Stating the (not so) obvious

This is a strange, new, and frightening world you have entered.  This was not in the plan.  Nothing in the baby books or parents evenings told you about this. There is no page for this in the red book.

There are machines which beep; attachments and contraptions; devices, syringes, computers.  Some of these we will explain.  We will tell you about the machines which go beep and the medicines we give.  You will learn more in the next few minutes and hours than you ever thought you could.  More than any parent ever wanted to know.

We will try to explain.  We will not.

We will forget to state the obvious.  We forget that what is obvious to us is a new world to you.  Not the medicines and the machines, but the rules that make this little world work.

We will say we have no restrictions on visiting, that you can spend as much time as you like watching your child.  But there will be times when we ask you to leave.  Sometimes you will know this is coming and we will have time to explain.  Sometimes, it will happen in a hurry and we will hustle you out.  The minutes will drag on.

When you finally drag yourself away, we will tell you that we will let you know if anything changes.  But you will come back and see that the numbers on the machines have changed;  there are more syringes than there were an hour ago.

We will tell you that your child needs this level of care.  That they need the machines and the syringes and the monitors.  Then we will move you to another ward.  We will remove the machines and the monitors.

All of this is terrifying.  It is our normal.  We forget that this is not normal, that our world has different rules that make no sense to anyone else.

I’m sorry.

Please help me remember



Telling other people’s stories

Today was the first “real” outing for my PhD research.  I know I talk about it all the time to friends, colleagues, family, but this was a proper presentation to a group of strangers in an academic setting.

And I was nervous.

Not nervous of presenting as much as nervous of getting it wrong, of mis-representing what was shared with me.

Participants in research give so much of themselves in these interviews.  They let me see into their lives in a way that overwhelms me. I remember the first time I took a history as a medical student and the sense of awe that I was allowed access into someone’s life in a way that I would never have normally.  Collecting research data is that feeling magnified.  And even the phrase “collecting data” seems so inadequate for what is being entrusted to me.  I have to find some way of respecting that trust. And what I want to do is capture each individual story; each glimpse into someone else’s life in its entirety.

But that’s the research.  I’m looking for patterns and themes across these stories.  I need to be able to pull threads out from people’s lives, to see each idea, before weaving it back together. And I’m a person with my own experiences and memories.  There’ll be a piece of me in this research, and the research will be in me.  Creating a new story that is at the same time more, and less, than the individual elements.

Who am I to decide what to include? How can I say what matters or what is important?  What right do I have to pick and choose which stories fit my narrative? Who gave me the power to tell a story around other people’s lives?

They did.

I only have these stories because they chose to share them.   Because they allowed me in and let me listen.  Because they felt it mattered that their experiences were shared, picked over, interpreted, re-interpreted, re-told…

I’ll do my best not to mess it up.



Many hats 

One of the things about being a Paediacademiatrician is that I end up wearing many hats/roles/jobs. (It’s also true that I own many real hats, but I’m not always so good at wearing them. I just buy them because they’re pretty.) 

One of the best things about working this way is that I get to do things that I wouldn’t be able to do if I was a straightforward clinician. Yes it’s busy, but it’s also incredibly exciting and rewarding.


Having many hats = good.

Wearing many hats = also good (see above)

Trying to explain to people around you that you have many hats & you feel quite strongly about wearing them and that they’re actually quite important… Not so good.

Trying to wear your “I’m a grown-up who is used to being taken seriously” hat when you’re talking to the people who give you the “hello minion” hat to wear = epic disaster.

The reality, my reality, is that there are parts of my life where I get taken seriously and what I have to say counts for something. And there are parts where it doesn’t. And keeping the two separate is getting more and more difficult. 

Because the things that I see & know & learn are important. They matter: not to me personally, but to all the people they affect. And increasingly, I feel that I can’t just let things go. That it is my job to challenge and question. 

So, maybe it’s time to stop wearing the minion hat.

Yellow was never my colour anyway.


The O-word has been cropping up a lot in the discussions about the junior doctor contract recently.

Overtime: 1. time spent working at your job that is in addition to your normal working hours; 2. the money paid for work that is done in addition to your normal working hours

One of the problems is the way in which the term is used, and what it means to different people.  For the employers in this dispute (whoever they are, Trusts, HEE, NHS England… have we worked that out yet??), the overtime is all about money.  That makes sense: it’s easier to quantify within a huge system.

But for the staff working in those organisations, overtime gets a bit more complex than that.  And that gets frustrating when we’re told that there’s a financial incentive to work unsafe hours.  (Apart from the belief that we have some kind of choice over the hours that we work – we don’t.  We get issued with a rota)  And yes, if you do a locum shift because there is yet another rota gap that hasn’t been filled, then most people will claim for that.

That’s not what overtime looks like for junior doctors.

Overtime is spending hours after a night shift trawling through patient notes, collecting data to complete audits.

It’s going in to work on your day off to teach and mentor and support your juniors; to present the audit; to write a guideline.

It’s giving witness statements and writing safeguarding reports and completing child protection paperwork.

It’s taking annual leave and using that to catch up on clinic letters.

It’s trying to get your mandatory training done while your partner watches films in bed and wonders why you never, ever seem to stop working.

All in our own time.  

On our days off.  


Just to get the job done.


It’s (a bit) about the money


Here’s the thing.

Last year, I spent more on clinical training than I did on my mortgage.

Last year was a quiet year.  (I’ve been trying to concentrate on the PhD).  It was about 1/3 less than 2014 where I got a bit carried away and thought that I could do a PhD and spend the time learning medicine.

It definitely wasn’t as expensive as the 2009 – 2012  period when I was preparing for exams, buying revision books, and paying for online and face-to-face courses just so that I could progress to the next level of training. (Total cost = around £5000.  I was lucky)  Oh, and paying for the MSc (£10,000).  Plus all the usual costs of training and courses.

It’s a rough ball-park, but even if I use my “quiet” year as a guide, I’ve spent at least £44,000 on post-graduate education.

You could argue that it’s my choice to do this.  And it is.  Nobody made me do a MSc (it’s just kind of important before you attempt a PhD).  Nobody made me do post-graduate exams (except that Membership of a Royal College is a pre-requisite for progression to being a registrar).

Learning about the neuro-psychological impact of cancer treatment isn’t in my mandatory training (unlike learning that fires really, really like oxygen) – but I think it’s kind of important to understand so that I know what questions to ask families when they come back to late-effects clinic.  It’s apparently not essential that I learn about end of life care (although it bloody should be), but what kind of service would I provide to families if I didn’t?

I love my job. And I don’t think that I will walk away from it.  (Last week I got given a Starburst by a patient and I was told to eat it.  My job is fantastic)

But I am starting to think if I am going to continue to invest in my job rather than my life.  I’m wondering if it’s really more important to constantly try and improve my practice, or if maybe I can stay in something more upmarket than a Travelodge occasionally.  If perhaps it would be nice if I had the kind of house where two people could fit in the kitchen at once.

I spent more on my training than I did on my mortgage.



Reflecting on/in language

My partner will quite happily tell you that I am very, very good at seeing nuance in the words that people use.  On a really bad day, I’m quite capable of turning “hello” into an existential crisis (and all before he’s had a chance to drink his tea…).

The language that we use matters.  This is one of the things that I’ve taken from the fab work that #MatExp have been doing – all those phrases and terms that we use as healthcare professionals without thinking – and the impact they have on the people hearing them.

I keep thinking about how much I’ve learnt from doing this PhD.  All the opportunities that I’ve had to talk to people that I just don’t have when I’m at work.  (And lets be honest, it’s the talking that I really love about my job).  And how much of a culture shock it’s been.

And maybe I’ve got just a little bit complacent.

Because now I’m writing up results. In formal, PhD-acceptable, academic language.  And as I’m writing, all those things that I thought I’d learnt about are flying out the window.  I find myself using words like “compliance” to talk about the decisions that families make.  I’m writing more approvingly if the families and professionals agree about issues.  I’m writing about how “difficult” it is for professionals if families dare to disagree with them…

One of the reasons that I like the e-portfolio emphasis on reflection is that it makes me write.  And as I write, it helps me think.  Hopefully, thinking will help me change what I do.

PhD writing is making me realise how much more there is to change.

Starting with an epic re-write of my current chapter… #hownottogetaPhD

Calling all paediacademiatricians…

The one thing I’ve realised as an academic trainee over the past 8 years (that went quickly) is that it’s very easy to become quite isolated.  I think this is something that all trainees experience: we rotate around every 4 – 6 months; you rarely meet your peers apart from at occasional training days; and you’re not even on-call with other people from your speciality.  Apparently there’s something called a “doctor’s mess” in our hospital, but it’s over on the adult side and I’ve never been able to get there.

Add in the academic side of training, and things can get much worse.  For one thing, we’re even more scattered (I work with colleagues in the same department, but in different buildings on campus); and we work even more bizarre shift patterns because of trying to combine the academic and clinical commitments.  This either means that you have blocks of time where you only see your research team; blocks of time where you only see your clinical team; or entire years where you don’t really get to know anybody properly because you split your time between two completely different spheres.

It leads to problems.  It can lead to isolation and a general feeling that you have no idea what you’re doing.  It leads to more practical issues, like not knowing when the application dates close for College exams or what your status is with the junior doctor contracts.  It means that you miss out on learning opportunities and experiences, just because you can’t find people in a similar situation.

I know that some places have regular get-togethers for their clinical academics, but I still don’t think that’s enough.  We work in increasingly specialised fields – the people having similar challenges to you might not be in the same University or even Deanery – but I’m sure they’re out there.  If you’re in a small unit, then the people around you may also be your supervisors and mentors… Not always an easy situation to discuss ideas or have a mini-panic in.

So, I suggest that we set-up a network of paediacademiatricians (something similar to our local group).  I don’t know what it looks like yet, but it has to be more accessible than face-to-face.  Meetings are lovely, but they can’t be the only option for trainees with complex rotas based all around the country with night shifts!

What would work? A website for basic information (conferences; exams; contact details for peer support)?? Regular twitter chats? (with a shorter hashtag than #paediacademiatrician)

Please help. Let me know what you want it to look like.

And then watch this space🙂

Equality in thought and deed?

Last week I got to go to the Royal Society’s annual “Diversity” event.  I admit that I went into this meeting with a certain amount of cynicism (just for a change).  Visible differences are much easier to address than hidden ones.  Much of the focus was (predictably) on promoting ethnic and gender diversity.  I’m not usually classed as an ethnic minority (half Welsh and half Latina – see what I mean about visible differences?)

I am however a woman: an easily recognised minority in science, especially in the higher rungs.  But I’m not aware of having experienced any gender discrimination in my science career.  I’m lucky: I work in a research field that is largely dominated by female researchers; my research group is almost entirely female.  I’ve never felt that it’s an issue.

This is very different to my experiences in the NHS.  Again, I work in a field that has a slightly higher number of female trainees than others, but the expectations of me as a woman are completely different.

“When are you getting married?” might seem innocuous, but it reinforces the message that I’m expected to see this as a goal in my life.  It’s often followed by “when are you having a baby?”.  It’s not “if” but “when” – again, as though this is something that I should be doing.  

This is just social chat amongst peers.  Much more damaging are the statemetns by my seniors:

“you’ll never be any good as a paediatrician until you’re a mother” still haunts me.

Being told that “doing a PhD is not an acceptable reason to work part-time; you should be raising a family” was easier to shrug off – at least it was an open acknowledgement of something rarely acknowledged: regardless how many other aspects to your life, a woman is seen primarily as a potential mate and mother.  Not a Professor or a Clinical director or a Chief Exec.

Universities have put a huge amount of working into ensuring “family friendly” working environments; funding bodies emphasise their family leave allowances; institutions have diversity officers… What about the NHS?

If we’re going to recruit the best people to research, then we need to make sure that these kind of attitudes aren’t allowed to stifle ambition.  We need to stop defining women as proto-mothers above all else. And we need to focus our attention away from the universitites to the wider environment, including the NHS.

I am not a mother in waiting; I am not an incomplete wife.

I am a PhD candidate and paediatric trainee. I am a baker of breads and cakes.  I am a cat owner (or owned).  I am a pole dancer and occasional aerial hooper. 

Define me by the thoughts in my mind and the works of my hands and my body; not by what my colleagues think I should be doing with my womb.

Working weekends

Here’s the thing: I hate working weekends.  Not because of the loss of time with other, non-healthcare people.  I’m quite capable of feeling up every “free” weekend with conferences or meetings anyway, so that doesn’t make much difference.  And I don’t mind working night shifts over the weekend either.  But I dread working Saturday and Sunday day shifts.

I hate it because despite the fact that junior doctors have a #7dayNHS the truth is that patients don’t.  We don’t have the same staffing levels or the same access to services at 10am on a Saturday as we do on a Tuesday, and so the care that we provide on a weekend is different to the care that I can (usually? hopefully? aspire to???) provide during the week.

Especially at this time of year, there’s a lot of pressure to be a certain type of doctor.  The tasks of medicine seem to take precedence over the art.  A ward round is encouraged to be a “business round” to get things done; get through the tasks; move on and on and on…

It’s not my kind of doctoring.  It makes me uncomfortable; it makes me worried; and (I think) it makes me a worse doctor.  I suspect it even makes me less efficient in the long-run as I reach emotional exhaustion much sooner.  A grumpy penguin is not one that you want in your team.  I really, really doubt that you want one as your doctor.

So, last weekend, I did something different.  I thought what would happen if I came home every night after my shift and could go through my day with someone that I trusted, and who would understand things from the patient’s side.  How would I feel telling them about my day?  Would I feel happy about what I’d done? Or would I feel ashamed about the way that I’d acted and the care that I’d given.

I don’t really buy into the whole concept of “What would X do?”.  It’s far too easily manipulated to what we ourselves want to happen, particularly if the person in question is a historical figure, 2000 years old with patchy fragments of oral history to form an idea of.  But I know a little more about what I’m like, and how I feel.  I know what I’d be happy to share, and what I would want to hide from the people that I respect and trust.

Eight months ago, I lost one of those people. And now I can’t go back and tell him about my day and which bits I cocked up.  But I can think if that was a shift that I would have wanted to tell him about; if he would have understood the decisions I made, or if he would have gently (but quite firmly) told me off…

It was a much better weekend.  Maybe I did take a bit longer with each patient; maybe it wasn’t (on the surface) the most time-efficient ward round I’ve ever done.  But it’s the first weekend in years that I’ve come home and not felt disappointed in myself.  It’s the first weekend in a long time that I haven’t felt cross or frustrated; I had fun with my patients – there was paint and Lego and proper paediatrics involved.  And I think it’s a weekend that I would love to have shared.




Monitoring: the end?

I have just completed my diary card for the week.

This may be the last time that I can.  And despite my love-hate relationship with “monitoring” and my concerns about its utility, losing this is one of my primary reasons for voting #yesyes to strike action.

If you’re not familiar with it, “monitoring” is a way of checking that the hours worked by junior doctors match up with those that they’re rostered to work.  It’s supposed to provide a check on excessive hours by imposing financial penalties on Trusts who repeatedly breach these contracted hours (e.g. if there are too few staff for the workload, or if people have left without adequate cover being provided).  If you draw an analogy with driving offences, monitoring is the equivalent of a speed camera.

It’s a patient safety mechanism.

But it’s more than that: it’s a realisation that there is a gulf between the work outlined in our contracts and job descriptions, and the work that actually happens on the floor.  It’s a recognition that we work in a service where demand is variable and that healthcare professionals will meet those demands.  It is an acknowledgement that we don’t work “to rule”, and that our professional code is such that we don’t just “clock off” on time.

It’s useful for other reasons: it asks you to record if you’ve had a natural break – for years, I thought this was a polite way of asking if you’d had a chance to pee during shift.  Recently, the form has been updated to explain that this is the 30 minute break we’re supposed to get. (The answer is usually no to both questions).  It’s a useful check for me sometimes to realise that I don’t actually work every day of the week, and that maybe I need some days off.  There is an option for “day off”, but there isn’t an option that says “Yes, I know it’s my day off but when else am I supposed to write my clinic letters?”

It is by no means perfect.  The Trust have to collect the data, but the responsibility lies with the individual to defend the hours that they have worked.  Experiences such as being called in to see the Clinical Director to explain why you stayed late are not uncommon; Trainee Encounter forms (usually used to pick up trainees who are struggling) have been used to report individuals for having poor time management if they complete their monitoring accurately.  It can be “explained” to trainees that a post which consistently breaches the hours agreed will result in those posts being withdrawn, leaving their colleagues without a job…

I never thought I’d be sad to see it go. But the thought that this may be my last monitoring exercise makes me deeply, deeply worried for the future.