Medical Woman Magazine V32 Issue 5 Spring:Summer 2015

MEDICAL WOMAN VOLUME 34: ISSUE 1

SPRING/SUMMER 2015

INSIDE: Women at the Top: Dr Alys Coles-King Clinical Excellence Awards Working Overseas Medical Memoirs – Prof Wendy Savage www.medicalwomensfederation.org.uk

Editor’s Letter

I

am delighted to bring to you the Spring/Summer issue of Medical Woman.

Since I became a mother the need for organisations such as the Medical Women’s Federation and publications such as Medical Woman have been of higher significance for me. I don’t think I quite realised how hard it really is

to balance a career and motherhood! The media continue to print unsupportive articles about the impact of part time female doctors within the NHS- and we have a collective responsibility to challenge these.

We have had more changes to the Editorial team; with Miss Jyoti Shah, a urologist in the Midlands becoming my Joint Editor. She will be representing Medical Woman at Council Meetings. Dr Heidi Mounsey has taken up the position of Deputy Editor, and she is a palliative medicine registrar based in Yorkshire. Their input will be greatly appreciated by the team that bring you Medical Woman.

Image thanks to lolography.com

I hope you enjoy this issue, and as always please e-mail or tweet me for feedback.

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

Dr Heidi Mounsey – Deputy Editor I’m a palliative medicine registrar based in Yorkshire. When I was little, I always wanted to be a scientist and “discover things” to make a difference to society – so much so, I completed a chemistry degree before turning to medicine – but as a doctor it feels like I make a difference to individuals (well, every so often), and that’s an incredible feeling.

Outside work, I volunteer for a charity providing first aid cover for music festivals, and I foster stray and abandoned kittens for a local cat shelter. My aim for this year is to learn to make my own cheese.

Miss Jyoti Shah – Joint Editor Jyoti Shah BSc(Hons) MD MS DHMSA FRCS (Urol) is a Consultant Urological Surgeon at Burton Hospital having graduated from Charing Cross & Westminster Medical School.

Jyoti has published extensively having authored three books under the Day-2-Day banner, book chapters and journal articles. She is the Commissioning Editor for The Annals and the Bulletin of the Royal College of Surgeons (RCS) of England, and is faculty on the course, How to write a surgical paper, for the College. She reviews for 12 International journals.

Jyoti was medical advisor to Tiger Country, a critically acclaimed play about the NHS, and the inspiration to one of the central characters in the play.

Jyoti is a GMC accredited educational supervisor, Postgraduate tutor for simulation, examiner for Leicester Medical School, and RCS college assessor for urology consultant interviews.

Contents

Contents Medical Woman, produced by the Medical Women’s Federation Editors: Dr Sara Khan doctorsarahkhan@gmail.com Miss Jyoti Shah Deputy Editor: Dr Heidi Mounsey 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,

News and Events

3

November Conference Review

4

Fawcett Society

5

Working as a Medic Overseas

16

Medical Memoirs

18

Sleep when the baby sleeps

20

Women in Urology

21

From the Doctors Palette

23

Remote and Rural

24

Top Tips

26

Wall of Wisdom

27

Obituaries

28

Dr Iona Frock

29

London WC1H 9HX Tel: 020 7387 7765 E-mail: admin.mwf@btconnect.com www.medicalwomensfederation.org.uk @medicalwomenuk www.facebook.com/MedWomen Patron: HRH The Duchess of Gloucester GCVO President: Dr Sally Davies

Advancing Women in Medicine Summit

6

Women at the Top

8

sallyjanedavies@gmail.com President-Elect: Professor Parveen Kumar Honorary Secretary: Dr Beryl De Souza bds@dr.com Honorary Treasurer: Dr Charlotte Gath

WHO and UN Commission on status of Women

9

charlottegath@aol.com Design & Production:

Clinical Excellence Awards

10

Twitter View

12

Women Living with HIV

13

Debate

14

The Magazine Production Company www.magazineproduction.com

Medical Woman: © All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means without the prior written consent of the Publisher. A reprint service is available. Great care is taken to ensure accuracy in the preparation of this publication, but Medical Woman can not be held responsible for its content. The views expressed are those of the contributors and not necessarily those of the Publisher.

www.medicalwomensfederation.org.uk

1

Contributors

Contributors SPRING 2015

Dr Heidi Mounsey Editor’s Page

A medical woman you admire/respect: Dr Elizabeth Garrett Anderson

Five favourite things in life:

Dr Heidi Mounsey

• Cats and kittens • Glastonbury festival • Cheese • Books • Summer

Prof Wendy Savage Medical Memoirs pg18

A medical woman you admire/respect: Dame Rosemary Rue was the most impressive person I have met in the MWF. She was so modest, effective and uncomplaining but did so much for women doctors as well as being a great public health doctor.

Prof Wendy Savage

Five favourite things in life:

• Sunshine • Reading novels • Listening to classical music • S pending time with my children and grandchildren • Walking on the fells in the Howgills and the Lake District

Dr Jyoti Shah

Dr Charlotte Gath

Career Focus pg22

Women in Urology pg21

A medical woman you admire/respect: Elisabeth Kubler-Ross, psychiatrist – gave us great insights into Death, Dying, Grief and Care Giving.

Five favourite things in life: Miss Jyoti Shah

• Receiving a thank you letter from a patient • Reading a good thriller • Keeping fit by running, doing Insanity & Metafit • Cooking a tasty curry • Country walks

Dr Alys Cole-King Women at the Top pg8

A medical woman you admire/respect: Ilora Finlay (Prof. Baroness Finlay of Llandaff)

Dr Alys ColeKing

2

Five favourite things in life: • Family and friends • Walks and picnics • Gardening • A great comedy • Listening to my children play their musical instruments

A medical woman you admire/respect: The medical woman I admire (among many!) is Baroness Sheila Hollins for her national leadership around mental health and learning disability.

Five favourite things in life: • I talian sunshine • Hills and mountains • Daffodils • Dogs • My four sons

Dr Charlotte Gath

Dr Mary Armitage Clinical Excellence Awards pg10

A medical woman you admire/respect: Dame Carol Black

Five favourite things in life: • My family • The sea • Reading • Skiing • Socialising with friends

Dr Mary Armitage

Medical Woman | Spring 2015

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

NEWS & EVENTS

doctors since 1917.

Sunday Afternoon Tea, Cardiff, September 14th 2014

The Medical Women’s Federation (MWF) was

Shabeena Hayat, MWF Junior Doctor Rep, Cardiff A lovely afternoon was had by all. Many of my friends and colleagues were able to chat to Sally and Carol about their career paths and intentions, and get some valuable advice. This was an enjoyable, relaxed opportunity to network with other local doctors of various specialities and grades. Many had children and brought them along to play around the house and garden whilst we chatted and shared experiences of career changes or challenges overcome as young female doctors with or without children. We look forward to our next excuse to eat cake and chat!

founded in 1917 and is today the largest and most influential body of women doctors in the UK. The MWF aims to: • Promote the personal and professional development of women in medicine • Improve the health of women and their families in society The MWF consistently works to change discriminatory attitudes and practices. It provides a unique network of women doctors in all branches of the profession, and at all stages from medical students to senior consultants. We aim to achieve real equality by providing practical, personal help from members who know the hurdles and have overcome them.

Achievements: MWF has campaigned for many years for: • the development and acceptance of flexible training schemes and flexible working patterns at all levels of the profession • recognition and fair treatment of sessional doctors in general practice • the need for continuing medical education and a proper career structure for non-consultant hospital career grade practitioners • family-friendly employment policies and childcare tax relief • proper treatment for women who suffer 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

MWF Student Representative for Imperial College Medical School Hi, my name is Mala Mawkin and I have loved being Medical Women’s Federation Imperial College Student representative this year.

I have been busily promoting elective awards and student competitions to the students at Imperial this year, as well as promoting MWF in general. MWF Imperial partnered up with Imperial College Surgical Society to host a “Women in Surgery” talk. The aim of this was to bring to life the real issue that exists in managing a work-life balance as a female doctor (and show it can be done!).

The discussion was led by some of our own MWF members and MWF was promoted during the evening. I have loved chatting to students this year at Imperial and getting their insights into how MWF’s objectives are helping them as students, and getting more students involved into the MWF Imperial Network. Management BSc at Imperial is a course taken up by a lot of our 4th year female medical students and it will be interesting to see how MWF will be able to aid females at Imperial to gain the skills to get into key management positions in the NHS after graduation – this is a really exciting space for us to explore next year!

I would definitely recommend any medical student interested in MWF campaigns to get involved and help to improve the career path we are embarking on.

Mala Mawkin, 2nd year medical student, Imperial College School of Medicine @malamawks

East Midlands Local Group Report Dr Yin Ng (East Midlands Local Group Report) In October, we had a student careers evening at Nottingham Medical School ably organised Dr Hana Baig (MWF Junior doctor representative) and a 2nd year Nottingham student friend of hers, with some input from Sue Ward, Jo Jones and me. There were a couple of short talks about career planning, and work-life balance, followed by a Q&A session, with questions that Hana had drawn up, asked of a panel of seven doctors of various ages, grades and specialties.

The event ended with an informal session with refreshments. About 17 doctors and 40 students attended. Several students signed up for more info about MWF. Hopefully an active student nucleus will develop, with the help of our new Nottingham student rep, who is Louise Chenciner, a 3rd year student who won a Katherine Branson essay prize in 2014.

This event was generously sponsored by MDU (Medical Defence Union) and Wesleyan.

Dates for your Diary: April – June 2015 MWF Mature Student Grant Awards April – C linical Excellence Awards are due to open, please look out for further information on how we can support you on our website.

15th May 2015 – MWF May Conference, “Stepping Up & Speaking Out; Empowering Women Doctors & their Patients”, MWF AGM and Council Meeting, Manchester (16th May) June – September MWF Junior Doctor Prize October – 3 months extra free MWF membership promotion October – Elective Bursary applications opens 6th November – Autumn Conference, “Building Resilient Leaders” and Council Meeting, London (8th November) November – International travel Fellowship opens December – Katherine Branson Student Essay Competition opens

3

Conference Review

Healthy Doctors:

HEALTHY PATIENTS

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

The Autumn Conference was very topical in light of the concern over the effect proposed contract changes will have on doctor wellbeing and patient safety. The delegates ranged from students to retired members and represented a wide range of specialties. As usual there was a packed programme but there was still plenty of time during breaks for networking, looking at the poster presentations, and catching up with other MWF members.

D

r Clare Gerada, the opening speaker, summed up the theme of the conference with her talk entitled, ‘Pull your own oxygen mask down before helping others’. The constant reorganisation of the NHS, increasing workload along with excessive monitoring of those in training grades are some of the causes of an increase in young female doctors presenting to the Practitioner Health Programme in London. The good news is that doctors do well with treatment and 75% get back to work.

Dr Deborah Cohen presented results from a survey of attitudes to mental health issues amongst doctors. Whereas doctors might think they would seek help at an early stage, when it comes to it they disclose their difficulties late. Doctors in training grades present later than consultants and GPs which may partly be due to fear of jeopardising their career progression.

Anna Rowland from the GMC gave us an overview of fitness to practise, particularly with regard to the health of the doctor and its impact on patient safety. The GMC are reviewing how they deal with health cases and introducing safeguards to try to protect vulnerable doctors as well as the public.

The Dame Rosemary Rue lecture was given by Professor Jane Anderson, a clinician and researcher in HIV. She described how Dame Rosemary Rue chose a career in medicine after a serious illness in childhood and how she persevered despite being told on more than one occasion that medicine was no career for firstly a married woman and then a mother. Professor Anderson linked the challenges to our expectations of what constitutes a good medical life (as in that of Rosemary Rue) with the life changing effect of a diagnosis such as HIV as both change people’s views of who they are and where they are going. In her own career she failed to get in to medical school at the first attempt due to failing her physics A’ level. She later went back as a mature student and so graduated just as the HIV epidemic was starting, and entered a specialty that would not have existed had she entered medical school earlier. Decade by decade she outlined to us the progress made since then so HIV is now considered a chronic illness rather 4

than a life limiting one and controlled with just one pill a day.

The resilience shown by Dame Rosemary Rue is something she also recognises in her patients.

Amongst the abstract presenters were medical students and junior doctors who had taken the opportunity to present at the conference; something the MWF is keen to encourage. The winning extract was ‘Giving them a Voice: The Importance of a Junior Doctor’s Forum in the National Health Service’ presented

by Dr Ceri Murphy. During a paediatric FY1 post she helped set up a junior doctors’ forum as a platform for suggestions with the aim of improving work-life balance and the working environment. Highly commended abstracts were ‘Barriers to Black and Minority Ethnic Women in Medical Leadership Roles; A Trainee’s Perspective’ from Dr Abeyna Jones and ‘From Theatre Huddle to Clinic Cuddle…?’ by Miss Elizabeth Bell, Consultant Breast Surgeon.

Our conference dinner was at the Waldorf Hotel and the after dinner speaker was MWF Past President Ilora Findlay, Baroness Findlay of Llandaff. She entertained us with some amusing stories from the House of Lords, in particular the times when her medical expertise has been needed. We now know why she was unable to shake hands with President Obama! Prof Findlay is currently President of the BMA and she feels she owes a great deal to her time as an officer for the MWF when she ‘cut her teeth’ on committees in a friendly and supportive atmosphere and gained the confidence to take on positions of leadership in other organisations. This was a fitting close to an inspirational day.

Medical Woman | Spring 2015

Charity Spotlight

The Fawcett Society The Fawcett Society is the UK’s leading charity for women’s equality and rights at home, at work, and in public life. We have a long and proud history that has its roots in the campaign for women’s votes almost 150 years ago. Millicent Garrett Fawcett pioneered that work and it took 60 years to achieve her aim.

M

illicent Garret Fawcett worked alongside the Suffragettes who employed more headlinegrabbing tactics in their campaign. Her skill was to navigate the case for women’s suffrage through Parliament using her intimate knowledge of the democratic process and hard-headed rational thinking.

Women’s equality, of course, has made massive strides since then but there are still many areas where women are prevented from reaching their potential. Women are more likely to have low paid jobs, have fewer financial assets, and to live in poverty, especially in older age. These often have knock on effects on health and well-being.

In Parliament, where key decisions affecting all our lives are made, men outnumber women by almost five to one. The number of women MPs has increased by only 3.2% in 10 years. In the media, women’s appearance is treated as far more important than what they say or do.

Today, the Fawcett Society is the largest independent membership organisation with a dedicated focus on advancing women’s equality and rights in Britain. Our member base is central to our power and influence, delivering strength in numbers and ensuring we have the funds to continue our work.

We have a growing number of active and effective local groups that take the movement directly to local audiences.

Our work continues Millicent Fawcett’s level-headed approach.

We collect evidence and commission independent research to increase awareness and promote practical solutions to the everyday challenges that women face. We give voice to their concerns, needs, and interests at the highest levels and across political doctrine.

Our latest publication Where’s the Benefit, highlighted how families are being put at risk of poverty and ill health by stricter rules that are applied to claiming Jobseeker’s Allowance.

These benefit changes ignore the reality of women’s lives. More than 90% of lone parents are women, and women are far more likely to experience domestic violence than men. Yet time and again they are expected to meet near impossible conditions to receive a basic benefit. Lone parents, for example, may be asked to attend job centre meetings at school pick up time or apply for jobs that are up to an hour and a half away.

In the run up to the General Election 2015 there has been renewed interest in ensuring women make their views clear through the ballot box. We believe that as a society we will be stronger, healthier, and happier when everyone, men and women, enjoy full equality and respect. To come up with solutions that work for everyone, both men and women need to be involved in conversations about what gender equality looks like. An unequal society affects us all. Join us in working towards a fairer society for everyone. www.medicalwomensfederation.org.uk

As we approach our 150th anniversary, the Fawcett Society is continuing its drive to allow women to shape their own lives.

If you would like to become a member, or support our work, take a look at www.fawcettsociety.org.uk 5

Feature

Advancing Women in Medicine Summit

I

n December the Advancing Women in Medicine Summit took place at The King’s Fund. This was a joint venture as a result of a collaboration between the Medical Women’s Federation, the King’s Fund, the Faculty of Medical Leadership and Management (FMLM), the British Medical Association (BMA), and the Royal College of Surgeons (RCS).

The aim of this summit was to move from debating the issues facing women doctors in leadership positions, to agreeing the actions for change. The summit was a significant demonstration of an ongoing commitment to building medical leadership, including growing and supporting the pipeline of future medical leaders.

I hope you get a real flavour of the event by the accounts below, written from different perspectives, by both male and female doctors, at different levels in their careers.

Dr Suzy Lishman President, The Royal College of Pathologists Suzy.lishman@rcpath.org @ilovepathology The Advancing Women in Medicine Summit was an inspirational day. It brought together women at all stages of their careers and gave them the opportunity to listen to current leaders, share their experiences, and network with each other.

I particularly enjoyed hearing from Kate Granger, who described leadership as a bit like jumping out of a plane, something that she recently did to raise money for the Yorkshire Cancer Centre. Kate’s description of how she introduced the ‘Hello my name is…’ campaign for more compassionate care was truly inspirational.

Even at the summit there were a few misconceptions about women in senior positions. Few speakers appeared to know that there are now six women presidents of medical Royal Colleges!

The commitment wall was a great idea and gave delegates the chance to make a pledge to improving the opportunities for women in medicine. My pledge was to ensure that it wouldn’t be another thirty years before the Royal College of Pathologists elected another female president.

Despite there being more women in medicine than ever, we know that they are under-represented in leadership and academic roles. This may reflect an absence of role models or lack of confidence. Everyone, regardless of gender, needs mentors and champions. I have been very fortunate in having inspirational role models to encourage and support me. I believe that successful women leaders have an obligation to mentor the next generation.

Having more women in the most senior positions shows that it can be done, provides role models and mentors, and makes it the norm rather than the exception. It’s a great time to be a woman in medicine – things are looking better than ever but there’s still some way to go and we mustn’t rest on our laurels.

6

Dr Abeyna Jones Occupational Medicine Trainee I was thrilled to be invited to this historical event at The King’s Fund. I personally enjoyed the networking opportunities with current female leaders within the profession and also those rising stars who I’m sure I will work closely with throughout my medical career. One of my top memorable quotes included Sir Bruce Keogh recognising that talented junior doctors continue to be used as ‘service fodder’ in the NHS and “Difference and diversity stimulate innovation. Utilise the minds of the totality of the workforce.”

I am particularly passionate about equality and inclusion in healthcare, and most importantly the right to work in an open and transparent culture where diversity of thought is encouraged.

Hence, my pledge was, “I aspire to be myself, be open and honest with my colleagues and patients. #equalitynhs”.

I sincerely hope that rhetoric is translated into action and I’m eager to observe and experience the results in the NHS. Greater male representation at this summit would have been preferable as much of the discussion was about gender disparity; both men and women need to contribute towards formation of policy that will support both genders. Equally, awareness of these issues amongst the male medical population in particular is essential for progression. Other barriers to progression that may not have been explored in depth during this summit includes failure to nurture talent in the NHS, a suboptimal work environment in leadership roles, and the impact that ethnicity and cultural issues have on women pursuing these roles in the first place. We need to consider that many women are intersectional (multiple marginalised identities), hence only advocating for women may not be enough.

Leadership fellowships, positive action initiatives, awareness of the impact of implicit bias, and flexibly designed work policies designed to support joint parental responsibilities are a few suggestions which may continue to enhance opportunities for all in the future. We need to remember that one of the keys to becoming a successful leader is to start early, so I would encourage this mindset to be continually instilled from medical school upwards.

Dr Krishna Kasaraneni, GP & Chair of Equality and Inclusion Committee of the BMA As a son and grandson of women doctors, the issue of women in medical leadership is a personal one for me as well as a professional one. For far too long, we as a society and the health service have failed to involve and promote women to leadership roles consistently. The underlying reasons for the underrepresentation of women leaders in the NHS are complex.

But ‘complex’ does not mean impossible. The King’s Fund event brought to a head many of the issues that have been discussed Medical Woman | Spring 2015

Feature

Vijaya Nath, Dr Sally Davies

Dame Sally Davies

and researched for decades, and made the delegates commit to promote change. It was an action event rather than a talking one. The momentum built up by this needs to be maintained to promote tangible change.

So, what are the barriers that we need to break down? Firstly, the perceptions of women doctors in the NHS. The tag still remains that somehow women don’t contribute to medicine as much as men, which is why phrases like ‘feminisation of the workforce’ creep in. This needs to change and it won’t happen overnight. The senior leadership need to change it. Which brings me on to the second point – men. Promoting women leaders in the health service and removing obstacles can only be achieved by getting the buy in from the men who are in positions of responsibility now. Mentoring, career planning, and talent spotting undoubtedly help and should be part of an overall leadership strategy in NHS organisations. Express commitment to such a strategy from both male and female leaders sets the tone for the whole organisation. And finally, training. For doctors at the beginning of their careers, we need to ensure that there is better training about resilience and breaking down the barriers in their career paths. This is why the BMA has organised the Diversity in Leadership training events.

Now is the time for concerted action by all health organisations to increase the representation of women in senior positions by recognising barriers and tackling them. It is time to show respect to the role women play in the NHS and promote a truly diverse leadership that the NHS needs and the public deserve.

Amy Woods & Dr Sara Khan

Amy Woods, Student Editor of Medical Woman, Medical Student, St George’s University As a final year medical student I was privileged to attend the Advancing Women in Medicine Summit held in December.

It was a day of inspirational speakers including Clare Marx, Sally Davies, and Jane Dacre, not to mention the ever-inspirational (and fellow Yorkshire-woman) Kate Granger – who started the famous #hellomynameis trend and showed how one person can make a real and tangible difference to the daily patient experience in the NHS. She also talked about the difficulties often faced by women in part-time work. The day was punctuated with speeches from a wide variety of leaders, women and men who talked about their own experiences, the challenges facing women and how we move forward. One of the most refreshing aspects of the day was that it was not just about highlighting problems; it was about proposing and promising real and practical solutions. For example, the BMA now have a fund for childcare costs so that those with young children are not excluded from engaging in committee meetings. Others talked about providing areas for breastfeeding, approaches to encourage women into male-led specialities such as surgery, and the use of female shortlists in committees.

It was an incredible opportunity to meet and speak to female leaders across the whole spectrum of medicine and policy-making, and I left feeling inspired and motivated, thinking about how we can all make our own individual goals to effect change on a greater scale.

JOIN US! JOIN US! JOIN US!

You can now pay for membership and events on the MWF website! So, what are you waiting for? Pass this magazine onto your friends, family and work colleagues, it’s about time they took advantage of what MWF has to offer.

Become a member at: www.medicalwomensfederation.org.uk

WHAT YOU GET FOR YOUR MEMBERSHIP FEES: MEDICAL WOMAN – Our in-house magazine is issued twice a year in both paper and online formats.

GRANTS, PRIZES AND BURSARIES – for both Students and Junior Doctors.

SUPPORT WITH AWARDS – we are a nominating body for ACCEA and give support with individual applications from women. We also nominate Medical Women for the Women in the City Award and the Woman of Achievement Award.

NETWORKING OPPORTUNITIES – we hold small networking events in our local groups and hold 2 national conferences a year.

MWF is a supportive community which will help boost your CV, confidence and career through to retirement!

www.medicalwomensfederation.org.uk

7

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

WOMEN AT THE TOP Alys Cole-King – MB, BCh, DGM, MSc, FRCPsych Consultant Liaison Psychiatrist (Betsi Cadwaladr University Health Board) and Director ‘Connecting with People’ – a social enterprise Name: Alys Cole-King Approximate age: Late 40s Lives: Snowdonia Medical School: Cardiff Year Qualified: 1990 Speciality: Liaison Psychiatry Place currently works: Betsi Cadwaladr University Health Board and Director Connecting with People

Dr Alys Cole-King is the Royal College of Psychiatrists (RCPscyh) spokesperson on suicide and selfharm, a member of their Patient Safety Working Group, and has contributed to several college reports.

Alys sits on the Royal College of General Practitioners (RCGP) Mental Health Training Advisory Group and contributed to both the RCGP and RCPsych curricula. She is primary author of the RCGP/RCPsych Suicide Mitigation in Primary Care factsheet, and has written papers, book chapters, and contributions for the RCGP e-learning module on suicide prevention. In 2010, Alys co-founded a social enterprise called Connecting with People. It pioneered a robust approach to suicide prevention in healthcare, combining compassion and governance. This approach is strongly evidence based and uses a set of clinical tools (fully peer reviewed and published) to ensure quality and consistency of care.

Modular training is used to build knowledge, skills, and compassion.

Clear structure and recording of information ensures excellent governance. The app is easily and securely integrated with NHS IT systems.

8

First Ambition: I always wanted to be a doctor or an actress. I spent my teenage and undergraduate years writing and acting in plays. I supplemented my grant by performing in an improvised comedy group. I intended to train as a GP but, during a clinical placement, it seemed most patients also had emotional and psychosocial needs and psychiatrists would have 20 or so minutes to deal with them rather than the more usual 10 minutes in primary care.

Other Career Related Interests/Roles: I co-founded a not for profit social enterprise to progress work on implementing research findings in clinical practice. The Connecting with People assessment approach involves a common assessment framework for suicidal thoughts to improve the quality, consistency, and documentation of assessments, care plans, and safety plans. It pioneered a robust approach to suicide prevention in healthcare. This approach is strongly evidence based and uses a set of clinical tools (fully peer reviewed and published) to ensure quality and consistency of care.

Modular training is used to build knowledge, skills, and compassion.

Challenges along the way: I found it difficult to find the right people and mechanisms to do this work within the NHS, and had to look outside the health service to move it forward. The main challenge is ensuring that organisations recognise and prioritise their responsibility to improve clinical governance and quality improvements to prevent unnecessary suicide. This includes understanding that suicide is preventable, that everyone has a role in suicide prevention, and that changes in care will save lives. Significant in-roads have been made to tackle stigma in the general population but there is still stigma and a chronic lack of awareness within the NHS that is hindering constructive change.

Rewards of your role(s): The Connecting with People approach has now been adopted by a number of NHS Trusts across the UK and we are starting to work with other statutory service providers and overseas healthcare organisations. I also find my roles as Royal College of Psychiatrists spokesperson on suicide and self-harm, and Patient Safety Working Group member, very rewarding.

Inspirations/influences: My co-founders at Connecting with People, Gavin Peake-Jones, Bob Mann, and Sian Peake-Jones have been immensely supportive. They have all made huge personal sacrifices to make this work possible. Their professional backgrounds in strategy, culture change, social policy, and IT have been vital to creating the Connecting with People assessment approach that puts research into practice.

Quotas for senior positions for women in healthcare – yes or no? I would have previously said no until I attended the King’s Fund Advancing Women in Medicine Summit where I learnt that currently the unconscious bias is so profound that quotas are necessary to redress the balance.

ADVICE Do’s: Be clear about what you want to achieve. Develop your own resilience and resourcefulness to help you cope with set backs. Success doesn’t happen in a straight line!

Don’ts: Don’t try to do everything; you need to seek support and advice from people with complementary skills and expertise. Don’t waste energy pushing at a few closed doors when there are hundreds of others that are open.

How to get there: Be confident but humble. Play to your strengths and surround yourself with the right people to close the gaps on the areas where you don’t have expertise.

Medical Woman | Spring 2015

Feature

WHO and UN Commission on Status of Women (CSW) Dr Clarissa Fabre – GP East Sussex and former MWF president

I

have been MWIA (Medical Women’s International Association) representative to WHO (World Health Organisation) for 2 years now, and over that period two areas have emerged that are of special interest to me.

The first is the Safe Childbirth Checklist, which has been developed by the Harvard School of Public Health in collaboration with WHO, and is supported by the Bill and Melinda Gates Foundation. The aim of the checklist is to reduce maternal and perinatal mortality (for more detail see www.who.int). I am delighted that Dr Rosemary Ogu, an MWIA member and a consultant in O&G at Port Harcourt, has taken the lead in piloting the checklist in several primary care centres in Nigeria. It is excellent that MWIA has become involved.

The second area is the Clinical Handbook on Domestic and Sexual Violence which MWIA will write in the next year. My focus will be on prevention and the involvement of men and boys.

In early March I went to New York to attend the UN Commission on the Status of Women conference. We all marched through the streets of New York from the UN to Times Square to commemorate International Women’s Day. Highlights for me were Hillary Clinton (‘Despite obstacles that remain there has never been a better time in history to be born female…in 1995 if you were born in Nepal or Afghanistan there was a high chance that your mother would die in childbirth… BUT, despite a lot of progress, we are not there yet – more than 30 million girls never go to secondary school, there is gender biased sex selection especially in China and India, and more than half the nations in the world have no laws to prevent VAW. Laws have to be enforced, not just on paper… we need judges committed to enforcement’); Ban Ki Moon, the UN Secretary General (‘We need full participation of both genders’); Mary Robinson, the UN Special Envoy for Climate Change (‘We are not in a www.medicalwomensfederation.org.uk

Dr Fabre in Times Square witih the International Women’s Day March

comfortable place on climate change’).

Countering Cyber-violence against Women is a very important subject discussed at one of the side-events – women aged 18-30 are most affected by this new type of VAW( Violence aga inst Women), most often perpetrated by someone known to them. New laws are required which balance rights to privacy with freedom of expression.

MWIA ran an excellent parallel session at the UN. Ruchira Gupta, a former journalist and founder of an anti-sex trafficking organisation in India, was an inspiration. ‘We need to address the needs and concerns of ‘the last girl’ – 13 years old, poor, works in a brothel, raped by 8-10 customers every night, does not have a phone to ring a helpline, no education...’

Her film ‘The Selling of Innocents’ won an Emmy award. A Polish government minister spoke of the restrictions around abortion and the divisive issue of sex education in her country. I would like to congratulate our UN representatives for organising such a well-attended and thought provoking meeting.

International Women’s Day March Through New York

The Indian government recently tried to block the showing of a new film ‘India’s Daughter’, because it showed India in a bad light. The film showed the rape and murder of a medical student, and there were interviews with some of the perpetrators: ‘a girl is more responsible for rape than a boy… she should just be silent and allow the rape. Then they would have dropped her off after ‘doing her’ and only hit the boy she was with.’ As Hillary Clinton said, the situation for women has improved over the last 20 years, but there is much to be done, and we must be constantly vigilant.

9

Feature

Clinical Excellence Awards and the Medical Women’s Federation Dr Mary Armitage, CBE. Mary was previously Clinical Vice-President, Royal College of Physicians, and then Deputy Director of Medical Education at the Department of Health. She was a consultant physician at the Royal Bournemouth Hospital for 25 years, where she was Medical Director until her retirement in 2013. She was appointed as Medical Director to the Advisory Committee on Clinical Excellence Awards (ACCEA) in April 2014 and also acts as the secondary care advisor to two Clinical Commissioning Groups and is a school governor.

She is a tiger mother to two daughters, and has a long suffering husband who supports her.

S

hortly after I was appointed as Medical Director to ACCEA, the MWF President Sally Davies asked me if I would write an article about the scheme, with a view to encouraging women to apply for clinical excellence awards. I share her enthusiasm to ensure that women achieve recognition for their work; too often they are reluctant to put themselves forward, despite exceptional achievements.

The national scheme is underpinned by regional subcommittees, whose members score all of the applications in their region, against a set of published criteria across five domains. Following scoring, each subcommittee has an initial meeting, to discuss the ranking of the applicants against the indicative number of bronze, silver and gold awards. The chair and medical director then have a second meeting in each region to agree the recommendations for the main committee to consider, and then ACCEA makes the final recommendations to health ministers. ACCEA also advises ministers regarding continuation of awards following review of renewal applications.

Employer Based Awards are made at levels 1-9, a local 9 being financially equivalent to a national bronze award.

A very competitive process The process has become extremely competitive in recent years; in 2009 and preceding years over 600 new national awards were made, but from 2010 the number of new awards has been held at 300 in England, with around 17 new 10

awards in Wales. Consequently, since the number of new awards was halved, the bar has been significantly raised and each year there are deserving candidates who are not successful.

However my message to you is: if you don’t play you can’t win.

We know that women over many years have been less likely to apply for awards than men. Recently, more are applying, and they are as likely to succeed, certainly at bronze. Clearly the data vary across the different levels over the years:

In 2012, only 1.4% of the eligible population of women applied for a bronze, compared to 2.8% of men. While many more men applied than women, the success rate at bronze was 21.5% for women compared to 18.5% for men. In 2013, 1.7% of eligible women applied (17.3% successful), compared to 2.1% of eligible men (22.5% successful) for bronze. At the higher levels, where the numbers are small, it is important not to overanalyse.

Generally, fewer women apply, but many are competitive.

The distribution of current award holders reflects the lower application rates in women and lower awards received over the years.

For example, 122 women hold silver awards compared to 539 men, and 320 women and 1245 men hold a bronze.

The application form So we need to encourage more women to apply. How can any candidate optimise their chances? The scheme is designed to offer every applicant an equal opportunity, and applications are considered on merit. However, the most important thing is to READ THE GUIDANCE CAREFULLY. There is published guidance for applicants and for assessors, as well as for employers and for National Nominating Bodies (NNB), of which the Medical Women’s Federation is one. Read both the guidance for applicants as well as for assessors, so that you understand how you will be scored. The guidance is very clear, but you would be surprised how many applicants fail to follow it!

Medical Woman | Spring 2015

Feature Pay attention to the job plan section, because the scheme rewards excellence over and above that expected of every doctor in meeting their contract. This applies to every domain: clinical, management, research or teaching. You must give dates and avoid repetition across domains. Try and quantify evidence with outcomes where possible and emphasise personal contributions and impact. Show a “step up” if you are applying for a higher level, not just continuation of work. Don’t use abbreviations, and spend time setting out your form carefully, so that it is easy to read and looks professional – use bullet points and new lines.

The assessors are triangulating all of the information in your application; the evidence in the five domains, as well as your CEO’s level of support and any citations from NNBs or specialist societies or personal citations. However, it is the scoring and attendant ranking from the subcommittees that is the most important predictor of those who are successful in gaining a new award. At bronze level, 60% of new awards are made to those applicants who do not have any NNB citations, and another 30% to those who are ranked by the subcommittee and have external citations. Royal colleges and other external bodies have a limited number of candidates they can support, and it is very competitive to secure their citations – so be reassured that if you do not have the external support to your application you still have a very good chance of success if your application demonstrates good evidence.

Are there any rules about progression for higher awards?

The eligibility criteria are clearly set out in the guidance. There is no set number of local points that should be held before achieving a national bronze, nor is there a fixed period of time to hold a consultant post, or for progression between awards.

However, ACCEA has information regarding successful award holders over a number of years, and from these data a number of general principles are evident.

It is possible to go from “null points” to a national bronze. Some applicants (e.g. academic GPs, consultants in occupational or public health posts, or appointments from overseas who have not been in the system very long) may have few or no points yet demonstrate sustained excellence and move straight to a national bronze. www.medicalwomensfederation.org.uk

However, the data show that it is extremely unusual to jump from L1 or L2 points, and rare from L3. The majority of new bronzes are awarded to those with L5, L6 and L7 points. And the average length of time for a new award holder is 12 years as a consultant, and consultants with seven to nine years of experience are most likely to receive a bronze. Equally, whilst it is possible to progress from bronze to silver, or silver to gold at a three year interval, very few consultants progress in less than four years, and the average time to progress to silver is 5.2 years, gold 4.5 years and platinum 6.3 years.

The message here is about sustainability and continued excellence throughout your career. It is important to work at local level to achieve local CEAs early in your career, to optimise your chances of success when competing for higher awards. It is difficult when working hard delivering your local service, but consider taking on local leadership roles: college tutor or director of medical education; service lead or clinical director; audit or clinical governance lead.

Consider regional work in the deanery, or for your royal college. Invitations to work on national committees will follow; accept them. National awards recognise national contributions, but also the roll out of local excellence, developments, research and impact that is wider than your local trust.

Regional Subcommittees There are 13 regional subcommittees, plus a subcommittee for Department of Health (DH) and one for Wales.

Each subcommittee aims to have 24 members: 50% professionals (doctors); 25% employer representatives and 25% lay members. Each subcommittee is led by a lay chair and a medical vice-chair.

The subcommittees ideally should have an appropriate balance of those from teaching hospitals, universities and from district general hospitals; a spread across the geography of the region; a good mix of different specialties in the professional members and a mix of different levels of award holders. It is obviously not possible for all specialties, even major ones, to be represented and professional and employer members are not there to represent any specific specialty or organisation.

All members score the written evidence on the form and must respect confidentiality and score consistently. It is also desirable for there to be an appropriate

balance of ethnicity and gender across the members. Many subcommittees struggle to recruit employer representatives. Human resources experience is very valuable as well and in many subcommittees the employer representation is through a medical director, or associate medical director.

The exact balance across all subcommittees varies from year to year, as members leave and new ones join, so any analysis can only be a snapshot at that time. For the 2014 round, the percentage of women across the regional subcommittees varied between 15% and 48%. There are two female chairs, and currently no female medical vice-chairs. Nine of the subcommittees have less than one third female members. It is the first time that the medical director of ACCEA is a woman!

We are always looking to recruit new members; only two subcommittees currently have the full complement of 24 members, and most have one to three vacancies. We hope that there will be an award round in 2015, subject to ministerial agreement. So I would like to encourage you to contact the ACCEA secretariat (ACCEA.secretariat@dh.gsi.gov.uk ) to ask about vacancies in your region and consider applying to be a professional member.

Each member scores either bronze applications (new and renewals), or the silver, gold, and platinum new and renewal applications. The number of applications varies between regions, but there are usually between 100 and 250 applications overall for each region. The review of applications and scoring is done electronically, in a window of five to six weeks after the round has closed. There are then two meetings of the subcommittee. We offer training to new members prior to the round opening.

It is a significant amount of work: many members end up doing the scoring at home in the evenings and weekends.

However, it is rewarding. It is a humbling and inspiring experience to read the achievements, innovations, outcomes and sheer commitment from so many of our colleagues, and many of them are women!

The MWF would like to thank Dr Armitage for her article and the encouragement she has given MWF. We congratulate our members who were successful in gaining new awards as well as renewal of existing awards. When the 2015 round is announced we encourage eligible members to contact MWF. The more women that apply the better!

11

Twitterview

Twitterview MWF @medicalwomenuk with Dr Melanie Jones, MWF Past President

Q: @medicsupport

What is your medical background?

A: @medicalwomenuk Med school in Cardiff, grad 78, training in Wales and the Caribbean, consultant anaesthetist until 2011 #MWFview

Q: @medicsupport

Who/what has been your biggest inspiration?

A: @medicalwomenuk My mum, doctor combined work with raising kids. Cons job at 52!

Compromise needed Showed me multiple roles in life #MWFview

Q: @medicsupport

What has been your greatest achievement?

A: @medicalwomenuk Promoting LTFT training and improving access to training for docs with carers responsibilities or health issues #MWFview

Q: @medicsupport

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

A: @medicalwomenuk joined Twitter last July, check my account 2-3 times a day, it’s addictive, husband says it’s my new best friend #MWFview

A: @medicalwomenuk

Yes. I combined clinical work with #meded and studying for MA. Portfolio means variety +more control over life #MWFview

Q: @medicsupport

How would senior doctors benefit from being on Twitter?

A: @medicalwomenuk No hierarchy, get views of patients+trainees+students+other professions Help others. Identify current issues #MWFview

Q: @medicsupport

Are there options for medics once they retire so they can stay involved?

A: @medicalwomenuk Prepare for retirement. Can share experiences, teach, start business.

Also important to let go+enjoy retirement #MWFview when retired don’t give anyone advice / guidance unless yr information up to date, keep up expertise or let it go #MWFview

Q: @medicsupport

Q: @medicsupport

There are many groups on Facebook and LinkedIn for medics, do you use these? What are the benefits?

A: @medicalwomenuk Not Facebook as my children use this, try to respect their privacy+independence. LinkedIn great work connections #MWFview

Q: @medicsupport

Q: @medicsupport

Why did you decide to set up a Twitter account?

A: @medicalwomenuk I ran career workshop at #mwfconf2014 *bossy*delegate asked my twitter name+insisted I join #MWFview pic.twitter.com/lK7KhwMIGn Why did you found Medical Careers support?

A: @medicalwomenuk After 10yrs Assoc Dean @walesdeanery decided to work for self+share expertise Scary jump #MWFview pic.twitter. com/83inG3fj33

In the light of GMC social media guidelines, what are the possible pitfalls of using these channels?

A: @medicalwomenuk Must remain professional, follow GMP, identify yourself, swearing doesn’t improve yr posts, don’t follow patients #MWFview

Did you find it enjoyable getting to grips with Twitter?

A: @medicalwomenuk Bit nervous at first, lurked. I can never keep quiet for long so decided to just dive in, share knowledge+views #MWFview

Q: @medicsupport

Q: @medicsupport

Q: @medicsupport

Do you suggest women medics use Twitter as a networking tool?

A: @medicalwomenuk Absolutely, connected with so many good people, great network support if feel down, all helpful if have a query #MWFview

Q: @medicsupport

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

A: @medicalwomenuk Know yourself+your values, explore options, aim for good enough, if struggling ask for help #MWFview pic.twitter.com/NxVj6mycRS If you are looking for medical career info, comprehensive website from @NHS_MedCareers http://www.medicalcareers.nhs.uk/default. aspx?page=0 … #MWFview

Q: @medicsupport

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

A: @medicalwomenuk

What motivates you? volunteer to help others, ask role models for shadowing opportunity, #MWFview pic.twitter.com/x7MNrTC6fX

Q: @medicsupport

Do you encourage near peer mentoring/buddying?

A: @medicalwomenuk

Yes support each other, be positive, give feedback on strengths, share and learn from experiences, widens horizons #MWFview

Q: @medicsupport

Do you encourage portfolio careers?

12

How do you balance the personal and professional side of Twitter?

A: @medicalwomenuk Try to keep within my area of expertise, personal views, don’t diss employers, don’t openly promote my business #MWFview

Q: @medicsupport

What would you say to people who say they do not have the time for Twitter?

A: @medicalwomenuk Make time! you learn many things, follow conferences you can’t get to, meet new people, definitely widen horizons #MWFview

Q: @medicsupport

Name someone you love to follow on Twitter and why?

A: @medicalwomenuk @clarercgp support for doctors, @bmjcareers great variety, @drumeshprabhu for leadership and transparency #MWFview @medicalwomenuk @wedocs for joining us all into a network, @options4doctors for alternate careers, and of course @ medicalwomenuk #MWFview @medicalwomenuk and finally @johnwalsh @sarah_searz for promotion of heart, hard work and hope in NHS #teamshiny #MWFview Q: @medicsupport How can people get support from you? / where is your next careers workshop?

A: @medicalwomenuk Find me on Twitter and send a message. I’ll be in Cambridge 19 February, Careers Masterclass for trainers #MWFview

Medical Woman | Spring 2015

Feature

The Sexual and Reproductive Health and Human Rights of Women Living with HIV...

Key Findings from the Salamander Trust Global Values & Preferences Survey.

Dr Amelia Jane Hawkes – completed foundation training, Leamington Spa

L

ast year the Salamander Trust worked to gather information on the attitudes and concerns of women living with HIV. They conducted an internet based survey and focus groups in 94 countries globally: http://tiny.cc/2udqwx This survey was commissioned by the World Health Organisation (WHO) to inform a revision of the current WHO guideline about the sexual and reproductive health (SRH) of women who are HIV positive. This should mean that services will be designed with the input of the women who will be using them, and with their concerns and needs at the forefront of system planning decisions.

This survey demonstrates the interface of the social and health aspects of HIV as a disease. It highlights that the areas women are most affected by are their social roles and their relationships.

There were two areas of the survey that caught my attention, both as a health care professional and as a woman. The first is the link between HIV and violence, and the second is the right of women to make a decision about having children.

I found these areas particularly interesting, having just spent three months working in a rural area of the Eastern Cape in South Africa for the Keiskamma Trust (an organisation that works in communities heavily affected by HIV). One of the main issues affecting our programme of prevention of mother to child transmission was that women were booking very late into their pregnancies, and in some cases during their third trimester.

When talking to these women it became apparent that one of the big reasons for coming so late was due to the HIV testing, which was seen as mandatory in pregnancy. Women were so scared of discovering their HIV status that they would rather avoid health care providers completely. There was also a general feeling that confidentiality wasn’t well observed and that people would be known to be HIV positive once they were diagnosed because community health care workers would come to their house.

Eighty nine per cent of women surveyed had experienced some form of violence, or fear of violence, either prior to, or because of, their diagnosis. WHO research demonstrates that intimate partner violence increases women’s vulnerability to HIV by 50%. The report uses the analogy of a house, with the different components (such as the roof and walls) made up of the different areas that shape women’s lives such as mental health and human rights. The key foundation of this house is safety. A woman cannot focus on the other areas of her life when her foundation (or safety) is unstable. Fear of violence is also a leading factor in non-disclosure to partners. Financial dependence on a male partner means that choices about children, sex and other household decisions are not shared. Enquiring about gender based violence in a healthcare www.medicalwomensfederation.org.uk

setting is a priority, and the assessment of women’s mental health and availability of peer support essential.

The second element that struck me was the area of contraception and pregnancy – the decision about when or whether to have children. Although 70% of respondents reported being able to talk to their service provider about their fertility desires, only 50% felt they had received support to do so and nearly 60% had an unplanned pregnancy. The report emphasises the need to initiate open discussion about fertility and pregnancy – find out what your patient wants, what their plans are and (as much as possible) make the medicine work around their decisions. A woman who had always planned to be a mother may feel discouraged from getting pregnant out of fear of passing on the virus to her partner or her unborn child.

Although preventing vertical transmission of HIV is an area of focus for health care systems, women’s rights and desires to have families seem to be ignored in the midst of these efforts. I was very saddened to see that respondents had been forced or coerced into making decisions about their fertility by judgmental health staff.

In terms of my future practice, it is important to see how little things can contribute to the stigma that a woman can feel. One quote from a woman in the UK stood out for me: ‘I have also given up complaining about the yellow stickers on all my tests saying “danger of infection” because I just feel that I am not listened to and I don’t want to alienate my HIV doctor.’ It made me think of all the small institutional practices that might make a woman feel uncomfortable and how easy it could be to unwittingly say the wrong thing or sound judgmental. There is so much that women living with HIV already have to face in their communities and homes in terms of discrimination and violence that we should ensure the health system is a safe haven, and a place where their thoughts and problems are listened to and acted upon.

The themes of the survey echo the concerns of any woman: the need to be safe and for your children to be safe; the need to be supported by your partner, your doctor and your community in your decisions. Globally, there are certain issues that all women prioritise and if we want to be good doctors we need to start prioritising them too. This survey gives any medical professional a better understanding of all women as patients (not only those affected by HIV), a sound basis to lobby for their rights and the motivation to advocate for them within the health system.

2006 guidelines WHO Sexual and reproductive health of women living with HIV/AIDS II http://www.keiskamma.org/index.php/health III WHO (2013) Responding to intimate partner violence and sexual violence against women. WHO clinical and policy guidelines. Geneva: World Health Organization. Available from: http://www.who.int/reproductivehealth/ publications/violence/9789241548595/en/ I

13

Debate

DEBATE: THIS ISSUE’S CONVERSATION:

“I believe that doctors should practise what they preach, and lead a healthy lifestyle considering smoking, alcohol, diet and exercise.”

OPINION...

Doctors are seen to lead the way in patient care and what better way than to lead by example. Research suggests that clinicians who maintain healthy lifestyles are more likely to discuss healthier lifestyle choices for their patients, as they have personal experience of the positive implications of healthy living. Patients therefore feel more inclined to lead a particular lifestyle if they find their doctors upholding the same principles. This sends the message that physicians who practise what they preach attain greater success in their clinical practice than their unhealthy counterparts. If physicians are not able to work towards a healthy lifestyle, then why should they expect their patients to do the same?

Many doctors are also fully aware of the consequences of smoking, drinking alcohol, and maintaining a sedentary lifestyle, as well as the disease burden and the impact this has on healthcare spending. Therefore, it is important for doctors to act as role models, with research suggesting that the way a doctor looks, feels, and behaves impacting on the way they treat and advise their patients. However, to what degree should doctors uphold their moral responsibilities to their patients? Much like other individuals, it is important to realize that doctors are people too who

are susceptible to the same strengths and weaknesses and are undoubtedly imperfect. Doctors equally have their own comfort foods and their lazy days and should be entitled to such.

They already endure high stress levels from examinations, long hours and a heavy workload; therefore, is burdening doctors more by telling them to not smoke, drink, or have the occasional food binge a wise move? However, a doctor must realise that humans are not very forgiving and whilst doctors should have the choice of leading their personal lives as they please, if a recovering alcoholic witnesses their doctor drinking three pints of lager then this undoubtedly tarnishes the perception the patient holds of their doctor.

Therefore, it is important for doctors to strike a balance between diminishing hypocrisy within their own clinical practice by firstly making changes within themselves, but equally allowing a degree of flexibility which enables them to maintain a lifestyle which meets their personal requirements.

Nabila Rehnnuma Graduate-entry Medical student from Cambridge University

AND OVER ON TWITTER… melanie jones@medicsupport @medicalwomenuk Doctors Are People, have same problems+struggles as their patients.

Does docs disclosing their own problems help patients?

Rosalyn Halewell@RosalynHallewell @medicalwomenuk @medicsupport ‘lead by example’ useful - don’t stand outside hospital smoking and then tell patients not to – hypocritical Rose@DrRoseM @medicalwomenuk difficult to explain, but I think that people who have their own struggles with weight etc often give the best advice to pts

14

Medical Woman | Spring 2015

Debate

FOR: “The NHS should change the name to NSS: National Sick Services” How can any health system function and create a healthier public if the doctors who are responsible for the treatment and advice don’t have a clue themselves about what healthy is?

Being one of them, I can tell you with certainty that most medical professionals maintain the worst possible lifestyle throughout their life.

The diet of many doctors and nurses is simply shocking; they practically live on French fries, pizza, sandwiches, cakes, coffee and soft drinks. Most of them do not exercise, and they deal with the significant emotional stress we are exposed to daily by drinking alcohol, excessive eating, or medication. All these bad habits make them, in fact, one of the unhealthiest groups of people in the UK. Having a health service with such an unhealthy group of people leading it makes me think it should really be called a “National Sick Service”. Professionals who know very little about wellbeing, and aren’t able to take care of their own health, certainly can’t teach, advise or inspire anyone to get healthier. Any patient who comes to see us thinks that if we can’t do better then they certainly won’t be able to.

I am heading faster towards my 50th birthday than I wish to admit, but I stopped caring. Thanks to a whole foods plant based diet, three to five hours of intense physical

exercise per week, and 15-30 minutes of yoga or meditation daily to deal with everyday stress, I am biologically in my twenties. With perfect blood pressure, and cholesterol far below average, I am preparing for my first half Iron Man, which is something I would never have dreamed of doing a few years ago.

Many people feel inspired by my health and vitality, and they follow my example reaching within just a few months the level of health and fitness they always wanted.

By doing so they drastically reduce their risk of multiple medical problems.

I believe that all medical professionals should be assessed yearly not only on their professional development but also on their health and fitness; and smoking, or drinking excess alcohol, should have disciplinary consequences. We doctors are the most important link and the only hope for people in westernised countries to help prevent diabetes, heart attacks, strokes, cancer, and other terrible conditions.

We are not just the service providers, but more like an army of health guardians, and therefore we should act this way – with health and fitness discipline.

Dr Agnes Electra Chlebinska Specialist in Preventative Medicine and Director of Health and Fitness Social Club The Transformers, http://www.thetransformers.com/

AGAINST: Should we, as doctors, practise what we preach and be models of the perfect lifestyle, or should we be realistic and susceptible to imperfection? As a GP who has struggled with my weight since adolescence, I feel I am far better at guiding patients through the struggles of attempting to lose weight than a colleague who has only ever struggled to put weight on.

As someone who has tried to lose weight, succeeded, failed, and tried again on a regular cycle, I can empathise fully with those who have failed. I then pick them up and motivate them to try again.

My patients often notice that I have lost weight; they ask me how, and they ask me the details of different diets they have read about. Many doctors who have never had weight issues belong to the ‘eat less, move more’ school of dieting, which

www.medicalwomensfederation.org.uk

is unhelpful for most patients, who have tried to do this on numerous occasions but failed.

It is a common misconception that people with normal weight are healthy, or have healthy lifestyles. If we insist on doctors following a healthy lifestyle, what will be the next step: screening everyone for lipids and insisting they take statins if above the 10% risk, or preventing those with high genetic risk of disease from working?

Doctors are people, not robots; we are susceptible to human foibles and we are there to guide, advise, and allow our patients to make informed choices as to how to live their lives.

Dr Clare Dyer GP Partner & CCG Lead, Hertfordshire

15

Working Abroad

WORKING AS A MEDIC OVERSEAS

for Newbies

Authors: Dr. Abeyna Jones and Sara Sabin, Directors of Medic Footprints, London

INTRODUCTION GMC figures indicate that at least 5500 doctors in the UK were planning to move overseas in 2013 (1). This number is likely to increase over future years as more doctors consider alternative career options within or outside medicine, combined with finding an opportunity to have an improved work-life balance.

It is not clear how many people eventually return to the UK; however, it is evident that the concept of working overseas is now widely supported amongst institutions and organisations in the UK. Below are a few reasons why doctors may want to go abroad: • Taking a natural break from medicine in the UK • Developing a specific skill, knowledge, or specialist interest (i.e. Fellowships) • Experience the cultures and extra-curricular opportunities of another country whilst practising medicine • Lucrative salary packages with potential added benefits • Academic opportunities WHEN TO GO Training as a doctor in the UK gives flexibility and transferable skills that you can take with you anywhere in the world. There are a number of natural career breaks when it is popular for doctors to go overseas.

• After Foundation Year 2 • After Core Specialist Training • After Certificate of Completion of Training (“CCT”) – One year Fellowships for sub-specialty training are commonly taken overseas in countries such as Canada or Australia before doctors commence consultant posts.

• During Consultancy and beyond – There are GP and specialist doctor shortages in many regions of the world. It is worth exploring where these are and to focus your efforts on addressing this gap.

16

It is possible for doctors to work overseas during a training programme. With a National Training Number (NTN) you can apply for either an Out of Programme Experience (OOPE) or an Out of Programme Training (OOPT) (2). These are usually prospectively approved by your Training Programme Director (TPD) and Specialist College. There is also a case for having overseas experience or training retrospectively approved, which is heavily reliant on the evidence you provide.

THINGS TO CONSIDER Whatever the reason for your move overseas, there is a substantial amount of planning that is required before booking your plane ticket.

Eligibility • Nationality – Will your passport allow you to get a visa for the country that you are looking to work in?

• Council registration – You will need a Certificate of Good Standing from the GMC. This is one of the documents required for medical councils overseas. You will also need evidence of your current registration. It is relatively easy for British graduates to obtain registration in many countries.

• Original evidence of your primary medical degree and postgraduate qualifications – These are essential for any registration.

• Current health status – are you fit and healthy to travel and work overseas? Will your chosen destination cater for any chronic health problems? A medical report is usually required for most immigration applications.

• How long are you planning to move overseas for? Most salaried posts will offer a minimum of 6 months contract.

However, the average is at least a year. If you cannot spare that much time, consider short term voluntary posts.

Medical Woman | Spring 2015

Working Abroad

“More doctors consider alternative career options within or outside medicine, combined with finding an opportunity to have an improved work-life balance.”

Personal • Career – what impact will moving overseas have on your career plans?

• Finance – consider your NHS pension, loans, mortgages, and financial commitments. Will you have sufficient income in your home bank account to cover any emergencies whilst overseas? If you are still paying your student loan, you will have to inform them of your new salary to determine your monthly repayments.

• Family / children – if you have, or are planning, a family, will your destination be conducive for your partner and/or children?

What is the cost of childcare and/or quality of schooling for your children? Do you have enough evidence to prove that your partner is your partner? Check the country’s website for specific rules for immigration purposes.

• Indemnity insurance – will this cover you overseas? Some insurers can arrange this but you should check before leaving.

• Costs of registering – registration and visa can be costly.

• Cost of moving – If your visit is temporary, try to ship over as little as possible. However, this will depend on your chosen destination.

• Plans to return – Will a post still be available for you when you return, or are you planning to apply for posts whilst overseas?

Ensure your employer is aware of your plans. This helps facilitate the process of flying home for short notice interviews.

• Travel plans – It is common to want to spend some of your time overseas travelling before or after you start your post, hence this needs to be factored in with your start and end date.

• Safety – Moving overseas as an individual can be nervewracking, especially as a female. However, most places will either have an expat community or a support system to help you familiarise yourself with the culture. Most places are safe and accepting of women, contrary to stereotypes – see our countries section below.

in much shorter time periods. This will be heavily dependant on the medical registration and visa application requirements of your country.

POPULAR DESTINATIONS Some of the most popular destinations for doctors, which we can organise placements for are discussed in detail below: a) Australia Australia is one of the most popular destinations for UK doctors going overseas. Great weather, a better work-life balance, a similar culture and good pay all make it an attractive option. The gender shift towards an increasing number of UK female doctors is mirrored in Australia. It is therefore regarded as a relatively safe destination to work with excellent career prospects.

Australia is popular for fellowships in several specialties because of a paralleled healthcare system with the UK. Many doctors will commonly choose to stay on and work as consultants in this country. Staff shortages are mainly in rural areas where there is a desperate need for general and rural practitioners. b) New Zealand New Zealand is a safe destination for women, with a thriving multi-cultural society, offering a mild year-round climate and an excellent quality of life. It is, perfect for those who love the outdoors. Specialists such as radiologists and psychiatrists are in high demand, alongside general practitioners. Junior doctor posts are currently competitive.

Know your country! Research your chosen destination thoroughly by connecting with others who have worked there, currently living there, or planning a similar trip. It will certainly be difficult in the first few months whilst you are adapting to a different culture and health system.

c) Canada Canada is a safe place to live and one of the most desirable destinations for immigrants. It is consistently recognised for its high standard of living, low mortality rate, good education and health systems, low crime rate, and beauty. Canada welcomes ethnic diversity and has active policies to encourage immigration of skilled workers. It is another popular destination for fellowships, with several international trainees remaining on as consultants due to excellent remuneration packages and quality of life.

HOW AND WHEN TO GET STARTED Take into account your professional and personal requirements.

Once you have identified a country and/or location, there are several options: 1. Contact the hospital or voluntary organisation directly 2. Apply through a recruitment agency 3. Advice from online forums 4. Check international job boards The best time to start planning is NOW. In most circumstances, it is best to give yourself a minimum of a year to comfortably organise your placement overseas. However, it can be achieved

d) UAE Vacancies for international medical graduates in the UAE tend to be more popular with post CCT specialists and GPs. While this may be the common trend, there are still opportunities for junior doctors.

The standard of living and salaries in the UAE are high and tax free. It is not unusual to receive the equivalent of GBP 8,0009,000 per month. Expats tend to live in expat communities, where accommodation is of a high standard. Contrary to ongoing stereotypes, cities like Dubai and Abu Dhabi cater for more of a western lifestyle in comparison to the rest of the Middle East.

www.medicalwomensfederation.org.uk

17

Medical Memoirs

MEDICAL MEMOIRS

Professor Wendy Savage Obstetrics pioneer and the country’s first female consultant in her field, at the London Hospital. Professor in Middlesex University’s Health And Social Sciences Department, and a campaigner of Doctors for Women’s Choice on Abortion.

The British Medical Journal describes Prof Savage as a champion of “women’s rights in childbirth and fertility” When I was at Croydon High School and had just started chemistry, which I loved, I was asked what I wanted to do when I left school. I said I would like to become a research chemist. This is because that was the sort of career that was respected. I was not asked about this again.

I

started to study Physics, Chemistry, Mineralogy and Maths at Cambridge, but at the end of the first year realised that I wanted to do medicine. I saw what the life of a chemist was and wanted a career that had more contact with people.

As a result, I had to do an extra year and this was my first experience of discrimination because I am a woman. The two men in my group who had changed from Classics and Modern languages respectively, did not have to prolong their undergraduate time. This is despite having no science AL subjects.

My father was not pleased with my career change and cut me off with an overdraft of £25 (which was a lot at the time).

My tutor, Miss Gillies, found a grant which paid for my fees and I worked as a waitress during the fourth (extra) year. I also got a grant from the Nuffield Foundation for the fees for my clinical years.

18

I obtained a clinical place at the London. I ran a grocers shop for the first 18 months with the help of a friend. I also did supply teaching in the holidays and worked for a drug company on its stall during conferences. The shop was due for demolition and I persuaded the London Hospital Estates to rent me a house just behind the outpatient department for £2.82 a week where I let two rooms to my fellow students to enable me to eat!

I failed medicine and surgery finals and took Conjoint three months later and embarked on a series of short posts having missed the start of the house job year. I discovered that you could do 26 fortnightly locums if you could persuade your dean to sign you up. I spent time in Christchurch and Exeter before returning to the London and doing four months of surgery and two months of medicine in the Receiving Room (A&E). I got married in the summer, got pregnant, and worked until I was 38 weeks. I went back to work when my daughter was three months old and used to breast feed her when on nights in the bedroom off the RR. Medical Woman | Autumn 2014

Medical Memoirs Once qualified I did some time as an outpatient orthopaedic officer and then a GP locum where I worked until I had my second child. We went to Boston when she was three weeks old. I got a part-time research post with Prof Kass at the City Hospital and had my third child two weeks before we left and went to Nigeria.

I got a post in a community hospital with a brilliant Italian doctor who taught me surgery and found myself looking after the hospital when he went on leave. After 18 months we moved again and went to Enugu. I got a job doing obstetrics and gynaecology (O&G) at the women’s clinic. I had a late miscarriage there which was not a good experience.

I saw four young women die of unsafe abortions including my own housemaid aged 17 years, which made me question what I had been taught about abortion.

After three years I was evacuated with the children because of the Biafran war. I had seen some shocking things after the September massacre. I set up a blood bank which helped to reduce the maternal deaths from 69 in 1200 deliveries the year before I came to five the next year.

We then went to Kenya in 1967 and I decided to specialise in O&G. I liked this subject most as a student but thought that this might have been because it was the only time we were allowed to do anything. I got a training post recognised for the MRCOG, wrote my book, and did the six month surgery experience that was required.

I reviewed the abortion deaths and had this paper published in the East African Medical Journal. I planned my fourth pregnancy but the Professor would not release me from the surgical post so I had to work until I went into labour, and then went back to work within three weeks in order to get signed up for this.

Back in England I got a registrar post at the Royal Free Hospital on a 1 in 2 rota with an extra day on call for outlying hospitals and no days off when one’s opposite number was on leave. We bought a house nearby. Whilst we were decorating this, the children used to come and have baths in the hospital as we had no hot water for months.

I got my MRCOG at the first attempt but my husband and I separated. I resigned and re-trained in venereology, family planning, and psychosexual medicine. These were areas that I thought had been neglected in my O&G training. Applying for Senior Registrar posts was unproductive and so I applied for two posts overseas, one in Jamaica and one in New Zealand.

The latter answered first so I went with my four children to a newly created post setting up an obstetric unit in Cook Hospital, Gisborne.

When the older O&G specialist did not retire, as expected, I was asked to set up family planning and venereal disease clinics. I started doing abortions with the support of the Medical Superintendent although the law was like that in GB before the 1967 Abortion Act was passed.

The birth rate dropped so there was not enough work and I planned to take up a post in the USA but had problems getting my visa. So, I returned to England where I got the lecturer post at the London in 1976 with the late Peter Huntingford, who was very pro-choice. We set up a Day Care Abortion Unit and after he resigned in 1981, I ran this. I started doing antenatal clinics in the community with four, and later five, GP practices www.medicalwomensfederation.org.uk

Prof Wendy Savage with her children and Grandchildren

and took the students out with me. In 1985 I was suddenly suspended on the grounds of incompetence citing five obstetric cases. However, the District Medical Officer explained that I had been suspended because “Peter Huntingford and I had turned Tower Hamlets into the abortion capital of Europe.”

I had always believed that my support of a woman’s right to choose was at the bottom of this attempt to get me sacked.

The enquiry was held in public under the HM 61/112 disciplinary procedure for the first and only time as the rules were changed after I had been exonerated and reinstated. After the enquiry I returned to work as Senior Lecturer at the London but transferred to the Academic Department of General Practice after a few months. Without the support of the GPs and the knowledge that about once every six weeks I made a difference to the way a woman had her baby, I would not have been able to withstand the hostile atmosphere in the O&G department.

Teaching the medical students was also rewarding.

I became President of the Medical Women’s Federation in 1992 and I still attend conferences and council meetings. I was able to get a sabbatical in 1997-8 to do an MSc in Public Health which was very enjoyable. I retired at the age of 65 in 2000 and was elected to the GMC in 1989, having become so well known because of my unjust suspension. In 2000 I became a screener for the GMC, dealing with initial complaints against doctors.

I retired from the GMC in 2005 and became involved with the Keep Our NHS Public campaign. I ran this from 2008-2014.

I have made attempts to give up the co-ordinating role of Doctors for a Woman’s Choice on Abortion, which I have held since 1977, so far without success.

Publications A Savage Enquiry. Virago. 1986 Birth and Power: A Savage Enquiry Revisited. Middlesex University Press. 2007

19

Taboo Topics

“Sleep when the baby sleeps” Dr Stephanie de Giorgio – GP partner in Walmer, Kent. Co-founder Resilient GP

A

sensible bit of advice really, handed out to all new mothers. Ten years after the birth of my eldest daughter, it still makes me shudder to hear it. I was an O&G SHO in training at the time. After a pretty hideous labour and delivery (managed amazingly by my work colleagues) I was handed my baby. Was there that “amazing rush of love” that everyone talks about? No. There was fear and a hideous feeling that I had made a huge mistake and that if we could all pretend that this hadn’t happened, that would be great.

Medical mothers are often asked advice by other mums in those early postnatal meet ups as if we somehow know what we are doing because we are doctors. I could have done with someone to ask myself. Were my feelings normal? But instead, I put on a brave face, told everyone I was fine and plodded on. I thought it was just how motherhood was. “Sleep when your baby sleeps,” said the health visitor. Not a hope in hell. I lived in fear of her waking up, actual physical fear. I was terrified of my baby. Breastfeeding made everything worse and I could set my watch by the feeling of doom that washed over me at 5pm every evening.

I went back to work when she was 6 months old, to two emotionally draining jobs. It was when my daughter was 13 months old that I finally realised I needed help. I had barely had a positive thought for months. Nothing was fun and I was exhausted. If you look at pictures of me at that time, though, you wouldn’t have a clue: a smile was always plastered on my face. My mother, grandmother, four aunts and great aunt all had postnatal depression (PND). My sister has also developed it. I should really have known what was going on.

This is when my journey as a doctor/patient with PND began.

I went to my NHS GP, but she told me that medication wasn’t necessary and to try a local “depressed mums group”. It sure was depressing, and for me, utterly useless. I didn’t want to say what I did for a living because I wanted to be a patient, not give anyone else advice and this meant holding back from talking. I went back to my GP and got a referral to a private psychiatrist. NHS provision locally was woeful. The relief I felt on finding help was immense. Straight on meds and after a month or two, life began to feel better. I also had cognitive analytical therapy, which helped.

An added complication for me was the dilemma of disclosing my illness at work. There are many stories about doctors finding life very difficult after admitting to a mental health problem. So I kept schtum. It had never affected my work, so no reason to tell.

My career changed to general practice, I kept going and remained very well on medication. Then I decided to have another baby. This time the NHS showed just how brilliant it can be. My midwife made an early referral to the health visitor who visited me antenatally. When the antenatal depression hit at 24 weeks, my GP referred me to the local specialist perinatal health psychiatry team. Would this have happened had I not been a GP and known about it to tell them who to refer me to? I will never know.

This team was utterly amazing and looked after me through the depths of crashing postnatal depression which again came on

20

very quickly after delivery. Through my brain-fog, I wanted to be able to discuss the various meds with someone who knew exactly what they were doing, and who treated me as a patient, but one with more knowledge than normal. With help from them, my wonderfully supportive husband and friends, I got better and after six months it was time to return to work again. This time, both of my employers knew that I had been unwell, due to the two weeks off I had had during my pregnancy, when it got too much to work safely. The approach from the two was very different and it was the first time I felt vulnerable being a doctor with a mental health problem.

One employer sent me to see an occupational health doctor in Harley Street. This was, I think, to ensure that I wouldn’t do harm to anyone else, rather than to support me. Sitting opposite this older man behind a huge wooden desk was massively intimidating. Having to re-tell my history, which makes me tearful, made me feel vulnerable. What if he said I couldn’t work?

I was this man’s equal, we were both GPs yet I felt about one inch tall and very stupid in front of him. What if I hadn’t been a doctor, how would I have felt then?

Returning to my GP job was altogether different. Because so many mothers with PND become expert at putting on their smiling face despite dying inside, everyone thought I was back to my normal self. The reality was that I was terrified of seeing patients again. I had to ask for occupational health input. I worked reduced surgeries and did no phone calls for two weeks, then returned to normal. My first morning back was hideous. But I did it, I survived it and carried on. Three years on, I am working and well on medication, which will probably be lifelong given the course of my illness and my family history.

One in seven women suffer from a perinatal mental health problem. That means one in seven female doctors too and anecdotally I wonder if we have a higher risk. During the last year, as I have become more open about my experience, many others have contacted me telling me about theirs. They range from anxiety to psychosis. We are most definitely not immune and may make ourselves more unwell by trying to cope with it alone. Increased regulation has hardened the pressure to divulge ones medical history. On the Care Quality Commission form I had to fill in to become a partner, it asks if I have any medical problems that may affect my practice. This doesn’t now, so I said “no”. I am also asked the same question every year during my appraisal process. Luckily, so far, I have had appraisers who have looked upon my illness sensitively. I am dreading the first one that doesn’t.

We have a duty of care towards our patients that ensures we are well enough to work and we must take this seriously. Perhaps we need to be kinder to each other in medicine and allow mental health to be talked about, so that people don’t hide their illness until it gets to a crisis point. Acknowledging and accepting that some medical mothers will suffer from perinatal health problems would be a very good start.

Medical Woman | Spring 2015

Career Focus

Women in UROLOGY I asked three female consultants about their experiences as urology trainees and newly appointed consultants, and whether they would recommend urology to others.

Dr Charlotte Gath – Consultant in Public Health, Warwickshire County Council

A

mong the current cohort of urology consultants, those who are between five and 10 years away from retirement and who started urology specialist training in the 1990s, began their specialist training when the number of female trainees and consultants could be counted on the fingers of one hand.

Almost all the consultants and trainees, and even the majority of their patients, were men.

Since then urology has been steadily changing, as a result of the “feminisation of medicine”, reflecting the national increase of women in general practice and in consultant career grade posts. Currently 9.95% of all surgical consultants are female, and in urology the figure is 7.51%, slightly lower than ENT at 11% but higher than orthopaedics at 5.3% (data from the Health & Social Care Information Centre, census for NHS workers, Sept 2013).

SUSAN WILLIS is a locum consultant urological surgeon at Guys’ Hospital, London, having completed her specialist training last year. She has two young children. Susan recently attended the Royal Society of Medicine’s Urology Section Winter Meeting in Zanzibar, where she was one of three female urologists attending. It is an open secret that His Excellency the President of Zanzibar has himself had kidney stones and, as a chemical pathologist, he took a personal interest in the meeting. He attended one of the conference sessions, along with his security entourage, at which www.medicalwomensfederation.org.uk

Susan was asked to present the evidence around consuming hard or soft water in the formation of kidney stones. Despite the African heat and electricity supply (the lights went out twice during the session) and rather daunting atmosphere, Susan stayed cool and gave an excellent presentation, and certainly flew the flag for female (as well as male) urologists – see picture. She said afterwards that it was no worse than presenting to her consultant colleagues at Guy’s!

When asked what attracted her to urology in the first place, Susan says candidly that she never expected to become a surgeon, and selected preregistration house jobs on the basis of location, and what her friends were doing.

She says she ended up in a lovely DGH doing three months general surgery and three months urology. She was surprised to find herself enjoying general surgery, especially the teamwork and camaraderie – everyone there first thing, and all staying until the last operation was complete and the final patient seen on the ward round. What’s more, she says, she loved being in theatre. This wasn’t a choice – the house officers were often essential first or second assistants – forcing her to quickly gain some surgical acumen.

She was dreading the three months in urology; just old men and catheters, she thought. Well, she says now, that’s often true, but they’re delightful old men, in whom one of the most satisfying procedures in urology is frequently performed – the relief of acute retention.

Again, she was quickly involved with performing flexible cystoscopy and seeing emergencies in A&E. She thinks it’s this level of involvement in the team during early medical training that can really inspire you. She had a great registrar who really got her involved and was a great inspiration. Susan then saw how broad and deep the specialty of urology is, and says she never looked back.

Susan thinks one of the great things about urology is the variety of

procedures and sub-specialties. She is particularly interested in stone disease and endourology, and enjoys operating with patience and precision.

Susan has never found it difficult being in a small minority among urology consultants. In fact, she has always found colleagues to be welcoming and has not experienced (to her knowledge) any difficulty or challenging attitudes with colleagues in relation to this. Susan says that most days a male patient will ask why she chose urology (usually just prior to performing a prostate examination).

Would she encourage female junior doctors to choose urology and what advice would she give them? Susan says, “Do whatever you want to do, but be honest with yourself. We’re just people caring for our fellow humans. I honestly don’t see it as a male/female thing. I would say to any person considering urology (or any surgical specialty), to think hard about the life you want for yourself in the future. Look at the lifestyles of the consultants who are doing the things you enjoy – would you be happy to live that life?”

ESTHER MCLARTY is a consultant urological surgeon at Derriford Hospital, Plymouth. She enjoys the technological advances in urology and is excited at the arrival of Derriford Hospital’s latest gadget – the da Vinci robot. The constantly changing nature of urology fascinates her and she is happiest performing major abdominal and pelvic cancer surgery. The best part of her job is meeting patients, which remains her main motivation.

21

Career Focus Her original choice of general surgery changed to urology very early in her career when she was put off by the ‘in-fighting’ that she found so prevalent amongst the general surgeons.

Esther finds she is frequently asked by hospital managers to undertake much of the urology department’s organisation, who prefer to ask her over the male consultants. One of the biggest difficulties she finds is that as a department the urologists can have feisty and often unpleasant discussions, and whilst Esther reels over these for days, her colleagues seem to forget quickly. She finds the challenges of being a female surgeon are now so engrained that it just bounces over her. Esther would definitely encourage junior doctors to consider a career in urology but her advice would be to think about career progression very early on. She suggests prioritising family and personal life early.

JYOTI SHAH is a consultant urological surgeon at Queen’s Hospital, Burton on Trent. The mix of major open surgery and endoscopic surgery, and the immense relief men in acute retention get from something as simple as a catheter, was what originally attracted Jyoti to urology as a final year medical student. She enjoys general urology, cancer and male lower urinary tract dysfunction. The best part of her job is her patients and her love of urology keeps her motivated on a daily basis. Women remain a minority in urology although attitudes are slowly changing. Eighteen years ago she was referred to as ‘urobabe’ and is now asked what her husband does and whether she has children in interviews!

Women have come a long way in what is still a very male dominated profession but we still have a long way to go. Jyoti’s advice is to be the best that you can be and encourage others to follow your lead. As time progresses, we have to

hope that equality becomes reality. For those considering urology as a career, she would recommend enjoying the journey to becoming a urology consultant, which may be rocky but has to be fun. “I would encourage anyone to do urology. It is an incredibly rewarding profession with nice colleagues (usually) and lovely patients.

My advice is to find something you enjoy – you will be doing this for a long time as a consultant! If you really want to do urology, follow your heart and enjoy the journey. It’s not just about the end-point.”

MEDICAL WOMEN’S FEDERATION

Spring Conference 2015

STEPPING UP & SPEAKING OUT

Empowering Women Doctors & their Patients Friday 15th November 2015 – Macdonald Manchester Spa Hotel, London Road, Manchester M2 2PG

Speakers and Workshops to be announced…

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!

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

22

Medical Woman | Spring 2015

Feature

From the

DOCTOR’S PALETTE Dr Sandeep Ranote Dr Sandeep Ranote is a Consultant in Child and Adolescent Psychiatry leading young people’s eating disorder services, and Associate Medical Director at 5 Boroughs partnership NHS Foundation trust. She is the national strategic clinical network lead for CAMHS (NHS England); sits on the Royal College of Psychiatrists’ eating disorder faculty; is a professional media contributor for the charity BEAT; and has contributed a regular column to mental health and arts charity magazine ‘Reflections’ as well as mentoring training doctors and supporting the women in leadership agenda. She is currently part of the ministerial task-force for CAMHS. Follow her on twitter @DrSRanote

I

am delighted that Sara and the team at Medical Woman have invited me to do this as I am a great supporter of women in medicine and helping them to ‘lean in’, to realise their potential and follow their aspirations both personally and professionally. So sit back, relax, and join me: this is about developing a dialogue that I hope will continue through encouraging you to debate, discuss and reflect.

I’ve been a qualified doctor for almost 19 years, and a specialist in child and adolescent psychiatry for 10 of those years. So, where does art fit in? Well, that’s simple. Art is in everyone’s lives, irrespective of culture, background, employment, social class, or geographical setting and that’s what makes it so wonderful. It’s a universal language that allows us to connect with ourselves and the world, and I believe that we are all born artists. To be creative is all about developing through making mistakes. As Oscar Wilde said, “Art is the most intense form of individualism we know”!

I first found my passion for art as a schoolgirl. I was studying science subjects in a highly academic and sometimes intense environment, but it was also a school that encouraged us to be creative and allowed us space to achieve this. Creativity is something I feel we don’t do enough of in the workplace and at home now. I was 12 when I visited my first art gallery and fell in love with the space, the tranquility, the vibrancy, and the realization that it was a place where we could all go without ‘special invitation’ or ‘elite membership’. I soon learned that you did not need to be ‘an expert on art history and technique’ to enjoy the experience and leave with something positive and that in itself was liberating. This is when my relationship with art began, and almost 30 years later, continues.

I ran a partnership project, ‘Capture it’, with Manchester Art Gallery (2012) delivering wellbeing groups at the gallery as part of young people’s mental health recovery packages. The results were positive. I am a firm believer in therapeutic choice and the role of creative arts in keeping all of us well. There is a growing evidence base now with multiple studies to support this. A study by the Scottish Government (2013) showed that a higher frequency of engagement with arts and culture is generally associated with a higher level of subjective wellbeing and those that participated in a creative or cultural activity were 38% more likely to report good health compared to those who did not. There is also a growing neuroscience base to creativity and innovation being linked to distraction, often outside of the normal working environment, when dopamine levels are also found to increase. Studies at www.medicalwomensfederation.org.uk

@ The Tate Liverpool

Harvard have also supported this and the “three B’s theory” (Bath, Bed and Bus), suggests that creative thoughts are more likely to occur when on a break from the normal routine.

This week my ‘To do’ list began to look overwhelming – do you ever get that feeling that everything is getting on top of you, the world is closing in and you don’t know where to begin? If, right now, you are thinking ‘YES!’ then you know how my week was going. So, I did something we don’t do enough of: I took an afternoon off and visited The Tate Gallery in Liverpool. Although it was windy, bitterly cold and raining outside, once inside, my world began to feel colourful, warm, calm, and clear again. Why don’t we hold a mentoring or supervision session in an art gallery?

What about a team away day? Why don’t we create distraction areas within our healthcare workplaces that could have the potential to promote positive wellbeing as well as creative thinking and problem solving? Environment is a vital ingredient to supporting a positive outcome, and a space filled with creative arts that welcomes us all is a potentially powerful tool in improving our wellbeing. The NHS and the staff who work within it are under so much pressure right now that it is hard to ‘smell the roses’. Instead do their amygdalas smell fear? We are collectively working hard to provide our patients with improved environments and solutions to allow them to stay at home and out of hospitals, but in doing so have we become in-patients in our own wards?

Could creative arts be one solution? As Pablo Picasso said ‘The purpose of art is washing the dust of daily life off our souls’!

I am now introducing this wonderful language to my three children and my team, but I have realised very quickly that they need no introduction… we are all born artists!

23

Remote & Rural

Remote & Rural Gabrielle Deehan, gap year Medical Student, St Andrews Gabrielle is taking a year out of her medical studies, having completed her pre-clinical studies at the University of St Andrews, to compare the provision of remote and rural healthcare across the developed world with her experiences in Scotland.

W

e flew low in a tiny plane, trying to spot caribou on the plains below, on a bumpy journey returning from a brief visit to a remote Alaskan village, home to just 300 people. Inaccessible by land, the plane that drops off and collects the doctor on his monthly visits also carries the post and groceries: passengers must help with the loading and offloading before boarding.

As commutes go, it certainly beat cycling on city streets and dodging lorries. We were in the village for just twenty-four hours, with the doctor trying to see as many patients as he could, helped along by a large pot of moose stew.

For the first leg of my tour, I have been exploring healthcare systems in Canada and the USA. My expectations of incredible remote landscapes and interesting people with lifestyles so far from my own were wholly realised. I saw how small communities can group together to look after their own with varying degrees of success. I also learned a great deal about the traditional lifestyles of North America’s indigenous people – and how these ways have collided with the modern world, creating a cacophony of social problems with wide medical consequences.

Many of the communities I visited offer traditional healing practices, alongside modern medicine. These practices are blended to create services such as family treatments for behavioural problems, which involve counselling and wilderness sessions, designed to reintroduce the attendants to their lost cultural ways.

I was very fortunate to be invited to help build a sweat lodge in Northern Ontario, Canada, with some people who belonged to the Ojibwe First Nation, of Lake Superior. Sweat lodges are very important in Ojbwe culture – each is used for a different purpose and is maintained by a sweat lodge keeper, who re-builds the lodge at an interval mandated by the spirits.

Appropriately, the sweat lodge I visited – and helped to re-build – was a lodge for healing. The lodge building took all day: it was constructed with flexible branches from nearby trees, which were tied together with coloured cloth. Cedar branches were laid on the floor and a fire pit was constructed with rocks. The floor and frame were then covered and a long ceremony was performed, making offerings of food and tobacco to the earth and the spirits, preparing the lodge for use. When it was time for the sweat, the women donned long skirts in order to be closer to the earth, and we entered the total darkness of the cramped lodge. Large ‘grandfather’ rocks, which had been sitting in the fire all day, were then delivered to the fire pit, and water which had been collected from a nearby waterfall was poured on them. Multiple rounds of 24

rocks were delivered, accompanied by singing, instruments and prayers. It was unlike anything I have ever experienced before – the smells and sounds heightened by the darkness and the heat.

Needless to say, it was very sweaty.

Efforts to maintain traditional customs became a theme across the places I visited. In Alaska, traditional subsistence living, with food caught locally during the long summer days and preserved using traditional, highly industrious methods in order to last the winter, is at odds with the much easier option of less healthy foods on demand at the local supermarket. As such, there is great Medical Woman | Spring 2015

Remote & Rural

disparity between the health of those who follow a traditional lifestyle (often the highly respected elders) and those who do not.

I could sympathise with patients who wanted to lose weight but found the short, cold winter days difficult for exercising and fresh food to be very expensive, as everything is brought in by air.

A great deal of the healthcare in remote Alaska is performed by community health aides – members of the local community who travel to the nearest town for a few short training courses and are then responsible for delivering healthcare to their own community.

Health aides are well supported by colleagues in hospitals and clinics, who are reachable by telephone or videoconference. It is incredible how useful a good quality photograph or a brief videocall can be. The health aides are obliged to follow instructions in a manual as they work; a hefty tome of algorithms to follow for the most common patient presentations. Incredibly, this includes scenarios such as patients who have fallen in icy water whilst out ice fishing! Teaching local community members to care for their own is a positive thing for creating local jobs and a good solution to recruitment problems. However, every health aide I met had stories of how they were forced to attend to their own family members in emergencies. One woman recounted how she was the only health aide available to resuscitate her teenaged son after he was hit by a pick-up truck. She watched him die.

They keep secret, intimate, details of their neighbours’ lives, help friends and foes in need, and even after experiencing tragic death in their own communities, they continue to care for their own with pride.

If you’d like to see some pictures and read more about my adventures, I am blogging at R and A scholar.wp.st-andrews.ac.uk. www.medicalwomensfederation.org.uk

25

Top Tips

TOPTIPS

for

MEDICAL STUDENTS PRESENTING PATIENT CLERKINGS

By Sonia Onyeka, 4th year medical student, St George’s University of London

1 2

TAKE A COMPREHENSIVE HISTORY FROM THE PATIENT Aim to take a thorough history from the patient first. This avoids creating noticeable gaps and avoids an onslaught of questions from the doctor afterwards. If necessary, use the medical notes, but only after speaking to the patient. The notes may provide you with extra details you may have omitted.

Remember: a clear history leads to a clear summary.

MAKE IT FLOW The aim is to tell a story; in a logical order. This makes it easier for individuals who are listening to understand.

3

AIM TO SUMMARISE THE PATIENT HISTORY IN A FEW SENTENCES After presenting the full patient history, it is good practice to conclude with a brief summary of the case in three to four sentences. You may also be expected to include your differential diagnoses and management plan at the end of the summary, so be prepared to do this.

4

ALWAYS MENTION THE RELEVANT RISK FACTORS OF THE PATIENTS EARLY WHEN PRESENTING Stating the risk factors at the beginning of the history paints a vivid picture and gives helpful clues towards the end diagnosis. For instance: a patient with diabetes, a history of smoking, and cramping pain in the lower limb supports a differential diagnosis of intermittent claudication.

5

MENTION THE IMPORTANT NEGATIVE AND POSITIVE FINDINGS ON EXAMINATION If the patient was examined, describe the key positive and negative findings because this rules in/rules out various pathologies that may be responsible for the patient’s presentation.

6

ADAPT THE SUMMARY ACCORDING TO THE SPECIALTY An awareness of your audience helps tailor the history appropriately. For instance, it is important to discuss the social situation when taking a history from a geriatric patient in more depth compared to other acute medical specialties.

7

PAY ATTENTION ON THE WARD ROUND Observing a ward round is a great way to learn how members of the medical team summarise a patient to each other. It is an opportunity to make note of the presenting style used between doctors and incorporate this into your own repertoire.

8

PRACTISE! Presenting patients is a skill and, just like any skill, to improve you must practise. In reality, it can be challenging to pin down a doctor on a busy ward so make use of your placement partner(s) or anyone else who is willing to listen.

9

BE CONFIDENT Your presentation skills won’t be perfect the first few times but confidence can go a long way.

Take your time. Rushing makes you appear uncertain and leaves the listener unconvinced by the history.

10 26

ALWAYS GET FEEDBACK Constructive feedback from experienced doctors and even peers can be invaluable. Make sure the feedback is specific, identifies areas for improvement and gives practical tips on exactly how to improve for the future.

Medical Woman | Autumn 2014

Wall of Wisdom

The Wall of Wisdom This issue’s question was:

“WHAT’S YOUR TOP TIP ON ACHIEVING WORK/LIFE BALANCE?” “I have a rubbish work/life balance, but I appreciate that’s what comes from priori tising the two things that I love: my family and being a partner in general practice.

In terms of advice, I keep separate email accounts for separate work streams. I have a perso nal email, and also a separate account, for example, for British Medical Association work. I find accounts that sort discussions in thread s are most helpful. I also use online docum ent storage that I can access from any of my electronic devices. I don’t use remo te login to my work desktop as I feel email can encroach enough on home life, and I need a clear boundary from clinical work.

I record notes from meetings contempor aneously electronically and disseminate them immediately for comments. This ensures timeliness, accur acy and efficiency. I protect one midweek evening per week to ‘clear the decks’ at work and tackle ongoing projects. Giving myse lf a defined period of three-four hours after surgery closes, focuses my mind on the tasks at hand. It’s easy for work to expand so set a limit and try to stick to it.

The person that stays at work the longes t isn’t necessarily the one who works hardest.

Instead, try to ‘work smart’.”

Dr Katie Bramall-Stainer is a six session partner in Hertford and a member of Herts Local Medical Commitee, and BMA General Practitioners Committee.

“Never feel bad about being a working mum. It’s a really good role model for your children. I worked part time, although I was never explicit about it. Most people thought I worked elsewhere when I wasn’t at my job. Many men work across several sites, thus I never felt guilty about splitting my time between my children and work.

My children frequently tell me they are really proud of my achievements. That makes it all worthwhile.”

Dr Caroline Allum, Medical Director, Hertfordshire Community NHS Trust

BE REALISTIC

TIME – Be realistic about how long things will take to prepare, how long things will take to achieve and even how long it will take you to get to work so you do not start late. If, realistically, you do not actually have the time to do the task then be sure to learn to delegate or say no for everyone’s sake.

GOALS - Be realistic about what you and others want in life and be true to your wishes and needs, concentrating on the things that really matter to you. This should help to achieve some work –life balance and may also help you to deliver what others want and need. Do not set yourself up to fail but set realistic goals which are interesting, achievable and push your boundaries. Pick only fights that really matter. Doing tasks you do not want to do can lead to difficulties in time management and can prevent you achieving your real goals in good time.

Being realistic means accepting that good is good enough and one does not always need to strive for perfection in everything. This is somethin g that can be difficult sometimes!

Dr Frances Cranfield, Senior Partner General Practice in Hertfordshire, Assistant Coroner, GP Expert Witness

the night before - clothes out, Get everything ready for the morning g and getting stressed in the rushin bags packed, shoes ready. If you are earlier too)! I get up for a bed to go (and earlier up get just mornings, them up 15 minutes earlier wake then kids, the e befor hour shower half an the start of the day! at time’ le ‘cudd es minut than we need to for 15 everyone - makes for es cuddl and me Milk for baby, cup of tea for a happy start to the day. registrar/Academic Clinical Fellow Bristol Dr Jessica Watson mum of four and GP

www.medicalwomensfederation.org.uk

“Top tip from me (and it’s only taken nearly 13 years of kids to implement): meal planning and once a month cooking. It means evenings are far less stressful, you do not need to decide what to cook, just get it out of the freezer in the morning. On work days my 12 yr old will put it in the oven ready for when I get home from work with the younger two children.”

Dr Clare Dyer, GP Partner and CCG lead, Watford

“Have the best childcare you can afford - it will enable your brain to focus on work when you are at work. On-line supermarket shopping. Create a list based on a meal plan. Takes 10 minutes at the weekend and saves so much hassle in the week.

If financially viable, get a cleaner for your house.”

Dr Stephanie De Giorgio, GP Partner in Kent & Co-founder of Resilient GP

balance ones responsibilities over the years.

“The key has been to develop an approach to a few tips in order to succeed: down laid but n I realised I was no superwoma • Let go of guilt. tionist and learn to • Create your own standard - stop being a perfec make compromises. will be a happier person.

• Live to your own standard and in turn you dar of everyone’s activities calen a • Good organisation/ delegation - keep . phone your or on may it be meeting friends for coffee, • Find time for yourself - find ways to relax, ar amongst Asian women, which in popul s spa days with friends, or kitty partie too. y famil and work your t benefi will turn comfortable with and have confidence • Reliable childcare- find someone you feel observe the interaction between your and them in, communicate frequently with children and the carer. at short notice. One may have • Flexibility - be willing and ready to do things negotiate for what you need. and ss succe ve to substitute new goals to achie re of friends, family and work. mixtu good a with ective persp in • Keep all things as to how one combines career, on decisi nal There is no single formula and it is a perso spouse, and children” rary Lecturer at Bart’s and London Trust Dr Sushma Shah, GP Principal and Hono

creative with what you can manage “I think it’s about being realistic but to serve home-cooked food so I know and deciding on your priorities. I like y sugar or salt, but I’m perfectly happ it doesn’t contain lots of hidden fat, time, so I n ratio prepa on save to ables veget to use pre-chopped, frozen and pop in a load of stuff before work make good use of my slow cooker, e wher itask mult to try also I . home have a lovely meal waiting when I get t listening to whils days, mic acade my on on possible: I walk to the stati ad and “reading” all at once, then inste an audiobook - exercise, commute listen and time” “me as it use I le, of viewing the train journey as a hass That way, I’m relaxed when I get to to my audiobook whilst crocheting!

I do have at home with my husband work and can spend what free time ing out on doing things for me. “ miss and son, without feeling that I am Teacher Development Lead at Dr Kerry Boardman, GP and Community n Londo e Colleg King’s GKT School of Medicine,

27

Obituaries

OBITUARIES PRUDENCE BARRON, MBE, FRCS (EDIN) (nee Halton)

DR DULCIE GOODING – LADY REID

Born: 16th September 1917 Died: 10th October 2014 m Arthur Barron, OBE, FRCS (2 daughters, 1 son)

Born: 22nd October 1933 Died: 24th October 2014

Prudence was born (1917) in India where her father was serving in the Army in WW1. Her mother was eventually able to bring her home to Carlisle in 1918 and after attending school locally, Prue, as she liked to be known, moved on to Cheltenham Ladies’ College.

Having always been fascinated by hospitals as a child, her enlightened mother encouraged her to apply for medicine. In October 1936 she went up to the London School of Medicine for Women, (The Royal Free Hospital). In May 1939 she started a clinical attachment at The Royal Free Hospital; however clinical experience became very fragmented during the war, attending clinics from Bedford, to Woking to Luton. She sat and passed her finals in June 1942, becoming MBBS. Prue was asked to do a locum at Cumberland Infirmary, Carlisle and there she found she enjoyed surgery. ‘It was easier than listening to strange noises in chests’.

In October 1943 she went to work at Bruntsfield Hospital in Edinburgh with the surgeon, Miss Gertrude Hertzfeld – ‘A great surgeon and a very hard task master’ – and then at the Sick Childrens’ Hospital in Edinburgh as a clinical assistant. Having passed her FRCS in July 1945 just after VE Day, there followed surgical paediatric posts at Carlisle and Birmingham.

It was in Birmingham where Prue assisted at the first paediatric open heart operation.

When she was demonstrating in the Anatomy Department back at Bruntsfield Hospital, she met and subsequently married fellow surgeon Arthur Barron. They were married in 1950. As at that time it was not considered proper for consultants’ wives to work, Prue resigned her post.

Five years and three children later, she started working part-time as Medical Officer (M.O.) at Crawford’s Biscuit Factory followed by parttime in a General Practice in Leith, welfare clinics and GP locums.

In 1967, having done a locum the year before, Prue was appointed M.O. for geriatric beds at Queensberry House on the Royal Mile in Edinburgh where she worked for ten years until becoming a Geriatric Associate Specialist based at the Royal Victoria Hospital. It was during this time, in 1971, that tragically Arthur died of a stroke; on 22nd July 1975 on what would have been their 25th wedding anniversary, Prue was invested an MBE for services to geriatrics. Latterly she undertook voluntary work at St Columba’s Hospice in Edinburgh, remaining dedicated until finally retiring in 1983.

Prue was a member of the Medical Women’s Federation for 66 years and held the Chair of the Scottish Eastern branch. She actively encouraged young medical women with moral and practical support. Throughout, Prue found time to devote to various voluntary organisations, becoming leading lights in Mothers’ Union, Marriage Guidance and chairman of Edinburgh Cruse Bereavement Care. Through all the years, Prue has been a steadfast friend and supporter to very many grateful people.

Dulcie was born and brought up in London and qualified as a doctor in 1959 after training at the Royal Free Hospital Medical School, London University.

After her preregistration posts in Hampstead General Hospital, she trained at the London School of Hygiene and Tropical Medicine, obtaining their Diploma in Public Health.

She was medical officer of a school in the London Borough of Hounslow for deaf children which also had a specialised unit for deaf blind children born as the result of their mothers contracting rubella during early pregnancy.

She moved from London to Aylesbury in the mid 1960s when she was appointed to the staff of the Medical Officer of Health in Buckinghamshire, Dr – later Sir – John Reid, who she later married.

She was responsible for planning the medical services for the new city of Milton Keynes. Such long term strategic planning was a part of her career that she especially enjoyed.

She moved back to London when she was appointed as the Area Medical Officer for the Borough of Brent and Harrow. At that time, she was the only woman in the country to hold such a post.

She moved to Oxfordshire to work on medical staffing at the Oxford Regional Health Authority with Dr – later Dame – Rosemary Rue. She worked with Rosemary to facilitate the part-time work of doctors who for personal reasons were unable to work full time. Although this scheme was open to both men and women, the majority were women and it allowed many women doctors to work part time while their children were young and return to full time senior posts later. This project set a precedence for schemes involving part time post graduate training which were adopted nationally. Dulcie was proud of her contribution to policies that helped to overcome some of the obstacles for women in medicine.

Dulcie made a succession of lovely homes, in London, Buckinghamshire and Oxford before moving to Bosham in her retirement. She inherited a property developer gene, and would begin structural alterations wherever she moved. Dulcie was also a passionate gardener. She relaxed with her embroidery, painting and reading – especially history, and while living in Bosham she attended a course on modern history at the University of Chichester, which facilitated her own work on her family history.

She worked with and later in her retirement married Sir John Reid.

They sadly had only a few years of happiness before his sudden death.

She enjoyed supporting him through his year as president of the BMA and travelling with him to professional commitments in Europe and America.

Her final illness was long and a prolonged decline allowing her to continue to work at home on her family history, but preventing her from enjoying her last years as fully as she would have wished. Ever practical and independent, she arranged for her care in her own home to within a few weeks of her death. Dulcie had two children by her first marriage, a daughter and a son, and three grandchildren.

Doreen Dinwoodie

28

Medical Woman | Spring 2015

Dr Iona Frock

Nine to Five Dr Catherine Harkin, GP, Scotland Illustration by Laura Coppolaro

It was five to six. Iona glanced contentedly at the clock on the wall as she typed the last few notes into the computer. It was all working out rather well. Despite being duty doctor she had managed to crack through the on-the-day patients with more than her usual efficiency and stem the flood of repeat prescriptions, results, forms, and phone calls; and it really looked as though she might be getting away on time. After all, it was important. She recalled the irritating conversation with Seonaid’s form teacher that had sparked this sudden burst of clinical ruthlessness: “Do you think you’re going to make it to the parents’ evening, Iona?” Miss Fox had said, in that tone that suggested Iona was a small child failing to tie its own shoelaces. “Seonaid was so disappointed last time, and we find that when a child is struggling it really helps if they have support at home...”

“She is not “struggling”,” Iona began, “and if you had a better handle on those bullies –” but Seonaid tugged her sleeve and shook her head warningly.

“Anyway,” Miss Fox continued, “now that you GPs only work nine to five it shouldn’t be that difficult, should it? So we’ll see you next Wednesday...”

Iona took a deep breath, but then surveyed the dark circles under the teacher’s eyes and decided that the comment she had been about to make about long holidays and short hours would be unkind, so she smiled through gritted teeth and promised to do her best to attend. www.medicalwomensfederation.org.uk

And tonight was the night. Two minutes until the phones went over and she was free. With a satisfied smile Iona rolled back her chair and bent down to pick up her bag, at which point her desk phone rang.

“It’s Mrs. Mone,” said Lucy’s voice. “With chest pain. Again.

I’ll just put her through.”

As the conversation proceeded along its familiar tramlines Iona thanked her stars that video consults had not yet reached their neck of the woods, and the patient couldn’t see the rude faces she was making. Unfortunately, the last time Iona had seen Mrs Mone had not been one of the 9,999,999 times her chest pain had not been cardiac but the one time when it had. However, the dramatic collapse two hours after Iona had reassured her it was nothing serious had certainly given her neighbours something to talk about, and the supercilious letter from cardiology had made a good topic for a Significant Event Analysis.

“Going to see her?” said Lucy, as Iona raced towards the door.

“Shall I call the school and tell them you’ll be late?”

The ensuing drama was such that Iona had to ignore the persistent chirping of her mobile until the ambulance had hurtled off into the distance. Tired and hungry, she glanced at the screen: a text from Lucy that said, “Go home. This is Tuesday. Parent nite 2moro.”

It was so nice to have a nine-to-five job...

29

MEDICAL WOMEN’S FEDERATION

Autumn Conference 2015 6th November 2015

The Light, Friends House, 173 Euston Rd, London NW1 2BJ

BUILDING RESILIENT LEADERS Speakers: Prof Amanda Howe Vice Chair RCGP & President Elect of WONCA

Vijaya Nath, Assistant Director Leadership Development, Kings Fund

Niall Dickson Chief Executive and Registrar of GMC

THE LARGEST BODY OF WOMEN DOCTORS IN THE UK LOOKS FORWARD TO

A year in the life of a Royal College President

MEETING YOU!

Dr Suzy Lishman, President of Royal College of Pathologists

Careers interview Dr Dora Black, Honorary Consultant Child and Adolescent Psychiatrist at Traumatic Stress Clinic, London

Why not submit an Abstract?

We will be welcoming abstracts on any topic related to the conference title or women doctors or women’s health.

Deadline 12th September 2015

Formal Conference Dinner 6th November 2015 Hilton London Euston Hotel, 17-18 Upper Woburn Place, London WC1H 0HT We will be joined by Clive Anderson television & radio presenter, comedy writer and former barrister

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