 1, Spring/Summer 2013

MEDICAL WOMAN Issue 1 : Spring/Summer 2013

inside: Clinical Commissioning what’s next?

Women At The Top Olwen Williams Women in Leadership

by Penny Newman Freezing Eggs the facts

www.medicalwomensfederation.org.uk

Editor’s Letter

A

n Editor of a well known magazine for GPs recently sent me a tweet saying that “launching a magazine is a labour of love”, and I would have to agree.

It has taken the Medical Woman Editorial team months to source quotes for designers, printers and get a feel for how best to produce the best magazine in a digital world. The digital revolution has meant that many publications have had to take a hard look at their printed matter and the costs; and we at the MWF are no different. In this day and age the MWF are accessible 24/7; you can Tweet us @medicalwomenuk, join the MWF Facebook group, read Medical Woman on your tablet and be updated via our brand new website, still at the same address: www.medicalwomensfederation.org.uk.

I feel really proud by what we have achieved as a team, and the direction we have taken the magazine in. We have invested time in commissioning articles which we hope will appeal to a variety of readers and we have more ideas up our sleeves which we hope will develop into other features for you to read. Miss Katie Fraser’s article on eggs freezing (p18) was a real eye opener for me; and Dr Penny Newman’s tips on leadership (p12) have been taken on board.

Our front cover competition was a joy to judge – we had some brilliant entries.

This issue’s cover, the winner, is by Miss Sahiba Singh, a medical student at Kings College London; 2nd place went to Miss Shan Shan Jing, and her entry will be the front cover for our next issue. I hope you also enjoy reading our witty new column, based on a fictional character called Dr Iona Frock, written by our member, GP Dr Catherine Harkin, Scottish Eastern Local Secretary (p33). Many thanks to all our contributors for the time they have spent in writing for us.

If you have any views on what you would like to read about in Medical Woman or doctors who you’d like us to interview I urge you to get in contact with us; remember, this is YOUR magazine. I hope you are pleased with this new, revamped Medical Woman. Thank you to Sarah Kwok, my Deputy Editor who sadly will be leaving the team as she is starting her Anaesthetics fellowship in Singapore in May.

“Successful women can still have their feet on the ground. They just wear better shoes.”

Maud Van De Venne

Sara Khan, Editor of Medical Woman doctorsarahkhan@gmail.com @DrSaraK about.me/sarakhan

Contents

Contents Medical Woman, produced by the Medical Women’s Federation Editor: Dr Sara Khan doctorsarahkhan@gmail.com Deputy Editor: Dr Sarah Kwok kwoksa@gmail.com Assistant Editors: Ms Anji Thomas and Miss Francesca Rutherford E-mail: admin.mwf@btconnect.com MEDICAL WOMEN’S FEDERATION Tavistock House North, Tavistock Square, London WC1H 9HX Tel: 020 7387 7765 Fax: 020 7388 9216 E-mail: admin.mwf@btconnect.com

News & Events

3

Freezing Eggs

18

Say it, Write it, Tweet it

4

Debate 20

The Francis Report

6

Careers Clinic

fecornish@btinternet.com

Women at the Top

7

Out of Programme Experience 24

President-Elect: Dr Sally Davies

Clinical Commissioning

8

Junior Doctor Prize Winner

25

Twitterview 10

Medical Elective

26

Top Apps

11

Top Tips

28

Medical Leadership

12

Film Review

29

In the Hot Seat

14

The Mummy Diaries

30

Charity Spotlight

16

Medical Memoirs

32

Global Health

17

Dr Iona Frock

33

www.medicalwomensfederation.org.uk Patron: HRH The Duchess of Gloucester GCVO

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President: Dr Fiona Cornish

DaviesSJ8@cardiff.ac.uk Vice President: Dr Jean McEwan j.mcewan@ucl.ac.uk Honorary Secretary: Dr Beryl De Souza bds@dr.com Honorary Treasurer: Dr Yasmin Drabu ynaqushbandi@yahoo.co.uk Design & Production: The Magazine Production Company www.magazineproduction.com

Medical Woman: © All rights reserved. No 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.

www.medicalwomensfederation.org.uk

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Contributors

Contributors SPRING 2013

Miss Francesca Rutherford Is a new-ish addition the Medical Woman team, and the MWF HQ Office Administrator

A medical woman you admire/respect:

Francesca Rutherford

Dr Gillian Hunt, an MWF member who recently received her MD at the age of 90 – Amazing!

Five favourite things in life: • Family, Friends & my boyfriend • Laughing • Collecting Maps & globes • Cheese • Exploring / traveling

Dr Penny Newman Is a GP and Consultant in Public Health, who gives us tips on medical leadership on p12-13 in this issue.

A medical woman you admire/respect: Every generous woman who has made it to the top and those who are trying!

Penny Newman

Five favourite things in life: • My girls (young and old) • Chilled white wine in a beautiful place • Exploring overseas • Modern architecture & design • Working on something I am passionate about

Fiona Cornish Our MWF President offers her views on the Francis Report on p6.

A medical woman you admire/respect: Dr Clare Gerada, current RCGP Chair.

Fiona Cornish

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Five favourite things in life: • My family • Being a GP in Cambridge • My bicycle- liberating, exhilarating, efficient • Plain chocolate • Swimming in warm clear sea

Ms Katie Fraser Fills us in on recent advances in eggs freezing on p18-19.

A medical woman you admire/respect: Florence Nightingale and Miss Leonie Penna (Clinical Director for Women’s Services and Consultant Obstetrician/ Lead for Labour ward at Kings College Hospital).

Katie Fraser

Five favourite things in life: • Family, fiancé and friends (am I allowed 3-in-1?) • Take That – been to 30 live concerts since I was 9 years old! • Red wine • The Sun • Cycling along the River Thames (Southside)

Dr Catherine Harkin Introduces us to the new Medical Woman fictional character Dr Iona Frock on p33.

A medical woman you admire/respect: The late Dr LeClair Bissell, a retired expert in addiction medicine.

Five favourite things in life:

Catherine Harkin

• Opera • Gardening • Cats • Scuba diving • and my partner Carrie!

Sahiba Singh Medical Student, King’s College London, MBBS 4. The winner of our first cover competition! We hope you like it as much as we did :)

A medical woman you admire/respect: Dr. Fiona Wood, a plastic surgeon from Australia, who developed a patented ‘spray-on-skin’ for the treatment of burns and profound scarring.

Sahiba Singh

Five favourite things in life: • My Family and Friends • The fact that I’m able to do Medicine as a career • Surgery • Sketching • Reading

Medical Woman | Spring 2013

News/Events

Events & Members News 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

International Women’s Day – MWF with Wellbeing of Women at Hobbs in London – March 7th 2013 This year to celebrate International Women’s Day we arranged a shopping evening with Wellbeing of Women, at the Hobbs flagship store in Covent Garden. It was a brilliant evening with champagne, canapés and a presentation on the trends for Spring/Summer 2013.

Hobbs kindly donated prizes for a raffle that included a leather bag, £200 vouchers and products from The Sanctuary!

MWF Electives Evening at GKT – 11th December 2011 The GKT Student’s division of MWF organised a well attended electives bursary evening in December. There was an introduction to the MWF, information about how they support student electives financially and presentations from GKT Elective Bursary recipients. This was an informative and fun networking event for students.

MWF Autumn Meeting & Gala Dinner, Grand Connaught Rooms and The Walforf Hotel, London – 9th November 2012 Our annual Autumn Conference “Tacking Taboo Topics” was well attended, including a diverse range of subjects including death, domestic violence and the anachronistic “Obedient Wives Club”. The panel discussion (Why women should join networks) prompted interesting personal comments, and the abstract presenters provided snapshots from everything from fistulas in Sierra Leone to the age at which GPs have their first baby.

It was an axhilirating day full of networking and chatter, which was rounded off with a splendid dinner at the Waldorf Hotel.

BTOG Conference 2013 by Laura Davis, Medical Student The annual British Thoracic Oncology Group Conference was held 25th January 2013 at the Burlington Hotel, Dublin. Speakers were from the international oncological community and spoke on a diverse range of subjects, including the role of molecular pathology in future research and novel approaches for the treatment of the thoracic cancers. A ‘Dragons’ Den’-style debate was held, with propositions for and against new models of cancer management. During the afternoon, smaller workshops were held on subtypes of malignancy, and awards were given for prize-winning posters. A dinner and dance was held at the hotel in the evening, providing and opportunity to discuss ideas and potential research, before the event was closed on the afternoon of the following day.

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!

www.medicalwomensfederation.org.uk

Other MWF Member news: •C ongratulations to our members Professor Bhu Sandhu and Dr Geetha Subramanian for their awards in the 2013 New Year Honour Lists!

•W ell done to Professor Jane Dacre Director of University College London Medical School (and a new MWF member!), who won the medical category of the Women In The City award •C ongratulations to our member Professor Dame Carol Black and Claire Gerada MBE who were included in the Radui 4 Top 100 Women’s Power List 2013 •C ongratulations to our member Dr Gillian Hunt who, at the age of 90, received an MD in November, at the same ceremony that her daughter also received an MD – Very Inspiring!

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Say it, Write it, Tweet it

“Say it, Writ Dear Editor,

When my husband first brought up the possibility of moving abroad for a few years, my initial reaction was “yes please!”. The thought of living somewhere warm, and having a new adventure filled me with excitement, especially after spending the last eleven years training and sitting exams!

Unfortunately, this joy was short-lived as I spoke to a friend about our plans and she informed me with a dead-pan face, “You do realise you’ll have to re-train as a GP after 2 years?”.

No! I didn’t realise!

“But I’ll be working as a GP the whole time”, I replied.

It turns out this doesn’t matter; I could be topping up my tan on the beach or seeing thirty patients a day, but either way after two years abroad you need to do some sort of re-training! But what does this mean? Repeating hospital placements? Re-sitting the AKT? The dreaded CSA again?

I searched high and low for the exact rules but the information was much harder to find than I imagined. Finally, I came across some proper advice on the COGPED website, which informed me after two or more years abroad I could complete the GP Induction & Refresher Scheme, which involves up to six months of full-time supervised training in General Practice, and then I could safely work in general practice again. Phew!

I can’t help feeling irked by the idea of any sort of re-training – surely when accountants or lawyers work abroad they don’t have to come back and train again? And even other medical specialties seem to accept working without the need for a refresher scheme.

In a world that is so internationally mobile, shouldn’t general practice be flexible enough to allow us to work abroad without being penalised? I understand the need for maintaining high standards but working abroad doesn’t automatically mean that you become de-skilled as a GP! Dr Meera Dattani, GP, London Useful links: http://www.cogped.org.uk/index.php http://www.gprecruitment.org.uk/refresher.html

Dear Editor, Why I like working with female GPs...

I like women. My wife is one, for instance. We work well together.

The daily exactitudes of running our household are rather like those of a general practice. We strive to offer a range of services to our patients (er, children); we scrutinise our practice and work hard to maintain and develop our skill base (learning new recipes); we organise our current account to maintain a healthy cash flow (I earn it, she does the shopping); we hold frequent and structured practice meetings (over dinner); and we are actively seeking to expand our premises (getting the loft converted).

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We work differently. And we do it well.

It’s the same in medicine. You need men and women.

And yet I have heard a male partner intone, when talking about taking on a new doctor, “we’re not going near a woman of child-bearing age”. Leaving aside for a moment the fact this is outrageously sexist, it also just does not make good business sense. A woman may be out the practice on maternity leave for, say, two years in total. But she may be in general practice for 30 years. The time off is not particularly significant. If that woman is a partner, rather than salaried, the terms of the partnership agreement may dictate that she fund a maternity locum. So you can’t argue it in financial terms either.

Besides, think for a moment what she will bring to the practice by the very virtue of having had children. A whole wealth of knowledge. A deep and intuitive understanding of pregnant women’s concerns. A fluency and deftness at assessing babies and children. A gentle empathy for those women who come to us exhausted and spent, hollow at coping with the children and housework while the husband is away at work.

We should accept and nurture these qualities that come so much easier to women than to men. We should be bold enough to say, of course, that women and men are equal, but that is not to say identical. Some women in medicine take the view that in order to succeed, they ought to behave like men.

You see this with some female consultant surgeons. Their body language and communication mirrors that of their male counterparts. They adopt the gruff, abrupt qualities that are considered (misguidedly) a pre-requisite for seniority in hospital medicine. This is a shame.

Some male GPs, I have heard, often speak demeaningly of their part-time female colleagues. Yes it’s true more women work part time than men. Out of necessity. Usually (but not always) this is to deal with the children. Rather than minimise this part of a woman’s working week, male GPs should spare a thought for what this time out of the practice involves: an organisational maelstrom. Walking a precarious tightrope of calm, with the ferocious waterfalls of tantrum and truculence on either side.

Now think what this brings to the practice. Not only do you have a GP possessing a well-rehearsed familiarity with women and children’s health, you also have someone with exceptional organisational skills and the patience of a saint.

So next time you need to recruit a GP partner, don’t let anyone say they “won’t go near someone of child-bearing age”.

Just be careful when drawing-up their terms of service. Women often make subtle and effective negotiators. I should know: I have two daughters.

Dr Oliver Starr (@15medical) is a GP in Stevenage and a member of the Society of Medical Writers.

Find out more at somw.org.uk or @socmedwriters Medical Woman | Spring 2013

Say it, Write it, Tweet it

te it, Tweet it” Dear Editor,

I’m Alice Rothwell, a final year medical student. According to a somewhat cavalier Orthopaedic surgeon I recently encountered on placement, I’m also “a skirt-wearing bimbo”.

Don’t worry, this will not be a hyperbolic, oestrogen-fuelled rant. I’m not going to do a Caitlin Moran, leap onto my feminist steed and ride (side-saddle) through the familiar annals of antisexism rhetoric. Though well I might.

Instead, I’d just like to succinctly express my opinion on this hideously archaic, philistine attitude with which I, and 99.99% of the modern medical community, firmly disagree.

I’m aware that individual doctors adopt unique pedagogical styles when teaching medical students. There’s the consultant cardiologist who makes a lecture-hall of students flap bits of paper over their heads to represent atrio-ventricular depolarisation; the neonatologist who squished play-dough and a butternut squash together to outline the embryological development of the nuchal crest in utero; the radiologist who cracked a smile by telling us that x-ray interpretation is really just ‘50 shades of grey’.

And, at the other end of the spectrum, the old-school hardnuts. Those who learned the tough way, and teach the tough way. This brusque method has its advantages, too: frank embarrassment has helped identify specific gaps in my clinical knowledge throughout my medical education. Thanks to a Colorectal Registrar who grilled me in third year, for instance, the eponymous rules of Courvoisier, Rigler and Rovsing trip off the tongue like a nursery rhyme. As well as now being suitably equipped for academic assassinations on future GI placements, I now also have the added benefit of providing good pub quiz fodder.

Thank God, in fact, for idiosyncrasies and personal flair in a world of blandly delivered ‘learning outcomes’.

However, there’s a fine line between throwing someone in at the deep end and drowning them in a tsunami of unfairness. In this instance, the unashamedly opinionated orthopod in question

ploughed through that line in a tank. Thankfully, it’s only on rare occasions that this chauvinistic attitude rears its ugly head.

For the most part, I have benefited from an educational system that is entirely equal in its treatment of men and women. Equal opportunities have afforded me the chance to win prizes and scholarships at undergraduate and national levels, obtain a first class BA, secure publications, and to beat tough competition in gaining a coveted Academic Foundation Programme post for my FY1 job next year.

I take great encouragement from the inspirational careers held by senior healthcare professionals, be they male or female, surgeon or medic. The multi-tasking ability of my clinical superiors is also something I wish to emulate in my future career. Professor Clayton-Smith springs to mind as an example of one of modern medicine’s almost unfeasibly qualified doctors: Clinical Lead for Research at Central Manchester University Hospitals Foundation Trust, Fellow of the RCP London, leader of a European research group in Dysmorphology. She also happens to have raised a happy family of three successful, talented children, one of whom I’m lucky enough to have become close friends with at university.

With this in mind, I hope that the future medical community can continue to develop to its full potential, unhindered by the ever-dwindling prehistoric sexism that once prevailed. Currently, medical schools churn out an increasing number of female graduates (with an approximate 60:40 split at Leeds), and it is predicted that women will outnumber their male counterparts within the next five years.

I don’t want violins. I don’t need patronising. If the few remaining traditionalist males within medicine absolutely insist upon exerting their muscular brawn, however, then they can hold the door open for the future (female) frontline of the NHS to walk through. In their skirts.

Kind regards, A. Rothwell

SOAPBOX SOAPBOX SOAPBOX SOAPBOX and you tweeted...

Voted the most family-friendly Deanery in the UK, by the Medical Women’s Federation http://bit.ly/uRBARu @WalesDeanery Excited for the Why Women Should Join Networks panel at the @medicalwomenuk event today #RCSWinS #MWF Info on the issue http://ow.ly/f9z4m @RCSnews I’m going to London event of @medicalwomenuk http://www.medicalwomensfederation.org.uk/ I’m interested in what they do & I’m a sucker for freebies @loccitane_uk @_elljay_ Today Dr Fiona Cornish, president @medicalwomenuk, has been speaking to students on our MSc in #Medical #Leadership http://www.rcplondon.ac.uk/cpd/non-clinical-cpd/leadership/msc-medical-leadership @RCPLondon 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 admin.mwf@btconnect.com | 020 7387 7765

www.medicalwomensfederation.org.uk

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Commentary

The Francis Report A commentary on

Dr Fiona Cornish – GP, Cambridge and MWF President

A

lthough the Francis Report, published on 6th February on the Mid Staffs Trust, makes uncomfortable reading, it reinforces the essence of what we all entered medicine for, Patient Care.

The report shows, only too clearly, the consequences of what happens when the NHS loses sight of patient care in its desperate attempts to balance

in the NHS, which cannot be measured.

This is an extract from her commentary: “I was encouraged to hear Health Secretary for the NHS in England, Jeremy Hunt acknowledge that many of the important things that matter to patients simply cannot be measured.

Giving his first major speech post-Francis to the think-tank Reform, he said he was also keen to reduce bureaucratic

patient care, and by ensuring they are free to focus their attention on what matters most to patients.

“The second lesson we must take from the Francis report is the need to create an environment in which health professionals right across the NHS can raise concerns on behalf of their patients without fear of recrimination, and where concerns will be properly and thoroughly investigated”

‘Firstly, we need to refocus and restore patient care back to its rightful place at the heart of everything we do, across the entire health service from the most junior healthcare assistant to the most senior consultant.’ budgets and achieve targets. We can now understand the distress of the patients and families whose relatives were subject to such lapses of care.

The flurry of correspondence in the newspapers, including an excellent letter to the Times from MWF member, Dr Kim Holt, on the treatment of whistleblowers, has certainly provoked discussion of some very awkward truths. We now have to concentrate on restoring confidence in the NHS and re-establishing patient care at the centre of everything we do, across the whole health service.

We had already chosen the title for our November Meeting before the Francis Report, “Patient and Doctor Safety: Can women change the culture of the NHS?” This now seems more pertinent than ever, and I am sure will generate much lively debate.

Dr Clare Gerada has written an excellent commentary on the Francis Report, highlighting the need for care and kindness 6

burdens on the NHS by a third. Let’s hope that this will be a positive way forward and not another round of tickboxes and micro-management.”

Many of the Royal Colleges have issued statements and you might like to read an extract from the RCGP statement, which identifies some of the changes needed.

Firstly, we need to refocus and restore patient care back to its rightful place at the heart of everything we do, across the entire health service from the most junior healthcare assistant to the most senior consultant.

“Clinicians, including GPs and their teams, must be given the ability to do what is most important: listening to patients and caring for them.

“GPs have so far ridden the storm but financial constraints and top-down targets are starting to adversely affect the level of care we can deliver to our patients. We need to reverse this trend by increasing the number of GPs available to provide

“The second lesson we must take from the Francis report is the need to create an environment in which health professionals right across the NHS can raise concerns on behalf of their patients without fear of recrimination, and where concerns will be properly and thoroughly investigated. In anticipation of the report, the RCGP has produced a UK-wide position statement on raising concerns and whistle blowing in the NHS that we hope will prove invaluable for GPs, hospital staff and patients.

“The NHS was set up 65 years ago to provide fair and effective healthcare and to protect patients. If it is to continue doing this, the Government and all of us working in the NHS must stop underestimating the importance of kindness and compassion, the fundamentals of good patient care that cannot be budgeted for.”

I would like to think that the values of the MWF and all its members reflect the conviction that we can and must restore confidence in the NHS. Medical Woman | Spring 2013

Women at the Top

Women At The Top Dr Olwen Williams OBE – Consultant Genitourinary/HIV Physician, North Wales

Name: Olwen E Williams Born: Manchester, UK but ‘Made in Wales’ Lives: St Asaph, Denbighshire North Wales Medical School: Liverpool Year Qualified: 1984 Specialty: Genitourinary Medicine/HIV First Ambition: To be a vet but was put off by male members of my family who said a woman couldn’t do the job – aged 8 this was my first recollection of sexism.

Soon afterwards I decided to become a doctor.

Other Career Related Interests/Roles: Enjoy being part of Civil Society – I have been member of BBC Audience Council, Wales committee Equality & Human Rights Commission & currently trustee National AIDS Trust (NAT).

Challenges along the way: Failing my driving test 3 times! Re-sitting A levels… do you really want a long list?

Rewards of your role(s): Inner peace & contentment in knowing I’ve made a difference to people’s lives in all sorts of ways.

Dr Olwen Williams OBE has worked as a Consultant Genitourinary/HIV Physician in North Wales for more than 20 years. She has worked closely with the Welsh Government and advised on development of the Welsh Sexual Health Strategy, HIV service delivery and issues regarding Sexual Assault and Domestic Violence.

She is currently a Chief of Staff (clinical leader) for her Betsi Cadwaladr University Health Board and manages a £180 million budget which covers delivery of services in Primary, Community and Specialist Medicine.

Dr Williams was awarded Welsh Woman of the Year in 2000 and received an OBE for services to medicine in Wales 2005.

Inspirations: The fight for Equality – I cannot cite any of the feminists of the 1960 s and 70s as I had an inherent self belief that things were not right when I was very young.

Influences: My mother who died when I was 10, and a whole hoard of strong Aunties, who still hold me to account.

Motto: The sole purpose of human existence is to kindle a light in the darkness of mere being – Carl Jung Put not off till tomorrow what can be enjoyed today.

Quotas for senior positions for women in healthcare – yes or no?

People should be in roles by merit not gender.

Advice Do’s: Treat everyone with respect and kindness – you never know when you will need their help or support.

Be honest, but I’m afraid sometimes I’m frank!

Enjoy life both work and play, the balance is what you make it – both can be so rewarding.

Network, network, network!

Make coffee for your Team.

Smile.

Don’ts: Try to be something you’re not – Superwoman doesn’t exist.

Don’t do something you don’t enjoy.

Don’t become a scary woman.

How to get there: Explore every opportunity that comes your way, regardless of how hard out it might be.

Chance plays a big part in getting there.

Identify someone you can get honest and valued feedback from – bouncing ideas can be affirming.

www.medicalwomensfederation.org.uk

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Clinical Commissioning

What is clinical commissioning, and why is it important?

Dr Nikita Kanani Clinical executive with Bexley Clinical Commissioning Group, Medical Adviser for NHS Direct, Quality Improvement lead for the Faculty of Medical Leadership and Management. @NikkiKF

“Commissioning is simply the process by which health and care services are provided effectively to meet the needs of the local population.”

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n 2010, the Coalition White Paper ‘Equity and Excellence: Liberating the NHS’ outlined some of the far-reaching changes we are now seeing within healthcare. In part a continuation of the market reforms of the early 1990s, the NHS has been majorly reorganised over the past two years.

The Health and Social Care Bill was poorly received by many, and by 2011 the government reluctantly agreed to a ‘pause’ and the establishment of the ‘Future Forum’ to review the Bill which was cleared with over 1,000 amendments. It gained royal assent in March 2012, becoming the Health and Social Care Act 2012.

Although there have been many objections to the Act, one of the central tenets – ‘clinically led commissioning’ – is widely accepted as an important part of improving service provision within health.

But many remain confused by the concept of commissioning, and this article aims to translate the concept of commissioning from a process driven ‘cycle’ to a useful tool to improve care.

Commissioning is simply the process by which health and care services are provided effectively to meet the needs of the local population. However, it is a complex process with three main stages – planning, procuring and monitoring.

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Strategic Planning This is the most important part of commissioning a new service, and involves working with multiple stakeholders (people or representatives of organisations with a vested interest in the service under discussion) to understand what the local health needs are and what resources are available.

This stage starts with a ‘Joint Strategic Needs Assessment (JSNA)’ which is a report co-authored by health and social care, usually with a steer from Public Health. The vast amount of information allows commissioners to understand the local population and its needs, and this informs the commissioning priorities for the coming year. This information is paired with national drivers, new policy and the organisation’s strategy.

At this stage, the current provision is also reviewed, along with the resources available to understand the gaps and priorities for the area. Robust data should be used here to understand the service and the effects of any changes. Engagement events should be held to help determine these priorities and understand the aspirations for the proposed service, and to begin describing what the service should or could look like.

What does this mean for me?

If you are in Primary Care, Clinical Commissioning Group (CCG) members will be involved in this process. You may be invited to an engagement event to help align local priorities with resources, or be able to give expert advice in your specialist role.

If you are in Secondary/ Tertiary Care or Mental Health, you may wish to get involved in this process by contacting your local CCG in order to give input early on in the process.

Procurement and Market Management A complex stage, procurement refers to the task of developing the plans already made into service specifications – details of what the service will and will not entail – and contracts. Contracts need to involve information on who will provide the service, where they will provide it and when. This is often described as a vision for the service and includes patient outcomes based on local information and national guidance. Monitoring arrangements are also included at this point (see below), with a focus on identifying ways in which a quality service is provided. If the contract is above a certain value, a tendering process is commenced where Medical Woman | Spring 2013

Clinical Commissioning

“It is not the strongest of the species that survives, nor the most intelligent. It is the one that is the most adaptable to change.�

Charles Darwin

service providers compete (on cost and quality amongst other things) to deliver the service.

What does this mean for me?

For most doctors, you will not need to get involved with procurement, which can be a relief as it is a complex area.

However, the CCG leads often need to review contracts and bids to provide the service.

Monitoring, Evaluation and Feedback The final vital stage of the Commissioning Cycle involves monitoring the service that has been procured. This can be through a variety of methods including incentives (e.g.

Locally Enhanced Services), performance frameworks (e.g.

Commissioning for Quality and Innovation payments) and service user feedback (e.g. patient surveys). This data is collected and ideally sent to the providers involved to influence service improvement and ensure that the service meets the specification set out initially.

What does this mean for me?

As a doctor you may be involved in providing the service, and you will certainly have insight into how users find the service.

Feedback is a core component of the monitoring process, and the data from the service evaluation will be useful to review.

Do you want to get involved?

There are many benefits of being involved in commissioning and designing services. As a patient advocate, the input from a clinician is useful and practical. It allows you to understand health services in a new dimension, creating and developing networks with a range of people within your area and beyond.

Sharing knowledge and experiences improves the care you can give to your own patients, and allows you to develop your creative and innovative side. The skills that you can learn are vast, adding to your repertoire and your appraisal folder!

At CCG level, there is often remuneration available, and the option to work flexibly. Get in touch with your local GP lead, locality representative or clinical design team within the CCG for more information. www.medicalwomensfederation.org.uk

9

Twitterview

Twitterview with Dr Joanne Bailey – GP and GPC Representative, Herts @drjbailey

Q: @drjbailey

When did you join Twitter and how often due you check it?

A: @medicalwomenuk

I joined Twitter about 18m ago. Like a lot of people I go hot & cold, sometimes checking frequently, sometimes not for weeks

Q: @drjbailey

What attracted you to medicine?

A: @medicalwomenuk

Q: @drjbailey

Q: @drjbailey

A: @medicalwomenuk With difficulty! Is there any other answer?! #prioritise #NHS #tatt

Was going to be an accountant but went with friend to med school open day at UCL. Became fascinated by problem-solving angle

How do you keep up with your family and friends?

What do you enjoy most about your job and why?

Q: @drjbailey

Clinically, the sense of making a difference in people’s lives.

GPC work to influence policy = both satisfying & frustrating!

A: @medicalwomenuk

A: @medicalwomenuk Q: @drjbailey

How did you become involved in GP politics?

A: @medicalwomenuk PCT-sponsored Kings Fund leadership course. Potential to influence policy helps sense of being in control of working life!

Q: @drjbailey

How do you manage your multiple roles?

Doing fewer clinical sessions than I’d like so can do the rest in my own time, & by choosing complementary/overlapping roles

Q: @drjbailey

What is your greatest fear?

A: @medicalwomenuk Greatest fear? *Thinks* Hmm deep & meaningful ‘losing my daughter’ or light-hearted ‘spiders... or maybe daddy-long-legs’?

What has been your greatest achievement?

Q: @drjbailey

Greatest achievement in life? Being a family! Still working at it :)

A: @medicalwomenuk

A: @medicalwomenuk Q: @drjbailey

What has been your favourite role to date: GP Partner, Salaried or Locum?

A: @medicalwomenuk

A difficult one as each has pros & cons! Right now I’m enjoying flexibility of locum work as general practice v pressurised.

Q: @drjbailey

What are your feelings about the upcoming GP Contract changes?

A: @medicalwomenuk I believe Gov intent for NHS is malign. Practices work-saturated & stand to lose £000s. Model of GP must adapt to survive.

Q: @drjbailey

What are the issues affecting female GPs in 2013?

What uplifts you?

My faith and my daughter. Truly blessed :D

Q: @drjbailey

What do you do to relax?

A: @medicalwomenuk Read a novel, watch a film, take a long bath. Can I mention red wine?

Q: @drjbailey

Name someone you love to follow on Twitter and why

A: @medicalwomenuk

As its Friday... Tweeps that make me smile @queen_uk @ mrsmillsst@jamieoliver @amateuradam (health warning!) #FF

Q: @drjbailey

As a woman in the medical profession, have you experienced discrimination?

A: @medicalwomenuk Workforce issues, mainly: few part-time part’ships, unfav’ble employm’t contracts, locum superann changes, pressure of work.

A: @medicalwomenuk Not that I’m aware of tho’ I did feel my career choices were limited.

Luckily general practice has been great as so flexible

Q: @drjbailey

Q: @drjbailey

Who/what has been your biggest inspiration?

A: @medicalwomenuk

With the rapidly changing NHS + university system, should we encourage our daughters to follow a career in medicine?

My mum is such an inspiration – fiercely independent in her 80s.

Career-wise must be Laurence Buckman – he was local GPC rep & made national medical politics sound such fun!

A: @medicalwomenuk Hmm something I have been wondering myself. Unsure if I’m honest. Not as good a choice as it was but still a great career...

Q: @drjbailey

Q: @drjbailey What advice would you give a female medical

What has been the best year of your career and why?

A: @medicalwomenuk

1989-90: Finished training. Offered great partnership. DRCOG. Took on fundholding lead 1st wave & so politicisation began.

10

student/junior doctor about developing her career?

A: @medicalwomenuk Don’t think I’m equipped to answer this!

Everyone is different. I’d sit down 1:1 & talk through, be available #mentorship Medical Woman | Spring 2013

TopAPPS

Top Apps

For Medical Women

Priorities

Increase your productivity with this task manager app , which let’s you include notes, due dates and a timer.Dr Williams was awarded Welsh Woman of the Year in 2000 and received an OBE for services to medicine in Wales 2005.

Packing Pro For those of you who travel for work and pleasure, use this packing list app that helps you pack only the essentials.

Evernote Evernote is a tool for remembering anything and everything that happens in your life. Notes, ideas and recordings can all be put into Evernote; some doctors have been using it to record evidence of CPD activity ready for appraisals.

Snapp!

MyFitness Pal

Do you come home from conferences or networking meetings with a stack of business cards and no place to put or keep track of them? Then use Snapp! It allows you to enter a contact’s email address and it sends a personalised follow up email straight away.

If you’re wondering whether those Pret goodies you have everyday at lunch are actually healthy, try looking what you eat up on MyFitness Pal.

the Medical Women’s Federation

Oxford Spring Conference

The largest body of women doctors in the UK looks forward to meeting you!

Friday 10th May 2013 – The Oxford Hotel

With a glimpse at current state of the art pain research, our conference focuses on various aspects of physical and emotional pain and its impact on women and their families.

Professor Raymond Tallis, Author, Philosopher & Chair of Healthcare Professionals for Assisted Dying Professor Michael Sharpe, Professor of Psychological Medicine, Oxford And… Dr Peggy Frith & Jane Moore Workshops: Ethical Issues in Pain Relief • Chronic Pain in Musculo/Skeletal disease Work/Life Balance • Women in Academic Medicine • And many more!

You still want more? How about a social programme excellent for networking?!

For more information on the conference and all other MWF events please visit:

www.medicalwomensfederation.org.uk or scan the QR Code. www.medicalwomensfederation.org.uk

11

Medical Leadership

Medical Leadership:

Tips to get females to the top Dr Penny Newman GP and Consultant in Public Health, Primary Care Advisor, Commissioning Development, NHS Midlands and East

T

he demography of the medical workforce is changing. Women doctors have been the majority entrants to medical school for over the last two decades, are now 31% of Consultants and 45% of GPs, and are predicted to become the majority of doctors in future. They are therefore a significant, valuable and growing part of the medical workforce.

Behind this trend the picture is more complex. Women doctors are under-represented in certain specialties such as cardiology and surgery, and over represented in posts such as salaried GP. There are relatively few in senior leadership positions such as medical director, and on Clinical Commissioning Groups (CCGs), although the proportion varies between organisations.

Why does this matter?

• The NHS is currently fishing for its top medical leadership talent from just over half its talent pool at a time when new leadership behaviours are most needed.

• More female leaders as role models may inspire others, the majority of whom are women who in turn can improve career satisfaction and ensure a return on investment in medical training.

• Women understand the issues other women bring as staff, patients, mothers and carers so can help ensure their needs are met.

• Research suggests women have better communication skills and are more patient centred, and they received relatively fewer complains to the GMC (27% of complaints)1 . A “critical mass” of three or more women in top teams is required for real change in working cultures more appropriate for the 21st century .

• Diverse top-teams benefit from improved decision-making, innovation and creativity, better governance and less “group-think”.

While there is not universal agreement that women doctors experience barriers to career progression, and male and female perception of the extent of these barriers differ, research indicates role conflict between clinical, leadership and domestic responsibilities can play a major role in limiting advancement.

12

Other structural obstacles include, for example, late night meetings, the salaried GP contract, and lack of role models or mentors. Finally, mindsets – both individual and organisational – for example, low personal aspiration but also “an old boys’ network” or “organisational bias” all contribute to what has been described as a “cumulative disadvantage” for women doctors in progressing their careers2.

The new Faculty of Medical Leadership and Management (FMLM) recognise the significant and growing contribution of women doctors to leadership, and the talent they represent.

To give women doctors’ a helping hand to achieve their potential we asked female members what advice they would give their colleagues and what development they had found valuable.

The resulting short report contains the condensed wisdom of 78 doctors from all areas of medicine, representing over one thousand years of collective experience (on average 23 years), that is likely to be of value to more seasoned female medical leaders as well as to those starting out on their leadership journey.

The tips below are a summary from this paper.

For the full report please see https://www.fmlm.ac.uk/ resources/transitions-female-medical-leader

1. What is leadership?

The Kings Fund describes leadership as “the art of motivating a group of people to achieve a common goal”. The leadership competencies for doctors are outlined in the Medical Leadership Competency Framework, although a very different model has been developed by McKinsey following interviews with 85 senior women executives5 which is about having a well of physical, intellectual, emotional and spiritual strength that drives personal achievement and inspires others to follow.

2. Managing yourself The focus of the majority of advice was on managing yourself: • Have self belief, self awareness and confidence, identify and stick to your values, and what’s important to you and the organisation, and develop an authentic leadership style – resist Medical Woman | Spring 2013

Medical Leadership

‘While there is not universal agreement that women doctors experience barriers to career progression, and male and female perception of the extent of these barriers differ, research indicates role conflict between clinical, leadership and domestic responsibilities can play a major role in limiting advancement.’

emulating more stereotypical behaviours, which will also help you survive long term.

• Develop positive behaviours and emotionally intelligence, be polite, kind, fair, encouraging, courageous, act with integrity, and adopt a “can do” attitude.

• Overcome set backs by being emotionally and physically fit and resilient, choose your battles carefully and tackle undermining and demoralising behaviour calmly.

6. Personal development

3. Managing others

Women doctors learned on the job and from others, attended external courses and invested in or created developmental relationships including mentors, coaches, networks and sponsors.

The advice was clear: Establish multiple both formal and informal supportive relationships, in and outside of medicine, and early on in your career, with both men and women. FMLM has recently established an on line women’s doctors network you can now join.

Inspiring Women Leaders in Medicine http://www.linkedin.com/ groups/Inspiring-Women-Leaders-in-Medicine-4494986

Team work is the secret of success and leadership is about developing and supporting others – you cannot do it alone!

7. Your career

• Be a good role model, deliver what you commit to and demonstrate both integrity and competence to build trust6.

• Build and maintain a high performing team, recruit ambitious people, consult, communicate, delegate and encourage others to develop their own leadership skills. Understand others’ perspectives.

• Develop a flexible leadership style as personalities and individual differ and include a coaching style, or ability to listen well and ask questions.

• Manage undermining behaviour, discrimination, professional jealousy and intimidation from both male and female colleagues by being tough, keeping calm, not becoming disheartened, and understanding the real agenda and dealing with it.

4. Work smart Colleagues recommend multiple time saving activities but being well organised and effective is not enough. Connecting to the right people, taking risks, being heard, image, presence and finding support7, can aid career progression as you will increasingly be judged for the larger impact you are having through your relationships, your profile and your image.

5. Work life balance Finding the right balance between home and work responsibilities is important and for self and family, establishing a robust support network at home, adopting time saving practices and being clear on priorities. www.medicalwomensfederation.org.uk

Women’s careers have been described in three phases8 – Idealistic Achievement (ages 24-35), Pragmatic Endurance (age 36-45) and Reinventive Contribution (age 45 and up). People approach their careers differently – some may be very clear where they want to end up and plan how to get there, while others look for opportunities that match their strengths, or take what comes if it fits their skills set and aspirations. In this way careers for women (and many men) are not necessarily linear. Portfolio careers are increasingly an option balancing clinical and leadership roles.

References 1. GMC The state of medical education and practice in the UK report: 2012 2. Penny Newman. Releasing Potential: Women doctors and clinical leadership. NHS Leadership Academy and NHS Midlands and East, October 2011 3. Konrad, A., Kramer, V., and Erkut, S., 2008, “Critical mass: The impact of three or more women on corporate boards”, Organizational Dynamics, 37(2): 145-164.

4. Terjesen, S. Sealy, R. & Singh, V., 2009, “Women directors on corporate boards: A review and research agenda”, Corporate Governance: An International Review, 17(3):320-337.

5. McKinsey Centred leadership: How talented women thrive A new approach to leadership can help women become more self-confident and effective business leaders.

McKinsey Quarterly. September 2008 Joanna Barsh, Susie Cranston, and Rebecca A. Craske 6. Sephen MR Covey, Rebecca Merrill Thespeed of Trust. Free Press, 2006 7. Suzanne Doyle Morris. Beyond the Boys Club. Strategies for achieving career success as a woman working in a male dominated field. Wit and Wisodom press. 2009 8. O’Neil D, Bilimoria D Womens Career Development Phases: Idealism, Endurance and Reinvention by, Career Development International, 10, 3, p. 168-189, 2005.

13

In the Hot Seat

In the Hot Seat Professor Jane Dacre – Professor of Medical Education, UCL

Professor Jane Dacre qualified as a doctor in 1980 at UCH Medical School. She undertook her clinical training in General Medicine and Rheumatology at St Bartholomews Hospital, London. She completed her research training at St Bartholomews Medical College, developing digital imaging methods for the evaluation of radiological joint space size in patients with osteoarthritis.

In the 1980s, Jane became interested in Medical Education. She was the clinical lead for the development of the first Clinical Skills Centre in the UK and was a co-author of the GALS screen, a novel method of joint examination, which is used in all UK medical schools.

She has been instrumental in the development, implementation and evaluation of several undergraduate and postgraduate assessment systems in medicine. This includes: the finals examinations at Barts and UCL,

MWF President, Dr Fiona Cornish and Professor Jane Dacre at the Women In The City Gala Lunch

What attracted you to medicine?

My father was a doctor, so it seemed reasonable job to do. Then whilst at school, I developed a big interest in biology, so it became clear that Medicine was the job for me... I was about 12 years old when I decided, so on reflection now, I don’t know how rational that was.

the Royal College of Anaesthetists postgraduate examination, the PLAB test, the MRCP (UK) examination and the tests of competence in the GMC Performance Procedures.

How did you become involved in medical education?

I first developed a serious interest in teaching as a medical registrar. I often taught large groups of students whilst on call. I was then asked whether I would like to be involved in setting up the first clinical skills

Jane has a broad interest in all aspects of the performance of doctors. Recently this has included an evaluation of the effects of gender and ethnicity on the career trajectories, and performance of women and BME doctors.

In 2012 Jane was the winner of the medical category in the Women In The City, Women of Achievement award (which is co-judged by MWF).

14

“I realised just how little educational help the students in those days were getting in developing their skills, so thought it would be a good idea to work in that area.”

Medical Woman | Spring 2013

In the Hot Seat

“Medicine will always be a very fulfilling job for women, and one they will excel at; but it will always be quite hard work, quite stressful, and quite demanding.” centre in the UK... and it went from there. I realised just how little educational help the students in those days were getting in developing their skills, so thought it would be a good idea to work in that area. At the time I was in training as a general physician and rheumatologist, so I kept both interests going in parallel. One night, I had to put in a CVP line, having never been taught how to. The ITU Charge Nurse talked me through it, but it was terrifying. I realised that there must be a better way to do it.

Who has been your biggest inspiration?

A group of strong powerful women like Carol Black and Parveen Kumar, who have led the way for women in medicine and who have shown that it can be done.

How do you keep up with your family and friends?

Not as well as I would like. I enjoy seeing them at times like Christmas and weekends. With my close family, we try to eat together in the evening and Sunday supper is family time.

How do you manage your multiple roles?

Do you still practice clinically?

Yes, I gave up acute medicine a few years ago, but still see rheumatology patients at the Whittington Hospital in London.

As my clinical load is less, i try to focus on the more complex patients whose problems make them difficult to be seen in the usual hurly burly of a general clinic. I feel it is very important to keep my clinical roots.

I strive to be very organised, and am a master of multi tasking and prioritising. I am also supported by my family, and Deanne my PA, who is fantastic, and who runs my work life.

What uplifts you?

Nature, wildlife, and beautiful scenery.

What do you do to relax?

What do you enjoy most about your job and why?

Our medical students are a constant source of inspiration. It is a privilege to work alongside such a talented group of young people. The variety of what I do is also hugely rewarding.

For the past 3 years I have been the Medical Director of the MRCP (UK). I love the challenges brought by the academic and business mix of a large scale international postgraduate examination, with a fantastic reputation.

What has been your greatest achievement?

It used to be having chaired the Steering Group for the RCP women in medicine research project, but more recently, it is getting UCL medical to be at the top of the National Student Survey, and best in London for 3 years running.

You have achieved so much in your career already, how do you stay motivated?

Fortunately, I am constitutionally quite relaxed. A trait I inherited from my father. However, to keep it that way, I need family time, and nice places to go to with beautiful scenery.

As a woman in the medical profession have you experienced discrimination?

Of course I have! These days is it much more subtle, but it is all around us.

With the rapidly changing NHS and university system, should we encourage our daughters to follow a career in medicine?

Medicine will always be a very fulfilling job for women, and one they will excel at; but it will always be quite hard work, quite stressful, and quite demanding. If our daughters are resilient enough, they should definitely go for it.

I like working with my colleagues, and solving problems. Good teams are very motivating.

Are you aware of any plans to make training part time easier?

Do you have any regrets?

I have great hopes for the outcome of the shape of training review, as there is a chance that it will make training better for everyone, including those wanting to work less than full time.

Not really, but I used to feel guilty about not going to all the school shows. Now, as my children have grown up, I realise that they did not miss it as much as I had thought they did.

Have you worked abroad?

I have travelled a lot in the past few years, mainly with the MRCP and taking the PACES exam to interesting places. This year, we set up a centre in Khartoum and Kolkata. www.medicalwomensfederation.org.uk

What advice would you give a female medical student/junior doctor about developing her career?

Work through the difficult times when you have a lot of domestic commitments, and do your best because it will be alright in the end, and to quote the Best Marigold Hotel, if it isn’t alright, it isn’t the end!

15

Charity Spotlight

Womankind Worldwide Sarah Jackson, Communications Manager

While a large number of health problems in the developing world can be blamed on poor infrastructure and lack of resources, such as safe drinking water and mosquito nets, there are also health issues that must be tackled by a change in attitudes and beliefs. Domestic violence and rape, female genital mutilation (FGM), enduring myths surrounding HIV and AIDS and poor understanding and stigma of mental illness are just such issues; and Womankind Worldwide is working with partner organisations in Africa, Asia and Latin America to unlock that change. I have outlined some of the work we are doing in this article.

Supporting women living with HIV in Malawi Malawi has one of the highest HIV infection rates in the world, and women are disproportionately affected. Poverty prevents many HIV positive women from accessing and adhering to treatment. It often means they cannot afford the two meals a day required to meet the nutritional requirements that accompany the treatment, or the costs of medicines or transport fees to the hospital. Many women have been forced to sell property or sex to meet medical bills and essential needs. Their children are often forced to leave school because the family cannot afford school fees.

Supported by Womankind, the Coalition of Women Living with HIV or AIDS (COWLHA) is a unique grassroots movement of over 30,000 women who are affected by the illness. COWLHA supports rural women to form associations sharing information on sexual and reproductive health, providing advice and support to each other, raising awareness about HIV in their communities to break down the stigma and collectively campaigning for better access to services. Last year COWLHA’s pioneering work was 16

recognised by the AIDs and Rights Alliance for Southern Africa with their Human Rights, HIV and TB Award.

Ending FGM in Ethiopia An estimated 80% of all Ethiopian women have undergone female genital mutilation (FGM), increasing the likelihood of birth-related complications, HIV infection, and a lifetime of pain and suffering. Womankind’s local partner KMG brings women, men, boys and girls together to discuss these practices and supports them to come up with solutions. For instance, many communities have adopted resolutions to penalise any community member who circumcises their daughter and to report them to the police. Thanks to KMG’s award-winning work in Kembatta reported rates of FGM have been reduced from 97% to 4% over ten years, protecting over 175,000 girls.

Huge advances for women’s health can be made by tackling gender inequality and the discrimination which drives violence against women. We’re proud to support partners who not only provide critical services to women but campaign to change attitudes too.

In no country in the world do women enjoy the same rights or opportunities as men. Every day women and girls face discrimination, poverty and violence just because they are female. We’re working to change that. Please visit us at www.womankind.org.uk to get involved.

Medical Woman | Spring 2013

Global Health Dr Clarissa Fabre MWIA representative to the WHO, Immediate Past President MWF

An update on global health

A

recent BMJ article (BMJ 2012;345:e6877) stated “WHO is in crisis. Unless member states can be persuaded to ‘untie’ their donations and give the organisation leeway to control its budget and set priorities, WHO will slide further into irrelevance with disastrous consequences for global health.” When WHO was formed in 1948 its main funding came from member states, which paid according to the size of their population and economy. As a proportion of total WHO revenues, these contributions have declined from 80% in 1978/9 to 25% in 2010/11. As a consequence, WHO’s work is largely controlled by the donors rather than by its assembly of member states, distorting priorities and the coherence of its programmes. A strong and effective WHO is essential to address health crises such as high child and maternal mortality, malnourishment, lack of access to clean water, as well as the rise of non-communicable diseases such as diabetes and obesity.

This requires a well-governed, focused and effective WHO to set its own priorities.

The Bill and Melinda Gates Foundation, in conjunction with the UK Government and the United Nations Population Fund, organised a landmark summit on Family Planning in London last year. Melinda Gates, a Catholic, has vowed to dedicate the remainder of her life to improving access to contraception across the globe. She predicted that women in Africa and Asia would soon be ‘voting with their feet’, as women in the west had done, and would ignore the church ban on artificial birth control. The Foundation is pouring £360 million into this initiative over the next 8 years. Another top priority for the Foundation is a vaccination programme. Women will not choose to have fewer children until they are sure their offspring will survive beyond childhood, and that is starting to happen.

www.medicalwomensfederation.org.uk

Last year, our president Fiona Cornish and I met a delegation of Chinese doctors and hospital administrators at BMA House to discuss women in medicine, and healthcare in China. It was a fascinating discussion. China has 1.3 billion people without a serviceable primary healthcare system. Medical care is sought directly from hospital specialists. Appointments are made on the basis of a doctor’s reputation. Traditional Chinese Medicine still plays a significant role and herbal drugs are the first choice of many patients, especially the elderly. Most urban couples are limited to one child, while rural families are allowed 2 children if their firstborn is a girl. The strict limits have led to forced abortions and sterilizations. The vast majority of children in orphanages are girls. These factors have led to a long-term gender imbalance. In 2001, 117 boys were born to every 100 girls. More than 1.3 million abortions are carried out in China every year, with 29. 3% Women in every 1,000 undergoing the procedure, compared with 17.5% in England and Wales. Analysts have put the high rate down to young people not knowing how to use contraceptives properly; 50% of women who had an abortion failed to use any form of birth control.

What is MWIA (and indirectly MWF) doing in relation to all this? In the last year, we have had discussions and made statements on regulating female genital cosmetic surgery and the plight of the girl in Pakistan who was shot as she pursued an education. As the representative to the WHO, I shall again be attending the World Health Assembly in Geneva in May. This is an enormous conference, and every member country wants to have its say. Through Dr Shelley Ross, the Secretary General of MWIA, I shall be having meetings in Geneva with those involved with family planning, gender-based violence, female genital mutilation and cervical cancer. I have joined the Partnership for Maternal, Newborn and Child Health, and hope gradually to build up some influence in that sphere.

17

Egg Freezing

Time To Place All Your Eggs In One Very Cold Basket?

Miss Katharine Fraser, ST5 – Obstetrics and Gynaecology, London Deanery • The fetus at 4-months has up to 7-million follicles, decreasing to 1-2 million at birth • At the menarche, there are 300-400,000 follicles remaining and less than 1000 by the time of menopause • From these pools, only around 400 oocytes are released by ovulation during a woman’s lifetime • The average age for menopause in the UK is 51 years • The average age for women to have their first baby in the UK is 29.7 years 2 • The number of IVF cycles performed each year continues to increase – approximately 47,000 women received over 60,000 IVF or ICSI treatments in 2011* • The overall live birth rate per IVF cycle started is approximately 24%* • The average age of women undergoing IVF treatment is 35 years* • 60% of IVF cycles are funded privately* * (1) HFEA [Human fertility & embryology authority] figures released February 2013

T

he number of women having babies in their 40s has risen by more than 15% in five years whilst teenage pregnancy rates are at their lowest in decades2.

The shift in society and family structure, driven by changes in lifestyle choices (women pursuing higher education and professional careers) as well as financial concerns, has impacted on the decisions made by women and couples about when to start their families.

The media have been quick to promote the ‘women who have it all’ with coverage of Uma Thurman and Nicole Kidman to name but a few celebrities having babies over the age of forty. However, we are now starting to see that the worrying truth behind delaying parenthood is an overall decline in fertility – and ultimately a rise in the number of childless women. Humans already have poor pickings compared with other species with a fecundity rate of only 20%3 and this figure is known to decline with age.

In fact despite the menopause averaging in the fifties, natural population data indicates that fecundity usually ends at around 39-41 years. Women may be lured into a false sense of security with a fallback plan of IVF and we have certainly seen a rise in the number and the age of women seeking IVF. Importantly however, assisted conception success is largely determined by maternal age and egg numbers – which correlate negatively. Thus, despite the development of many new techniques, success rates for IVF in women over the age of 40 are low (around 9%) and this has remained unchanged over the last decade.

With recent advances in vitrification techniques, freezing eggs may be the answer in prolonging fertility. Unlike freezing embryos, which has been successfully used in IVF for many years, egg cryopreservation gives women with the ability to preserve good quality, younger eggs without the immediate necessity of a long-term partner to father the child. Research has been so promising that oocyte cryopreservation is now 18

being offered to young women who need to undergo chemotherapy and radiotherapy for cancer treatment at the potential cost of their fertility.

What processes are involved in oocyte cryopreservation?

As per IVF treatments used throughout the UK currently, the initial phase of egg collection is ovarian stimulation. Drugs such as Clomiphene (‘Clomid’) and GnRH injections are used to stimulate ovarian follicle development by up-regulating the hypo-thalamo-pituitary axis and subsequent gonadotrophin release. These drugs come with significant side effects – in particular ovarian hyperstimulation and multiple pregnancy.

Once a patient undertakes ovarian stimulation, close monitoring using ultrasound imaging of follicular development is required.

The egg collection procedure is performed usually under general anaesthetic. Women must be aware of the potential risk of pelvic infection and the subsequent potential threat to future fertility following egg collection.

Vitrification is the new rapid technique for ‘freezing’ eggs and embryos and prevents the formation of ice-crystals in the living cells. By producing a glass-like structure – instead of ice – there is less damage to the eggs and an association with excellent survival and fertilisation rates. The eggs are exposed to high concentrations of cryoprotectants to allow rapid dehydration of cells and then loaded into tiny storage devices to facilitate ultra-rapid cooling at a rate of thousands of degrees per minute. At time that fertilization is desired, the vitrification process is reversed, by warming and rehydrating oocytes. Eggs can be injected with a single sperm 3-4 hours later after warming.

Recent research has shown excellent safety and efficacy with oocyte vitrification and cryopreservation techniques. Fertilisation and implantation rates of cryopreserved oocytes fertilised with Medical Woman | Spring 2013

Egg Freezing ICSI (intra-cytoplasmic sperm injection) are now comparable with those of fresh oocytes4,5. Consent focuses not only on the procedures, but highlights issues concerning the length of time for egg storage (the current maximum length as per guidance by the HFEA is 10-years). What should happen to the eggs if the donor were to die or become unable to make decisions? May eggs be donated for use by other women?1 Women also need to understand that freezing their eggs does not guarantee conception, progression through a normal pregnancy or the ultimate outcome of a live-birth. Pregnancy over the age of 40 years is associated with higher miscarriage rates, higher risks of pregnancy-induced illness such as pre-eclampsia6 and increased risk of stillbirth at Full term7,8. Older mums also face more problems in the intra-partum period with recent figures suggesting only a 10% rate of spontaneous vaginal delivery in those over 40 years.

Who are the likely candidates and what is the optimal age for oocyte cryopreservation?

Not including those undergoing cancer treatment, most women who consider cryopreservation are in their late thirties after career progression has taken over, life-partners have not yet been found, and worries about the ‘biological clock’ kick-in. However, there is a known gradual decline in quality and quantity of oocytes due to increased meiotic non-dysjunction (Table 1) and it has also been observed that there is an accelerated loss of follicles after the age of 389. Combined, these factors decrease chances of successful conception and increase risk of miscarriage – regardless of IVF. In the event that we do adopt a culture of social egg freezing, the target patient group should be women in their early twenties who foresee that they may delay starting their family. With the evidence showing similar rates of success with frozen versus fresh egg ICSI, it is surely most ethical to freeze the better quality ‘younger’ eggs for use in later IVF than encourage a 40-year old to use her fresh eggs.

Maternal Age Risk of Down’s Syndrome at Term 20 1:1450 25 1:1350 30 1:940 35 1:350 40 1:85 45 1:35 [figures reproduced from The Wolfson Clinic, Queen Mary University Hospital website, Morris et al 2013] There is debate around the optimum age group to educate girls/women about their fertility time limit. One ACU specialist I work alongside feels that girls should be educated at school – but this may seem contradictory to recent efforts to improve sex-education and drive down the teenage pregnancy rate.

Perhaps a worthy target is young women at the start of their university years? This group are the potential academics and professionals of the future. However, it may not be in a student’s interest to consider her fertility status during ‘freshers week’; nor cover the costs of procedures with student loans! Could we pass the responsibility to GPs to target those attending for routine smears (i.e. aged over 25) – a QOF for ‘discussion about fertility clock’? www.medicalwomensfederation.org.uk

Can we predict fertility status and decline?

As well as age factors discussed above, other lifestyle factors such as smoking may affect rate of follicle depletion. Significant consideration must be made into genetic components as there is a known strong concordance in the age of menopause between mother and daughter and between monozygotic twins.

Increasingly, markers of ovarian reserve have been studied as a tool to predict the menopause including early follicular phase hormones; estradiol, follicle stimulating hormone (FSH), inhibin B, and anti-Mullerian hormone (AMH). Importantly, there is no single hormone which obviously appears to differentiate each stage. Estradiol does not decrease significantly until the onset of the menopause so is not a reliable predictor of fertility status.

Consistently high levels of FSH are diagnostic of the menopause having taken place but no steady pattern of change across the reproductive aging process has been observed. Alongside the cyclical changes in FSH levels, it unfortunately proves it to be a poor forecaster of fertility decline. AMH is the determinant of sexual development in the embryo and levels are independent of the phase of the menstrual cycle. AMH is produced almost exclusively by the granulosa cells of the ovary and shows a nonlinear decline across adult life10. Alongside ultrasound imaging to count the number of antral follicles within the ovary, AMH may indeed aid fertility specialists and women in making decisions about their fertility choices.

The advent of social egg freezing highlights new ethical and moral debate for fertility professionals. In offering such medicalisation of pregnancy we must consider factors like the optimal age for freezing as well as the maximum age for fertilising.

There is not currently any guidance as to how many eggs one should aim to freeze and store; nor how many cycles of stimulation and collection would be required to achieve this.

Importantly, women must understand that egg cryopreservation is not an alternative to normal conception and that it certainly should not be a case of putting all your eggs in one basket.

A woman’s otherwise ‘normal’ fertility must never be compromised when undertaking elective and presumptive procedures.

Older women needto be realistic about the risks of undertaking pregnancy later in life – with higher mortality and morbidity for both mother and baby at all gestations and during childbirth, none of these new elective treatments should be taken lightly.

References 1. www.hfea.gov.uk 2. www.statistics.gov.uk 3. Cooke, L, Nelson S. Reproductve ageing and fertility in an ageing population.

The Obstetrician and Gynaecologist 2011; 13: 161-168 4. Cobo, A et al. Obstetric and perinatal outcome in 200 infants conceived from virtrified oocytes. Repro Biomed Online 16, 608-610 5. Grifo, J.A. et al. Delivery rate using cryopreserved oocytes is comparable to conventional in vitro fertilisation using fresh oocyes: potential fertility preservation for female cancer patients. Fetil Steril 93 (2), 3913-3996 6. http://publications.nice.org.uk/hypertension-in-pregnancy-cg107 7. Royal College of Obstetrics and Gynaecology. Induction of Labour at Term in Older Mothers. Scientific Advisory Committee Opinion Paper 34.

RCOG 2013 8. Royal College of Obstetrics and Gynaecology. Reproductive Ageing.

Scientific Advisory Committee Opinion Paper24. RCOG 2011 9. Hansen KR et al. A new model of reproductive ageing: the decline in ovarian nongrowing follicle number from birth to menopause. Human Reproduction 2008; 23: 699-708 10. Nelson et al. Fertil Steril 2010; 95: 736-741

19

Debate

Debate: This Issue’s Conversation:

“Is power dressing appropriate for the medical woman?”

AGAINST Dr Jennifer Ann Langdon GP Principal, Maidenhead, Berkshire

P

ower dressing means dressing in a style intended to show that you are an important, powerful person. You walk in, wearing your killer heels and your built-up shoulder pads in your tailored suit, and you’ve said it. It’s all Dynasty and Alexis Carrington: she’s coming to sort you out. I say “she”, because this is all about women and how we look.

As a GP, I have gone visiting in a boat on the Thames and to a house in a flood. I have rescued an alcoholic on a horse in a muddy field. I have cleaned up a doubly incontinent transvestite, and numerous vomiting babies. Work is entirely unpredictable, with long hours and occasional bursts of phrenetic activity, involving all types of patients from celebrities to a guy that lives in a van.

When choosing clothes, I tend to shy away from anything that says “dry clean only” and, whatever it is, has to go with wellies or snow boots. I go for comfort and practicality, with a patterned fabric if possible so blood stains or worse won’t show.

The “look” I go for is authoritative and honest, knowledgeable and friendly, colourful and comfortable. If you have a jacket on, patients will find you more believable, and a stethoscope increases your credibility even more. Looking scruffy, with unkempt hair does not enhance your reputation with your patients or staff. You need to do a professional job and look the part, but be approachable and essentially non-threatening. Artificial barriers between us and them do not help, and being comfortable is important for both.

The doctor-patient relationship is not about us having power over our patients any more – that patronising era is as old fashioned as Dynasty. There is no place for power dressing in Medicine.

20

Medical Woman | Spring 2013

Debate

:ebateD FOR Dr. Claire Nightingale, Consultant Anaesthetist, Buckinghamshire Healthcare NHS Trust

P

ower Dressing: A clothing style intended to convey the impression of assertiveness and competence.

As long as humans have worn garments, there has been an element of power dressing. If one thinks of tribal chieftains, Roman Emperors and ancient Egyptians, it is clear that clothing can be used to signify power and influence.

The term “Power dressing” was first recorded in the New York paper the Post-Standard in September 1979. It reflects the style of dress worn by influential women of the time, including Margaret Thatcher, Princess Diana and the cast of Dynasty and Dallas. All of whom became and still remain iconic people in their fields.

The aim of power dressing is to convey that you mean business, that you are a competent and successful person. This is very true of millions of Chinese who, with their increasing influence on the world stage, have changed from wearing Mao suits 20 years ago, to being avid consumers of European fashion.

I believe that if attention is shown to the way you dress, your patients will hopefully feel they are in the care of a person who takes pride in their profession and has high standards and regard for detail, meaning they have more confidence in you and respect your judgment.

In the past women often felt that they had to emulate men in the way they dressed in order to be taken seriously, however with increasing equality, the rules are relaxing and women now feel confident to dress in a more feminine manner. Giorgio Armani, the fashion designer, recently said that women no longer need to wear powerful clothes in order to earn respect from their colleagues. However, style is as relevant as it has always been, and women need fashion to make them feel confident, to elevate them to a higher sphere and therefore raise expectations of what we can achieve.

My view is summarised by the singer Sam Cooke who said, “I dress my best because I want to give my very best”.

ON THE FENCE Dr Ceri Murphy, FY1, Leicestershire

P

resentation in today’s society is becoming increasingly more important. ‘Power dressing’ began in the 1980s as a fashion phenomenon characterised by women’s suits with shoulder pads, shorter skirts and stilettos.

Not exactly functional attire for a medic! Self-presentation initially propagated, seemingly related to female empowerment in the workplace; and thereafter became a way of women feeling both confident and capable in their professional environment.

For the modern working woman, power dressing is a way of evoking a desired reaction from those around us. If utilised conservatively, the way we present ourselves can be extremely striking and powerful. This is a useful extra tool for medical women aiming for promotion and/or career progression whilst simultaneously fitting in maternity leave and/or a family life. However, readers beware for if the mark is overstepped such that one’s presentation [is expressed] or takes on a sexual manner www.medicalwomensfederation.org.uk

then the respect of peers and patients alike is instantly lost.

Abusing one’s sexuality in this way undermines your credibility as a female doctor. We are placed not just in a position of complete trust but are also expected to have a more approachable side than our male counterparts. For example, Margaret Thatcher only ever referred to her makeover as ‘advertising’ when she became Prime Minister (and she never had any cleavage on show).

She demonstrated better than most that it takes more to command the attention of a room and retain its respect than flashing a bit of flesh.

Undoubtedly, it is imperative to maintain a smart and personable professional manner in the workplace, but there is nothing wrong with dressing to command people’s attention.

However, making ourselves inferior by over sexualising the persona of the female doctor won’t win us any battles and will serve only to keep that ‘boys club’ door firmly closed.

21

Careers Clinic

Applying for General Practice Dr Shivani Tanna, GP Registrar, London Deanery, Author of GPST Stage 3: Written and simulation exercises, Co-organiser of The Hammersmith Medicine GP Stage 3 course

The GPST application process Introduction General practice is a highly sought after career choice that many doctors apply for. Part of its appeal stems from the opportunity to maintain a ‘generalist’ patient-focused approach, combined with the choice to sub-specialise in any area that one desires, such as family planning or minor surgery. General practitioners (GPs) also contribute to research, teaching, leadership and management.

Having thoroughly enjoyed my hospital jobs and the excitement of the acute care and emergencies, a major attraction of general practice was the ability to work flexibly. Now with two small children I definitely feel this has been a sensible choice. However, this should not be the sole reason to become a GP, as despite less antisocial hours, the working days are longer and can be arduous, with an increasing reliance on contributing to out of hours care. I found the level of responsibility required as a trainee much greater than in any other job I have had.

Time management and organisation is now of even greater importance in order to be able to leave on time every day and manage levels of stress!

Applications to train in general practice have increased over the years and the selection process has become rigorous and competitive, especially for the most popular deaneries. Competition ratios range from 1.3 in the East Midlands, to 3.5 in London. It is therefore important to understand the assessments in order to maximise your potential of being offered a post within a specialist training scheme.

The following article will outline this process with a few helpful hints about how to maximise your chances of success.

The application process The current application format for general practice speciality training application was 22

Stage 1

2

3

Date November

January

February

What is involved

Written paper

Selection centre

Online application form to demonstrate and assess eligibility

Further details Submission of evidence Paper 1: professional

of foundation competence dilemmas & situational

& references judgement test

Simulation exercises involving three 10-minute consultations with a:

1. patient 2. relative or carer 3. non-medical colleague

Paper 2: Clinical

problem solving paper

Written prioritisation exercise in which you have 30 minutes to rank or prioritise five different tasks/issues with written justification for your responses, and a reflective exercise

Table 1: The stages of the application process

introduced in 2007. It has evolved to select doctors with the attributes to become good general practitioners. Table 1 summarises the stages of the application process.

Regional allocation to a specific deanery for selection centre (stage 3) depends on stage 2 score. The final allocation of jobs within each deanery depends on performance and scores at stage 3. If jobs remain unfilled after this stage 3, there is a second round of applications later in the year.

Stages 2 and 3 are testing different areas of the person specification, which can be found on the GP recruitment website (www.website). Broadly, these are based on the seven GMC principals of good medical practice and ethics.

The professional dilemma and situational judgement test This paper involves 60 scenarios a doctor at foundation level two may encounter, each with a choice of potential actions they can take.

There are two different types of questions. The first type involves ranking five different actions to take for a particular scenario in order of ‘appropriateness’.

These should be what you would actually do rather than what you should do.

The second involves choosing three of the most ‘appropriate actions’ out of eight for a particular scenario, which together comprise the best steps to take.

Maximum points are gained for answering the questions according to the marking scheme but some marks are attained for some variations of ranking, so as long as a question is completed some marks will be gained.

The clinical problem solving paper This paper has approximately 105 questions that are a mixture of extended matching questions and single best answers. The standard of knowledge required is that expected of a foundation year two doctor; really around the level Medical Woman | Spring 2013

Careers Clinic

• assess judgement regarding situations encountered in the workplace • test attitudes and ethical values rather than knowledge or clinical skills • can reflect complex situations & events • tailored to a particular context • job-relevant & professional attributes • relate to general experience & ability • scoring keys derived from the judgements of experts Box 1: An overview of what situational judgement tests may assess

Use a general book such as the oxford handbook of general practice for a good overview on subjects that will be tested, such as paediatrics Online revision question banks, such as onexamination, passmedicine, and emedica are the most effective way of revising for this examination. Most now have phone apps making these more accessible Books comprising questions with answers and explanations can be useful Courses which provide opportunities to practice questions and are designed to teach you common components and principles of subjects that appear frequently in the exam can be good for those who may not have been exposed to certain subjects, such as dermatology.

of clinical finals. The curriculum is also available on the GP recruitment website (http://www.gprecruitment.org.uk).

The selection centre The selection centre is reported as the most difficult and stressful part of the application process. Although there are usually three candidates for every two available places at this stage, the score determines whether one will get their first or subsequent choice training scheme. In a deanery such as London, this could mean the difference between commuting for five minutes or across town for two hours.

and experienced GPs assessing you at each stage, preferably those that have been through the selection centre process themselves . Most courses advertise that every part of the assessment will be covered but fail to mention you will not be practicing each yourself. Some courses use candidates to critique each other and do not have separate actors to role play the consultations. I would definitely recommend attending a course to improve confidence and to get an idea of what is expected, but do take the time to email the course organisers asking the questions in Box 3 before you book a place.

Take time to research who actually runs the course and how much experience they have.

Read the feedback from previous candidates where possible, and ask people who have attended the course in previous years about their experiences.

Box 2: Revision hints for the written paper

Will I get to do small group work, and how many candidates are there per group?

Will I get to practice each element myself? (three consultations and a written exercise myself) Are there separate consultation rooms for the small group teaching?

Do you use professional actors?

Are the tutors all GPs that have been through the selection centre process themselves?

Will I be given individual written feedback on every part of the assessment?

Will I be provided with a comprehensive guide with post course reading and practice exercises?

Box 3: Questions to ask organisers before booking a stage 3 course

www.medicalwomensfederation.org.uk

The assessment is made up of four parts outlined in Table 1. Although not recommended by the national recruitment office it is evident that practicing for this assessment is the most effective way of preparing. While group work with colleagues and friends is good for consultations, it is important to use a good book with practice written exercises and worked model answers to supplement practice.

Most candidates do attend a course to prepare for this stage and as a course organiser who has tutored over 250 doctors in the last three years, I have first-hand experience of how much people can improve in just one day! It is very important to research which course to go on as most are around two to three hundred pounds but offer different things.

To get the most out of a course you should be aiming to attend one where you get to practice every element of the assessment yourself. There should be good actors

Take time to research who actually runs the course and how much experience they have. Read the feedback from previous candidates where possible, and ask people who have attended the course in previous years about their experiences.

With an increasingly female medical workforce, general practice provides a good balance between professional and family life, with sufficient flexibility and challenges to fulfil most expectations. Even though competition may be fierce, chances of success can be improved with good insight into exactly what is required and focussed preparation.

References http://www.hammersmithmedicine.com/GP-Stage-3Courses date accessed 21.2.2013 http://www.gprecruitment.org.uk/ date accessed 17.2.2013 Hughes R; Tanna S: GPST Stage 3: Written and Simulation Exercises (Postgraduate Series), JP medical 2013

23

OOPE

Organising an out of programme experience [OOPE] in a developing country Dr Jodie February Smythe – ST4 Anaesthetics and ICM, South East School of Anaesthesia, London Deanery

T

his OOPE is really a third-life-crisis-gap-year for me.

I have been desperate to live abroad for a long time; I even applied to go to medical school in Scotland. My efforts were always discouraged or I was advised to achieve x,y,z milestone before I interrupted my career.

The following relates to the process I went through as an Anaesthetics trainee. However, it contains pertinent advice for anyone organising an OOPE in a developing country.

1. Timing

Time abroad should coincide with a natural break in your training, for two reasons. One, the deanery is more likely to authorise it and two, the transition back into training will be easier. I completed intermediate training [ST4], my essential postgraduate exams and I attained an intensive care medicine [ICM] number prior to leaving.

When I return, aside from a few more quizzes [FFICM], I only have higher training to complete.

2. A ttain a reasonable amount of experience in your specialty

You want to be useful to the people you serve. Having the FRCA and three years of anaesthetics training [in addition to ICM and acute specialties] has given me the confidence and experience required to be in a supervisory and unsupervised role.

3. Plans fall through

I think you need to have a vague idea as to what you want to do and a preference of the country, but do not feel disheartened when things do not go to plan. Initially, I organised a placement in trauma and paediatrics in Cali, Colombia but have ended up in Mbale, Uganda doing obstetrics.

4. Existing placements are more likely to be well structured

The placement in Cali was organised by making contact with a Colombian girl from my medical school, who then made contact with Anaesthetist friends back home. The hospital director I eventually liaised with wanted me to be a volunteer and donate $500 per month to the hospital [voluntourism].

In contrast, my placement in Uganda was advertised on the Obstetric Anaesthetists’ Association [OAA] website, is paid, well supported and provides accommodation and flights. Furthermore, my medical registration in Uganda was organised by the NGO. It made life infinitely easier and also relieved me of the pressure of saving money before coming out. Alternative options included Voluntary Services Overseas [VSO] who had advertised placements for an anaesthetist in Ethiopia and Zimbabwe.

5. Logistics of the out of programme experience

There is a distinction between Out-of-Programme Experience [OOPE] which is not recognised for training and therefore cannot count towards your CCT and Out-of-Programme 24

Training [OOPT] which does. For either you must have at least 6 months of training time remaining in the UK upon your return.

The OOPT requires more in terms of paperwork, namely: an evaluation, a report and a supervisor’s statement.

Anaesthetics is a great specialty for several reasons beyond coffee breaks and Sudoku. The Royal College of Anaesthetists [RCoA] strongly supports trainees taking time out of programme, recognising the merits of broadening clinical skills and knowledge.

A syllabus has been developed with Médecins Sans Frontières, which recognizes 6 months spent in a developing country as part of the general duties [ideally ST6 and above].

I opted for an OOPE, which also requires prospective approval, and allowed 12 months for application. The application involved completing a form from the RCoA website, attaching my proposed plan, having it signed by my college tutor and training programme director and then sending it to the deanery where it was approved within 6 weeks.

In contrast the OOPT is more rigorously authorised. This is because the position has to be approved for training with adequate supervision arrangements, and approved by the GMC. The RCoA specifies that the placement has to demonstrate that the learning outcomes will meet the curriculum requirements of ‘anaesthesia in developing countries.’

6. Ensure you are cut out for time away from creature comforts [crisps/chocolate/Starbucks] and your social network [the real one, not facebook]

Moving and settling in Uganda has been effortless for me, mainly because I am happy to be outside the M25 and the NHS. The only difficulty was leaving my partner but we are surviving.

Some other volunteers based within my NGO, but in different parts of Uganda, are really struggling with the isolation and are desperate to return home. I cannot explain our differences in experience. Ugandans are very friendly and warm, in addition I live in a guesthouse with a relatively high turnover of guests. Added to this, I spent two weeks of ST3 in neighbouring Kenya, working in Mombasa. Although a short period of time, nothing here has surprised me.

I am almost half way through my placement and I could not recommend it enough. It is an excellent opportunity for personal development. I was advised to not delude myself as to how much impact I would make, because although you can make changes in the developing world, they are only baby changes; you find a lot of obstacles to achieving a good standard of healthcare which are not purely resource/man power related. These obstacles are education, attitudes, culture and [dis]organisation. I have enjoyed the aspect of knowledge transfer; it is a two way process.

Most importantly, this trip has been a welcome break from the hamster wheel.

Medical Woman | Spring 2013

Essay Prize Winner Junior Doctor Essay Competition – 1st Prize Winner

A life changing experience

as a Doctor

by Dr Arunthethy Mahendrayogam, FY2 – Royal United Hospital, Bath

“Everybody feels the same when they start, but within a few weeks you’ll feel completely different.”

J

ust over a year ago, I started a week of shadowing as a junior doctor. The summer holiday spent celebrating the two new letters in front of my name now seemed a distant memory, as I fretted over the seemingly impossible job ahead.

Following my predecessor around the hospital, my mind boggled with millions of unanswered questions. I could not remember who each patient was, let alone remember what tests they needed, which forms needed filling, where the forms were and where they went. And how did people write in the notes so quickly? Or what would I do if somebody became sick?

On my last day of shadowing, I noticed a very experienced looking doctor chatting casually to the ward clerk, whilst simultaneously writing at lightening speed in several patients’ notes. Spotting my terrified, lost (and quite envious) expression, she smiled. “You must be one of the new FY1s?”She was a GP trainee, about to start her final year in general practice.

“Isn’t it funny, I’m doing my last ever day in hospital and you’re about to start your first!” she laughed. “Don’t worry, you’ll manage. Everybody feels the same when they start, but within a few weeks you’ll feel completely different.” I immediately felt more reassured. It was lovely to meet somebody who actually thought that I could do this!

The year passed, and slowly, I began to feel more comfortable with my job. The frequency of anxious phone calls home fell, www.medicalwomensfederation.org.uk

and tears in toilet cubicles became a thing of the past (mostly!). I learnt to manage the good days and the bad, and to enjoy the challenges that each day brought.

In the final month of my first year, I was working on the medical assessment unit. During handover, we paused on one patient, a young doctor, who had worked at the hospital, attending with an overdose.

When I went to take her bloods later that day, I realised she looked familiar.

“I know you, don’t I?” she asked.

It was the GP trainee I had met on my first day. We spoke for a while. She said that over the last few years she had experienced difficulties in her own life.

Her parents had been unwell, her marriage had ended, and she was caring for a young child alone. She was commuting to a practice far away and coming home late, but had been told that if she was not coping then perhaps the job was not for her. She had started to drink more, but with financial pressures and her training at stake, had tried to carry on.

“It can be such a stressful job on top of everything else,” she said. “I tried to cope with it all, but you’re made to feel like a bad doctor if you can’t.”

Later, I was pulled aside by another member of staff in the kitchen, asking if I thought that she would be sectioned.

“She seems a bit weird – really agitated” they added. “And, isn’t it scary that she’s a doctor! Why didn’t she get help earlier?”

I felt really angry. Any other patient admitted to the ward was allowed the

right to privacy. Their story would not be discussed over cups of coffee by the rest of the team, with bets on their likelihood of being sectioned. What made this patient any less deserving? And did being depressed as a doctor make her any more “sectionable” than another person who was depressed, or worse at her job?

I have thought about this meeting a lot since. It has made me realise that, as a doctor, you have to be especially protective of your own happiness and emotional health. Although well known that the job is stressful and holds a lot of responsibility, there still exists the expectation that we should always be able to cope with it and life outside of it, and that there is something lacking if you cannot. Yet being a doctor does not exempt you from the same stresses, which lead to stress or depression in others.

Perhaps the exclamations of surprise that someone in our profession is not coping helps us to set ourselves apart from them, as stronger, and more able to manage, but I am sure that more doctors have felt this way than would ever admit to their colleagues.

I have always felt privileged to do my job, and constantly try to rise to the challenges it sets. But if I can’t, if it all becomes too much, and I need more help, then this has taught me that my own health and happiness is as important as the people we see every day. We have a right to be a patient too, to admit when something is wrong, and to ask for help.

25

Medical Elective

A medical elective in

TOKYO Laura Hughes Final Year Medical Student, Edinburgh University

N

estled in the northwest of the Pacific Ocean, Japan’s archipelago is home to over 127 million people1. With a stimulating fusion of East meets West; where futuristic architecture, neon lights and raucous karaoke bars juxtapose ancient temples and tranquil teahouses, spending 8 weeks living in Tokyo for my medical elective was a feast for the senses.

Why Japan?

From a young age I have been intrigued

by Japan, its people and its intricate culture. I knew that immersing myself in the Japanese way of life would not only be socially enriching but with Tokyo’s leading practice, innovative technology and advanced healthcare system there would be much to learn.

Preparation Wanting to study ophthalmology, I found that Jikei University Hospital best suited my needs: an ophthalmology placement; experience with British elective students and situated in central Tokyo. I was conscious about potential communication difficulties but my concerns were eased as I discovered that many of the Jikei doctors spoke English.

I was confident that as long as I made as best an effort to understand and speak the language so as not to seem rude or ignorant, my experience would not be grossly hampered. Therefore, I completed two language courses that not only equipped me with basic language skills but also information on Japanese tradition and etiquette. Organising my elective was swift and efficient. Tokyo has a very low crime rate and is generally considered to be very safe. Still, there were risks to consider in travelling, particularly in respect to last year’s natural and nuclear disasters, and I was comforted that I was travelling with 26

three other students. And so armed with guidance from the foreign office and the travel clinic; and with a vigilant mind, I was off on my adventure!

Arriving in Tokyo

Spring is thought to be the most beautiful season to visit Japan. We arrived in time to experience the national appreciation and frenzied enthusiasm for the sakura zensen – the “cherry blossom front” – where the cherry blossom trees are in full bloom, transforming the landscape and creating a canopy for hanami parties where the Japanese sit under the trees on tarpolen mats to socialise, eat and drink merrily until their hearts are content!

Being in Japan has made me appreciate the force of nature and its consequences. The first earthquake I experienced was quite unsettling. Yet, with three or four small shudders each week, I became accustomed to them. Legend has it that a giant catfish sleeps beneath Tokyo Bay, and it is its wriggling that is felt in the hundreds of small tremors that rumble the city each year2.

Approximately every seventy years, the catfish awakes, resulting in the kind of earthquake and tsunami that was so devastating in March 2011.

The people The Japanese are fiercely proud of their country and encouraged us to explore its wonders: we were welcomed into homes (a rare honour); escorted to neighbouring cities to experience the more traditional ways of Japan – including onzen (hot volcanic springs); treated to Kabuki theatre tickets, museum exhibits and dinners; and even bought gifts!

There is meticulous etiquette in Japan, and fortunately for me, foreigners are expected to make mistakes. People greet one another with a flurry of bowing; the precise depth of the bow and the length of time it is held for Medical Woman | Spring 2013

Medical Elective depends upon the relative status of the two individuals. Gaijin (outsiders) are not expected to bow, but it is terribly infectious.

The hospital Jikei University was founded by Kanehiro Takaki (1849-1920), who studied at London’s St. Thomas’s Hospital and consequently Jikei medical school has strong links with King’s College3. We were Jikei’s first students to apply from Edinburgh and a professor told us wryly that since Takaki was educated by an Edinburgh graduate, he was under an obligation to accept us!

Interestingly, doctors at Jikei are paid a lesser salary than those at other hospitals but choose to work there because of its many departments and opportunities to see and treat diverse diseases.

Staff at Jikei behaved in some ways in which I was unaccustomed to: white coats are worn over very casual clothes, watches and ties are acceptable and there is much less consideration to hand hygiene than in Scotland. There are no “private” hospitals in Japan but the system operates with patients paying for 30% of their costs and the remaining 70% subsidised by tax. This equates to a patient paying about £430 for each intravitreal ranibizumab injection for age-related macular degeneration and VIP suites can cost up to £2000 per night excluding treatment costs.

My experience in the ophthalmology department My timetable for the ophthalmology department was split between clinics, the operating theatre and patient examination with the trainees. A typical day would be spent observing cataract, retinal or lacrimal surgery or intravitreal injections in the morning and specialized clinics such as neuro-ophthalmology, paediatric or macular disease in the afternoon.

Having been told of a novel cataract technique by professors in Edinburgh prior to coming to Japan, I was interested to see how this surgery was performed and I was not disappointed.

Two theatres would run simultaneously, sharing a list that began at around 8.30am. Whilst one patient in one room was being prepared and anaesthetised, the surgeon would be operating in the other. Each cataract removal and intraocular lens insertion was recorded; the fastest one I saw completed in less than 4 minutes and 20 seconds. This rapid and very efficient means of operating enabled, on average, 20 cataract procedures to be completed by lunch time – an impressive feat!

Medical students in Jikei learn very much by observation (their first clinical year is in year 5 and venepuncture is only done once qualified) and although I expressed an interest to assist in theatre and to examine patients in clinic, I was expected to sit and learn passively My experience at Jikei has not solidified my future career plans but it has caused me to carefully consider my intended discipline as, though not truly reflective of an ophthalmology job in Britain, it has given me further insight into the specialty and what an ophthalmology training programme entails.

My experience in the radiology department Despite enjoying my time in the ophthalmology department, my supervisor noted that eight weeks was very specialised for a student and so kindly offered that I may diversify my learning by spending some time in the department of diagnostic radiology.

Compared with other developed countries, Japan is the runaway leader in the number of MRI and CT scanners per head of population4. Jikei Hospital is in the affluent district of Minato-Ku www.medicalwomensfederation.org.uk

and so due to high consumer-demand, and the subsequent income for the hospital, the doctors are driven to prescribe more and to order more imaging and tests.

I became involved in the daily machinations of the radiology department and was considered equally a student and a guest: I attended lectures and tutorials with the Japanese medical students; had individual teaching; observed clinical practice with patients; taught younger students Medical English; and was asked to deliver a lecture for the department and visiting doctors. Speaking on the radiological manifestations of sarcoidosis, I enjoyed preparing for and delivering the lecture. As there is a high prevalence of sarcoidosis in Japan5, I also felt that my contribution was of value.

Personal and Professional Development Adapting to a new environment; a new way of life and a new language did pose as much of a culture shock as I had anticipated.

Yes, I stood out for being a foreigner but mostly felt welcomed and appreciated. The manners and altruism of the Japanese people undoubtedly contributed to this – there is certainly a sincerity and respect that Japanese people have for one another and their environment that Britain lacks. The hospital setting, though differing slightly from British practice, was also comfortingly familiar and reminded me that no matter where you are in the world, people are people: we are afflicted by the same diseases, experience the same worries and fears, rely upon our families and care-givers, and no matter the language barrier, can be eased by a smile and an attentive ear.

I would certainly recommend my elective at Jikei to any other medical student with an interest in Japan – I had such a fruitful experience and have made memories that I know will last a lifetime. I reckon I shall bemoan the infrequency and unreliability of the British transport system; and I must remember in my OSCE final that the patients might think it strange if I bow.

References

1. DK Publishing. DK Eyewitness Travel Guide: Japan. London: Dorling Kindersley, 2011. 2. Dodd, J. Richmond, S. The rough guide to Tokyo.

4th ed. New York: Rough Guides, 2008. 3. The Jikei University school of medicine; Founding spirit- patient centered medical care; http://www.jikei. ac.jp/eng/found.html; accessed 27th May 2012. 4. Nomura H, Nakayama T. The Japanese healthcare system BMJ 2005;331:648 5. Koyama T et al Radiologic manifestations of sarcoidosis in various organs. RadioGraphics.

2004;24:87–104 Photographs: a shrine and cherry blossom in the Imperial Palace, Kyoto; the crowds in Harajuku, Tokyo; two young ladies in Gion City, a very traditional area with teahouses, Kyoto; in theatre; a conveyorbelt sushi restaurant, Kamakura.

27

Top Tips

TopTIPS

for Medical Students

CV writing

Sarah Hudson & Laura Hobbs, Final year medical students, University of Cambridge

1. Push yourself academically For foundation year applications, candidates are ranked in deciles compared to other students at their medical school.

Academic achievement counts for fifty percent of the Foundation Programme Application score.

• Do an intercalated degree. This is a really good chance to gain extra CV points and learn something new even if it may not be related to medicine.

• Consider doing a PhD. Especially if you are thinking of going into a competitive speciality.

• Always try your best!

2. Get experience in the specialities which you think might interest you Some people have careers planned out while others find every speciality appealing. While you don’t have to know you want to be a neurosurgeon since you were able to talk, it helps to have experiences which show you have sought extra training in the field you choose to specialise in.

• Student-selected components. Use these to gain further insight into a specialty or undertake research in that field.

• Elective. An exciting opportunity to learn about medicine in a totally different environment.

• The local team in your chosen speciality. Having someone you have built a relationship with to advise you is invaluable.

• Taster courses.

• Conferences.

• Societies. Join in or even set one up yourself.

3. Get involved in academic medicine • Research. Make the most of opportunities which arise during your student selected components and if you do an extra degree. Make your application stand out.

• Audit. This will be a constant part of your professional life.

Getting your name on an accredited audit will come in useful in applying for specialty training.

3. Make your work known • Get published. Particularly if you can get into a journal with a PubMed ID and score extra points in the Foundation Application.

• Give a poster presentation. If you are the first named author and it is at a national or international conference given by a professional medical body you get extra points for your Foundation Application.

• Do an oral presentation. In some circumstances this gains you Foundation Application points but is always a great learning experience and helps for your CV later on. Ask for feedback.

4. Get involved in extra curricular activities These will be useful for speciality or core training applications and show you have the necessary personal qualities.

• Having a broad range of interests shows you are more than just an academic and makes you human!

• A great opportunity to show leadership qualities as well as teamwork.

• Committees are ways to show your willingness to represent your peers in a position of trust in what may be medically related or unrelated roles.

• Teaching is a great way to learn and is an important quality for speciality or core training applications.

5. Get organised Keep a folder of what you have achieved to make your life easy when you need to show evidence supporting you CV. Ask for feedback on any presentations or teaching you do and keep it safe!

6. Aim to be a good doctor!

Fifty percent of the points for the Foundation Programme Application 2013 will be from a situational judgement test.

• GMC “Good Medical Practice”. Important to read.

• Ethics and law. Essential for any doctor to have read up on.

• Be enthusiastic!

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Medical Woman | Spring 2013

Film Review

Film review:

Mother: Caring for 7 Billion Ms Scarlet McNally, Consultant Orthopaedic Surgeon, Eastbourne A new hard-hitting film “Mother: Caring for 7 Billion” should be required viewing for all doctors, policy-makers and the public. Its message is that the exponentially increasing world population is the major cause of poverty, over-consumption, food poverty, riots, wars, de-forestation, ill-health, major crises, conflict and climate change. It has vignettes from biologists, medics and economists.

Over-population is cogently argued as the cause of world economic meltdown.

The first half presents harrowing concepts and figures, the second half attempts a way forward: world population has doubled in the last forty years to 7 billion. Half the world’s population is under 28. 40% of pregnancies in the USA are unintended. one-third of maternal deaths in Ethiopia are due to unsafe abortions. 215 million women have no access to contraception. The grain to produce one tankful of bio-diesel would feed one person for a year.

It tackles the cultural issues around “the girl effect”: the girls who stay in education have better health, have children later and have fewer children, who in turn have better health. We need to empower women throughout the world. But the film also showed that cultural change and education needs to include everyone in society.

The film suggests that the problem is increasing because the topic is seen as too sensitive. We are clearly shown the urgent need to tackle the issue. As healthcare professionals, we are stuck in the paradigm of allowing patient choice and treating each individual patient. We should, the film suggests, be using our advocacy role to demand change across societies. Women in other cultures should have the choices that we ourselves have; cultures need to change so that people are valued for what they can contribute and we should reverse the consumer culture (e.g. by facilitating sustainable transport).

The film shows an Ethiopian woman who rejected being a child-bride and is trying to change her society. It tackles problems of how to change societal expectations – radio soap operas bringing up taboo subjects had increased spousal communication. It mentions micro finance initiatives, lending money mainly to women for small projects.

There are suggestions about how to try to reverse the direction: proper funding for family planning, access to choices for all women, access to long-term reversible contraception, support for international development, better education for girls, better sex education for all, change of society to expect different life histories and facilitating more sustainable lifestyles.

“Mother: Caring for 7 Billion” and information about the topics is available via www.motherthefilm.com One hour of your life, and one film, could make you see your role in the world differently.

Reference: Fauchere C, Johnson J (2011) “mother: caring for 7 billion”

www.medicalwomensfederation.org.uk

29

The Mummy Diaries

T he Mummy Diaries

Ms Samantha Williams, ST4, General Surgery, Severn Deanery

“Surgery takes a long time to learn. Of course, there are lots of facts to remember, and cutting people is a craft best acquired carefully.”

Gabriel Weston

Surgical Registrar Vs A Newborn

M

otherhood also takes time to learn, and is a craft best acquired quickly. The first night I was at home with Max on my own, was when I realised, I was not fully prepared for this. In my arms I had a crying baby completely dependent on me. I had not taken any exams on the subject, I did not have a “Core Topics” book to secretly refer to, I couldn’t request investigations to aid my diagnosis, and there was no house officer to delegate to or a consultant on-call to ask what to do. Mistakes were poorly tolerated and if I was going to survive this, I was going to have to learn fast.

Strangely, I had spent most of the pregnancy worrying about the potential complications of labour; 4th degree tears, haemorrhoids, urinary incontinence, rectal prolapse, the possibility of a gynaecologist having to operate on me etc. I had not given much thought to what happens next: that provided you have a safe car seat, you are sent home with a brand new human being and your every move over the next 18 years will determine whether or not they turn out to be a nice, well rounded, individual. This is when surgery with its rules, hierarchy and fast, largely predictable outcomes seemed much more straightforward.

30

Maternity leave was a strange concept for me. I loved this curious new miniperson that stuck to me all day like a limpet and rewarded me with smiles for good behaviour. But I had gone from being a full-time, high maintenance career woman with a busy social life to a full time stay at home mum. My new regime was feeding every three hours, rarely leaving the house and barely finishing half of the enormous number of essential chores, that up to this point I had been blissfully unaware of. Goodness knows how other mothers managed the added extras like getting dressed or providing dinner for ones husband? I started new revolutionary routines, found in various motherhood manuals on a weekly basis.

These were inevitably broken soon after as Max declared himself as an individual, as stubborn as his mother, but without the regards for rules and time keeping that I am so keen on.

With my partner working full time and no family near by, six months on we had to bite the bullet and recruit some help.

This is when I discovered the secret to this motherhood business... delegation. Into our lives walked our nanny, my savior, the wife I so desperately needed. She seemed to enjoy doing strange things like pureeing vegetables, washing baby clothes, sterilising

bottles, keeping order in the kitchen and picking up toys that had been purposefully thrown on the floor. Which meant that some of my time, I could get back to my comfort zone: attending conferences with adults who didn’t talk about baby-led weaning; writing papers in proper English, not high pitched baby language; and attending operating lists where everything was clean and sterile and no one tried to sabotage the beautiful order. After a year off work, I was fully prepared to be released back into the surgical world. Being the control freak that I am, I decided that handing over the reigns to another woman to look after my child full time was a step too far, so I opted for 60% less-than-fulltime training so I could be in control at home and at work.

It meant taking the hit that my training was going to be almost doubled and being an ST3 when I became pregnant, meant I would be a trainee for an unconceivable length of time (CCT date was estimated to be a decade away). However, the way I look at it, surgical training traditionally took until your were into your forties.

This was to ensure that not only were you good at the cutting, but by the time you had any real responsibility you had a bit of common sense to go with it. If I had gone through my training in the fastest possible Medical Woman | Spring 2013

The Mummy Diaries

time I would be facing my CCT date in 2 years time (aged 34). Despite having to put up with half a salary, in reality working more than 60% time and still getting the jibes from males colleagues about ‘long weekends’, I am secretly relieved to defer that responsibility until I am a lot older and a little wiser.

However, the best-laid plans often go awry! Two years on and control is not a word I would often use to describe my days. I do manage to take my son to a play date, swimming or to soft-play at least once a week. I’m sure he won’t remember or thank me for this as a teenager, but it does mean I see him at his best and capture those precious firsts that I would hate to miss out on. After four days at home, I am very ready to get back into work and see other professionals, actually finish a conversation and go to the loo on my own.

I know that I have had quality time with my son, so on work days I never feel guilty about staying on late for the clinic that overruns or hanging around to do a case out of hours. In fact, I think absence has made the heart grow fonder, and I am now more passionate and enthusiastic about being a surgeon than I have ever been.

So motherhood and a career in surgery, can I recommend it? Well, I’m now 30 weeks pregnant again, so it cant be that bad. I’m back in my TED stockings, standing on a stool so I can rest my bump on the operating table and the theatre nurses are discretely slipping sweets behind my mask to get me through the AAA repairs. It’s not easy physically, and I’m never going to be one of those perfectly manicured career women again, but I know that for me it is the perfect balance. www.medicalwomensfederation.org.uk

“I had gone from being a full-time, high maintenance career woman with a busy social life to a full time stay at home mum.”

31

Medical Memoirs

My Career in Medicine: 1947-2000 Dr. Alison Bush, Retired GP, Colchester medical student and part time researcher at St. Mary’s Hospital.

When my son was six months old, I temporarily moved to Geneva and left him with my parents. My mother was an excellent surrogate but at that stage I had to discontinue breast feeding. My son stayed with my parents for six months. We reclaimed him (with some difficulty) six months later.

The arrival of my daughter Philippa coincided with my sitting for the Diploma of Child Health in 1955. My youngest was born at home three years later. At this time, apart from occasional GP locums and a research job from home, work was not the priority.

I did have a succession of au- pairs, some bringing babies along to live with us and also on one occasion a full time nanny.

Alison Bush, far left, Ipswich & Colchester Group Retired Ladies Lunch

I

was born in 1926 in Geneva Switzerland, the middle daughter of three. My parents had just been appointed to run the Quaker Centre there. As a child I was quite a tomboy, wrote adventurously and was keen on wildlife and nature. The idea of being a doctor grew slowly on me, perhaps being encouraged by a surgeon family friend. My memory of this is that I expressed an interest and in turn received some encouragement. I never really varied after that, except to fancy the idea of studying French literature at the Sorbonne in Paris but that was a poor second.

How I chose this specialty Lots of specialties appealed to me, especially paediatrics. I was disappointed that geriatrics often came more into my orbit, as I had done some research on deaf children, and also scurried around Hampshire looking for cases of babies who might be deaf or autistic with the intention of writing them up. I was enthusiastic about the Children’s Hospital in Birmingham where I attended meetings during my stay there in 1960. I was also interested in Psychiatry, having worked in Subnormality (as it was called) at Borocourt Hospital, near Reading. In the end, after a year as registrar at Broadmoor Hospital, (where I encountered Jimmy Saville!) I turned to General Practice as a worthwhile solution.

During these years Dr. Rosemary Rue, Assistant County Medical Officer for Oxfordshire came into my life. Dame Rue (as she later became) was MWF President (1982-83) and was a pioneer for flexible training and working in medicine.

Having a husband and a family: How did I manage?

I fell in love with a gifted scientist while still at Barts Medical School. The Quaker wedding on the Lake of Geneva coincided with my finals and meanwhile Ian had completed work for his PhD. In a small window of opportunity the wedding and a three day honeymoon in the Swiss mountains was followed by very full-time work.

Subsequently, I worked to support Ian in his years as part-time 32

Problems & Prejudices: I was accepted at Barts in 1947 with the first batch of women to enter the Medical School. The college had fallen for having women students “hammer and tongs”. It was useless they said to accept anything less than “a hockey team”.

Just then the NHS 1949-1950 was ushered. I remember amidst the excitement a general air of disapprobation around the college but I don’t believe there was a single resignation. The women were welcomed in. I remember no particularly strong prejudices against women.

Career Highlights: This to me was a late but welcome event. After many years of moving I settled for a time in Reading and it was here that I got to know Dr. Rosemary Rue. However, in 1970 I decided to move from Reading to Colchester to be closer to my growing children. I kept up my friendship with Dr. Rue throughout the years which followed. I remember her with much love and respect.

The last twenty years when I was in General Practice 19701990 were relatively safe and settled. I had “put up my plate” successfully on Mersea Island, 10 miles south of Colchester, Essex. First working on my own (very contentedly), then creating a group practice. I had deep feelings of thankfulness and satisfaction during this time. The NHS was miraculous for families and for the general population. Retiring in 1989, aged 62 years, I was still able to participate in locum work on “my” island.

Now, 25 years on, my advice to a younger self might be : Keep your mind open to new light! Treasure what you have discovered, and bear in mind those principles of service, mindfulness, and thankfulness which are part of your business.

Strong wishes and ambitions may indeed take a lifetime to materialise. The world also changes, a long life may bring wisdom and a caring love for your fellows but always there is the need to be open to new opportunities and ideas (and there is plenty to draw on as we reach old age.) Keep hoping, trusting and working for solutions, always with non-violence. Learn how to control personal demons, turning them into good effects, using love and forgiveness as your tools.

Medical Woman | Spring 2013

Dr Iona Frock

Meet

Dr Iona Frock our new fictional character…

Words by Dr Catherine Harkin, GP Illustration by Laura Coppolaro

I Don’t Like Mondays It was Monday morning. It was far too early. It was also far too late.

“KIDS!!” shouted Iona up the stairs, “Come on! You’ll be late for school!”

“Don’t care” Seonaid muttered resentfully, feet-dragging towards the table and picking up a piece of toast, “Hate school…”

“Not half as much as I hate working all hours to pay the damn fees” thought Iona, as Farquhar rustled the newspaper irritably. Iona’s eye caught the headline, which as usual said “Incompetent GP fatcats entirely responsible for collapse of civilization as we know it” or words to that effect, and not for the first time she wondered why she had ever chosen a career in primary care. “…and it’s all your fault,” mumbled Seonaid, spraying crumbs. Iona sighed. Yes, in retrospect perhaps they should have called the child Jane rather than having her go through her entire school career being called See-yo-nade by the bullies as if she were some kind of soft drink. But it was too late now. The bang of the letterbox announced the arrival of the post, and Iona hurried off to pick it up. Bills... junk mail… OH GOD a letter from the GMC… Fortunately it was only one of their chummy little missives intended to de-terrify the notion of revalidation by telling everyone how it was all coming along, which Iona dealt with in her usual manner by throwing it straight in the recycling bin. She would worry about that when it happened. But what was this? Another envelope... an invitation.

“Do you want to come to my medical school reunion, darling?” said Iona, padding back to the breakfast-table.

“NO” said the newspaper. “I can’t imagine anything I’d like less. Load of doctors standing about talking shop – anyway why do you want to go? You never liked any of these people to start with and last time we went it was a giant boastathon where everyone went on and on about being professors and postgraduate deans and running the BMA and I was bored out of my skull and you just felt miserable…”

This was true. Iona had a sudden flashback to the last reunion, where the crushing sense of failure and inadequacy induced by an evening of listening to her contemporaries reeling off lists of their achievements had caused her to knock back too much white wine and give an entirely false account of her current career to an ex-classmate who was now a well-known medical journalist. Fortunately said classmate had also been too intoxicated to retain the information, but Iona still had occasional nightmares about bumping into him again and being asked whether her paper had been cited in any more journals since the BMJ had published it.

“Maybe we’ll not go then,” she said, picking up the car keys, “We can talk about it later when I get home. ‘Bye darling – have a nice day. Don’t forget the cat food. Purroxetine won’t eat the own-brand stuff. ” www.medicalwomensfederation.org.uk

33

Medical Women’s Federation

Autumn Conference 2013 Friday 8th November 2013 Grand Connaught Rooms, Covent Garden, London

Patients’ and Doctors’ Safety:

Can women change the culture of the NHS?

The largest body of women doctors in the UK looks forward to meeting you!

Speakers Dame Fiona Caldicott Chair of National Information Governance Board

The Dame Rosemary Rue Lecture: Prof Bhupinder Sandhu OBE Professor of Paediatric Gastroenterology

Prof Vivienne Nathanson Director of Professional Activities, British Medical Association

Dr Vicky Osgood Assistant Director of Postgraduate Education, General Medical Council

Workshops l l

Career Guidance

l

Learning to Coach

Whistleblowing Safety

l

Tax and Pensions

Why not submit an Abstract? Deadline – Friday 4th October 2013

You still want more? How about a social programme excellent for networking?!

Registration details will be available shortly at

www.medicalwomensfederation.org.uk MWF, Tavistock House North, Tavistock Square, London WC1H 9HX Email: admin@btconnect.com Tel: 0207 387 7765