A quick update

So, it’s been quite a while since my last post – so much for at least once a month…. It’s been a hectic couple of months and I’m now starting to calm down & get things sorted. May was a particularly busy month with a talk at a local primary school about a career in surgery, and attendance at my first Medical Women’s Federation conference.

 

The primary school visit came about because I had signed up with Inspiring the Future last year, where teachers can find people from all careers and walks of life to participate in careers days. I have to say I really enjoyed doing this. I spoke to every year group from P1 to P5 and even visited the nursery children! It was great to stand there as a female surgeon, as a role model for future generations and hopefully planting a seed to inspire future surgeons.

 

I have recently been elected as the NI standing council rep for the Medical Women’s Federation. This is a fantastic resource for mentorship, support & networking. The spring conference was held in Edinburgh, entitled ‘Medicine at the Margins: Creative Solutions to Healthcare Challenges’. I found this a completely inspiring day and so unlike any medical meetings I have been to before.Some of the highlights for me were the talks by Dr Christine Goodall OBE, Dr Jacqueline Andrews, Dr Phillippa Whitford and the Dame Hilda Rose Memorial Lecture given by Dr Catherine Calderwood, Chief Medical Officer for Scotland.

 

First up was Dr Christine Goodall OBE, a senior lecturer and honorary consultant oral surgeon at Glasgow University who founded the charity Medics against Violence in 2008. The education provided in primary and secondary schools, youth clubs & prisons has helped to decrease homicide and serious assault in Scotland. Treating violence as a public health issue works.

 

Dr Jacqueline Andrews spoke to us about the Leeds Female Leaders’ Network which is creating a vision for cultural change and working towards gender equality in the workplace & in leadership roles within the NHS. She reiterated the importance of role models – “you can’t be what you can’t see”.

 

In a similar vein, Dr Catherine Calderwood, Chief Medical Officer for Scotland gave a powerfully inspirational talk on “The Importance of Women”. We hear increasingly about the feminisation of the workforce and how this is becoming a major problem. The majority of female trainees and consultant work full time and bring different skills into the workplace which can only serve to enhance things. On the subject of leadership, only 32% consultants and 24% of medical directors are women. She explored the barriers to leadership including personal expectations, organisational cultures and work-life balance. I felt this was a powerful call to step up as female leaders and to support those who fly with us.

 

I came away completely inspired and energised after spending time with so many amazing & dynamic women who are dedicated to supporting and mentoring other women in medicine. As an added bonus, I also got to meet some Twitter friends! I’m excited to increase the profile & membership of MWF within Northern Ireland over the next 3 years and hope that we can serve as role models for the next generation of female leaders.

Closing the gender gap – time to fast forward

“If you don’t like the way the world is, you change it. You have an obligation to change it. You just do it one step at a time.” Marian Wright Edelman, president and founder of the Children’s Defense Fund.

 

The theme of this year’s International Women’s Day is #PledgeforParity. According to the World Economic Forum in its Global Gender Gap Report 2015, it will take approximately 117 years to achieve global gender parity. Why is this important? It has been shown that accelerating women’s advancement in the workplace and therefore creating gender-balanced teams produces better outcomes and creates prosperity. More equality means a higher GDP and more productivity. Also, more gender-balanced leadership results in better all-around performance.

So what does this mean for surgery? There have been some improvements. The number of female consultant surgeons in the UK has increased from just 3% in 1991 to 11% in 2014. Obviously we still have some way to go considering approximately 60% of graduating medical students are female. There is still a large gap between the number of women who go into surgical training & those that become consultants. One of the most important changes that we can make to improve this situation is to create an inclusive, flexible culture for everyone. It is increasingly recognised that men in surgical training want work/life balance (whatever that means for the individual) too. Those in senior positions have the opportunity to set the tone for their unit or organisation to one that is supportive, inclusive and that challenges conscious and unconscious bias. To help women and girls achieve their ambitions, visible role models are imperative . In the words of Marian Wright Edelman, “you can’t be what you can’t see”. We need to define opportunities for advancement and encourage women to put themselves forward.

 

My pledge for #IWD2016 is to help women and girls achieve their ambitions. For me, this means being a visible and positive role model for young women, reminding them that girls can do anything. The inspirational and successful #ILookLikeASurgeon and #ILookLikeAnEngineer campaigns on Twitter have gone a long way to showing girls that any career they want is within their reach.

 

If we are to achieve gender parity in the workplace we need to work together (men & women) to reinvent gender roles, challenge the norms and provide equal opportunities for all. Only then, within a supportive working environment, will all talent be allowed to flourish. So, make a decision today to be part of that change.

New year…..

So, one of my goals for this year was to try & write one blog post a month…..not doing too well on that one!! 

Last year was a bit of a whirlwind & if you had told me this time last year I would be involved in a global Twitter movement, be interviewed on local & national radio (as well as a local paper) and would have started a blog I would have thought you were crazy!

I also had the opportunity to visit the Cleveland Clinic in Ohio for a month which was a great experience. 

On the work front, I am finally starting to feel that I’m finding my feet as a consultant after 2 1/2 years. I really enjoy my job and have made some positive changes. 

On the home front, I made the decision to start looking after myself a bit better. I know that “self care” is trendy at the moment but I now firmly believe that if you don’t take to time out to look after yourself then how can you be expected to look after anyone else. For me, that means (almost) daily meditation with the Headspace app, yoga, time with my personal trainer & a sugar free diet. All of these have been helpful in improving my sleep & my mood. 

Having done the I Quit Sugar programme in October 2015 & now on board as one of their experts, I am increasingly convinced that our highly processed diet is making us sick & fat. So just giving some advance warning about many posts on this subject as I continue to research it! 

I am definitely going to try and post more regularly so stay tuned…..

#notfairnotsafe

“The NHS will last as long as there are folk left with faith to fight for it”

Aneurin Bevan

Any of you who follow me on Twitter will have seen a deluge of tweets about the junior doctor protests today (sorry about that!). All the recent coverage over the last few days has incensed me. Jeremy Hunt is claiming that 11,000 excess deaths at the weekend are caused by the fact that “financial penalties” and “excessive overtime” deter hospitals from rostering enough staff at the weekend. This is a blatant misinterpretation of a study published in the BMJ recently which stated that around 11 000 more patients die each year within 30 days from admission occurring between Friday and Monday compared with admission on the remaining days of the week. The absolute risk of death (within 30 days) after admission to hospital is 1.8% overall; the statement that you have a 15% higher chance of dying if you are admitted on a Saturday means that the absolute risk of death goes up to 1.98% – doesn’t sound quite as dramatic does it?

This weekend effect is not unique to the NHS and the causes are unclear. In this paper, the authors state that “It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.” Despite this, Jeremy Hunt told his Labour opposite Heidi Alexander: “There are 11,000 excess deaths because we do not staff our hospitals properly at weekends. I think it is my job, and the Government’s job, to deal with that, and to stand up for patients.” Last month, he blamed consultants, now he’s blaming junior doctors!

There are less staff at the weekends because there is no elective service (there are between ½ and ⅔ less patients admitted at the weekend compared with during the week).  At a time when rotas are more stretched than ever, the gaps are being filled by locum doctors or by the staff already there, putting them under even more pressure and at risk of burnout.

Then this morning, Mr Hunt stated that the junior doctors are so angry because the BMA has misrepresented the Government’s plans and is misleading them. What he has failed to grasp is that junior doctors (describing anyone from a newly qualified F1 to an ST8 who is about to become a consultant) are intelligent people who have read the Dept of Health proposals and have come to their own conclusions. If they thought they were being mislead by the BMA then they would have said so & would not have felt compelled to protest today.

The numbers evident in the photos from today speak volumes. I have never witnessed such solidarity in our profession. We have been taken for granted for far too long and the time has come to say “enough is enough”. This is an attack on our professionalism and our sense of vocation. Myself and my colleagues (junior & senior) are dedicated & committed professionals with patients safety at the forefront of everything that we do. We already staff a 24/7 NHS and will continue to do so.

This proposed contract will remove the safeguards against working excessive hours & will penalise those in the specialties with the most anti-social hours. It will also deter others from entering these specialties, many of which already have a recruitment crisis. The protest is not about pay, it is about safety – for doctors and patients. The NHS is worth fighting for and we will continue to do so.

IMG_3747

Bullying in surgery

“The standard you walk by is the standard you accept”

Lieutenant General David Morrison

The External Advisory Group report on discrimination, bullying & sexual harassment advising the Royal Australasian College of Surgeons makes grim reading. Approximately 50% of Fellows, trainees and international medical graduates report being subjected to discrimination, bullying or sexual harassment. Of those,  39% report bullying, 18% report discrimination, 19% report workplace harassment and 7% sexual harassment. This is unacceptable in any workplace and can have wide ranging effects, not only for the trainee but also for patients.

Unfortunately, this problem is not unique to Australia. We also have a similar issue in the UK. A survey published by RCSEd in May 2014 found that 3 out of 5 surgical trainees had been victims of undermining and bullying at work, and 9 out of 10 have observed it first hand. This figure is three times higher than recorded across other healthcare professions in the NHS (BMJ 2013). The figures from the RCSEd survey are backed up by the GMC trainee survey in 2013, where surgery was found to be an outlier with respect to bullying & undermining in the workplace.

There is a reluctance to speak out about these issues for fear of reprisal, that the behaviour will actually get worse or that it could be seen as “career suicide”. In fact, only a third of those who experienced or witnessed bullying behaviour felt able to report it. But where this behaviour is experienced or witnessed but not reported, it contributes to normalising the behaviour. This means a lot of the time we laugh it off, “suck it up” and get on with things.

Surgery is seen as a macho culture, where you have to be tough to survive and unfortunately this kind of behaviour is often seen as part of the training & culture. This may be partly due to the hierarchy within the profession with there often being a parent/child approach with trainees. We should be treating our trainees as equal adults, albeit with less experience. The culture of “junior” and “senior” doctors means that you are still regarded as junior even when you are highly trained & deserve to be treated like the professional that you are. As a senior surgical registrar nearing the end of my training, It was very frustrating not be taken seriously because you are seen as “junior” and therefore are undermined. However, history shows us that we tend to emulate the behaviours of our seniors and so the cycle continues.

This is a significant issue and the RCSEd is determined to address it head on. The college has set up Professional Excellence groups to provide a safe forum to raise concerns. They have also set the Faculty of Surgical Trainers to provide a forum for accrediting surgical teaching.

But we need to do more. We need to change the culture. The days of teaching by humiliation should be long gone. Creating a toxic environment where trainees are scared to speak up can have a detrimental impact on patient safety as they are less likely to raise concerns or ask for help when they need it. It affects good communication and team working. This kind of environment also has a negative effect on the quality of training and the quality of life of the trainee who feels undermined. We need to act as positive role models for our trainees and teach appropriate behaviours.

We need to create an open culture within our organisations where people feel they can raise concerns without fear of repercussion or a lack of faith that anything will be done.
<a href=”http://www.bloglovin.com/blog/14452943/?claim=jn8fjr5krzs”>Follow my blog with Bloglovin</a>

Time to banish the Poo Taboo

Gut health

Talking about bowel habits and poo is still seen as taboo and many patients are embarrassed to talk to their doctor about these types of symptoms which can lead to considerable delay in diagnosing serious bowel conditions such as bowel cancer or inflammatory bowel disease. Equally important are disorders such as irritable bowel syndrome and faecal incontinence, both of which can have considerable impact on the patient’s life. Recent research has revealed that while over half of people in the UK suffer with a chronic or persistent gut problem, almost 60% believe that talking about poo is unthinkable.
As a colorectal surgeon, I was interested to discover the Gut Week campaign which runs this year from 31st August to 6th September. Now in its 17th year, it is part of an ongoing campaign by Love Your Gut, supported by 5 leading digestive health charities: Bowel & Cancer Research, Bowel Disease Research Foundation, Core (the Digestive Diseases Foundation), the Primary Care Society for Gastroenterology and St Mark’s Hospital Foundation. It’s aim is to raise awareness of gut symptoms and disorders, emphasising the importance of maintaining good gut health and providing resources for further information.
Initiatives like this are so important in breaking down the stigma around bowel conditions. I have had many patients suffer in silence, only coming to see a health doctor when they really can no longer cope. There are many reasons for this, but I think it is primarily because they are embarrassed or feel that it is something that they just have to put up with. I commonly see patients with incontinence or rectal prolapse who have been suffering for years.
So, how do you discuss these things with your doctor? Firstly, it is important to remember that you are not alone. Over half the population will have a gut problem and your GP, surgeon or gastroenterologist will have seen many of these things before. We appreciate that discussing poo & bowel habits can be embarrassing but we will not be embarrassed so you should try not to be. Using everyday words is fine and the more honest you can be about your symptoms the better – it’s difficult to be too graphic with a colorectal surgeon!! If examination is required, the reasons behind this will be explained and it will not be done without your consent.

Embarrassment is temporary but ignoring symptoms may lead to a more advanced diagnosis if presentation is delayed. Dealing with things at an early stage is always easier.

Over the next number of weeks, I will post more about common digestive disorders, their symptoms, investigation and management along with links to online resources for further information.

Is surgery losing its allure?

Cropped image of surgeon using scissors during surgery in operating room. Horizontal shot.

I knew from fairly early on in my medical student career that I wanted to be a surgeon. Inspired by enthusiastic and passionate teachers in my third year surgical attachment, there was no question that I was going to do anything else. I loved the mix of patient contact, challenging cases and the ability to do something very practical to impact on a patient’s health and wellbeing.

Therefore I was disheartened to see a recent BMJ Careers article about how surgery is becoming a less attractive career option. Historically surgery has been a popular specialty and is usually oversubscribed. Although the ratio of applicants to jobs has remained fairly static, the fill rate of posts after the first round of interviews is decreasing. In Northern Ireland, only 45% of core surgical training posts have been filled after the first round of recruitment. This is leading to problems with CT rotas and means that we are becoming ever more reliant on employing locums.

So, why is surgery not seen as attractive option any more? One reason may be the higher proportion of female medical graduates. Women now make up almost 60% of graduates but only 30% of core surgical trainees and 11% of general surgical consultants in the UK. A paper published in 2013 by Dr Ed Fitzgerald found that 59% of male and 68% of female medical graduates believe that surgery is not a career that welcomes women. This is partly due to the perception that there are still negative attitudes towards women in surgery. Indeed, a survey published in the The Bulletin (RCSEng) found that many students cited poor work/life balance as a reason for not choosing a surgical career. Two female respondents said that they had been directly dissuaded from a surgical career by their consultant, told that being female and wishing to have a family would only be a hindrance to their training. Poor anatomy training was the second most common reason.

There is a general dissatisfaction with surgical training as documented by the 2014 GMC trainee survey. Satisfaction ranges from 72.1% for foundation trainees to 82.5% for ST4 and upwards. These are the lowest average scores of all specialties. If foundation trainees have a poor experience then they may not pursue a surgical career.

There are obviously still many issues that need to be addressed. The first is to get rid of the perceptions of a male dominated specialty. We continue to have an image problem with the continuing stereotype of the arrogant, aggressive & misogynistic surgeon. The #ILookLikeASurgeon campaign started by Heather Logghe  on Twitter is an important step to challenging this stereotype and continues to gather momentum.

Looking at a change in working patterns to include more flexible working hours will go a long way to making surgery more accessible. Both men and women would like more balance with more than 30% consultant surgeons in the UK expressing a desire to work part-time at some point in their career (RCSEng workforce census 2011).

Those of us who already have a career in surgery have a responsibility to encourage younger generations to apply. We need to engage and support our trainees, especially those at foundation level. If we don’t do this then we will fail to recruit the best candidates for the jobs as we will be recruiting from an ever smaller pool of suitable applicants.

We also need more visible and positive role models (of both genders) to engage and inspire those considering a career in surgery. We need to positively influence attitudes of colleagues and junior staff to encourage diversity within the profession and to continue to dispel the myths and stereotypes about gender, personality & work-life balance.

Be part of the change. #challengestereotypes #ILookLikeaSurgeon

The privilege of caring

Never underestimate the impact we have on patients and their lives. Life can change immeasurably in the blink of an eye and after that moment nothing will ever be the same again. As a colorectal surgeon I spend a lot of my time telling patients they have cancer, and it still doesn’t get any easier. It is a life-changing diagnosis and the way the news is delivered will have a lasting impact on the patient and may have an impact on the doctor-patient relationship. Although some may have been expecting the diagnosis, they still hold onto hope that they are wrong, that you are going to tell them that everything is going to be ok.  To hear the word “cancer” spoken out loud makes it frighteningly real.

My job is to help them understand, to make treatment plans and to answer their questions to the best of my abilities. Being honest and specific with information allows the patient to start making sense of things and can provide a sense of relief as the detail can create boundaries to contain the patient’s fears as it is all too easy to imagine the worst case scenario. But there are some questions that I don’t have the answer to and, although my patients ask them, I’m not sure they really want to hear the answers. We can only make generalisations and we all have patients who have defied the odds and are still alive several years down the line despite widespread disease. I feel we walk a very fine line between not giving false hope but not dashing hopes completely.

My job as a surgeon is both an honour and a privilege. I see people at their most vulnerable and they have to trust that I will do my best to treat them. Patients often comment that I look awfully young to be a surgeon and I sometimes wonder if they find it harder to put their trust in me and what I can do to help.

I was reminded of this impact that we have by one of my patients who I treated for a rectal cancer last year. He wrote a poem about his experience of diagnosis and dedicated it to me (it has been reproduced below with his permission). I was so humbled and moved by this. It’s easy to get caught up in the routine and go through the motions but we should never forget, that for our patients, their appointment will change their life forever.

The Surgeon

We waited outside the consultant’s room

Waited to be called, pale & expectant

When the call came we entered the room

The surgeon, a focal point

The essence of her filled the space

Surrounded by assistance

The number in the room

Compounded the gravity

She seemed young, younger than us

But essential, assured, unhurried and prepared

A thousand years visible in her eyes

She was older than all of us

Behind her, a nurse sat and watched patiently

One of a kind devoted to stemming

The endless stream of cance

Acknowledging the inevitable

A dispenser of hope

‘You’ve seen the scans?’

I stared at the snapshot in her hand

The tumour, round, white and red

Like a moon round Saturn

Alien and deadly

Stared back at me

‘It has blocked the bowel here and there

We will cut that bit out and then with care

Join what’s left, careful to keep a blood flow.’

I assented, white as the tumour

With a nervous smile bereft of humour

I stared at the snapshot in her hand

The same hand that held the knife

The same hand that held my life

Surgery is women’s work

So, it’s 2015 and I still get asked if i’m sure I’m a surgeon! It probably doesn’t help that I am the first female general surgeon in my hospital but surely in this day & age people realise women can be surgeons?

Some of you may have noticed the Twitter campaign #ILookLikeaSurgeon over the last few days. This has led on from the very successful #ILookLikeAnEngineer campaign started by Isis Wenger (@isisAnchalee) after her image, used as part of a recruiting campaign for engineers, sparked unexpected controversy. The reason for the controversy?…..she didn’t “look like an engineer” (too pretty, too sexy etc). I’m pretty sure that no man has ever been told that he is too handsome to do his job! These 2 hashtag campaigns are part of a larger movement  #ThisIsWhatWeLookLike – started by a philosopher and anaesthetist to change the way we think about women and work.

Those of us in surgery have been mistaken for nurses, physiotherapists, secretaries etc – all very admirable & important jobs but it would be nice if it didn’t come as such a surprise that we are surgeons, an issue highlighted by @rhiharries in a recent Guardian article. Comments such as “you don’t look like a surgeon”, “isn’t that a man’s job?” or (my personal favourite about a hernia repair) “are you sure you know how to do my operation?” are still fairly commonplace.

While we are by no means oppressed as women can be in other countries, there are still issues with the way our society views and treats professional women. It’s been amazing to see so many inspirational women pulling together & supporting this campaign & each other. I am so happy to be a part of this, promoting positive role models and changing perceptions of women in male-dominated professions.

I hope that this might encourage more women to join a career path that I love and feel privileged to do. Defy the stereotype & be part of the solution! #ILookLikeaSurgeon because I am a surgeon.

Just to say hello

So this is my first ever blog post! Seems like everyone is doing it so thought I’d join in 🙂 I’m a locum consultant surgeon in NI – one of only 2 female surgeons with a colorectal interest! I’m passionate about encouraging more women into surgery and defying the stereotype. This has been prompted by a Twitter campaign challenging gender stereotypes in professions that are traditionally thought of as male – it all started with #ILookLikeanEngineer and has progressed on to #ILookLikeaSurgeon. It’s great to see so many amazing women challenging stereotypes!