Starting to feel like a grown-up

I am not comfortable with being a grown-up. Responsible adult? Yes. Being “the sensible one”? Quite definitely. Having a mortgage and a job? Done that; doing that. But real, actual grown-upness? Knowing what I’m doing? No. Not comfortable with that, at all. 

I’ve been very happy with my status as the baby on a team; I’ve reminded people of it continually. I bring cakes to work because “the junior brings the snacks”. I have to pause before I answer the phone with “registrar” ( and I still forget sometimes); I walk to work reminding myself what my job title is…

So, no. I am not comfortable with being a “grown-up” and that is not how I see myself. In fact, it’s something that I will run screaming from. Or so I thought.

I’ve had a fantastic week (I know it’s only Thursday; there is so much potential for things to even themselves out). I’ve been to the BMA’s annual meeting; I’ve met some fantastic young people who want to apply for medical school at a “speed mentoring” event; and I’ve eaten some great steak and drunk lovely wine with an amazing team of foundation year academics. 

And I’ve had it forced home that I am an adult now. I’m a grown-up. There are some advantages: people listen a little bit more; there’s some experience that I can share (even if it is that stuff is hard and life can be really, really sh*t at times).  I can see things changing, improving…

I’m definitely not a “guru” – although I still think that should come with some kind of hat/cape combination – but I might be ready to start being a grown-up…

Now… Where’s the Lego?

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Diabetes week: Skin in the Game

From one of the amazing people who takes the time to (try to) make me a better Dr.  

Betabetic

If you’d asked me about diabetes a few years ago, I would probably have had an opinion. I’m not known for being short on opinions on any given subject, but it feels weird, now, knowing that I would have had something to say about it then. Back then, I didn’t have diabetes. I knew people who had it. I had made films about it – I interviewed the first athlete in the UK to have a continuous glucose monitor, which allowed him to become the first truly-competitive british marathon runner with Type-1 diabetes. But I didn’t have it.

Now I do have it, and I’m still a total noob at this diabetes thing. Sixteen months since I started insulin, I feel like I know very little. I’ve had a rapid education from the @OurDiabetes community on Twitter. I’m not short on facts, on physiological understanding, on sick-rules and carb-counting cheats…

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Knees like a three year old

My knees are callused, not smooth. They would win no prizes in a beauty contest; they do not resemble the elegant knees I see on adverts for shaving creams and epilators.  But I think they’re important. They’re paediatrician knees.  They’re the knees of somebody who spends hours of each day crawling around; playing peekaboo; pushing fire engines and chasing balls that are stuck under beds. 

My shoes break readily across the instep, leaving white tracks across bright pink leather; scattering sequins as I squat down. Paediatrician shoes. 

I spend a lot of my day crouching down; kneeling on my callused knees as I listen to chests and hearts; flexing my feet as I squat precariously in the gap between beds to talk to somebody; finding a stable position on the floor to take bloods. 

Hospitals are scary places. They’re even more scary as a patient or a parent if the person caring for you is above your eye level; if their position of power is augmented by towering above you; if they are far too busy and important to spend time with you…

I didn’t think it was that important; I heard from @grangerkate and @Adsthepoet how it made them feel and I started thinking… A meeting with my supervisor where I sat on the lowest chair in the room; a meeting with a consultant where he sat behind a desk as I stood in front of it like a school child in the headmaster’s office…

It matters. It makes a difference. And I will embrace my paediatrician knees with pride on holiday this year.

Now, where’s the body lotion?

What is the point of medical education?

I’m at a conference on medical education.  This is another one of these things that I never thought I’d “do” but I seem to have ended up involved with anyway… (Plus it means I get to come to awesome conferences like #MadeinHENE – which has been fantastic)

I know next to nothing about medical education (apart from the fact that I’m experiencing it, but I’m not sure how much that really counts for a lot of people): I started doing a MSc but decided I didn’t have time to do that and clinical exams and research; I go to a lot of meetings about education and training… and did I mention that I’m actually living and breathing this whole “medical education” thing?

What I don’t really understand though is this: what is the point of medical education?  What’s it for?

To train doctors, but for what purpose?  What are we trying to achieve?

A lot of what I hear about medical education talks in dichotomies: training or service provision; competence or professionalism; “basic” sciences or humanities…

If you’d asked me a few years ago, I would have said: training over service provision every time; professionalism over a competency based, curriculum driven, portfolio recorded experience….And of course, anatomy is a given: much more important than all this “communication skills” stuff…

Except… What is the point of all this training? What are we here for at the end of the day?

Is medical education about sharing the culture of what it means to be a doctor; to share the hidden secrets of a professional group?  Being part of a professional group is wonderful in so many ways: we share experiences, a culture, a language… But being part of any group can exclude others.  It supports this bubble that I think many of “us” live in; it means that patients and families have to use “our” language to be taken seriously in “our” world; it makes us different & special.  It’s comforting and comfortable when you’re in the group; but if you’re outside?  If you’re a patient trying to move in “our” world?

Is anatomy and histopathology really more of a basic skill than listening to a patient? (and I really mean ACTIVE listening, not just sitting there waiting for somebody to answer the questions that the Dr thinks are important) Is it more important to learn some pathological classification that is rapidly becoming outdated than it is to learn how to negotiate in a team, or how to be assertive and advocate for your patient?*

I don’t know (maybe I need to go back and do that MSc – don’t tell my PhD supervisor though…)

But I do wonder why we aren’t really talking about this?

*I am interested in oncology; I spent ages learning pathological classifications; and now it’s all gone to cytogenetics… Paradigm shifts are really, really annoying sometimes