Medical Woman Magazine V32:4 September 2014 by The Magazine Production Company

MEDICAL WOMAN VOLUME 33: ISSUE 2

AUTUMN/WINTER 2014

INSIDE: How I got here: CMO Professor Dame Sally Davies How Visible are you? Sexual Health in the older population Ready Steady Mums Medical Women in World War 1 www.medicalwomensfederation.org.uk

Editor’s Letter

ersonally, recent months have been rather challenging due to attempting to balance my wonderful son (who sleeps as babies do – in an extremely disrupted fashion) with my professional commitments. The discovery that “baby brain” truly does exist was a bit of a shock to my system to say the least.

Therefore, I wholeheartedly thank my wonderful team with their help in producing this issue, especially Francesca who has put up with having to send me several reminder e-mails so that this issue was produced in time! I hope you enjoy the variety – from dietary advice (p18), to sexual health in the older population (p10), we feature top women within our profession (p12 and p14) as well as up and coming future leaders (Dr Emma Stanton on p16). I’m delighted to welcome Dr Niky Hartley who is our new Joint Editor, and a Image thanks to lolography.com

Consultant Radiologist in the East Midlands. More from her in the next issue, meanwhile enjoy reading about our Junior & Student Editors Rebecca, Brooke and Amy, below.

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

Amy Woods

Brooke Calvert

Dr Rebecca Say

I’m a final year graduate student at St George’s, London and I was originally brought up in Yorkshire-leaving me with a fondness for gravy and a habit of actually talking to people on public transport. After finishing a degree in Ecology and a stint in student politics I spent time volunteering in Calcutta-sparking a desire to try my hand at medicine and I’ve never looked back since! At university I’m the Co-president of Gender Equality Society and my main interests are in medical education, pediatrics and general med. In my spare time I watch old episodes of The X Files, and enjoy discussing politics and feminism. I recently discovered the joys of Pinterest and I am spending quality time narrowing down the perfect (imaginary) puppy to get.

I graduated in June from UCL, and have begun my FY1 job at Watford General hospital. I’ve lived in London all my life, and try to make the most of this amazing city by visiting as many pop-up restaurants, outdoor cinemas and markets as I can find the time! I recently returned from an incredible elective working in a primary care clinic on the island of Roatan, Honduras where I saw patients suffering from extreme poverty and helped to diagnose and treat them with extremely limited resources, all whilst speaking almost exclusively in Spanish! I am passionate about primary care, obstetrics & gynaecology, social media and both teaching and being taught wherever possible.

I am a National Institute for Health Research Doctoral Research Fellow at Newcastle University and an academic specialty training registrar in obstetrics and gynaecology in the Northern Deanery. My research interests are in women’s experiences of maternity care and shared decision making. I am also the mother of Daniel who is six months old and have two teenage step-children. I am currently on maternity leave and enjoying every minute!

Contents

Contents Medical Woman, produced by the Medical Women’s Federation Editor: Dr Sara Khan doctorsarahkhan@gmail.com Assistant Editors: Ms Anji Thomas and Miss Francesca Rutherford E-mail: admin.mwf@btconnect.com Junior Editor: Dr Rebecca Say and Dr Brooke Calvert Student Editor: Amy Woods

MEDICAL WOMEN’S FEDERATION Tavistock House North, Tavistock Square, London WC1H 9HX

MWF Spring Conference

Women in WWI

News/Events 4

Clinical Genetics

Say it, Write it, Tweet it

Making the Invisible Visible:

How Visible are you?

Tel: 020 7387 7765 E-mail: admin.mwf@btconnect.com www.medicalwomensfederation.org.uk @medicalwomenuk www.facebook.com/MedWomen Patron:

Gender-based violence 25

HRH The Duchess of Gloucester GCVO President: Dr Sally Davies sallyjanedavies@gmail.com President-Elect: Professor Parveen Kumar

Honorary Treasurer: Dr Charlotte Gath charlottegath@aol.com Design & Production:

in the Older Population

Working in South Africa

In the Hot Seat

A Breadtfeeding Paediatrician

Women at the Top

The Mummy Diaries

Top Apps for Medical Women

Who puts the cash in the cash

Twitterview: Emma Stanton

student’s adventures...

Expand your Horizons

Book Review:

Honorary Secretary: Dr Beryl De Souza bds@dr.com

On Being Less Than Sexual Health

machines? An urban medical 34

The Magazine Production Company www.magazineproduction.com

Stress and Diet: How Good Nutrition Can Help

Ready Steady... Mums! 20

A Painful Inch to Gain

Top Tips for New Docs

Dr Iona Frock

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.

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Contributors

Contributors AUTUMN 2014

Gabrielle Deehan Remote Living & Healthcare pg34

A medical woman you admire/respect: Sophia Jex-Blake

Five favourite things in life:

Gabrielle Deehan

• Skiing • Driving • Travelling • Reading • Kitkats

Dr Ania Koziell The Mummy Diaries pg32

A medical woman you admire/respect: Michelle Winn, Prof of Genetics at Duke, USA – colleague and collaborator from an ethnic minority who tragically and very recently died of pancreatic cancer aged 47 – working as long as she could throughout her illness.

Dr Ania Koziell

Five favourite things in life: • My kids • Mountains • Horse riding • Sea and sunshine!

Dr Alexandra Murray Clinical Genetics pg24

A medical woman you admire/respect: Rosalind Franklin

Five favourite things in life:

Dr Alexandra Murray

• My dog • Cricket • Chocolate • My family • Books (not necessarily in that order!)

Dr Vicky Thomas A Breastfeeding Paediatrician pg30

Dr Vicky Tho mas

Dr Najette Ayadi O’Donnell Working Abroad pg28

A medical woman you admire/respect: Professor Jenny Higham: my dean whilst at Imperial College. A strong personality and a fantastic advisor on my life and career thus far.

Five favourite things in life:

Dr Najette Ayadi O’Do •Q ueens Park Rangers FC nnell (I have a season ticket!) • Travelling (obsessed!) • Eating pistachio nut ice cream whilst in Italy • My nephew Sam’s laugh and smile first thing in the morning • Walking in my wellies in the rain...

Emma Stanton Twitterview pg16

A medical woman you admire/respect:

Dr Claire Maitland from Cardiac Arrest (what do you mean she’s not real?)

Jennifer Dixon – Chief executive at The Health Foundation.

Five favourite things in life: • My family • Good red wine • Chocolate • Finishing a run • Siting a difficult cannula on the first try

Five favourite things in life: • Fun times with good friends • Goddaughters • Sailing • Cornwall • New bike

Emma Stanton

Medical Woman | Autumn 2014

MWF Conference Report Background to MWF The Medical Women’s Federation – Working for women’s health and women doctors since 1917.

MWF Spring Conference: Diversity & Medical Careers

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.

Dr Judy Booth, Speciality Doctor in Palliative Medicine at Wheatfields Hospice in Leeds

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

Does the Medical School selection process encourage diversity in the profession? What should the over 65s be doing three times a week to stay looking young? What factors affect a woman’s choice of medical specialty?

discriminatory attitudes and practices. It provides a unique network of women doctors in all branches of the profession, and at

What would lead a man to steal from his children’s piggy banks whilst they sleep?

all stages from medical students to senior consultants. We aim to achieve real equality by providing practical, personal help from members who know the hurdles and have overcome them. Achievements: MWF has campaigned for many years for: • the development and acceptance of flexible training schemes and flexible working patterns at all levels of the profession • recognition and fair treatment of sessional doctors in general practice • the need for continuing medical education and a proper career structure for non-consultant hospital career grade practitioners • family-friendly employment policies and childcare tax relief • proper treatment for women who suffer sexual abuse or domestic violence • abolition of female genital mutilation • ensuring the needs of women patients and women doctors are considered in the planning and development of services • ensuring women doctors are active in professional life – MWF members are active in a large range of organisations, including the Royal Colleges, BMA, GMC, Local Medical Committees and Postgraduate Deaneries. Much progress has been made, but much more remains to be done!

Join MWF to boost your CV, confidence and career through to retirement! medicalwomensfederation .org.uk/about-us/join-us

www.medicalwomensfederation.org.uk

These are some of the questions considered by delegates at the MWF Spring Conference 2014 which took place on Friday 9th May at St. John’s Hotel, Solihull and was on the theme of ‘Diversity and Medical Careers’. The key note speakers at this meeting were inspirational women who have all had career paths shaped by circumstances, chance meetings or determination to follow their passion and make a difference. Dr Sarah Wollaston, a former GP, spoke about her decision to stand for parliament and the reasons she feels women are underrepresented in the House of Commons. We were surprised to learn that there is no training or mentoring for new MPs and that places on committees are not necessarily filled with MPs who have appropriate knowledge and experience of the issues but often by a ‘tap on the shoulder’, and so policies may not be evidence based. Professor Sarah Stewart-Brown spoke about her career and how she has coped with set backs and used them in a positive fashion. Her advice was to know yourself first and to understand your strengths and weaknesses so that you can trust your intuition when 3

MWF Conference Report opportunities arise. She feels women are under represented at professorial level because they tend not to have personal success as a goal. Dr Alison Walker stepped out of clinical practice to gain training in medical journalism and editorship as a registrar before going on to become a consultant in public health. When her husband’s career took the family to Greece, she rekindled contacts at the BMJ and was able to work remotely doing peer reviews of journal submissions. She is now an associate editor at the BMJ. Dr Henrietta Bowden-Jones did a degree in psychology and initially worked as a psychotherapist. She was encouraged by the departmental professor to study medicine and then pursued a career in research of drug addiction and alcohol dependency. A chance meeting gained her sponsorship to set up the National Problem Gambling Clinic and the charity Gambling Concern. There are 500,000 problem gamblers in the UK, and a significant proportion of these are women. The Dame Hilda Rose Memorial Lecture was given by Professor Baroness Sheila Hollins. Her career as Professor of the Psychiatry of Disability has been greatly influenced by having a son with learning disabilities and she now puts her personal and professional experience to good use in the House of Lords and as an advisor to WHO and the Catholic church. She also reflected on the importance of work/life balance and the strength she has gained from her family. There were two workshops on aspects of careers and the feedback from these echoed some of the speakers’ reflections on the need to know yourself well. Work/life balance and the importance of role models and mentors were also highlighted. The ‘Keeping doctors and patients healthy through exercise’ workshop had us all up on our feet practising good posture and rediscovering our pelvic floor muscles. Exercise can be fun, does not need to take up a lot of time or involve expensive gym membership and we were advised to put exercise time in our diary and reflect on how it makes us feel. Sharing goals helps you to achieve them. Our oral abstract winner was student Fopefoluwa Olayisade who had evaluated data on the sexual health of older people. Other oral abstracts were on the topics of transferable skills from medicine to business, medicine as an art being more compassionate than medicine as a science, career choices of women doctors, and inequalities within the medical profession. The two winning essay writers, Sophie Fitzsimmons and Louisa Chenciner were presented with the Katherine Branson Medical Student Essay Prize after reading out their work and the poster prize winners were Dr Catherine Grace and Abbie Taylor. A brief update on revalidation highlighted that 21% of women compared with 14% of men have had revalidation deferred.This is thought to be due mostly to the effect career breaks have on gathering evidence for appraisals. The GMC website has advice for doctors who are having difficulties with the revalidation process. The MWF Report ‘Role Models who sustain Medical Women’s Career Engagement’ was also launched at this meeting. Our new president Dr Sally Davies gave her inaugural address in which she included her own career path and her thoughts on the challenges that women still face in fulfilling their potential in a medical career. Despite the full programme there was time for networking over lunch and coffee. The conference dinner was well attended and the after dinner speaker Priscilla Morris, who is a voice coach, gave us an entertaining talk on her work including tips on improving communication by being aware of the volume, clarity and musicality of our voices as the way we say things is so much more important than the words we use. Several members attended an informal supper in Solihull on the Thursday evening and also enjoyed a trip to Baddesley Clinton, a local National Trust property on the Saturday afternoon following the Council meeting. 4

NEWS & EVENTS Notice to all members: To commemorate Dr Dorothy Ward the MWF council have agreed to rename our International Travel Fellowship Award to the Dr Dorothy Ward International Travel Fellowship in her memory in recognition of her work and support of the Medical Women’s International Association.

Queen’s Garden Party: 10th June 2014 The MWF were honoured to receive four tickets to the Queen’s Garden Party at Buckingham Palace this year. MWF President Dr Sally Davies and Medical Woman Editor Dr Sara Khan attended, along with two MWF members that were drawn from a hat; Dr Joyce Popoola who is a consultant renal physician at St George’s Hospital and Laura Grigis, a newly qualified doctor in Glasgow. We were lucky that it was a wonderful hot summer’s day and our choice of entering from the front meant we were able to walk in through the Buckingham Palace courtyard and extremely grand entrance. We had a good view of HRH Queen Elizabeth, the Duchess of Cambridge, Prince Philip and Princess Anne. We were honoured to be able to speak to the MWF Patron HRH Duchess of Gloucester who was very interested to hear about both our magazine Medical Woman, and Joyce’s work with renal transplant patients. We all felt very privileged to have a long walk through the beautiful gardens of Buckingham Palace. It was a once-ina-lifetime experience that won’t be forgotten!

WHO Update Dr Clarissa Fabre GP, East Sussex and former MWF President Accompanied by several members of the MWIA Executive Committee, including the President of MWIA, Professor Dr Kyung Ah Park, and Secretary General, Dr Shelley Ross, I attended the World Health Assembly (WHA) in Geneva in May. The highlights of the Assembly were the address by Dr Margaret Chan, who is always inspirational, Melinda Gates from the Bill and Melinda Gates Foundation ‘(Global Health is my second career’), Professor Sir Michael Marmot, speaking on Violence against Women, the UK Minister of Health, Jeremy Hunt addressing a fringe meeting on

Medical Woman | Autumn 2014

News/Events Dementia, and all our meetings with relevant WHO staff on subjects of interest to MWIA. Dr Shelley Ross, Secretary General of MWIA is in the process of drafting a two year action plan for the collaboration of MWIA with WHO. Over the next three years, MWIA is planning to produce a Clinical Manual on Domestic and Sexual Violence. Affecting one in three women globally, this subject has received a great deal of publicity in the last year, especially from the WHO and National Institute for Health and Care Excellence (NICE). Along with three other organisations representing doctors and medical students, MWIA presented a statement at the WHA (you can read the statement on our website). As a consequence of hearing Sir Michael Marmot in Geneva, another MWF member, Dr Bea Bhavagaya, a GP trainee with experience in Public Health, and I met Sir Michael in London to discuss MWIA’s proposed manual on Domestic and Sexual Violence. He mentioned the importance of having a dedicated person in every hospital, to whom staff could refer if suspicions were aroused, and pointed us towards useful publications and websites. He is an inspirational man, who speaks far and wide on various aspects of the social determinants of health. Another highlight of my MWIA activities has been attending the Global Summit to End Sexual Violence in Conflict, which was held in London in June. The Summit was opened by Angelina Jolie and the UK Foreign Secretary, William Hague. Their obvious commitment to the cause was palpable. I saw an extremely moving play about Afghan professionals, such as doctors and teachers, and their families, being targeted and sometimes murdered because they were helping women victims of violence. MWIA and the Medical Women’s Federation were subsequently asked by Amnesty International to write a statement supporting these doctors. I am grateful for the opportunity of representing MWIA at the WHO and related events, and look forward to attending the Geneva NGO Forum – Beijing+20 in November. This Forum will examine and review selected issues from the 12 critical areas of concern for women from the 1995 Beijing Platform for Action. These include poverty, education, health, violence and human rights.

Reports from our Local Area Groups LONDON Inspiring Women: “Women who make London” event Friday 11 July Dr Yasmin Drabu, MWF Vice President I was very proud to represent MWF at an Inspiring Women Event,” Women who make London” with the Lord Mayor Fiona Woolf CBE and Miriam Gonzalez Durantez held at the Elizabeth Garrett Anderson School on Friday 11th July. The event promoted and motivated young girls and gave them insight into jobs and educational routes into various careers. Over 900 girls had the opportunity to listen to the Lord Mayor and meet over 100 women from different industries – each telling their story about their career and answering questions. The Inspiring Women Campaign – which is spearheaded by Miriam Gonzalez Durantes, aims to bring about a significant cultural change – so that girls, whatever school they attend, whatever their background get the chance to meet women from all industries and gain first-hand insight into different jobs and routes

www.medicalwomensfederation.org.uk

into them. The target is to get 15,000 women to give an hour a year to go into a school or college near where they work or live and talk to girls about their career and experiences in life. Health sector professionals are amongst the most popular for schools, and there are not enough volunteers to fulfil demand. So come on ladies – one hour a year is no big deal! Sign up to this campaign and share your experience. To find out more and to register for this programme go to: www.inspiringthefuture.org

EAST MIDLANDS Leicester Medical School, Jenny Hong, 4th year student and MWF student Rep On June 10th, MWF at Leicester Medical School invited students and doctors to attend Guide to planning your career. Dr Jo Jones began the evening with her fantastic talk on “Career Planning 101” which helped to establish a framework for students to base their career planning on. She was followed by Dr Ushi Siriwardena, FY1 in Leicester, who gave her perspective on life as an FY1 which was particularly appreciated by our new graduates and final years at the event. Dr Abi Anness, ST1 trainee in Obstetrics & Gyaecology, provided us with an incredible story of her experiences in South Africa and the challenges of returning to the NHS. Last but not least, Dr Kath Higgins, one of our new senior members in Leicester, spoke about less than full time training and gave us a valuable insight into achieving better balance between our personal and professional lives. Also present at the event were Dr Yin Ng and Miss Ward, who never fail to attend our Leicester events. And typical of every MWF event, the evening delivered an excellent opportunity for discussion between medics at different levels of training and speciality. We have received great feedback from Leicester and Nottingham students and hope to organise the event again next year. We would like to thank Wesleyan, MPS, and Leicester University SU Medical Association for their generous sponsorship and our senior members for their continued support. The Nottingham Medical School MWF prize in Child Health 2014 was presented by Dr Yin Ng, Local secretary of the East Midlands group, to Lucy Simmonds who is about to start her final year as a student. Lucy hopes to be a surgeon, and has recently become a student member of MWF. The photo shows Lucy with Yin and Sue Ward, past President of MWF, 1) with her prize certificate, or 2) at the Medical school prizes board, where Lucy is pointing to her prize.

SUSSEX Dr Clarissa Fabre was invited to attend the Brighton and Sussex Medical School Summer Academic Award Ceremony as a member of the platform party, on the basis that MWF presents the annual medical student prize for the best project in O and G or paediatrics. Imagine her surprise when the guest of honour was Dame Valerie Beral, Professor of Epidemiology at the University of Oxford. Professor Beral had graduated from the University of Sydney, and had attended North Sydney Girls’ High School, just as Clarissa had. She is a longstanding member of MWF and has spoken at one of our November meetings. Her major research involves the role of reproductive, hormonal and infectious agents in cancer. She is Principal Investigator for the Million Women Study looking at the effect of women’s lifestyle on health, with particular focus on the effects of hormone replacement therapy. Since 1991 she has been involved in the international collaborative studies of breast, ovarian and endometrial cancer.

Say it, Write it, Tweet it

“Say it, Writ e

SOAPBOX SOAPBOX SOAPBOX SOAPBOX EXHAUSTED YET HOPEFUL Sohini Shreya Vipul Patel – I have just completed my third year of study at the University of Birmingham and I am intercalating in Medical Ethics and Law at Kings College London. Tired, fed-up and exhausted. It’s 6pm when I’m leaving hospital. I’ve performed awfully today, my peers knew the answers to most of the questions asked and I didn’t. My consultant asked a question and I replied, “I’m not sure”, the unforgettable look of disappointment he displayed still resides in my memory. I didn’t get the bloods I need to get signed off for my clinical passport – I still need to create a presentation for the end of the week and catch up on my revision. Exhausted. I wanted to push myself this semester, and I’m drowning already. I’m tired of being mediocre, I wanted to do better this term. I feel I should have already published something, if I am aspiring to be more than just an ordinary medical student. When did things get so hard? It was easy to do well at school and I flourished. I met deadlines with ease, extra curricular activities weren’t a chore and I was irritatingly keen to please my teachers. Where has my motivation gone? I was just a big fish in a small pond back then. I thought admittedly. I still need to revise tonight, cook dinner and sleep for a good few hours, before waking up at the crack of dawn again. I should practice my examinations as we have teaching tomorrow with one of the education fellows and I don’t want to be disappointed with myself, again. Exhausted. I’m still chasing, chasing a dream that I thought I achieved when I got a place to study medicine. These are a glimpse at some of my thoughts during my time at Medical School. We push and strain ourselves, to do better and work harder at the expense of our own health sometimes, consciously or subconsciously wondering if we will ever reach an end point. Medics are notorious for defining the motto “work hard, play hard” endlessly chasing the accolades and honors, posters and prizes, visiting the conferences and obtaining the certificates. They say if you haven’t been published at least once by the end of

your time at medical school, you are less than average. Average. Where is this standard being set? Our parents? Or was it the pushy teacher that we had in sixth form, or perhaps the terrifying notion that all of our peers are doing so much better than us? Including the latter, I personally am my own worst enemy. I have mounted my fellow medical students on a pedestal ever since I began reading medicine, inevitably, to my own detriment. I lose this tiresome battle with myself every time I consider where I want my medical career to be going. This introverted battle that we conceal from most of our peers for the sake of our own ego or perhaps to protect ourselves from endless ridicule, is one that I’m coming to terms with now. After exposing awareness to the many years that lie ahead, outlining not the career but the lifestyle choice we have made, perhaps studying “medicine” is a lesson in hindsight to save our own lives! Talking amongst friends and reading other student opinions it seems these woes and worries are not something I experience in isolation. But then it happens. A single, defining moment – walking along the corridor of a ward, with my stethoscope in hand and that beautiful, ostentatious, green badge on my shirt, highlighting my position as a medical student, I stand taller. I understand the meaning of a skip in my step as I rush back to the common room. With a wide grin I’m trying to suppress as I leave my consultant looking sentimentally back at me, I revel with someone that will understand this monumental occurrence. “Mum! I got it! I made the right diagnosis of the murmur! My consultant asked me to examine a patient and I made the right diagnosis! My first murmur and I got it!” This is why. I feel gloriously proud; I soak in this feeling allowing myself to have this moment. I want to be a doctor. I want to have this feeling over and over again. Wise words are spoken. “Remember this feeling, hold on to this moment. When you are tired and lonely and it’s all too much for one day, try and remember this feeling. When you have a patient that needs you to get it right, remember this feeling.” My mother, although not a doctor, the only one who can teach me such a fine lesson. Taking blood and dressing in scrubs for the first time or that ‘one’ patient that made you smile, although anecdotes that may seem trivial to those who are far more accomplished than I, I would urge you all to reflect and remember that feeling of purpose on those horrific days when you too wonder ‘why?’

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 6

Medical Woman | Autumn 2014

it, Tweet it”

Say it, Write it, Tweet it

ally Davies @sallydavies27 · Aug 5 Excellent discussion with Chair of RCGP on concerns about returning to practice after career break. S @medicalwomenuk vonne Lloyd @Yvonne_Lloyd · Aug 6 Collaborative plans are afoot @FMLM_UK @vijayanath1 @TheKingsFund @TheBMA and Y @medicalwomenUK to grow support for women’s medical leadership elanie jones @medicsupport · Jun 30 @medicalwomenuk Keep work and family life balanced. If now is the time for you to start a m family, go for it. Your career will catch up. F arah Jameel @DrFarahJameel · Jun 29 Dr Fiona Cornish, @medicalwomenuk past president tells General Practice to say “No” http://www.pulsetoday.co.uk/views/opinion/gps-must-start-saying-no-to-extra-work/20007100.article#.U7BicPldWSo … #YourGPCares #PutPatientsFirst edic Footprints @MedicFootprints · Jun 27 Don’t miss the article written by one of our directors, Dr. @AbeynaJones M http://ow.ly/yw9S4 @medicalwomenuk ara Khan @DrSaraK · May 22 Once again, I’m really enjoying #LMC conf. So important for young GPs to get involved with LMCs S to have a voice... aty Tuncer @KatyTuncer @DrSaraK @medicalwomenuk K yes we can change the world one healthy fit mother at a time! lla @moorlandsmrs · May 11 Medicine still needs feminism | BMJ http://www.bmj.com/content/348/bmj.g2623 … E Too right Helena - this is why we still need the Medical Women’s Federation.#MWF ijaya Nath @VijayaNath1 · May 9 From @medicalwomenuk reinforces the importance of female role models in clearing path for V future leaders http://bit.ly/1qlys81 #kflead ophie Fitzsimmons @sofitz · May 9 Loads of inspiring talks today at #MWFconf2014 - great to meet such a supportive group of S doctors! Thanks for having us @medicalwomenuk

DATES FOR YOUR DIARY: OCTOBER Elective bursary Applications for 2015 go live! 1st October – New members sign up now and receive 3 months free membership! 15th October 2014 – Academy of Medical Royal Colleges Conference, “Aging Practice”, Royal College of Surgeons, Edinburgh 17th-18th October – BMJ Careers Fair

NOVEMBER Dr Dorothy Ward International Travel Fellowship applications go live! 7th November – Autumn Conference, “Healthy Doctors: Healthy Patients” and Council Meeting (8th November)

DECEMBER Katherine Branson Essay Prize Questions released December - January – Subscription payments due

FEBRUARY Mature Student Grant Applications go live 15th May 2015 – MWF Spring Conference ‘Stepping up and speaking out; empowering women doctors and their patients’ – Abstracts and registration welcome from January 2014.

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Features

How visible are you?

visible

Dr Anita Houghton, Consultant and Coach, The Working Lives Partnership, London www.workinglives.co.uk

“

I was brought up to be modest,” says Sally, a newly appointed clinical director. “It was considered very rude in my family to grab attention for yourself. It was pretty frowned upon at school too. I remember a boy called Jason, he was constantly talking, asking questions, fooling around. The rest of us would roll our eyes and sit there waiting for the lesson to resume.” Much of our behaviour is learnt – we weren’t born that way. Go out to a restaurant and there will often be a table where one person is talking more loudly than anyone else. The person may be sitting several tables away and yet you can hear every word he or she says, rather better than you can hear your own. This person is not shouting, they just learnt to talk with a voice that carries, a voice that is heard. The Sallys of this world get very irritated with people like this – drawing attention to herself was something she’d given up when very young – it is intrusive and selfish – so seeing someone blatantly breaking this rule is hard to stomach. The truth is that we all want attention. We all want to be listened to, approved of, admired. Most of all we want to be seen. If you think you don’t I’m afraid you’re in denial. Show me a baby that doesn’t cry for attention; a toddler that doesn’t talk so that people in China could hear; a child that doesn’t want their painting admired. We all want attention but some of us have learnt to be quiet and self-effacing and to suppress our desire for it. That is much more likely to be the case if we’re female. As a result we’re furious when other people take all the attention – because not only are they breaking the rules, our rules, they’re taking the attention from us. The trouble is that being quiet and self-effacing all the time doesn’t help anyone. It’s wonderful when people are generous with their attention to others, modesty is an attractive and generous quality, but if it means that you deny your potential, that you limit your contribution to the world, that you underestimate your value and importance, then everybody loses. Where would Britain have been during the war if Churchill had been a shrinking violet? Where would India be if Gandhi hadn’t overcome his phobia of public speaking? Where would the deprived children of south London be if Camila Batmanghelidjh didn’t draw attention to their plight with her passion and her eye-catching outfits? We help no-one by hiding. That is not to say that we’re all born leaders, they are just the more obvious examples – there are as many talents and contributions as there are people. Look at Susan Boyle and Paul Potts, two people with remarkable singing talents who remained completely obscure for many years because they lacked the confidence to put themselves forward. We all have one thing in common: we cannot become and contribute the fullness of ourselves if we hide.

While both sexes can be affected, it is inevitable that women are more prone to this ‘hanging back syndrome’ than men. Girls are taught, whether overtly or implicitly, that their job is to take care of the people who do things, not to do them themselves. Even the more forward-thinking households are prone to this influence because no family lives in a vacuum. We live in societies where leadership roles are predominantly taken by men from higher social classes. If you go to Eton, followed by Oxbridge, instead of having to draw yourself up to your full height in order to take a prominent role you would actually be going against the grain if you didn’t. It is very different for women, and for people of both sexes from lower social class backgrounds, and also for people who have migrated from their country of birth. Those who do advance themselves beyond the expectations of their gender or class or ethnicity often appear more arrogant, more abrasive, more aggressive than their laid back colleagues who breezed through to the top, because they have had to push to be noticed. The word ‘strident’ is often used to describe women like this. If you watch a programme like Question Time you will see it there – the men are often sat back comfortably in their chairs, a slight smile on their lips, easily getting their point across with a voice that seems to come from somewhere low in their bodies. The women on the other hand are often sat forward in their chairs, pulling themselves up to their full height, their voice high and strained, coming from their throats. For the people for whom visibility comes naturally, confidence is key, but there is something less obvious going on. A game is being played and these people naturally know how to play it. The rest of us are still playing the game, we just don’t realise, and we don’t know the rules. I went to a talk by Germaine Greer several years ago and she talked about this game. She was an English fellow and lecturer at Cambridge University at the time and said how she’d noticed that the women loved teaching and did most of it, while the men wouldn’t dream of teaching if they thought they could get away with it, because they knew that prestige and advancement lay in research. She talked of a sabbatical she had spent as visiting professor in Miami. She was invited to join the tennis club, which she turned down as she didn’t play tennis. She later realised that all the men belonged to the club and that most important decisions about the department were made there. She observed how women thought that if they worked hard they would be rewarded, but men knew that what was more important was being visible in the right quarters. She noticed how women tended to focus on taking care of and developing those junior to them, while men tended to focus on networking with those more senior.

Medical Woman | Autumn 2014

visible Features

“While both sexes can be affected, it is inevitable that women are more prone to this ‘hanging back syndrome’ than men. Girls are taught, whether overtly or implicitly, that their job is to take care of the people who do things, not to do them themselves.”

– they behave as if they are a little more senior than they are – they go to conferences and speak whenever possible My clients, on the other hand, make sure other people get credit for their work and ideas, but not themselves. They say yes to jobs that no-one wants to do because they are afraid that saying no will make them look bad. They let other people talk at meetings. They notice other people taking credit for their ideas and don’t know what to do about it. They work extremely hard and so have little time for networking. They are working their socks off and yet they are invisible. This syndrome doesn’t just happen at work. It happens in communities, in families, in groups of friends. Time to wise up!!!

I have had a number of clients who have come up against this problem, many senior, and often women. They work hard, achieve, develop their staff, give credit to others and are generally good eggs, but they come to me because all is not going well. They are finding themselves not getting the credit they deserve, being passed over for positions they think they should have got, not being taken seriously, and having other people take credit for their ideas and their work. What has gone wrong, they say? What has gone wrong is that their beliefs about what will make them valued at work are at odds with the rules of the game. I ask them to think of a colleague who seems to be better at getting credibility and influence for themselves, and start to get curious about their behaviours. In no time at all they come up with a list of what these people do: – they always speak at meetings, if necessary interrupting other people – they put their name conspicuously on their work, and on other people’s – they mix with influential and powerful people and find ways of linking their names to them – they take credit for work they haven’t done and ideas they haven’t had – they choose areas of work that are more visible and have more kudos

If you would like to be more visible than you are: 2. Think of someone you admire who has that level of visibility and get curious about how they got there and how they maintain that visibility. What do they do exactly that is different from what you do?

isible www.medicalwomensfederation.org.uk

Try this: 1. C hoose an area of your life where you suspect your visibility is suboptimal – it may be work, or it may be your friendship group, community, club or your family. On a scale of 0 - 100, where 0 is completely invisible and 100 is in a blaze of publicity, put a cross where you would place yourself right now. On the same scale, put a cross where you would like to be, either now or at some point in the future.

3. Think about making yourself more visible and notice the feelings that come up. Is it fear, excitement, inertia? And what thoughts come – are there any that start ‘I’m not the sort of person who...’ Or ‘but it’s not nice to...’ ? Consider the possibility that you’re mistaken. Feel the fear and do it anyway! 4. Make a list of new behaviours that you could do without seriously offending your values, and start. 5. Remember it’s a game, and enjoy – that’s what the experts do! Wishing you some well-deserved attention... If you would like to receive regular tips like these by email, please do log on to www.workinglives.co.uk and sign up! Archives on hundreds of subjects can be found here: http://tinyurl.com/yktha9s 9

Features

Sexual Health

in the Older Population Dr Fopefoluwa Olayisade, Foundation Year One trainee: Royal Devon and Exeter Hospital Foundation Trust, Exeter, England. Winner of the May 2014 Elizabeth Garrett Anderson Abstract Prize

Introduction Sexuality and older age are often not seen as compatible: dominant images of sexuality revolve around youthful, healthy, beautiful bodies, which can represent a marked contrast with those associated with older age1. However, qualitative studies that have explored sexuality and sexual health among older people (defined in this article as over 50 years) identified that sex represents an important quality of life issue in later life with 80% of 50-90 reporting being sexually active2. In fact, participants identified that sex assumes no importance to quality of life when barriers to remaining sexually active are perceived to be insurmountable, for example following the death of a spouse or experience of a significant health problem1. Nevertheless, sexual health campaigns and policies in the UK are commonly focused on young people and the objectives of reducing sexually transmitted infections are often married with those of reducing conception rates. A possible consequence of a policy only focussing upon a younger age group is that it obscures the existence of infections in middle aged and older people, leading to the erroneous conclusion that sexual risk taking only occurs among young people.

Benefits and challenges of sex in later life The World Health Organisation defines sexual health as complete physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity3. Therefore, there is no doubt that sexual activity is a natural and important part of a healthy lifestyle no matter what your age. Sex is a physical activity that burns fat and also causes

Adapted from data provided by http://www.hpa.org.uk/web/HPAweb&Page&HPAwebAutoListName/Page/1201094610372

the brain to release endorphins, which are natural chemicals that act as pain killers and reduce anxiety. Sexual vigour can be seen as a ‘use it or lose it’ phenomenon with sexually active people having higher levels of naturally produced sex hormones. Sex also reinforces close and personal relationships, which are important in emotional wellbeing. Despite the many known and important benefits of sex it is crucial that the challenges of sexual activity in later life are recognised. Reduction in physical ability and stamina can play a big role in enjoying a fulfilling sex life. Heart disease, osteoporosis, arthritis, incontinence and emphysema all increase in incidence the older one gets. These chronic diseases, as well as the associated medications and treatment, can all have an impact on emotional and physical health and ultimately have a negative impact on sexual health.

Sexual health trends in the older population According to the health protection agency annual statistics on sexually transmitted infections (STIs); rates for all STIs have been consistently on the rise in the last 10 years among the older population4. These include all the common STIs: chlamydia, gonorrhoea, ano-gential warts, syphilis and probably most worryingly human immunodeficiency virus (HIV). In fact it has been reported that new diagnoses of HIV in the over 50s’ have doubled between 2000 and 2009. Several factors can be identified to explain the upward trend. Firstly, some over-50s have become newly single following either the death of a spouse or divorce and are now dating again. With the vast number of online dating sites, particularly those aimed primarily at over 50s age group, it has been increasingly easier to meet potential partners at the click of a button. In 2010, the Family Planning Association ran the first national campaign about sexual health aimed at the older population5. The campaign highlighted that a lack of knowledge may be a contributing factor in the rise of STIs. The issue is that many may think that safer sex does not apply to them as it is something that they may not have had to think about for years whilst in a long term relationship. During their adolescence and twenties – in the 1960s and 1970s – sexual liberation was at the height and safe sex was primarily about preventing pregnancy rather than prevention of STIs. From a female point of view, most women have undergone menopause by their early fifties and there may be a perceived freedom associated with not worrying about pregnancy. Thus, condom use is often a second thought when initiating a sexual relationship. However, menopause can be a double edged sword as Medical Woman | Autumn 2014

Features aged by setting three goals: people of all ages understand the risks they face and how to protect themselves; older people with diagnosed HIV can access any additional health and social care services they need; and finally, people with other physical health problems that affect their sexual health can get the support they need for sexual health problems.

Future developments

Lack of appropriate services

A key area for development is to how to increase awareness among the over-50s. Although they only accounted for three per cent of all STIs diagnosed in 2011, there was a 20% rise in new diagnoses in this group since 2009. More targeted campaigns, for example, with advertisements on specialist sites or posters in places frequented by the over-50s may help. In the UK, general practitioners (GPs) are most likely to have the opportunity to initiate discussion about sexual health issues with the over 50s, but evidence shows that only a minority of over 50s with current or recent sexual health concerns sought any professional help. Barriers identified included attributing problems to normal ageing, concerns about professional reactions to an older person with a sexually related concern and psychological factors including shame, fear and embarrassment. However, a significant concern was the lack of confidence that GPs felt when addressing sexual health issues with older people. They reported that they felt inadequately trained when discussing sexual health issues with younger patients compared to their older patients. There was a feeling that older patients were in heterosexual, monogamous relationships and there would be embarrassment on both sides if the idea of sexual health was raised. Other factors identified were lack of time and limited availability to refer to secondary care. The British Association for Sexual Health and HIV (BASHH) have made recommendations for taking a sexual health history from older people7. They recommend firstly that clinicians should optimise the physical environment for sexual history taking to create a welcoming, comfortable and confidential environment which more likely to encourage openness. Secondly, they suggest that professionals, particularly GPs should undergo training about how advancing age can impact on sexuality. Thirdly, they seek to improve communication skills suggesting a refresher course on the components of a sexual history and recognition of risk factors. Finally, they recommend GPs be updated about referral criteria to secondary care and initiatives and resources that patients can access themselves.

If you were to scrutinize all the sexual health campaigns, bulletins, leaflets and dedicated specialist services, you would be hard pressed to find the older population as the primary target audience for this material. This may lead to a lack of awareness and subsequent difficulty in recognising the signs and symptoms of common STIs and uncertainty in where to seek help and guidance. The Department of Health published ‘The Framework for Sexual Health Improvement in England’ in March 2013 which reported that late diagnosis of HIV is more common in the older age groups (half of those aged over 50) compared with younger age groups (one third of those aged 16-49)6. The earlier that HIV is diagnosed, the sooner a person can get access to treatment and improve their individual prognosis while making changes necessary to prevent onward transmission, for example avoiding unprotected sex. Their ambition was to protect people as they

References 1. Gott M, Hinchcliff S, Galena E. General Practitioner attitudes to discussing sexual health issues with older people. Social Science and Medicine 2004; 58: 2093-2103 2. Gott CM. Sexual activity and risk-taking in later life. Health Soc Care Comm 2001;9:72-8. 3. Defining sexual health http://www.who.int/reproductivehealth/topics/sexual_health/ sh_definitions/en/ (accessed 6/6/14) 4. Sexual Transmitted Infections Annual Data. Health Protection Agency 2011 http://www.hpa.org.uk/web/HPAweb&Page&HPAwebAutoListName/ Page/1201094610372 (accessed 6th April 2013) 5. The Middle-age Spread (STIs in the over 50s) – Sexual Health Week 2010 http://www.fpa.org.uk/campaignsandadvocacy/sexualhealthweek/stisandsafersexover50 (accessed 6th April 2013) 6. Department of Health: A Framework for Sexual Health Improvement in England. https://www.gov.uk/government/uploads/system/uploads/attachment_data/ file/142592/9287-2900714-TSO-SexualHealthPolicyNW_ACCESSIBLE.pdf (accessed 12/6/14) 7. French P. National Guidelines-consultations requiring sexual history taking. International journal of STD & AIDS (2007) 18:17-22

Taken from: The Middle-age Spread (STIs in the over 50s) – Sexual Health Week 2010 http://www.fpa.org.uk/campaignsandadvocacy/sexualhealthweek/stisandsafersexover50

decreasing levels of oestrogen can leave vaginal walls thinner and dryer so can be more susceptible to contracting STIs. Men also have a role to play in the upward trend. Erectile dysfunction is associated with heart disease, diabetes and a range of other conditions, there may be a belief and/or personal experience than condom usage worsens erectile dysfunction. The rising sales and requests of ViagraTM indicate that men are keen to still have an active sex life despite growing health concerns in older age.

www.medicalwomensfederation.org.uk

How I got here

In the Hot Seat CHIEF MEDICAL OFFICER PROFESSOR DAME SALLY C DAVIES, DBE FRS In this issue Professor Dame Sally Davies is in the hot seat. She is the Chief Medical Officer for England, and was previously Director General of Research and Development and Chief Scientific Adviser for the Department of Health and National Health Service in the United Kingdom We were unfortunately unable to meet her (an emergency meeting about the Ebola virus got in the way!), but are grateful that she took the time to answer some of our questions for this issue of Medical Woman.

Why did you choose medicine?

I chose medicine because I was fascinated by the double helix and I wanted to be part of bringing that into patient care. What’s the one thing you get from medicine you don’t get from anywhere else?

I love the variety, but for me it is the bringing of science together with the caring profession. What do you think are the most important qualities a good doctor should possess?

Good doctors have an understanding of the evidence and a ‘nose’ for what patients are telling so they can make a diagnosis and are able to prioritise tasks. In making the tough decisions and working with patients they are able to communicate, preserve patients’ dignities and be compassionate.

You are the first female CMO. What barriers, if any, did you face as a woman in medicine along the way?

Every career has its highs and lows. Mine is no different and I’m not sure the barriers were any worse than other people’s. At Central Middlesex I was very much supported along with other women because there was no gender bias against women. In academic medicine we still have a gender bias but I’ve always been treated with respect. I have had to prove I know my stuff and there have been occasions when things I’ve said have been passed over but then welcomed as important ideas when made later by a man. It is always difficult to balance career and family life and each person makes an individual choice. I have a very supportive husband and we chose to spend significant monies on a superb live-in nanny for 16 years! Without the nanny, I would not be doing the job I am doing now. It does not seem to have impacted adversely on my children, who are well-balanced and academically successful.

Who is the most memorable person you have worked with?

What has been the biggest challenge in your career?

Dr Misha Brozovic, Consultant Haematologist at Central Middlesex Hospital. Misha brought science to the patient, always knowing the latest evidence, always caring about her patients as people. She was an inspiring consultant to my senior registrar and senior colleague to me when I became a consultant.

Developing NIHR (National Institute for Health Research) to be the envy of the world for translational and clinical research. That we created it from nothing has been the greatest challenge that we have delivered. The challenge going forward is to build the platform for global action on antimicrobial resistance.

Why did you choose to specialise in haematology?

What do you consider your biggest achievement?

In my day, there was a lot more flexibility to try different things out to find the right specialty and gain experience across a broad range of issues. I rather fell into haematology because of the hours and life-work balance and then discovered I loved it and became a sub-specialist in sickle cell disease. Part of my interest in sickle is, of course, that it is the paradigm molecular disease.

Clearly, the establishment of NIHR and the increasing global focus on anti-microbial resistance, including the Prime Minister’s announcement of an independent commission to review market failure.

Do you miss clinical work?

I miss the patients, but some of my patients still email me to tell me how they are doing. 12

How are we going to educate patients on antibiotic use?

We really will need to use the media to help patients understand when to use antibiotics or not. I am also very excited about the new Longitude Prize because if we can get a cheap rapid diagnostic for you to use in your surgeries Medical Woman | Autumn 2014

How I got here

“In my day, there was a lot more flexibility to try different things out to find the right specialty and gain experience across a broad range of issues.” then it will make life much easier for you. We must, though, remember this is a long-term issue and will be essential for the conservation of antibiotics.

on work those long hours that I do work, but I ensure a focus on home when at home and I make sure I take all my holiday.

How are women involved in deciding what research should be funded by the NIHR?

Five things you need to become a successful leader within medicine:

In multiple ways, by including and involving them on our panels, as clinicians and patients. But it is important to recognise that we are spending public money on research which is about science and the need for evidence for improving care, not about gender.

I speak at many events with young women, including helping “Teach First”. Only the other day, five Year 6 young girls came in for an hour to see me.

The same as anywhere else – leadership is made up of individuals: a. Resilience – to deal with what life throws at you. b. Vision – clarity of vision enables others to be the future that you want. c. Collaboration – do not be afraid to collaborate with partners to achieve your goals. d. Decision-making – do not be afraid to make tough decisions and stick with them. e. Engagement – leaders are only as good as the people around them: have good people, treat them well.

Why do you think you have been so successful?

Do you have any regrets?

I am able to do strategic thinking, programme management and detailed delivery. I flex my skills and style to suit the occasion, but I always have a focus on pragmatic practicability and delivery. And there’s no easy way round hard work.

How could women researchers be more visible to school pupils/under-graduates?

Do you feel you have maintained a good work-life balance alongside your many achievements?

Some would say I haven’t got a good work-life balance but it’s helped by not feeling guilty, either at home or at work, by enjoying my work and making it fun as well as loving being with the family and, of course, having only one diary. Following on from that – how should busy doctors incorporate exercise into their lives in order to maintain a fit and healthy lifestyle?

I get up early and exercise with a friend before work. I wouldn’t go out if I didn’t plan this and it gives me a reason to go out. I also watch quite carefully what I eat and my alcohol intake as that’s calorie-rich. I generally eat a bag of raw vegetables for lunch which I bring in from home. What do you do to relax in your spare time?

I love being with the family, reading, cooking, opera and skiing for starters.

Are you involved in anything to promote women into leadership roles?

I have, through NIHR, instituted a rule that we would not expect to shortlist medical schools for major infrastructure grants if they do not achieve the Athena Swan Silver Award. In addition, I mentor a number of young people, many of whom are women. What are your top tips for women leaders?

• Use collaboration • Look at what you can do, do not focus on what you cannot. • Focus on achieving things – doing well in your day job and then other things. If you could change one thing in medicine right now, what would it be?

I would probably sort the antimicrobial resistance, which is multifaceted: public understanding; professional restraint; stopping using antibiotics in agriculture for growth promotion; sorting the discovery void in antibiotics, to name but a few of the things needed. Finally, where do you see the future of medicine?

What advice would you give to young mothers trying to forge success in their careers?

In addition to only having one diary, I would say that I focus www.medicalwomensfederation.org.uk

Technology is going to play a big role through telemedicine, big data as well as the increase in precision medicine and the impact of our improved understanding of the genome. 13

Women at the Top In this feature we profile medical women who have demonstrated reaching a senior position within medicine...

WOMEN AT THE TOP Lesley Regan – Professor of Obstetrics & Gynaecology at Imperial College. As Director

Name: Lesley Regan

of the world’s

Born: 08 03 1956 (International Women’s Day)

largest

Lives: Paddington, London

Recurrent

Medical School: Royal Free London

Miscarriage

Year Qualified: 1980

Clinic at

Speciality: Obstetrics and Gynaecology

St Mary’s

Place currently works: Imperial College at St Mary’s

Hospital, Lesley Regan’s clinical and research teams have significantly improved outcomes for women with a history of repeated miscarriage. She is co-director of the UK pregnancy Baby Bio Bank (BBB) – a tissue archive underpinning future translational research into the major complications of pregnancy. Another interest is the development of fertility sparing therapies for uterine fibroids. She is a Trustee of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) and ex-member of the Human Fertilisation and Embryology Authority. Lesley has written two best sellers: Miscarriage – what every woman needs to know: and Your Pregnancy Week by Week; which has now been translated into nine languages. She enjoys broadcasting about women’s health related issues and has presented a series of six TV documentaries for BBC Horizon. More recently, she has become involved in developing health care policies that encourage and empower women to look after and promote their own health. She received a Woman of Achievement Award for her contributions to Medicine and Healthcare in 2005 and 2013 and was elected Vice President for Strategic Development at the Royal College of Obstetricians and Gynaecologists in January 2014.

First Ambition: Opera singer – it was a totally unrealistic dream, but I still derive great joy from singing with my amateur choir. At medical school I was fascinated by the Psychiatry attachment until my O&G mentor persuaded me that I could offer far more practical solutions to women by becoming an OBGYN. Other Career Related Interests/Roles: My interest in Global Health, particularly reducing maternal mortality and morbidity, has expanded in recent years. I am a member of the Global Health Boards at the RCOG, RSM and Imperial. FIGO’s Women’s Sexual and Reproductive Rights Committee, which I chair has developed a web based curriculum to ensure that a human rights based approach adapted to local needs is firmly embedded into the future teaching of reproductive healthcare globally. Challenges along the way: Physics A level – after that ordeal the MB BS finals seemed quite easy. Men… particularly the grey suited variety in committees. And Children – there is nothing else in life that keeps you in touch with reality so effectively. My twin daughters are now 21 and have become treasured friends. Rewards of your role(s): The variety means there is always something interesting to look forward to. I am never bored and feel fortunate to work with talented people. Most of my career has been spent treating women when they present with reproductive problems. Understanding that pregnancy is the healthcare opportunity of two lifetimes, and that a woman’s response to pregnancy predicts her medical needs in later life as well as those of her baby, was my light bulb moment. Now I am trying to focus on helping women take control of their own lives. Inspirations/influences: Apart from Monteverdi, Handel and Verdi you mean? My father – who insisted that anything was possible if I tried hard enough. Luba Epsztejn at the Royal Free who taught me to heal. Gillian Hanson at Whipps Cross who taught me that only the best is acceptable. David Morris at Queen Charlotte’s who taught me to care and Ralph Robinson in Cambridge who taught me to cut – and to manage, both the patients and the firm. Quotas for senior positions for women in healthcare – yes or no? No. I believe in transparent selection processes and appointing the best person to do the job. We must reward talent and promote on merit. However, I still bristle occasionally at the persisting failure of our profession to allow room for enough senior women at decision making tables. And when I say our profession, I am particularly critical of women who are prejudiced against their own gender. ADVICE Do’s: Work hard and be persistent. Remember Osler’s dictum – all great doctors are blessed with the gift of toil. Maintain a sense of humour. Treat everyone with respect. Always consider opportunities that come out of the blue, you may not be offered a second bite at the cherry. Don’ts: Ask people to do things that you are not prepared to do yourself. Or ever find yourself saying “it was not my fault…” – if the patient has been let down, you need to find a solution and ensure that the problem cannot recur, not waste time apportioning blame. How to get there: Experience – there is no substitute for having seen it before – so spend time running the extra mile during your training years. Identify a problem that fascinates you – preferably something that is not already top of everyone else’s agenda - and then give it everything you’ve got. Ask yourself at least once every day, “is this the way I would like my mother/sister/daughter to be treated?”

Medical Woman | Autumn 2014

TOPAPPS For Medical Women

Top Apps

by Amy Woods & Brooke Calvert, Student Editors FIGURE 1 – An endlessly educational and fascinating

interactive tool-used by doctors and students alike. This app allows doctors to share images: from pictures of firework injuries in A&E, to classical radiological signs seen in real life cases. Figure 1 is a fascinating way to see rare conditions and signs, and as a platform to discuss difficult and unusual cases with other doctors around the world.

ONENOTE – The perfect way to organise your notes, Onenote allows you to easily create multiple notebooks which can be accessed anywhere and works with both Windows and Mac. It even has a handy search optionallowing you to search within your own notes. CITYMAPPER – One for Londoners – find your quickest commute, your next available bus and avoid any public transport morning nightmares by downloading Citymapper – your essential guide to getting around in Greater London.

RADIOPAEDIA –

Already a famous online educational resource used by a wide range of health care professionals-Radiopaedia now has an app. You can view high quality images and medical cases to improve your radiological knowledge whatever your level of qualification. It also has a handy offline availability to keep you entertained on the go.

WUNDERLIST –

If you are looking to increase your productivity this to-do list manager enables you to categorise tasks, share with family or colleagues and set reminders. It syncs seamlessly between web and your phone so it can be updated or accessed from anywhere, anytime.

MEDICAL WOMEN’S FEDERATION

Autumn Conference 2014

Healthy Doctors:

HEALTHY PATIENTS

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

Friday 7th November 2014 – Friends House, 173 Euston Road, London, NW1 2BJ

Our conference key note speakers will focus on doctors and patient’s health and wellbeing Dr Clare Gerada – Practitioner Health Programme, Chair of NHS England’s board for transforming primary care in London

Dr Debbie Cohen –

Senior Medical Research Fellow, Institute of Primary Care & Public Health, Director of Individual Support Programme, Cardiff University

Professor Jane Anderson – Consultant physician, director of the centre for the study of sexual health and HIV and honorary senior lecturer at Barts and The London

OUR S WORKSHOP ON HOW WILL FOCUS EALTHY TO HAVE A H ODY MIND AND B TICING WHILE PRAC MEDICINE

Why not submit an Abstract? Deadline – Friday 26th September 2014 You still want more? How about a social programme excellent for networking?! Registration details available at

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

www.medicalwomensfederation.org.uk

TwitterView

Twitterview MWF @medicalwomenuk with Emma Stanton @doctorpreneur

Q: @medicalwomenuk

A: @doctorpreneur

When did you join Twitter and how often do you check it? I joined Twitter April ‘09. How often I check depends on what I am up to – more often at conferences, rarely when clinical...

Q: @medicalwomenuk

What attracted you to medicine?

A: @doctopreneur

I was attracted to medicine because its all about people rather than paperwork. I have never regretted training to be a doc!

Q: @medicalwomenuk

Why did you found Beacon UK? I met Beacon in the US while I was @commonwealthfnd @harknessfellows & thought the model would be v relevant for the #NHS

Q: @medicalwomenuk

How do you divide up your time to fit all your varied roles in?

A: @doctopreneur

I do clinical work for #NHS on Mondays; the rest of my week is @beaconuk

What are your current roles in medicine?

Q: @medicalwomenuk

My current roles= CEO @beaconuk, clinician @MaudsleyNHS, general council @TheKingsFund & founder of @DiagnosisLtd

A: @doctorpreneur

Q: @medicalwomenuk

Did you make any sacrifices for your career?

A: @doctopreneur

Having a portfolio career sometimes means compromises more than sacrifices

Q: @medicalwomenuk

What has been your greatest achievement?

A: @doctorpreneur

It’s probably yet to come..! So far, I would say it has been sailing around the world on a 68-foot yacht from 2005-2006

Q: @medicalwomenuk

Who/what has been your biggest inspiration?

A: @doctopreneur

Ooh, I have been inspired by many peeps. Female heroes inc: @Marthalanefox @ariannahuff Psychiatry heroes inc: @baggaley_m

Q: @medicalwomenuk

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

A: @doctorpreneur

if I have – I have not noticed it.. Yet(!)

Q: @medicalwomenuk

You’ve circumnavigated the world in racing yacht – How did this impact your career? It made me more risk-taking, adventure-seeking, resilient, determined & to appreciate there is far more to life than work

Q: @medicalwomenuk

Do you recommend portfolio medical careers?

A: @doctopreneur

I don’t think portfolio careers r 4 evry 1 & key challenge is 2 remain focused... combining clinical & corporate works for me

Q: @medicalwomenuk

What would be your advice be to medics who are curious about healthcare entrepreneurship?

A: @doctorpreneur

being an entrepreneur is a rollercoaster. It’s fun & fast-paced but will take over everything!

Q: @medicalwomenuk

What advice can you give our members on getting into leadership roles?

A: @doctopreneur

U don’t learn about leadership in the classroom, seek out opportunities to manage teams, bid for grants & drive improvement

Q: @doctorpreneur

Where do you see yourself in 10 years?

A: @doctorpreneur

My goals are (1) to be happy and (2) to be making a difference

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

Q: @medicalwomenuk

Do what you enjoy & make time to look after yourself as well as your career

A: @doctopreneur

How do you keep a work/life balance and keep up with your family and friends?

Q: @medicalwomenuk

On a daily basis, I ensure I exercise. This yr I am spending August in Cornwall w/ family & friends visiting, can’t wait!

Would you recommend psychiatry as a career with a good work/life balance?

A: @doctorpreneur

DEFINITELY! Although I think GP can work pretty well from a work/life perspective for people who fancy a portfolio career

Q: @medicalwomenuk

What does being a ‘doctorpreneur’ mean to you?

A: @doctopreneur

it means combining my clinical role & expertise with all the fun & innovation of building a business/being an entrepreneur

Q: @medicalwomenuk What do you do to relax?

A: @doctorpreneur To relax I spend time with my favourite people, go sailing, do @psyclelondon @barrecore spend time in Cornwall, sleep more... Q: @medicalwomenuk

Name someone you love to follow on Twitter and why?

A: @doctopreneur

I love following @PostdocAli as she always shares brilliant articles & thought provoking links

Medical Woman | Autumn 2014

Expand your Horizons

Charity Spotlight

in rural South Africa

Retha Grobbelaar Africa Health Placements, Dr Abeyna Jones Medical Director of Medic Footprints & Dr Helen Cranage “Everything I had already learned and experienced within medicine was expanded beyond my expectations. I was surprised how quickly I adapted and developed the skills, knowledge and confidence to deal with pretty much anything Zululand had to throw at me – a completely different repertoire of cases compared to the NHS.”

his is how Dr Abeyna Jones describes her experience in South Africa. She was placed by Africa Health Placements (AHP), a social profit organisation that assists health professionals to register to work in South Africa and find a paid or volunteer position in the public health sector. “I found South Africa an aesthetically satisfying country with a wealth of cultures, languages and people; yet unfortunately disparities remain in the provision of healthcare services between rural and urban areas,” says Jones. Dr Helen Cranage, another doctor placed by AHP, says working in South Africa was incredibly rewarding. “The great thing about working in South Africa is that as there is such a great need for all types of medical services, there is great scope for developing any special interest that you have. After working in South Africa, you know you will have a plan for managing pretty much anything that comes your way,” says Cranage. AHP facilitates the process from enquiry to placement and supports foreignqualified and South African health workers to find the right position for their skills and interests. The organisation was formed in 2005 to work with the South African Department of Health to find innovative and pragmatic solutions to the staff shortages facing the public healthcare sector in the country. Since 2005, AHP has assisted with the placement of more than 3 000 healthcare professionals and support staff in southern Africa, improving the quality of healthcare that millions of people access. There are three main reasons doctors chose to work in South Africa’s public health sector: a) Work experience: The generalist nature of the medical services required in www.medicalwomensfederation.org.uk

rural hospitals provides doctors with excellent exposure to the full range of primary medical disciplines, including obstetrics and gynaecology, anaesthetics, surgery and internal medicine. This allows doctors to develop proficiency in a wide range of medical fields. In addition, they gain invaluable experience in the treatment of patients in advanced stages of diseases such as HIV/AIDS, as well as exposure to emergency situations, including trauma and birth complications. b) Making a difference: There is a humanitarian appeal of contributing towards improving the medical care provided to impoverished and underserved communities in the country. c) Lifestyle: The quality of life and exposure to unique experiences that South Africa is able to offer is a major pull factor. For example, doctors can trade being late for work because of traffic on the London underground for being late because there were elephants crossing the road on their way to work at Hlabisa Hospital in KwaZulu-Natal! AHP can assist doctors from the UK wanting to work in South Africa with: • Registering with the Health Professions Council of South Africa • Finding a paid or volunteer position in the public health sector • Obtaining a visa • Orientation

AbeynaJones ©NinaSologubenko

SaraSabin ©NinaSologubenko

AHP does not charge for its services. However, there will be costs involved including those linked to initial professional registration fees. Contact us today if you are interested in developing your medical skills while making a difference in rural South Africa! 17

Features

Stress and Diet: How Good Nutrition Can Help Dr Michelle Storfer, MBBS (UCL), BSc Nutrition Founder: The Food Effect, London (www.thefoodeffect.co.uk) www.twitter.com/TheFoodEffectDR www.facebook.com/foodeffect

tress is likely to impact most of us to a greater or lesser extent. When left unchecked, it is capable of having a lasting negative effect on our health. Proper nutrition is key in the fight to prevent, and counter, the negative effects of stress. This article will explore what to eat in times of stress, and examine tools for incorporating these tips into a busy schedule. As medics, most of us are bound to experience stress at some point in our lives. Emotional stress can have an impact on the vast majority of illnesses, both directly and indirectly. The mechanisms by which this occurs are becoming increasingly well understood. We now know that stress can suppress immune function, cause heart attacks or strokes, increase the risk of cancer, delay wound healing, promote inflammation, cause depression, exacerbate diabetes and even impair memory. What is less well known, is that stress can directly cause us to gain weight, and that there are several important ways in which food and stress interact. Through its nutrient content, food can be used to alleviate the short-term symptoms of stress; additionally, certain foods can help counteract the harmful effects of chronic stress on the body.

The Physiology of Stress When humans lived a more outdoor existence, stress served as a valuable means of keeping us safe, by generating the “fight or flight” response when faced with danger. This same mechanism is still triggered whenever we encounter emotional, psychological or physical strain – our bodies enter “stress mode” releasing adrenaline, noradrenaline and cortisol. Initially, appetite is suppressed so that blood can be re-routed to the muscles and limbs, to be used for physical action, instead of being used for non-essential processes like digestion. However over time, when stress persists and becomes chronic, it can cause weight gain in three main ways. Firstly, when cortisol levels remain elevated during on-going stress, which stimulates appetite. In essence, our bodies mistake increased cortisol levels for real hunger and as a consequence, we overeat. Secondly, stress causes us to have a preference for foods that are high in fat, salt and sugar. These foods inhibit activity in the parts of the brain that produce stress, providing temporary comfort. Finally, the hormonal cascade secreted during times of chronic stress causes the body to store more body fat. Chronic overproduction of cortisol and glucocorticoids by the adrenals causes weight gain and accumulation of fat tissue, especially around the middle, where it’s most harmful. 18

A study published in the journal Nature: Medicine reinforces these last two effects. The study considered the effects of stress on weight gain in mice. Researchers reported that chronic emotional stress turned on the chemical messenger neuropeptide Y, which is found in body fat. This hormone increases appetite, especially for carbohydrate-rich foods. It also causes the body to convert these calories directly into belly fat, another negative!

Stress Busting Foods Food can be effective in countering stress in several ways. Comfort foods, particularly carbohydrates, boost levels of serotonin, the neural chemical that induces calmness. Other foods decrease levels of cortisol and adrenaline which, when elevated over time, increase the risk of high blood pressure, heart disease, and obesity. Certain foods can also protect against the long-term harmful effects of stress. Sustained stress can also lead to exhaustion of the adrenal glands, which in addition to helping us deal with stress, play a key role in regulating weight, mood and energy. Adrenal exhaustion can be prevented by incorporating the right foods into your diet, ensuring high levels of the essential nutrients needed for optimal adrenal function and vital hormone production. The following are the best foods to ease stress and counteract the damage that chronic stress causes. Incorporating these foods into your diet will also benefit your body, energy levels, and general health too. 1. Complex Carbohydrates All carbohydrates prompt the brain to make more serotonin, the same relaxing brain chemical released when you eat chocolate. Unrefined “complex” carbohydrates, such as brown rice, wholegrain breads, and good old-fashioned porridge oats have the additional benefit of being high in fibre, meaning they are digested slowly, allowing a sustained release of serotonin and keeping you fuller for longer. Complex carbohydrates also help stabilise blood sugar levels and further ensure you feel sustained and satisfied for longer, by avoiding the “dips” you get shortly after eating refined “white” carbs. 2. Sweet Potatoes Sweet potatoes are particularly effective because they satisfy the urge we have for comforting sweets when we are under a great deal of pressure. They are full of beta-carotene and again, the fibre content helps your body to process the carbohydrates in a slow and steady manner, keeping you fuller for longer. Medical Woman | Autumn 2014

Features 3. Oranges As is well known, the magic nutrient here is vitamin C. Vitamin C helps reduce stress and return blood pressure and cortisol back to normal levels following a stressful situation. It is also wellknown for strengthening the immune system.

throughout the brain when we “fall in love”. Note, however, that you will only benefit from chocolate that has 70% cocoa content or above. As part of a healthy diet, up to four squares of goodquality dark chocolate every day, should not compromise your weight either.

4. Spinach This wonder-leaf contains plenty of protein, magnesium, folate, vitamin A, vitamin K, manganese, iron, vitamin B2, calcium, vitamin C, potassium, and vitamin B6. It also contains vitamin E, zinc, dietary fibre, copper and phosphorus! In short, that means: immune boosting, bone strengthening, vision-improving, blood circulation-enhancing goodness, and much more! Dark green leafy vegetables, such as spinach, are also a rich source of magnesium, a natural stress-buster and muscle relaxant. Too little magnesium can trigger headaches and fatigue, compounding the effects of stress. One cup of spinach provides 40% of your daily intake, so try substituting it for lettuce in salads and on sandwiches to replenish your magnesium stores. Dried apricots are another food rich in magnesium.

Food preparation tips to make healthy eating easier during times of stress. Finding a practical and realistic way to incorporate healthy eating habits into a busy lifestyle is often the most challenging part. Here are a few key tips to make life easier and less stressful, and ensure you‘re never too busy to provide yourself with good, wholesome nutrition.

5. Salmon and other Oily Fish The omega-3 fatty acids found in fish such as salmon and mackerel, prevent surges in the stress hormones, cortisol and adrenaline. They are also proven to protect against heart disease., Aim to eat at least 100g of oily fish twice a week for a steady supply of omega-3s. 6. Nuts Almonds are full of B vitamins, which make you more resilient during bouts of stress, and vitamin E, which bolsters the immune system. To obtain the optimum benefits, snack on about 20 almonds every day. Both pistachios and walnuts will help prevent your heart from racing when things get stressful. Research has shown that eating 40g of pistachios a day lowers blood pressure so your heart doesn’t have to work overtime. Walnuts have also been found to lower blood pressure, both at rest and under stress. Add chopped walnuts to salad, cereal, or porridge. 7. Avocados One of the best ways to reduce high blood pressure is to consume enough potassium. Whilst it’s commonly known that bananas are a good source of potassium, half an avocado has more potassium than a medium-sized banana. The mono-unsaturated fats found in avocados also help lower blood pressure, and are extremely good for your heart. Guacamole can be a great alternative when stress makes you crave a high-fat treat.

1. Preparation – the golden rule of healthy eating habits! The more you think ahead and take a few moments to plan and prepare your food, the easier it will be for you to enjoy healthy and tasty food, and the less likely you will be to make unhealthy choices when going about your day, rushed in the moment. This follows on to… 2. Pack your lunch for the following day whilst making dinner or before bed in the evening. This will save you time and stress in the morning, and ensure you make the right choices about what goes into your lunch when you have a few more moments to think about it. If you currently buy lunch out, this one will also save you money. Food bought on the go is rarely healthy. An added benefit of a healthy packed lunch is that you are less likely to get that “postlunch”, “afternoon slump” feeling, often experienced after eating packaged, processed, bad foods. 3. Do all your food preparation on Sunday If you have some free time on a Sunday or any other time in the week, set it aside to do all your cooking and food preparation for the week. Make a batch of healthy meals that you can portion for the week or freeze. This advance preparation can even include all your vegetable chopping. Washing and chopping your salad ingredients ahead of time, saves time and hassle during the week and means you’re much more likely to incorporate them into your meals if the burdensome preparation work is already complete. This makes adding those vital healthy nutrients that much easier!

8. Milk Calcium can reduce muscle spasms and soothe tension. It has also been shown to reduce stress inducing PMS symptoms such as mood swings, anxiety, and irritability.

4. Always carry snacks and water Having some protein-rich, healthful snacks in your handbag, car, or office, will help you avoid blood sugar level dips and the accompanying mood swings and fatigue. This is especially important if you know you’re going to be out and about for hours or working long shifts, where there’s a risk of this happening. Snacks should be 200 calories or less and a combination of fibre, healthy fats and protein for optimum satisfaction and blood sugar stability. Good examples are a portion of nuts, seeds and dried fruit; an apple and a handful of almonds.

9. Dark Chocolate Dark chocolate contains two compounds that can lower stress levels – anandamide, which binds to receptors in the brain that produce feelings of euphoria, and phenylethylamine (PEA), a substance naturally found in our nervous systems that is released

By incorporating these suggestions, you will find that it really is manageable to transform your eating for the good. I would recommend incorporating one tip at a time, getting used to it for a while, before adding another. This way the changes you make will last… hopefully for life!

www.medicalwomensfederation.org.uk

Features

Ready

Steady... Mums! Katy Tuncer is the pre and postnatal exercise expert who founded Ready Steady Mums – providing communityfocussed and medically-based fitness programmes for mothers across the UK. The recent workshop she facilitated at the Medical Women’s Federation Spring Conference, “Keeping Patients and Doctors Healthy Through Exercise”, was hugely oversubscribed and feedback overwhelmingly positive.

s medical professionals we know exercise matters, and we want to make a difference for ourselves and our patients, but what is the secret to fitness that fits our lives?

MWF Editor, Dr Sara Khan talked to Katy about: why, after women have a baby, their own health needs can get left behind; why many don’t exercise; and what doctors can do to get patients to change this… Sara: Most mothers don’t exercise. What is at stake here? Katy: Human beings are becoming more and more sedentary in today’s society. But we evolved to be active, and our health and wellbeing depend on it. Rising obesity, heart-disease and diabetes are clearly linked with physical inactivity for the population in general. The problem is even worse for women. Less than a third get the recommended amount of exercise, and motherhood often comes with a further drop in physical activity – at a time when we need it most. Pelvic floor damage, incontinence, sexual dysfunction, diastasis recti, lordosis and many other common postnatal conditions can often be improved through exercise. And beside the physical benefits, exercise can impact on self-confidence and relationships. Did you know 16% of new mothers will not let their husbands see them naked and 19% resort to extreme diets? Sara: I am not surprised, I see these kind of issues again and again in my patients. But despite knowing the benefits of exercise, what about the guilt? Many mothers think they should put all their efforts into the job of motherhood. Katy: Yes, new mums often confuse “self-care” with “selfishness,” falsely believing that they must put every moment into their baby to do a good job. Focus in antenatal classes remains on birth and childcare, far less on the mother’s emotional and physical needs for long-term recovery and successful child rearing. Every man and his dog has an opinion on how a mother should give birth; feed her baby; and balance work with family commitments. The

pressures are astonishing. We are seeing a growing epidemic of unhealthy mothers, both physically and mentally, which ultimately leads to unhealthy families. It’s all about balance. Research published this year in the Journal of Pediatrics by Dr Esther van Sluijs, is a wonderful step in the right direction. It found that the amount of activity that a mother and her child did each day was closely related in a sample size of over 500 mothers. So, we can now confidently tell patients, based on robust research that (and I paraphrase) “being active makes you a better mother”. Sara: Yes we can! And what are the other important messages for medical professionals to provide mothers? Katy: One valuable reassurance for mothers is that exercising and breast-feeding is safe. Research shows that dehydration can reduce milk supply, but exercise itself does not. In fact, the benefits of being out in fresh-air, building self-confidence and reducing stress are all thought to improve breast-feeding. The two most important things to start with are improving posture (especially addressing lordosis) and pelvic floor muscle training. Most mothers can attend to these areas immediately Medical Woman | Autumn 2014

Features

Katy Tuncer

after birth. When it is safe to move onto proper exercise will depend on various factors including type of birth, fitness prior to and during pregnancy and health complications. Sara: So once the decision is made to take up an active lifestyle, what can doctors do to support with the practical barriers mothers face? Katy: Budget cuts for specialist exercise support and services (especially physiotherapists) are coming at the time of a baby boom and when the economic down-turn is putting extra pressure on families. One of the most important things for mothers to hear is acknowledgment of the challenges they face, and practical advice on how they can overcome them. Setting a goal is one of the simplest and most effective actions. A good goal will motivate the patient over an extended time period, the best ones are specific and positive. We’re also far more likely to stick with a goal if we share it. Personally, I have found a huge amount of motivation to exercise from fellow mums in my local “Socialcise” group which meets every week in the park with buggies.

Practical and credible guidance on postnatal exercise was scarce, and I was determined to address the problem. I’ve always been fit and active (I am still the 400m hurdles record holder for the Oxbridge varsity match); I am scientific and analytical (a Physics graduate and former McKinsey consultant); and I’m an experienced Physical Training Instructor (qualified whilst in the British Army). So I extensively researched the medical literature to understand the detailed exercise needs of the postnatal body. I consulted with medical and postnatal fitness experts, before I began designing a combination of fitness programmes for mums. It was through testing these programmes that my local group of mums started meeting up and supporting each other for exercise sessions in the fresh air with our babies. We did specialist exercises to speed recovery from birth and rebuild core strength, and this was the birth of the first part of the Ready Steady Mums offering – the Virtual Personal Trainer. I worked with a film director to create the video demonstrations and a programmer to build the technical platform which automates a progressive exercise programme tailored for every mum. “Socialcise” is the other major pillar of Ready Steady Mums. Back in those early days we found that exercising together could transform our experience of motherhood. We encouraged friends to get involved and more local groups started springing up around the UK. This is when we invented “Socialcise” and invested in creating the support and resources required for other mums wanting to set up local groups and join this community movement. Sara: As a medical professional, what information and support is available for me from Ready Steady Mums? Katy: We have developed a programme to help health providers support patients with safe, effective exercise. Medical professionals are on the front-line in encouraging mums to invest in themselves and can convince mothers to prioritise self-care. Together we can build healthy, happy families across the U.K. I am personally delighted to hear from GPs, midwives, health visitors who wish to be part of our work. You will encourage new mums to join a free Ready Steady Mums “Socialcise” group to get active and fit following birth. These groups also provide a social forum for mothers to chat and find encouragement from other mums in their area – key to their mental wellbeing. We provide written material and direct advice for you if you have questions about pre and postnatal exercise for your patients. You can contact me by emailing katy@readysteadymums.com.

Sara: I know “Socialcise” is really taking off and has strong support from doctors, midwives and health visitors who want to help mothers with postnatal depression, feeding and sleep issues and self-confidence. How did you create “Socialcise” and other Ready Steady Mums programmes? Katy: I have two sons, now aged two and three. I remember feeling immense pride at what my body had achieved in growing my babies, but shocked at the impact pregnancy and birth had had on me. www.medicalwomensfederation.org.uk

Features

Women in

A WW1 Woman Doctor helped by the MWF Katrina Kirkwood, PhD Cardiff University

r Isabella Stenhouse, my grandmother, had only recently qualified when WW1 broke out, yet she served in military hospitals in France, Malta, and then Egypt. The few women doctors faced such poor conditions that the MWF mounted a campaign on their behalf. At the outbreak of WW1, less than 0.024% of all actively practising doctors in Britain were women. While nurses tended wounded soldiers, and untrained women morphed into VADs (Voluntary Aid Detachment) to care for injured men, women doctors were told by the War Office, the British Red Cross and even feminists such as Millicent Fawcett to stay home and take up the slack created by male doctors leaving for the front. Isabella had been qualified for one year. At her Edinburgh graduation there had been only five women amongst the 93 men. The young female doctors struggled for access to hospital appointments where they could develop their skills. Mostly, they were side-lined into specialties the men did not want. Isabella juggled family responsibilities in Edinburgh with working as a house surgeon in Liverpool Royal Infirmary. The departure of male doctors for the Front opened up a far wider range of experience to the women, but this did not satisfy some. Patriotism apart, they felt that proving their skills in war conditions would validate their claim to equal opportunities, forcing men to grant them access to the full range of civilian practice after the war. Senior women doctors set up whole hospitals staffed by women, the largest groups being the Scottish Women’s Hospitals (SWH) and the Women’s Hospital Corps (WHC), both of which had their roots in suffrage ideals. But Isabella was too young for SWH and in the wrong place for WHC. Her war began with a telegram from a French Red Cross hospital that led her to go there in 1915. She met Madame Curie with her mobile X-ray machine. She stood her ground between arguing British and French surgeons. She gave chloroform. She operated. She faced fire, relocation, grief and village festivals along with severely war-damaged men. Her experience grew, and when she returned to Edinburgh in the autumn, she became an anatomy demonstrator. By summer 1916, the army was desperate for doctors, and, impressed with the work of the WHC, the War Office decided to seek some medical women to work alongside the Royal Army Medical Corps (RAMC) in Malta. Dr Louisa Aldrich Blake, MWF Honorary Treasurer, contacted all the women on the medical register and forty volunteered. On 24th July, at the height 22

Isabella Stenhouse at Graduation, University of Edinburgh, 1913

of the Battle of the Somme, Isabella signed up. She embarked for Malta on 12th August. On the ship were fifteen other medical women. Their ages ranged from 53 downwards, their experience as doctors from 22 years to 1 year. While most of them had no war experience, a couple of the others had, like Isabella, ventured across the Channel to tend the wounded of Britain’s allies. From other ships came Dr May Thorne, a former President of the Association of Registered Medical Women; Dr Helen Hanson, a suffragist who had taken part in the 1911 census protest; Dr Barbara Cunningham, who had recently published an article in the Lancet on the health of munitions factory workers, and a wealth of others, including a few more with experience of war medicine. Malta was known as the ‘Nurse of the Mediterranean’. During 1915, buildings all over the island had been converted into hospitals to care for more than 25,000 men injured in the Gallipoli campaign. By 1916, it was catering for similar numbers of men suffering from infectious diseases contracted in Salonika. Most of the medical women served these sick patients, but Isabella, who Medical Woman | Autumn 2014

Features

Isabella Stenhouse (centre) wearing RAMC uniform in Alexandria, Egypt after the MWF campaign for women doctors to have the right to wear uniform

Isabella Stenhouse (centre, with hat) working with the RAMC in Malta

was training to become a surgeon, was placed in a surgical hospital. The army’s need for doctors was so great they soon requested more women, and by the end of 1916 roughly 80 women doctors were working alongside about 160 male medical officers. By summer 1917, the RAMC was so satisfied with the women that it renewed their annual contracts. It also began to employ medical women in military hospitals on the home front and in the newly formed Women’s Army Auxiliary Corps (WAAC). That summer too, German U-boat activity made it dangerous to ship patients to Malta and the army began treating the wounded in Salonika and Egypt. The women doctors were sent to help, and Isabella was posted to Egypt. These larger theatres of war brought into focus an issue that had been merely irritating in Malta. A male doctor who volunteered to help the RAMC was given a temporary commission and the right, among other privileges, to wear uniform and RAMC badges. Unlike their male colleagues, the women doctors had been given neither uniforms nor commissions, yet they were working in a culture where discipline was maintained entirely through respect for uniform and rank. With only women doctors and ‘char women’ wearing no uniform, many of the privates were treating the medical women with little or no respect, which affected the women’s ability to treat their patients. With letters censored, they could not campaign for change, but when Dr Kathleen Waring came home after refusing to renew her contract because of the poor conditions, she spoke out. The men of the BMA were concerned by her story and wrote to the MWF: “It seems to us that important professional principles are involved and we shall be glad to know the views of your society and to www.medicalwomensfederation.org.uk

co-operate with you in any action which you think might usefully be taken in the matter.1” Under pressure from both organisations, the army agreed to allow the wearing of uniform, but many of the women felt uniform alone was insufficient: their job required them to receive commissioned rank. The MWF was inundated with letters, and a consensus emerged. 1) We need rank for our patients’ sake as we each have to maintain discipline among 130 men. 2) We need it for the sake of the profession as a whole, that no one section of it may ever be considered inferior to another.2 The army’s response was that giving rank was not within their power; legislation would be needed. The MWF lobbied MPs and questions were asked in the House of Commons. “Is the Under-Secretary of State for War aware that women serving as whole-time doctors in the army and doing precisely the same work as their male colleagues receive neither military rank nor status, thereby being deprived of equal pay, ration and travelling allowances as well as gratuities; that they have their letters censored and suffer under many disabilities owing to their not holding commissioned rank; and whether, under these circumstances, steps will be taken to grant women temporary commissioned rank, thus removing these grievances and at the same time showing a just appreciation of the services rendered by women doctors in connection with the War?3” Receiving no satisfaction, in Autumn 1918 the MWF and the BMA drafted a memorandum on the issue, distributed it strategically and lobbied Downing Street. When the war ended and an election loomed, the MWF asked its members to lobby prospective candidates, and when the new government was installed, they requested a meeting with the new Secretary of State for War, Winston Churchill. A joint deputation of the MWF and the BMA was eventually received by Churchill’s deputy in March, but it was May before they received a reply from Churchill. It was a deeply dismissive refusal to grant temporary commissions to the women doctors, denying them equality with their male colleagues in the army. As 1919 progressed, the army began to reconsider the logistics of all its medical services, and the MWF and BMA realised they would have to let the campaign drop. It did not begin again until the next world war was looming. Far away from London and the politics of campaigning, Isabella’s war in Egypt had an unexpected ending. She had not only been facing the problem of working without rank, she had been falling in love. It was bittersweet. Her marriage was happy, but her career options as a married woman doctor were even more limited than if she had remained single. She continued to work, but not as a surgeon – like so many other medical women, she was side-lined into mother and baby work, but until her dying day she still maintained she was a captain, the rank she would have had if she had been a man. 1. Dr James Neal, MWF Archive 2. Dr C.M. Astley Meer, Egypt, MWF Archive 3. MWF Archive Further reference: Doctors of the Great War, Ian Whitehead, Pen and Sword Military, 2013 Leneman, L. Medical women in the first world war, BMJ, 1993, Dec 18; 307(6919): 1592-1594 http://maltaramc.com/ramcoff/1910_1919/ramcoff1916. Katrina is writing a book about Dr Isabella Stenhouse. www.katrinakirkwood.org http://isabellaandthestringofbeads.blogspot.co.uk/

Features

CLINICAL GENETICS Dr Alexandra Murray

Consultant Clinical Geneticist, All Wales Medical Genetics Service, University Hospital of Wales

he words “I’m a clinical geneticist” are usually a conversation stopper, at least for a few minutes until I answer the unvoiced response, “A what?” with a well-rehearsed explanation: “It’s a doctor who sees people with a family history of genetic conditions”. Of course, this is a huge oversimplification but it’s a good starting point in most situations. Clinical genetics is a very wide-ranging specialty: we see patients of all ages, some of whom are affected, or may be affected, by a genetic condition, while others are at risk of a condition known to run in their family. We work as part of a multidisciplinary team with genetic counsellors, clinical scientists and colleagues from allied specialties. A typical general genetics clinic could involve a child with developmental delay and dysmorphic features, a young man with suspected Marfan syndrome, a woman with a family history of Huntington disease and a couple with a history of recurrent miscarriages. Cancer genetics referrals account for approximately half the workload of most regional genetics centres. The majority of these are individuals with a family history of common cancers such as breast cancer, ovarian cancer and bowel cancer, only a small percentage of whom will have carry a cancer predisposing gene mutation. We also see rare, Mendelian cancer syndromes such as multiple endocrine neoplasia, neurofibromatosis and von Hippel Lindau disease. Compared with colleagues from many other specialties, clinical geneticists have the luxury of plenty of time to spend with their patients. Appointments vary from region to region but are usually between 45 and 60 minutes duration. After every consultation the patient receives a detailed letter summarising the discussion and management plan, with copies being sent to the referring doctor and GP. It would be a cliché to suggest that communication skills are more important in clinical genetics than any other specialty. However, since we have don’t give prescriptions or perform procedures and operations, our words are all we have to offer, and we put a lot of emphasis on good communication in our curriculum. Other desirable personal qualities include: good organisational skills; an ability to work autonomously and as part of a team; and, most importantly in my opinion, empathy.

Entry to the specialty is at ST3 but, unusually, we accept trainees from core medicine and paediatrics. Trainees must have obtained either MRCP or MRCPCH by the time they take up their post and we encourage all applicants to gain experience with both adults and children prior to application if they can. All four nations participate in national recruitment, with two rounds taking place each year, usually in April and October. The recruitment process is hosted by Health Education West Midlands and is very similar to recruitment for the RCPhosted medical specialties. Shortlisted candidates are invited to Birmingham for an interview, which involves three stations covering a range of topics such as their portfolio, research, ethics and clinical scenarios. Competition ratios are usually fairly low but criteria are stringent and the posts may not all be filled if there aren’t sufficient numbers of appointable candidates. Since trainees in most departments are supernumerary, with comparatively less service commitment than in many other specialties, we don’t face the same pressures to fill all vacancies. Training in clinical genetics covers paediatric genetics and dysmorphology, cancer genetics, cardiac genetics, prenatal genetics and neurogenetics as well as a wide range of miscellaneous conditions under the heading of ‘general’ genetics. The training programme is four years and a significant proportion of trainees spend some time out of programme in research, up to one year of which can count towards their training. In 2013 the specialty introduced a knowledge based assessment for the first time and all trainees are now required to pass the Specialty Certificate Examination (SCE) to obtain their Certificate of Completion of Training (CCT). Teaching plays a big role in the life of most clinical geneticists, especially since the publication of a report from the Public Health Genetics Foundation in 2011, which encouraged mainstream medical specialities to adopt genomic knowledge and technologies as part of their standard care pathways and professional training. Genetics has now been formally included in the curricula of many specialties and we are regularly approached to accommodate trainees from other programmes as observers in our clinics and to deliver teaching sessions. Clinical genetics is one of the most female-dominated medical specialties. According to the 2012 RCP census, 64% of consultants are female and the percentage is even higher in the current trainee cohort (~80%). This is partly because working less than full time is comparatively simple for a clinical geneticist, who has no inpatient work and rarely any formal outof-hours commitment. Currently, nearly 40% of consultants work less than full time. With public awareness of genetics, particularly in the field of healthcare, being at an all time high, thanks to high profile celebrities like Angelina Jolie and the ambitious governmentfunded 100,000 Genomes project, there has never been a more challenging and exciting time to work in our specialty. Medical Woman | Autumn 2014

Features

MAKING THE INVISIBLE VISIBLE: Gender-based violence Allison Hempenstall Allison is a final year medical student at the University of Melbourne, Australia and student representative for the Victorian Medical Women’s Society. She was a delegate at the 2014 World Health Assembly in Geneva representing the Medical Women’s International Association.

enny* was merely seven years old when her father first raped her. Living in a small Ugandan village, after some time she went to her aunt to seek help. ‘Hush little girl’ her aunt replied upon hearing this atrocity, ‘there is nothing that can be done about this, go home’. Years passed and Jenny’s father continued to rape and beat her. When Jenny was sixteen, she went to a nearby small health clinic. Here she discovered that she was both pregnant and HIV-infected. Her family took her to the outskirts of their village and performed a local abortion. She was never again seen at the health clinic. This vignette is confronting, disturbing and all too common. For some people reading this you may think this is incomprehensible and remote from your daily life; for others this will surface an uncomfortable truth. Gender-based violence (also known as violence against women) is that directed against a person on the basis of gender. It constitutes a breach of the fundamental right to life, liberty, security, dignity and equality between women and men. Genderbased violence includes but is not limited to domestic violence, sexual harassment and rape. It also encompasses female genital cutting, trafficking in women, forced marriage and prenatal sex selection. The World Health Assembly in Geneva this May placed serious emphasis on this issue with Director General of the World Health Organisation Dr. Margaret Chan, First Lady of Zambia Dr. Christine Kaseba and Epidemiologist Sir Michael Marmot all highlighting the public health significance of gender-based violence. According to a World Health Organisation 2013 global review one in three women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence. One in three. This staggering statistic is clear evidence that no one is immune to the direct or indirect effects of genderbased violence. Most of this is intimate partner violence and as such occurs behind closed doors and is invisible to society. It is frightening to know that in many cultures it is considered a normal part of life. Addressing gender-based violence goes above cultural sensitivities: it is a public health issue. Women who have been physically or sexually abused are at a greater risk of chronic health problems including anxiety and depression. Addressing this health priority requires a multifaceted approach, however there are simple and effective strategies we can all employ to lead the way in raising awareness, education and prevention of gender-based violence. It is a known truth that education is the key to empowerment of women. And empowerment of women is key in changing attitudes www.medicalwomensfederation.org.uk

“One in three women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence.” and decreasing violence. Research has shown that women who have not been educated are more likely to believe that hitting women is acceptable than those who have been educated. The Boko Haram kidnapping of over 300 girls in Nigeria highlights this ubiquitous issue and the complexities surrounding what many of us take for granted: an education. We must educate the women in our global community. In parallel we must also support the men in our global community as agents of change, transforming societal views. A recent Cochrane review published in the BMJ found that screening women for intimate partner violence in healthcare settings increases identification of violence against women. We need to ask these difficult questions and at first it will be uncomfortable and confronting. However it is the only way that we can begin to shed this stigma; the only way we begin to advocate for our patients. It is vital that in your village, your town, your city – you know the services that are available for those subject to gender-based violence. We as health professionals play a central role in both prevention and protection. Jenny’s story is not unique. Of the next three women you encounter today at least one will have experienced genderbased violence. Violence against women is never acceptable, never excusable, never tolerable. It is our responsibility as health professionals to raise our voices and condemn this atrocity. We must make the invisible, visible. *Names and places were changed to preserve anonymity. For further information please visit: http://apps.who.int/iris/ bitstream/10665/85239/1/9789241564625_eng.pdf http://www.bmj.com/content/348/bmj.g2913 25

Features

On Being Less Than Dr Sethina Watson – FY2 Severn Deanery, Twitter @morefluids & Email: Sethina@doctors.org.uk & Helen Burt – ST1 Clinical Radiology, Severn Deanery, North Bristol NHS Trust

‘Part-time women doctors ARE a real problem. Why is it sexist to say so?’ ‘Part-time women doctors are creating a timebomb.’ ‘Female doctors who work part-time after having children put NHS under strain.’

ccording to these headlines it would seem part-time women doctors really don’t have much to offer and are a real burden to the NHS. But what is it really like to work part-time? What drives women, and men, to become less than full time? The term ‘less than’ in itself conjures up a feeling of lesser importance, value and worth than that of full time counterparts. I worked part-time for the first three years of my foundation training. For me, it was personally worthwhile but I often felt professionally judged by my full-time colleagues. In 2012, my job share partner and I decided to research the experiences of current and former less- than full-time doctors across the UK. More than 190 doctors responded, both male (2.6%) and female (97.4%) from 12 different deaneries. They revealed levels of career satisfaction, working patterns and

Advantages to LTFT

Disadvantages to LTFT

Better work-life balance

Confidence issues

More varied experience than colleagues

Less continuity with patients/handover issues

Feel in control of life

Longer training/lower pay

Better focus when at work committed

Being seen as less

Spend time with family member

Difficulty feeling team

Effective communicator ‘days off’

Attending meetings on

Longer training – more time to boost CV

Lack of understanding/ empathy from others about LTFT working

Table 2

prioritisation. Disadvantages included continuity and hand over issues (60%), longer training, lower pay and not feeling part of the team. Cons by an Obs/Gynae ST3-5 “attitude that you are less than committed … Told I was “hardly here” or to be careful not to come across as being unenthusiastic…”

Table 1

childcare arrangements and shared the support they feel needed for those working less-than full-time (LTFT) The vast majority (97.3%) worked LTFT due to care-giving, ill-health or disability grounds. Respondents included all grades of doctor from foundation year 1 to consultant level. Overall satisfaction levels with working LTFT were good: 29.7% stating it was a very positive and 50% stating positive experience. However, nearly 1 in 3 stated that their experience lead them to change their career goals (Table 1). The main advantages of LTFT include better work-life balance (90%), being able to spend more time with loved ones and consequently enjoying work more. Other positives were the ability to work efficiently during the day and developing good skills in time management and 26

Pros by Emergency Medicine ST5+ “I love working part time and find the work life balance great. I really enjoy my days at work, and then really enjoy days off with my son.” Working patterns were typically working 60% of full-time with 50% of on-calls and out-of-hours working. Around 40% were in a slot-share or supernumerary position (Table 3). With regards to childcare, the survey revealed a surprising number (50%) relying on nurseries during the normal working day – leading to added pressure to leave on time. Only 14% used a nanny during a normal working day. With talk of 24/7 NHS service delivery, finding 7 day a week childcare might be a real problem for parttime doctors. Nearly 60% of trainees completed the same number of workplace based assessments as their full-time colleagues. The majority Medical Woman | Autumn 2014

Features

“The term may include ‘less-than’, but these doctors are more-than providing an important contribution to the NHS while achieving satisfaction with work-life balance.”

of respondents were able to participate fully in audit, presentations and teaching. However, many had no involvement in service improvement projects, research or publications. Support for this challenging career choice was an ongoing issue. Respondents most often sought support from a partner or spouse. Most felt supported by peers or senior colleagues but reported lower levels of support from junior colleagues or NHS Trusts. The survey revealed that more support is needed, such as • Networking (online and in-person), • Mentoring • National LTFT meetings/conferences • Greater clarity of the role of LTFT with HR, rota managers, deaneries and supervisors • Help with the application process and a simplification of administration involved Greater support for those in job shares would benefit all teams. A job share partnership can deliver more than the workload of a single doctor when working well. But it can be a disaster if poorly planned and supported, especially if new job share partners don’t know each other and have competing needs in a single job. As more women graduate medical school, addressing and accepting the reality that some will want to work part-time is essential. Part-time doctors and the added life experience they may bring can be an asset to the NHS. Building confidence as a LTFT doctor, encouraging team work and understanding the demands LTFT doctors face would improve the experience of being part-time and delivery of care for patients. The term may include ‘less-than’, but these doctors are morethan providing an important contribution to the NHS while achieving satisfaction with work-life balance.

Table 3

Table 4

Table 5

www.medicalwomensfederation.org.uk

Working Abroad

SOUTH AFRICA Dr Najette Ayadi O’Donnell, ST2 in Paediatrics, University College Hospital

FOUNDING EDITOR OF GET CAREER SAVVY, A CAREERS GUIDE FOR MEDICAL STUDENTS n.ayadio’donnell@nhs.net African Health Placements: http://www.ahp.org.za

icture the scene: It’s 7pm on a busy on call at a hospital in rural KwaZulu Natal in South Africa and my boss notices a woman being wheeled in. My boss happens to be Dr Kelly Gate, South Africa Rural Doctor of the year, 2012. The woman is sweaty and drowsy, mumbling in Zulu that she has been bitten by a snake. She is taken quickly to our trauma room, where her blood pressure is not recordable and her pulse is racing. We resuscitate her aggressively and note an ascending swelling of her left leg. We prepare the patient for snake bite anti venom. Anti-venom can cause severe anaphylaxis in up to 50% of people, so we have a tray ready for intubation and adrenaline drawn up. This does not happen in the UK. With the patient stabilised, we begin speaking to her further. She was bitten at 2pm and had taken traditional Zulu medicine immediately. This was snake skin prepared in juice. The patient was a traditional Zulu Sangoma (spiritual healer who speaks to the dead and uses recipes, passed down through generations to solve ailments from vomiting to impotency). In traditional medicine illness can be perceived as your ancestors speaking to you, be it a happy or angry message via signs or symptoms of the illness. So here I am treating a Zulu Sangoma and working as a doctor in rural South Africa, some months after finishing my FY2 year in London. So why did I go to South Africa? Back in 2009 as a final year medical student, I spent 11 weeks working in Cape Town. It was here that I fell in love with the people of South Africa and made a promise to myself to come back when I qualified. It was in my FY1 year that I met an anaesthetic trainee who pointed me in the direction of a charity called African Health Placements (AHP). AHP was set up to place health professionals into rural hospitals in South Africa and its sole aim is to act as a middle man between professionals and a job vacancy, ensuring vacancies in rural South Africa are filled. Rural hospitals have huge issues with recruiting skilled staff and the foreign workforce is often used to buffer the gigantic holes in personnel. One year later, with the help of AHP, I boarded a flight to Durban to take up the post as a Medical Officer at Bethesda Hospital, which is 440km north of Durban . Bethesda is a rural post situated up the Lebombo Mountain. There were days when 28

we had no running water and days when electricity would be cut out. 65% of our patients were HIV positive and unemployment was high. I couldn’t describe a regular day at Bethesda. Everyday something surprised me or left me feeling grateful for my upbringing and the opportunities I had growing up in London. Many a frustrating time I missed the NHS dearly. One day in outpatients, I got a knock on the door and a rather well dressed woman walked in with a set of notes. It was what followed her that left me shocked. Shuffling quietly in behind her were four men, in shackles and looking at the floor. “I’m from the police station. All these men need DNA medicals for suspected rape”. My face said it all. I ushered them in, with two other policemen and closed the door. “Can you give me a moment?” I ran out of the room to find my colleague from the UK. “Lizzy they want me to do DNA testing for rape suspects.” “What? How do you know their charge is suspected rape?” Flustered I replied, “The lady from the police station just told me”. So many things went through my mind. How do I do this? What if I get it wrong? I concluded that I wished she hadn’t told me why they needed a DNA medical. I’m a doctor. Not a judge. My professional capacity is to serve my patients. I don’t want to judge them and I certainly didn’t want to know why they were in shackles. In our department, we saw victims of rape on a daily basis. Those who are trained conduct professional medicals on the victims. In the same department both the victims and perpetrators of rape could be present at any given time. In the end, our senior was called and dealt with training Lizzy and I on how to take the DNA medical. South Africa has one of the worst rape statistics in the world We also went to rural clinics which were in the middle of nowhere and involved a lengthy drive over dirt track in a 4 x 4 hospital vehicle. Attending clinics gave me a greater appreciation and understanding of the difficulty and great effort my patients made to get to hospital but also it was fantastic to see traditional Zulu villages en route to work. The beauty of Zululand cannot be described properly. I simply could not do it justice. The vast geographical area that our hospital served, including 100,000 people with only 200 inpatient beds, meant patients were often managed at a local clinic level. These clinics were nurse led and any nurse could refer cases to hospital. A doctor would attend each clinic once a week.. I met some brilliant characters at clinic. The multiple Gogo’s (grandmothers) looking after their grandchildren for their deceased daughters. They really were the backbone of South African society. Then there was the teenager, on her second pregnancy, but desperate to sit her matric exam (essentially A level) in geography, despite my insistence that she should be admitted to hospital for IV antibiotics. The eventual plan, with Medical Woman | Autumn 2014

Working Abroad

“So here I am treating a Zulu Sangoma and working as a doctor in rural South Africa, some months after finishing my FY2 year in London.”

her amazing school teacher on board, involved driving her to school to sit the 2pm paper and then immediately returning to hospital for her IV antibiotics. We gave her first dose of antibiotics in the clinic. Working with the nurses, teacher and patient to conjure up this plan was awesome, all in the middle of rural South Africa. Then there was the 12 year old, whom I saw with his Gogo, who proudly announced that he wanted to be a doctor when he grew up. I proceeded to hand him my stethoscope as I wrote my consultation notes and marvelled at the look on his face as he listened to his own heart sounds, his Gogo’s and eventually mine. Then there were the patients I referred to hospital who weren’t sick enough to warrant an ambulance but who I felt needed further investigation. The joy I felt when I saw them the next day, waving at me in the queue for outpatients, made me almost weep. They made the extraordinary effort to come to hospital. I respected them so deeply. Coming to hospital involved using sparse resources and money. Back in the hospital as the female medical doctor, I witnessed the true devastation of HIV,, having watched numerous beautiful women in their 20’s and 30’s die so brutally from the disease with CD4 counts as low as 1, often leaving young children behind. www.medicalwomensfederation.org.uk

Another case was an 85 year old grandmother who was paralysed in both legs with a sensory loss to T4, most likely to be TB of the spine. With two cancelled MRI spines, I sent her home to spend Christmas with her family. That’s all she wanted. She will stay with me for life for many reasons I can’t explain but most notably for singing ‘nkosi sikelel iafrica’ (South Africa’s national anthem), whilst I was doing a LP on a lady on the neighbouring bed with crytptococcus meningitis. I had goose bumps. As a budding paediatrician, I got the opportunity to run the children’s ward. I was able to manage acute malnutrition, TB, HIV, severe sepsis and many cases of severe respiratory tract infections. I shall never forget the child with kwashiorkor and HIV, who tried to die on me twice but who some 3 weeks into treatment smiled and laughed for the first time. My job satisfaction was immeasurable. Some cases made me cry out of frustration and sadness, but the majority rendered me with uncontrollable laughter with days spent watching my small little patients play a game with balloons, running chaotically around the ward and desperate to win. With no toys to play with and despite being sick, they were first and foremost children after all. All in all, my year was about the people I met, the team I worked with and the people I served. They were what made the long shifts worth it. Whilst technically not counting towards UK training, without a doubt my year in South Africa has contributed to making me a more structured doctor, who is able to prioritise efficiently and who believes passionately in the delivery of consistently good health care, even when shifts are difficult and the workforce sparse. A year out is something all junior doctors should consider as it is a perfect opportunity to travel and work out what ‘type’ of doctor you want to be. A chance that is often difficult to come by, I believe, in a UK system of training that wants us to specialise so very quickly. I for one shall never forget the patients I served, the dedicated team of doctors I worked with or forgot how truly lucky we are to have the NHS in the UK.

Features

A Breastfeeding Paediatrician Dr Vicky Thomas, ST8 paediatric trainee, Northern Deanery

Ascribing all infant problems to breastfeeding

t is a truth universally acknowledged that middle class professional women in their twenties and thirties are the demographic most likely to try to breastfeed. Which, of course, includes medical women. We are also a demographic with huge social clout when it comes to breastfeeding promotion. What we say, as obstetricians, general practitioners, paediatricians, surgeons and physicians to our patients, has a huge impact on parents in wider society. Nearly twenty years ago, Freed et al identified that US paediatric trainees’ knowledge of breastfeeding was patchy, coloured by their own personal experience of parenting and not evidence based. Little seems to have changed in the intervening decades. As UK breastfeeding rates drop still further, the need for healthcare providers to be able to give accurate and supportive breastfeeding advice becomes imperative. Prior to having my son, my own breastfeeding knowledge was fairly basic. I was positive about breastfeeding, encouraged the mothers I met to initiate or continue, but had little understanding of the more complex physiology or practicalities. At least, I thought, I knew what I didn’t 30

know and tried to direct women on to more appropriate support. Unfortunately, the NHS resources to support breastfeeding mothers are varied and often inadequate. Most women running into trouble end up cradling a screaming baby with one arm while sobbing on the sofa, desperately googling ‘why do my nipples look like they have been grated’ with their other hand. Over the last year and a half I have become involved in mother-to-mother support. The first lesson this taught me is how much I still have to learn. I am only an expert on breastfeeding my baby – I may have suggestions that other mothers find useful, but I am a novice in many ways, and I am constantly grateful for the input of other nursing mothers. I have something of a head start when it comes to the science of feeding, and with a subspecialty interest in paediatric endocrinology I am overjoyed at having my own hormonal feedback loops to play with, but I am learning all the time. As an active participant in breastfeeding peer support, I find myself regularly cringing at the arrogant and ignorant misinformation from my colleagues reported by the women in my network. Here are some of the most common.

I hear this so much. When a breastfed baby is seen by medical staff, any issue with that baby is at risk of being attributed to the breastfeeding. This leaves us wide open to missing important diagnoses. Sadly, I have seen all of the following conditions initially misdiagnosed as breastfeeding problems: acute lymphoblastic leukaemia, congenital adrenal hyperplasia, urinary tract infection, cardiac failure, pyloric stenosis... The list goes on. When breastfed infants present with faltering growth or other issues, the physician’s brain must be engaged rather than reflexively telling the mother to reach for the formula. A similar issue is the knee jerk reaction experienced by breastfeeding mothers with other health issues who are started on medication. It is common to hear of mothers told to stop breastfeeding, when the medication they are being prescribed is actually safe in lactation, or where a safe alternative is readily available. There is a lack of awareness amongst clinicians of sources of information other than the BNF, such as the pharmacy support provided by the Breastfeeding Support Network, or Hales ‘Medication and Mother’s Milk’ (http://www.medsmilk. com). Such resources provide much more detailed information on medication safety in breastfeeding which can be used to help women make informed choices.

Not understanding the urgent need to resolve feeding issues It would seem obvious that there is a degree of urgency in sorting out feeding problems where women are in pain or unwell, yet they are often left to struggle on with tattered nipples and mastitis. A week’s delay in resolving the problem may seem minimal to a health professional but when a woman is feeding every 90 minutes or so, and almost continuously overnight due Medical Woman | Autumn 2014

Features to the normal but often poorly recognised phenomenon of cluster feeding, seven days of unnecessary agony is unacceptable. When women come to dread and avoid feeds because they are in such pain, when they start to fear and dislike their baby’s need for them, the impact of delays in resolving the issues on mother-infant bonding and maternal mental and physical health cannot be overstated. Meanwhile, on a biochemical level, the first six weeks of feeding, and especially the first fortnight are essential to initiate and establish a mother’s milk supply. When a baby is not emptying the breast adequately, the beautifully simple biological feedback loop works to tell the body to make less milk. In the early days this means that supply can dwindle rapidly and be difficult to re-establish subsequently. Painful feeding and latch issues should be taken seriously and the mother needs to be directed to a knowledgeable professional who can help her quickly.

The road to faltering growth is paved with good intentions I commonly see breastfed babies who have been referred for faltering weight gain. After taking a detailed history, a frequent pattern is that a well-meaning healthcare professional has advised a tired mother to give a bottle of formula at bedtime or a dummy overnight in an attempt to create an extended period of sleep. For some motherbaby pairs this will cause no problems, but for many it is likely to impact on that beautifully simple feedback loop I referred to above. It is especially important to feed overnight in the early days and weeks to establish supply. Cluster feeding (hours of almost constant feeding especially in the evenings and at night) is completely normal at the start as the sensible baby works to teach his or her mother’s breasts how much milk is required. Each night, the baby puts in an order for the next day’s milk. From an evolutionary biological perspective this of course makes sense – as Stone Age women, retreating to our beds and nursing our babies through the hours of darkness was eminently sensible. For modern women who may need to spend their days caring for other children singlehanded, running a household or in paid employment, this is incredibly hard work. There are, however, other methods to maximise nursing mothers’ sleep: keeping the baby in the same room or bed as the mother www.medicalwomensfederation.org.uk

(with advice regarding safe co-sleeping), delegating other tasks to partner, friends and family, sleeping when the baby sleeps and generally simplifying life as much as possible while the mother focuses on the feeding role only she can fill are all more helpful than risking losing milk supply in the early days. The most important role of the healthcare professional, in my opinion, is simply to acknowledge that this is normal and challenging. Women often benefit from direction to local breastfeeding groups both online and in real life. An online support group has the particular benefit of almost constant availability, with other breastfeeding mothers also awake and feeding overnight to help normalise the shared experience.

I am not a Friesian; my milk isn’t dairy It is relatively rare to see a breastfed baby with gastroenteritis, partly because older breastfed babies are in the minority in our society, and partly because they are much less likely to contract gastroenteritis. Medical staff can therefore struggle with knowing how best to advise the mother in this situation on simple oral fluid management. Mothers are often told to stop breastfeeding, as it is ‘dairy’. Of course, human milk is different in composition to both formula and cows’ milk, as is acknowledged by the fact that it is usually treated as closer to clear fluids in terms of pre-anaesthetic fasting (not to be consumed for at least four hours pre-op, as compared to six hours for formula and two or three hours for clear fluid). It is in fact a very appropriate rehydration fluid. As medical staff we are often uncomfortable with using it as we cannot witness with our own eyes how many millilitres have been tolerated. But babies tend to find it more palatable than oral rehydration solution, unsurprisingly to anyone who has ever tried drinking such, and it also has the benefit of being rich in immunoglobulins, and therefore likely to speed recovery.

The yuck factor Not comfortable with breastfeeding a toddler? I’m not asking you to do it yourself then, but please don’t allow your prejudice to come into play when treating me and my child. Women who are breastfeeding past six to 12 months often encounter reactions ranging from curiosity to outright

hostility when they come into contact with medical professionals. The World Health Organisation recommends that children are breastfed ‘up to two years of age or beyond’, and there are many health benefits for both mother and child recognised of extended or full term breastfeeding. We are not ‘just being used as dummies’. Toddler breastfeeding has a role in nutrition, in orofacial development and in boosting the immune system. Women who are breastfeeding an older child rarely set out to do so, but for most it seems a natural trajectory from nurturing their fetus in utero to feeding their newborn and then finding that infant is now a walking, talking, active pre-schooler. Specious arguments are bandied about suggesting that ‘it’s weird once they have teeth’, or ‘it’s wrong once they can ask for it.’ I would contend that some babies, including my own, cut teeth as early as two months of age, or are even born with teeth. And no one who has had any contact with a newborn could deny that they are capable of ‘asking for’ or even demanding a feed in the first few hours of life. As doctors, we frequently encounter patients who are making different lifestyle choices to ourselves, but I would suggest we save our censure for those who are actually harming themselves or others.

Supporting breastfeeding, supporting women I believe that medical women are in a unique position to support breastfeeding, but only if we are prepared to educate ourselves about it, and at the very least to learn how to signpost our patients to appropriate support, acknowledging the limitations of our own training and knowledge. “When we trust the makers of baby formula more than we do our own ability to nourish our babies, we lose a chance to claim an aspect of our power as women... Countless women have regained trust in their bodies through nursing their children, even if they weren’t sure at first that they could do it. It is an act of female power, and I think of it as feminism in its purest form.” Christine Northrup M.D. For further information: www.laleche.org.uk www.breastfeedingnetwork.org.uk www.isisonline.org.uk www.unicef.org.uk/babyfriendly 31

The Mummy Diaries

T he Mummy Diaries

Dr Ania Koziell, Clinical Academic, King’s College London

Unquestionably, one of the first thoughts that came into my head while sitting down to write this article was “wonder what the kids think..?”

fell in to re s e a rc h by chance rather than design, other than I’d always loved the science behind medicine and considered asking questions so much more fun than preordained guidelines and protocols; in the current system this made for rather a round peg in a square hole. Once there, I rapidly transitioned from considering this a transient phase necessary for expanding a few clinical horizons, to realising that this was probably the life for me. The challenge “to see what everyone else had seen but to try and think what nobody else had thought” (Albert Szent-Gyorgyi) was compelling beyond belief, ultimately to make a real difference to healthcare through scientific discovery. I was training as a Paediatric Nephrologist and had realised through clinical observation that a lot of what I was looking at was based on genetic malfunction. The opportunity to take this further seemed too good to miss, although I was never under any illusion that it was probably going to be rather a tough choice. Again by chance, my children arrived earlier than anticipated in my academic career. I started my PhD with a four month old – not ideal timing but I had a limit to when I could activate my fellowship, so just got along with it. Half insane with exhaustion I was on a mission – I had to make it work, heroically attending grant interviews 10 days after a caesarean, 32

travelling to the USA with a two week old to give a platform presentation at an international meeting (discovering I had to smuggle her in as babies were not allowed!), giving a talk a week after the third, supervising PhD’s, writing grants and papers during mat. leave… juggling nursery pick-ups, feeds, nappies and a terminally broken washing machine. Always working full-time. Looking back on all this – totally nuts! It taught me to micromanage and has at times been useful as anecdote – we were recently discussing the issue of an increase in female medical graduates and how to encourage women into academia – to which one of the faculty unbelievably responded “Well they just want to be part time GP’s anyway!” I immediately challenged this by doubting whether a guy might have done some of these things – and whether this was hard core enough. My coupe de grace was that I considered that if men had to give birth, the human race would surely have died out by now, and there would be no academics! Since my children have been around for the duration, I have learnt to canvass their opinion from an early age, and to think of something quick when responses aren’t quite what you want to hear. Overall, this time there was muted approval – “good role model for us, Mum”, “encourages us to be open minded and study what we feel passionate about”, “makes us question things rather than conforming to some standard image”, “you always have interesting stuff to talk about”, “... Like the presents we get when you’ve been away...” blended in with more negative:

“you spend too much time at work”, “insane hours”, “tired and crabby”, “get sick of homing home to cleaning ladies and nannies”, “hate you being away”. I’ve always worked hard on keeping an open connection with the kids and helped along with great holidays where everyone can touch base in some cool and exotic alternate environment such as our recent trekking in Ladakh, Northern India with my sister and her kids (who is albeit in a different profession, in a similar situation) – dedicated “mummy time” as far as possible from work influences. I consider this sacred for a working mother; it’s so easy to lose touch. Mostly this works out – my professional life has also influenced life choices in at least one who wants to study Physics – attributing his love of science to all those hours after nursery he spent in the lab “while Mum finished her experiments.” It’s difficult to get things right. At the very start of my career I was struck by how hard and fierce senior female academics appeared, often displaying hyper-developed male characteristics – aggression, competitiveness. Many were childless, or had children they didn’t seem to see much: a happier minority residing with a house husband or suitable relative, others were latch-key kids, unlikely to follow the same stellar trajectory. It seemed that great sacrifice was a pre-requisite for success in academia, or there was no way of breaking through that glass ceiling. And I must admit, to a young female trainee, this all seemed rather an extreme way to prove the point; there had to be a better way. But I admired these illustrious, battleweary women, knowing full well that Medical Woman | Spring 2013

The Mummy Diaries

they’d probably had no other option. The problems they had encountered along the way were often just because they were women – within an extraordinary and inexplicably discriminatory milieu of male misconception about how gender or having children might influence intelligence or performance – conditioning them into thinking they were inferior. Many academic males were perfectly reasonable people in all other respects – but for a staunch belief that “men were from Mars” and “women from Venus” – this is where the line in the sand was to be drawn; no grey zones. The use of misogynistic tactics to get ahead – just because they could – were considered fair game. Hopefully, Athena Swann and increasing awareness that these attitudes are at least 60 years out of date will banish all of this to a bygone age. Nonetheless, maternity/paternity and issues surrounding young children are still often primarily addressed – forgetting that each stage of childhood has its special blessings – and older children are certainly not easier… in fact if anything, the game moves up several levels. I was grateful for the space that these academic female pioneers had created for the rest of us – this was truly groundbreaking. They had learnt the hard way that the academic world was more often cruel than not, and mostly “to the victor go the spoils” which was weighted heavily towards possession of a Y chromosome. Rosalind Franklin’s radiograph was pivotal in Watson and Crick’s ability to publish the structure of DNA, yet it is unclear whether her data was shared with her full consent. The jury remains out whether this occurred www.medicalwomensfederation.org.uk

by accident and the pair acted in good faith, near-plagiarism, or outright misogyny. In the end, everyone did get their say; it was simply Watson and Crick who got to go first – and without Rosalind as a co-author on their seminal paper. Even recently, a male colleague tried to argue that “she simply didn’t get it” – contrary to primary sources of evidence that someone passed on her data. It doesn’t really matter – by current rules of authorship, she should have been included. So, at the outset, this all seemed rather daunting but I didn’t care – I was passionate about research – and adhered to the principle that even though there were lots of good people out there, it’s the ones that persevere that generally succeed. I was also determined to show that it was ok to have a family, and that there were ways of blending the two – to my mind this was the next step in the pathway to accepting women as equals within the academic workplace. Nonetheless, whilst children are at all times an enriching experience, I underestimated how tricky this can be. The first hurdle remains convincing mentors that this doesn’t signal a lack of commitment, simply a phase of life. I can honestly say that telling my first supervisor that I was unable to give a lecture as this coincided with having a baby elicited the first negative (nonoverridden) doll’s eye reflex in a conscious individual without an obvious brain stem injury; the room became deathly quiet and bright blue eyes fixated on me – a frosty “well that changes everything!” still echoes. Clinical academics make up around five per cent of the medical consultant workforce and are generally university employees

with a hybrid role. You spend about half of the week as a practising doctor, the other half responsible for educating medical and science students and for carrying out research into health and disease – it’s a super-busy schedule but I can honestly say that there is no aspect of my job that is either dull or boring and I would never consider doing anything else. However, there’s no room for private practice and the pay is not in line with full time clinical colleagues. As a university employee there is far less job security – it is a white knuckle ride – and there is an element of survival of the fittest, really a bit like running your own business. You’re only ever as good as your last job, and historic Nature papers unfortunately count for little without contemporaneous publication in high impact factor journals together with grant acquisition. Moreover, universities (and the Research Excellence Framework for that matter) generally don’t take into account a part time commitment in assessments – another aspect that really needs to change. Aside from this, there remain some real obstacles specific to women in academic medicine, as highlighted by the Medical Staff Committee in submitting evidence to the House of Lords Enquiry in September 2013, specifically: i) family responsibilities and impact of pregnancy and childcare, ii) lack of female role-models, and iii) indirect discrimination through a gender-biased conception of merit. If women’s and men’s career profiles are to become equivalent, a number of challenges remain. In common with many other women juggling kids and work, I have had to accept that as the primary carer it has compromised career progression as one’s time is inevitably constrained, and this is rarely understood. Grants are written in preference to papers, as these keep you in a job – meetings can’t be attended as it coincides with important school exams, sports day or other events and no one can substitute, so profiles descend. However I’d like to finish on a positive note – with dedication and perseverance (and rather a lot of adrenaline and crazy optimism), it can be made to work – it’s not for everyone but I would still say give it a go. A couple of great (male) mentors have kept me going through the bad times, partly by emphasising that women have a different trajectory – professional lives often starting to take off again in the 40’s as the kids become increasingly independent – so not to give up – well, here’s hoping! 33

Features

Who puts the cash in the cash machines?

An urban medical student’s adventures in remote living and healthcare... Gabrielle Deehan, gap year Medical Student, St Andrews Gabrielle has just completed her third year of medicine at St Andrews and is taking a year out of her medical studies to compare the provision of remote and rural healthcare across the developed world with her experiences in Scotland.

Imagine living on a beautiful island: miles of, white sandy beaches, a small, kind community, and no rush hour. This idyllic setting is a daily reality for nearly one million Scottish people who live in remote areas. Admittedly, the weather was omitted from my description, but the culture, history and the highland cows more than make up for the cold; the whisky certainly doesn’t hurt, either. During my time at medical school in St Andrews I have enjoyed visiting much of Scotland, including the Western Isles (those islands very far off the west coast) and Shetland (of pony fame). As a Londoner, I have found myself to be embarrassingly fascinated by the mechanics of remote living in these places. I find myself asking about Santa Claus’ logistics, how ATMs get their cash, and where the recycling ends up! However, a week at a hospital in Shetland last summer, organised by my medical school, made me realise there was a much more serious question to be asked: what happens when somebody is really, really unwell? 34

One day in Shetland, I scrubbed into theatre for the first time and held a retractor. I was absolutely delighted with myself and had my fingers crossed that I’d be able to scrub in for the rest of the afternoon. Then the phone rang, and the rest of the day’s theatre list was cancelled. The hospital came to a semistandstill for an ordinary young girl who had fallen from her bike: unthinkable in a city hospital! It was a glorious, summer’s day and she had been out playing with her older brothers, who dared her to go over a ramp they’d built. Unfortunately, she’d fallen from her bike and had badly injured her head. The team in Shetland prepared to evacuate her to the mainland. With only a vague understanding of the term ‘extradural haematoma’, but realising how serious the girl’s injury was, I was quite worried. How had no one realised there wasn’t a brain surgeon in Shetland? Why was everybody so calm? Incredibly, the team in Shetland keep stocks of kit ready to do just about any emergency operation and they Medical Woman | Autumn 2014

Book Review have such broad knowledge and experience that if it isn’t possible to evacuate a casualty to the mainland, they can manage most situations. I was flabbergasted by the breadth of their work and their strong teamwork. As it turned out, the girl was evacuated and made a full recovery following surgery on the mainland, but the team had operated on patients with head injuries before and they certainly will again. Another fascinating part of this placement was the distances patients travel to attend clinics. A visiting consultant had a map of the islands that constitute Shetland and asked each patient to point out where they had travelled from to get to the hospital. It was interesting to see these places on the map but the distances were really felt at the end of the week, when we hired a car and drove for hours to one of the northernmost islands for an agricultural show. Patients regularly drive for miles and take a ferry or two for a brief appointment with a visiting specialist, and frequently travel to the mainland for operations (both planned and emergency); this isn’t ideal for patients with mobility issues, but it is accepted as part of rural life. While planning and executing rural healthcare often isn’t easy for anyone involved, it is important: six per cent of Scotland’s population occupy 94% of the country’s landmass. These people constitute an important part of Scotland’s heritage and identity: they must not be disadvantaged by their geography. Providing the rural people of Scotland with good healthcare is not an easy task. What is the future of remote healthcare in the age of super-specialisation? I have certainly realised the value of a true generalist. However, another face of super-specialisation is excellent, groundbreaking care: the great conundrum of rural healthcare lies in the balance of the many financial, political and ethical implications associated with the healthcare needs of small population in remote areas. For example, although there are many additional, wholly justified additional costs to providing healthcare in a rural place, there is no sense in having a resident neurosurgeon in Shetland, who would spend her entire working week de-skilling. For the next year, I will be visiting remote and rural healthcare providers in North America, Australasia, Scandinavia and Scotland to experience how they deal with issues such as recruiting suitable staff, managing acutely unwell patients and patient confidentiality. I hope this will give me an insight into the systems in place in other developed countries, with a variety of healthcare funding structures and a wide spread of healthcare spend per capita. I look forward to sharing these adventures with you. This is made possible by a generous scholarship donated by the R&A (The Royal and Ancient Golf Club of St Andrews) the governing body of golf, and administered by the University of St Andrews: I am immensely grateful to both organisations for their support. BLOG: I will be blogging at http://randascholar.wp.standrews.ac.uk throughout the year, alongside the other R&A scholars. A specific link to my posts is: http:// randascholar.wp.st-andrews.ac.uk/category/gabby/ www.medicalwomensfederation.org.uk

Book review:

A Painful Inch to Gain By Eileen Crofton

he fight for equality and entry into the medical profession has been well covered by a number of historians – and this book does not aim to replace these, rather it takes a personal approach, thus allowing us a window into the lives of those pioneering women who took the first, difficult steps into the medical profession. The book focuses on the famous Edinburgh Campaign by Sophia Jex-Blake and her colleagues in the 19th Century as well as those lighting the way before this. This book looks at the challenges that women faced in a variety of arenas, covering traditionally discussed barriers such as how to gain a licence to practice (often requiring study in multiple countries, in multiple languages) but also building on the personal approach by looking at the more practical and day to day problems faced by women training to be doctors-gaining clinical experience, finding suitable lodgings and not least, choosing the appropriate attire; finding a balance between sensible clothing (there is a memorable anecdote involving a Bunsen burner and a hat) and avoiding criticism for appearing too feminine – something which echoes through the centuries to discussions we have even now. This book brings the struggle to life through the use of real correspondence between the pioneers leading the fight – reflecting their everyday frustrations, bitter disappointments and above all, their determination in the face of what must have often seemed insurmountable resistance to their cause. We are given a glimpse into the attitudes of the institutions to which these women were attempting access: comments from professors refusing to teach mixed classes, male students blocking women from sitting their examinations and the opinions of now revered publications such as The Lancet and The BMJ. This book offers a uniquely personal insight into the lives of the women who trail-blazed the way into medicine, providing a real inspiration for anyone facing challenges in their professional or personal lives and is perfect for anyone who is just starting out in medicine or anyone who wants to feel a little closer to our pioneering past.

Review by Amy Woods, final year graduate student at St George’s, London 35

Top Tips

TOPTIPS NEW DOCS for

Compiled by Dr Brooke Calvert, MWF Junior Editor, with the help of Twitter #tipsfornewdocs

2 WHEN YOU PICK UP THE PHONE to receive or make a call, always state your name, designation and where you are calling from. Then ask the person on the other end of the phone to do the same.

EFORE YOU ASK FOR ADVICE, have all the information you need in front of you: grab the B drug chart, obs chart and notes and make sure you are familiar with it. There is nothing worse than having the consultant tutt impatiently down the phone while you flick through!

RITE EVERYTHING DOWN. It doesn’t matter if it’s a five second conversation in the corridor W with a patient, if it isn’t recorded it didn’t happen!

MAKE FRIENDS EVERYWHERE YOU CAN. Porters, ward clerks, nurses, consultants, medical directors. Small sacrifices like forgoing a quick tea-break to help a colleague with a stack of bloods will make both your days more pleasant, and you will be more likely to get out on time at the end.

MAKE THE MOST OF ZERO DAYS! Suddenly daylight hours during the working week become a lot more valuable so use them to do as much admin as you can. Errands to the bank, and calling the gas company seems to drop to the end of the to-do list in a normal working week.

9 10 36

DON’T LOSE YOUR LIST! Buy a clipboard and keep it in your hands at all times. ENJOY IT! After six years of saying “Sorry I’m just one of the medical students”, you have reached your goal. Have confidence in your knowledge, and know when to ask for help.

Medical Woman | Autumn 2014

Dr Iona Frock

This time I’m not going to cry... Dr Catherine Harkin, GP, Scotland Illustration by Laura Coppolaro

“Mum?” said Seonaid tapping gently on the study door. A few moments later the door opened a crack and Iona’s stressed expression appeared. “What is it? I’m busy. Have those nasty girls been cyberbullying you again?” “No, they’ve stopped calling me See-yo-nade and started calling me ActuallyIt’sShona instead. I just wanted you to help with my maths homework.” “Can’t Daddy do it?” “He’s writing another angry letter to the Daily Mail saying GPs aren’t stupid and lazy. Can you come? It’s due in tomorrow...” “Just try, darling. My appraisal stuff has to be in by tomorrow as well. I’m nearly finished so I’ll come and help you as soon as I’ve uploaded this last bit.” Seonaid shuffled away and Iona returned to her computer. The arrival of an email from her appraiser, the ferociously efficient Dr Athene Swan, had focused her mind on the fact that she had not visited the appraisal website since a month after her last one, and she was determined that this year was going to be different. No frantic last-minute scramble to scan and upload multiple bits of paper, no shoving patient satisfaction questionnaires at the terminally ill or multi-source feedback forms at the cleaning lady. It was going to be all done and dusted in plenty of time so that there would be no repetition of last year’s distressing scene. Iona’s face went hot at the memory. She had thought she had everything under control. But the words “Hello Iona, thanks for coming in” had barely escaped www.medicalwomensfederation.org.uk

Dr Swan’s lips when Iona had burst into tears and sobbed uncontrollably for ten minutes. It was most embarrassing – especially when Dr Swan had stopped handing her tissues and started to drum her fingers on the desk. “I’m sorry, Athene” Iona had sniffled, “I don’t know what’s wrong with me.” “Don’t worry about it, Iona,” Athene had said briskly, “happens all the time. In fact, we get to put the packs of Handy Andies on expenses now. Going through hundreds. Last appraisee took fortyfive minutes to stop wailing and I hate to see a grown man cry. But could we get on? Things to do, boxes to tick, you know how it is...” So this year, thought Iona, there will be no snivelling. She gazed with pleasure at the screen with all its little green highlights, her beautiful CPD log, her insightful reflections, her pristine audit data. It was perfect. All she had to do was save it. An imperious “Mrrraoooow!” announced that Kitalopram the kitten had spotted the half-open door and decided to join her. Iona’s fond smile gave way to a howl of horror as the cat sprang on to the keyboard and danced across the keys, and the computer screen went blank. Loud purring mingled with the sound of sobs as Iona buried her face in Kitalopram’s fur... Where appraisal was concerned, it seemed, it was definitely best to be prepared and get the crying done in advance. With grateful thanks to Dr Heather Gray for the idea. 37

MEDICAL WOMEN’S FEDERATION

Spring Conference 2015 Friday 15th May 2015

Macdonald Manchester Spa Hotel, London Road, Manchester M2 2PG

STEPPING UP & SPEAKING OUT

Empowering Women Doctors & their Patients Speakers will include female medical leaders from a variety of fields including healthcare management, academia and medical education. There will also be a session on taboo women’s health issues and an opportunity to think about how we can engage with our patients to help them speak up.

THE LARGEST BODY OF WOMEN DOCTORS IN THE UK LOOKS FORWARD TO MEETING YOU!

Speakers and Workshops to be announced…

Why not submit an Abstract? We will be welcoming abstracts under the following categories – Education and training, Health and Work-Life balance, Audit and research, Management and Leadership.

Deadline 3rd April 2015

You still want more? We will be holding social events excellent for networking! Registration details available at

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