And I would do it again

Dr Crippen has been asked for advice by Sammy, a teenager considering career choices.  In this age of increasing government interference and a disintegrating health care system, is it still worth going into medicine?  Or would this young person be better advised to apply to a different course?

Dr Crippen, who describes himself as ‘a middle aged GP who has been beavering away in the NHS for over 20 years’, makes the sad admission that if he’d known at that age what he knows now, he would have made a different choice.  Not, I gather, because of the way he feels about doctoring itself; but because of the appalling ways in which doctors, and the NHS in general, are messed about by the government and the public.  As for Sammy, Dr Crippen advises him or her (it isn’t clear) that "if the passion burns deep, then you must do it. But it if it is just one of several options, then I would look elsewhere."

What I’d have made of this advice at that age, I’m not sure.  I certainly didn’t feel as if I had a deeply burning passion to do medicine – which worried me somewhat, since it had been made quite clear to me that it would involve a lot of hard work and exhaustion and stress and, all in all, it sounded like the kind of thing that you probably ought to have a burning passion for if you were going to have any chance of not hating it.  Young and immature, I didn’t as yet have enough sense of who I was to have any real feel for who I might be as an adult, which made it hard to picture what I might be happy spending my life doing.  I didn’t really know what it felt like to have a deeply burning passion for one particular job rather than others, but it seemed a fair bet you’d know it if you had it. 

All I knew was that medicine sounded as though it was likely to be interesting, one way or the other, and that I liked the idea of doing a job that did some kind of good in the world.  And, yes, being a firefighter would have probably fit that description better, but there was no way I had what it took to be a firefighter – I was hopeless at anything physical.  Not that I was at all sure I had whatever it took to be a doctor, either – didn’t it involve having, um, some kind of superpowers, or something equally daunting?  But I had always been good at academic stuff, particularly science, and that seemed like, well, at least some kind of a start.  And none of the many other things that I could have done really sounded all that interesting. 

I applied, in the end, because it was a path I couldn’t turn away from.  Because, even if I didn’t have a deeply burning passion at that stage, I did have a deeply burning, unarticulated, knowledge that if I didn’t at least explore this path, I’d regret it.

All this was a long time ago, I remember.

My training was easier than Dr Crippen’s.  A lot easier.  He qualified in the dire days that we now speak of in hushed tones, the days of the one-in-two rotas and hundred-plus-hour weeks, the days when you were left with no time or energy to do anything outside medicine, the days when your soul and spirit were ground down to powder.

I qualified in 1995, when reforms were already taking over.  The worst on-call rota I’ve ever worked was a one in five (one night in five and one weekend in five of being at the mercy of my bleep and still having to work a full day the next day).  The worst shift system I’ve worked had a week of twelve-hour nights once every five weeks with days at home to sleep, with easier shifts for the other four weeks.  (Evening shifts, which are actually the worst in a way because of the way they impact on your social life, were sensibly split up on this rota so that you never did more than two or three in a row.)  All of this was doable (except the full weekends on call, a torture now mercifully consigned to history). 

Dr Crippen says that doing medicine will deprive you of your twenties.  In my case, the reverse was true – I think my twenties were far better than they might have been if I were doing anything else.  The first half of my twenties was spent at university, and I don’t think any other course is quite as good as medicine for giving you a ready-made social life.  It must be said that I was at a university (Liverpool) renowned for the quality of its medical students’ society, so maybe other medical students wouldn’t have as good an experience.  But I had a truly fantastic time. 

Then I graduated, and started on the long hours, and had less time to spare.  But the time that I did have was, in a way, even better.  Finding out that I could handle a job as challenging and worthwhile as medicine gave me a confidence I hadn’t had before.  And there was a camaraderie in those long hours that I haven’t quite found anywhere else before or since – the Blitz spirit, the feeling that, yes, it was crap, but we were all in it and facing it together.  Somehow, I don’t think I’d have had the same experience working in law or finance or pure science.

It still wasn’t easy, and will never be for any junior doctor – there
were times when I felt so exhausted that my brain no longer felt
connected to my body, times when I was so sleep-deprived that I would
fall into an abyss of unconsciousness between one thought and the next as my body
tried to wrest control away and grab the sleep I needed, times when I
was so ground down that all I could do was come home and force myself to
eat something before I fell into bed.  Sore-footed and refractory,
indeed.  But, for me, these times were intermittent rather than
constant.  I had enough time off to rest, recharge, have a life.

I’ve got to add that, looking back, I probably went through that stage at just the right time.  I caught the window between the evil soul-destroying hours of decades back, and the increasing bureaucracy of recent years.  I built my own training scheme, picking up a six-month job here and a six-month job there according to whatever I felt I could do with learning a bit more about, ending up in some unexpected parts of the country and finding I could make a life for myself wherever I moved to.  These days, I’d have to join a training scheme and have three years of my life spoken for, at the end of which time I would be expected to go out and start work as a GP whether or not I felt I still had anything to learn from hospital jobs.  I’m glad I didn’t have to do it that way; and I think that the experience of a doctor trying to train as a GP today would be different from that of either myself or Dr Crippen.  (And, of course, the experience of a doctor trying to train in any other specialty will be different again.)

There were times we regretted/The summer palaces on slopes

Dr Crippen points out that if you want to be rich, medicine is not the best way to go about it.  As a teenager I was aware of this, and also aware of the fact that it was supremely unimportant to me.  I knew that, as a doctor, I’d always be comfortably off and never want for money.  I knew that, given that this was the case, job satisfaction was well above riches in my priorities.

I don’t, as it happens, even make anything like the hundred thousand a year that Dr Crippen gives as a ballpark figure for a GP’s earnings.  There’s a simple reason for this; I chose to become a salaried GP, employed by a practice, rather than buying in as a partner.  While I would love to earn a hundred thousand a year, I wouldn’t love it enough to saddle myself with the hassle and commitment involved in being a partner.  I’ve tried to picture what amount would be enough to persuade me to do this, and I’ve come up with a blank. 

So, I have a job where I work four days a week and don’t take work home (not as such, anyway, although trying to keep up with the journal reading can get crazy), and I still earn enough for us to have a lovely house in a very nice area, and two cars, and for my husband to stay at home full time with Jamie while he’s small.  Of course, it’s fair to say that my expenses are lower than Dr Crippen’s in other ways (I don’t live in London and have no intention of having four children), and also to point out that, from a financial viewpoint, it helps that we didn’t have Jamie until we were in our mid-thirties and had both had several years of full-time employment to put us on a sound financial footing.  But unless money really is your top priority in life – which I’m assuming it probably isn’t if you’re thinking about medicine in the first place – then I would not let concerns about it put you off a career in medicine.

Hard and bitter agony for us, like Death, our death.

There are a number of reasons why people try to put you off doing medicine.

There are, as I’ve said, the hours.  These have got better.  (At least, they’ve got better in terms of both the total number and the length of the individual shifts that doctors are expected to work.  The trade-off of this is a lot more shift systems, which can wreak havoc with some people’s family lives, social lives, and sleep patterns.)

There is the current state of the NHS.  This is probably the primary reason that everyone Sammy knows is advising him or her against a career in medicine.  You will have to deal with the fact that the NHS is at the mercy of some astonishingly clueless people.  Of course, you’ll probably have to deal with that anyway on the receiving end, whether or not you make medicine your profession – which is a thought that actually bothers me a lot more than the myriad ways in which the government is screwing up my profession.  That, I have to say, simply makes me more determined to stick around.  So far.  I reserve the right to change my mind on this as time goes by.

There is the fact that you will have to deal with the harder, grittier, side of life.  You will have to deal with telling people they’re dying, and taking care of them through their death.  You will have to deal with the grief and pain of people who have lost loved ones.  You will be faced with difficult ethical decisions.  You will have moments when the cruelties of fate rip your heart out and stomp on it.

This, I have to say, never put me off either.  Horrible things are going to happen in the world whether I’m there dealing with them or not.  If I’m there, at least I have some control in how they’re dealt with.  Walking away from my profession wouldn’t cure the patient with metastatic cancer – staying with it may mean that I can make sure he and his family at least get some support.

The hardest part, for me, is the frustration.  The frustration of knowing you can’t ever do enough.  Of knowing that I can’t see all my patients on time and still spend as long with each of them as they want.  Of knowing that I can’t spend as long with each of them as they want even if I don’t see them on time, because, um, I have to do other things occasionally like eat and sleep.  Of having to tell people that we simply don’t have an explanation for their symptoms, no matter how debilitating they are.  Of not having a magic wand.

But set down/This set down/This:

If you go into medicine, you will be able to make an actual difference in people’s lives.  This may be through actually doing something impressive like curing them, but it’s more likely to be in other ways – alleviating their symptoms, calming their fears, or just being a listening ear when they need it.  But you will be doing something that matters.

You will have the chance to learn how to deal with situations you would never have thought you could deal with.  In learning how to deal with them, you will find depths in yourself that you never thought you could find.  Ever see those recruiting ads for the Army that show you the kind of challenge that Army officers have to face and end with the slogan ‘Army Officer – Be The Best’?  Being a doctor is another way of being the best.

You will become more than you ever thought you could be.  To switch from Eliot to Yeats for a moment, you will be the centre that does hold when things fall apart.

Would all this have been of much help to me when I was making the decision myself?  Probably not.  It would just have scared me – yet another polemic about the horrors and wonders of it all to make me think "But surely I’m not the kind of person who can do this sort of thing!"  And, you know, at the time I wasn’t.  I really wasn’t.  That’s the point.  I became that person as a result of being willing to try that path.

The piece of advice that actually did help me most at the time came from a friend.  "I think you should do it," he told me, "because if you don’t, you’ll always wonder whether you could have done it or not."  That, unlike scary stories of hours or stress or inspiring stories of wonders awaiting me, was something at my level, something I could relate to.  I understood the idea of a challenge.  I understood the idea of giving things a try, just to see.

And if I’d tried it and it turned out not to be for me?  Then I could have done something else instead.  This is a piece of advice you may find of more practical help: You are not making a once-and-for-all decision, at this point in time, as to whether or not to spend your entire life working in the NHS.  If you decide after qualifying that medicine isn’t for you – well, a degree is a degree, and there will be a number of other jobs open to you.  If you decide that medicine is for you but the way the NHS do things isn’t, then there are a number of other countries you can move to where you may find medical practice more congenial.

But it was for me.  I don’t want this to sound as though I’m some kind of fantasy TV doctor of the 50s, dedicating my every moment to sitting selflessly by my patients’ bedsides and doing so with a willing heart.  There are plenty of days when my main thought is "When the hell do I get a coffee break?"  But in every one of those days, if I look for it, there is something else, something better – something to make me smile, or something to make me laugh, or something to make me think.  Plenty of days have all of the above.

I have had many moments of wondering whether I was right for medicine.  But I have never, since I started, had a single moment where I seriously wondered whether medicine was right for me.  It is right for me to the depths of my soul.  If you want to hear something positive from someone who has a career in medicine, there it is.  I would do it again.  I would do it again.  I would do it again.

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1 Comment

Filed under The doctor is OUT. To lunch.

One response to “And I would do it again

  1. Great article. Just caught up with it. I agree with nearly everything you say. Yes, medical training is hard now, but certainly not as hard as it was when I did it. The 1 : 2 were dreadful in terms of the rest of one’s life BUT there is no doubt that one got a huge amount of experience, experience that my young partners (your age) do not and cannot ever have.
    So the medical profession in deskilling.
    I am sure many people go into medicine as you do without a “burning desire” of whatever; nonetheless, I would counsel against that. It may be OK if you are part time, but not if you are going to be full time for your whole working life.
    The money? Almost vulgar isn’t it for doctors to talk about money. We are not supposed to. The ball park figure of £100,000 for GPs is a guesstimate, but I think it is reasonably accurate. This was not the place to discuss how much doctors SHOULD earn (I have not got a clue) but just a benchmark figure for comparison.
    A lot of married women doctors with children are being ripped of by enterprenurial practices where the partners are tkaing them on as wage slaves. I hate that. I hope it is not the case with you.
    And, of course, you are married with another earner. Would you manage if you were not?
    It’s all food for thought.
    John
    I do not live in London. North of (somewhere – don’t want to say where) but yes, close enough for commuters and so close enough for London prices to influence (inflate) house prices!!

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