AUTHORS: Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov
In this series the Medspire team interviews doctors about their career, their specialty, the choices they have made and their advice for doctors and medical students.
Today, the subject is Sam Thenabadu, a consultant in emergency medicine at King's College London. Dr Thenabadu is a deputy dean for King's College London medical school, and was lead crowd doctor at the Olympic Stadium in London.
A podcast of this interview is available here:
How did you get to where you are today?
I often tell anyone I meet - but especially students - that I was a King's College medical student back in the 1990s, so I've always felt like King's is home. My father was a paediatrician, and he worked in different places.
We travelled around the country, so I had quite a varied childhood. But I settled in London, and went to medical school at King's. It was a very different time back then - a different generation. There were less than 100 of us in a medical school cohort.
We had a tighter group, and were based more centrally at just a couple of hospitals. I've spent most of my working life around the south-east. I ventured to Hastings once for six months, and to South West London once, but in essence I've stayed around the south-east with King's as my hub. I have a lot of affiliations and love for the area.
I’ve wanted to be a generalist all my life. I started off in med school thinking I wanted to be a paediatrician, but that’s because I liked general medicine, enjoyed seeing children, and had a good paediatric placement.
Then I wanted to be a general physician. I actually wanted to be a geriatrician - again, because I like general medicine. That evolved into really enjoying the more acute side of things, so I ‘dipped my toes’ into emergency medicine. I came full circle when I went back to doing paediatric emergency medicine, because I really enjoyed that.
I've always been interested in education as well. I've always just had a thirst for knowledge. With emergency there's just so much to know, and I have an interest in lots of little things, rather than knowing a million things about one thing, so education and emergency naturally intertwined. Emergency medicine and medical education came together for me.
When did you decide on emergency medicine?
I was always drawn towards ‘front-door’ medicine - the unselected patients that walked in. That doesn't mean that I didn't enjoy the ward work - I did. I like the detective work that happens in more detail on the wards. But it was just that I felt more akin, more comfortable, with the emergency side.
Not knowing what's coming is quite a scary concept and you need to have some pretty broad generic skills to deal with that. It was those situations where you had to remain calm, to think on your feet, to work in a team - that was just a bigger draw to me. As my career was evolving as a medic, as a physician, I was actually looking at acute medicine.
Back then there was a push towards having acute physicians - they're established now. I entered one of their first training schemes to be an acute physician, because I was interested in the ‘front door’ of medicine.
In the end, I decided I wanted a more general role, so I stepped sideways again into emergency medicine, rather than acute medicine. There were a lot of drivers for that, including where I wanted to be geographically.
While you've got to think about the geography of where you want to be, and your family, emergency medicine was actually the best fit for me. I was attracted to the teamwork, and the need to think on your feet.
Those aren't easy things to do. But when I come home and ask myself: ‘How did it go today?’, while I'll think about the clinical cases I’ve seen, what I'm most proud of is working in a team, and that we give good care as a team. We are much more than the sum of our parts if we come together as a good team, and I see that day to day in emergency medicine.
What makes a great A&E physician?
People are keen to talk about ‘staying calm under pressure’, ‘being a team player’, and ‘good communications’. But I always take my team to one side and say: 'We need to have a really good knowledge base’. Literally any patient can walk in, and it doesn't matter if you're junior or senior.
You might be handed a card and it might be a six-month-old baby, an end-stage oncology patient, a pregnant lady, a trauma case, or a haemochromatosis. There's such a variety, so knowledge is really important. You never stop learning in emergency, and I like that.
I like the ability to keep reading around topics. I'm probably not quite as diligent as I used to be. But I will read three or four times a week around a clinical topic that I've just seen at work, and I'll think: ‘I don't remember enough about that topic, and I want to refresh’.
Sometimes, I'll think: 'Twenty one years in medicine, and I've never seen that topic’, so I'll read around it. Or I'll think: ‘I've seen that topic a lot, but the guidelines are changing and updating’. It's one of the privileges of emergency medicine - you see such a broad range of things, but you can also keep your mind active.
Having a really good knowledge base is the most important quality of a good A&E physician, because we can be the kindest and best communicators, but if we don't have our knowledge base, we're really going to struggle. We also need to know our limitations as to when to call for help.
All the way through med school we talk about escalation and when to call for help. I still do that on a daily basis. I'll call colleagues. I might call someone far more junior to me in grade, but who may have much more experience on a topic. I might call the renal SHO and say: 'I've got a very complex congenital renal patient. What do you think?' Being able to know your limitations is important as well.
I interviewed for the new tranche of ACCS doctors that are coming into emergency, and just listening to their take on what skills are needed was really interesting. For me, it's the core pillars of knowledge, but then also communication skills, and compassion.
I might be in a very busy, hectic job, but I only ever approach patients in the way that I'd want people to approach myself -my family, my mother - and that compassion is really important. If you have a little bit of all of those things, you'll do okay in emergency medicine.
What's been the biggest advancement in emergency medicine?
Emergency medicine is still one of the youngest specialties out there. I'm very proud of it, and quite privileged to be in it at this point where it's really changed - it's really taken off in the last two decades. Even the nomenclature has changed. We used to be called 'casualty'. We used to be part of the Royal College of Surgeons. Nothing wrong with that. But to have your own identity is important too.
The way that emergency physicians are perceived has really changed - from being people who may change careers multiple times, to people who have actually chosen this career from the off - maybe from medical school - and that they want to be in this specialty.
Thinking about 'casualty' has much more of a wartime sort of slant to it. Being rushed in and just temporising problems. I have huge respect for my colleagues working in trauma centres who do this, day in, day out. But there's so much more to emergency medicine now.
Even the change of name from 'casualty' to 'accident and emergency' to 'emergency medicine' encompasses far more than it did 30 years ago. Other changes are about the real depth of experience that we now have in training.
For example, I did subspecialty training in paediatric emergency medicine. Now, everyone is trained to have a general approach, but there'll be some of us who take on subspecialty interests so that we have an even deeper understanding and expertise.
In emergency medicine over the last few years, we've had intensive care and pre-hospital medicine as subspecialties. Having frailty as a subspecialty of emergency medicine is topical, because with elderly populations it's really important to have expertise in that.
I'm really proud that our royal college has embraced that - there needs to be not just a broad base of experience, but expertise within that broad base too.
I'm also proud that the specialty has embraced how we work with our allied healthcare colleagues. Again, people through medical school and in their junior years may work with physician associates, HCPs, advanced clinical practitioners.
Our royal college has really embraced those allied groups. I remember a brilliant talk by one of our past presidents who said: 'There are plenty of patients to go around, okay!' We don't need to be fighting over patients, but we do need to make sure we've got people with the right expertise.
It doesn't matter if your badge says 'doctor', 'nurse', 'advanced practitioner'. It's about us having the right competencies. That's a really nice place to work, because you have people from different backgrounds who bring different types of expertise into it. So it’s a really positive time to come into emergency medicine.
Where do you see the specialty heading?
The pressures on emergency departments are going through the roof. I have the utmost respect for my hospital colleagues, my inpatient colleagues, and my primary care colleagues. You need to spend a day walking in their shoes before you can start telling them that they're not doing things right.
But the whole service and the whole system is under pressure. We need to have efficiency for patients - so the best person and the best place to see that patient,rather than having just one door that everyone comes through. We talk about evolving into things, like same-day emergency care.
You might come into the emergency department, but it might be better to go to the surgical ambulatory unit. You might be better seen in an urgent care centre, which deals with more minor injuries. There's an advantage to the patient, but there is a disadvantage to those of us who are training that we don't want to deskill in certain areas.
Keeping our skill set up is really important. There will be an evolution to make pathways smoother for patients, which is essential. There will also be an evolution to get more subspecialty training within the department.
Will we have our ultrasound leads? Ultrasound is such an important tool. I think every medical student will be trained in ultrasound, and there will be different skills that will come through. Emergency can be core to that.
As a place of education, emergency departments are brilliant. You may come with certain learning outcomes and never see a certain type of patient, but there is always something you can learn in an emergency department. I'm sure if you spent 12 hours with me, you would walk away with at least six learning points.
I want to make sure that emergency departments go back to being one of the hubs where students are based, and where they actually do a shift, not just a couple of hours.
I know better than anyone that medical school timetables are very hard to write up, but I'm a believer in a slightly more old-fashioned approach, of coming on shift at eight o'clock in the morning with me, and staying till eight o'clock at night.
Doing that 12-hour shift and really ‘walking the walk’ of that doctor, nurse, clinician. These are the things that I hope we will see evolve in the next ten to twenty years.
What are the drawbacks of emergency medicine?
Whenever we talk about emergency medicine - or any specialty - you need to look at it as a whole. Shift work is challenging. But remember, with the NHS wanting to move towards a true seven-day service, most doctors will be moving towards a shift type of system.
Working 8:00am to 5:00pm is quite an archaic approach to healthcare when we have a 24-hour need for healthcare delivery. I look at some of my colleagues in other specialties - medicine, surgery - and they're already moving towards working shifts.
They may not be night shifts on sites, but they certainly are moving to doing far more of an 8:00am till midnight type of approach. It's important to understand that whatever grade you are, whatever stage of your training, shift work will probably happen in some guise.
It is important to remember that in emergency medicine, as a ‘front door’ open 24/7, we need to have staff there 24/7. So in your early years of training there is a significant amount of shift work, and there's a significant amount of out-of-hours work, and nights in particular. That is pretty hard.
In some of the modules we do at GKT, we talk about the transition module about shift working, sleep patterns, and how to drive home safely - really important topics, which we perhaps don't put enough emphasis on.
That's draining. On top of that you might have carer's responsibilities. Even just finding time for yourself is tricky. So it's about finding a new way of adopting your working week. It's not easy, but it's not something that goes on forever.
There are some consultants who will be working night shifts on the shop floor. I don't do that - I work till, say, 12:00am or 2:00am and then I'll go home and be on call there. But there are days when I'll have to stay till 3:00am or 4:00am, and those are very stressful days.
As you get older you might have to then drop your children to school at 7:30am the next morning, so it's a tough turnaround. But it would be naïve to think that our colleagues that work in the City don't have days where they have to work all night.
My best advice is to have an insight into what the whole job looks like, rather than just some aspects of the job. There's a real advantage to working shifts. I actually spend far more time doing school drop-offs than a lot of my colleagues who do medicine, because I can start a shift at midday.
So I can drop my children to school, see the schoolteacher at the school gate, and go to the school play. I am not a morning person, so I like being able to have a cup of coffee and ease into my day. Many of you will - through student life as well - also think: ‘I prefer lates to getting up at 6:00am or being on a train at 6:30 to commute in’. So it’s ‘horses for courses’. But always give it a try.
The nature of many junior doctor roles is you will have to undertake some of those shift patterns, and very soon you'll work out whether that can work for you. If you take a positive slant on it, could it actually work even better for you?
One of the reasons I got into education so much was that I had lots of time during the day before a late shift where I was afforded the opportunity to go and teach medical students, whereas if I was working 9:00am to 5:00pm I'd be doing my job.
I wouldn't have the time in the day to do that. That was my own time, but I chose to do that, and actually it helped my career blossom, far more than some of my colleagues who didn't always have that spare time.
How do you make decisions under pressure?
All the jobs that we do in medicine revolve around decision-making. I'm a real lover of understanding decision-making processes. I think our brains work in different ways as human beings. There’s type 1 thinking, where there’s pattern recognition, and you think: ‘I've seen that before - I'm going to do this’. It comes to you immediately - and it sometimes comes with experience.
The more patients you see, the more that you learn patterns, and you can do things quickly. Then there's a slower type 2 type of thinking, which is more about: ‘I've got to be methodical and look at the facts in front of me, and then make a decision’. In an emergency I say: ‘There's always time’, because if you rush in and make a decision without really taking time, you can make a mistake.
That time may not be three days to come back to you with something - it may be three minutes. But there is time. I always say: 'Never run to an arrest. Walk briskly, because turning up knackered and stressed is not the way that the patient needs to meet you, peri-arrest or arrest’. So there's always time in an emergency.
Decision-making is crucial, and for me - I'm quite a simple beast - I really just break it down into: what will kill them first? During my lectures I'll talk about how the airway kills you before breathing, and we go back to our old ‘A to E’ approach. It's something that I do every single day of my life.
I'll go and do a late shift tonight, and if I see a sick patient, I'll do an ‘A to E’ on them. It's not just something we teach medical students, it's something I still do, because it's the safest way to approach patients. I don't have any problems with asking for help.
The more senior you become, the more comfortable, hopefully, you get with saying: 'I don't know' and putting your hands up. I have no problems with asking my F1 or F2: 'What do you think?' I may have already seen the patient, so I'll always speak my thoughts out loud. But then I'll always pause, and ask others what they think.
Sometimes in an emergency you can see people speaking too loudly, or speaking over each other. But it’s time to slow down, and to collate everyone's thoughts, because that's what the patient in front of you needs. It doesn't mean that it's not stressful.
It doesn't mean that when you're making decisions, which can be life-changing, that you don't have internal stress. I was saying just to my colleagues recently that the role of a good leader is to internalise stress in the first instance, but to be honest about the stress.
I'll hopefully lay out the facts to people, but say: ' I'm really not sure what's going on. What do we think, team?' I don't just hold it all myself - I try to offer some calm leadership.
I'll always go home and debrief in my head what happened, and if I should have done things differently. You might think this can be difficult at 3:00am, when you get home after a shift. While you may not sleep very well that night, it’s important to have a self-debrief and, if possible, a debrief with everyone else.
We often talk about how when you have a big event, debrief it. But actually, with most things you do, you should have at least 60 seconds to debrief with yourself, to think: ‘Would I do that again?’, ‘Would I do anything differently?’. If possible, get a friend, an ally, and say: 'I did this. What do you think?’, and be honest with each other and say: ‘I might have done that differently’ - then see how you evolve.
One of the problems in emergency medicine is that although we see a huge volume of patients, who's to say that we're not doing the same thing wrong, over and over again, if we don't challenge ourselves and actually say: 'I'm not sure that was right’.
We need to read around topics or to be able to say: ‘My colleagues who are doing their professional membership exams, my CT1 trainee, my registrar, the guys who have just done their finals - they are the ones who have that knowledge’. So I've got no problems asking: 'What do you think about this situation?'
How do we get reflection right?
Reflection is something that we probably do in all parts of our life, so not doing it in our work life would seem bizarre. You will probably reflect on how you did the shopping: ‘That's too slow, went round the aisles, got caught up in the fun stuff at the beginning of the shop’. You'll get back in the car and think: ‘How did I spend an hour in there?’ We do this without even thinking.
I'm well aware that through medical school, sometimes it feels like there's hoops to jump through. But I am a firm believer in reflection. If you don't do it, how do you know that you're not just doing the same thing wrong, over and over again?
There's self-reflection and there's group reflection, which is important. One of the issues that professionals have is this ‘professional pride’ - that they don't want to necessarily say that they've done something suboptimally. It’s drilled into us: ‘You didn't do that right - you've failed’. I don't think that at all.
I think that it's about bettering yourself. Every single patient I see, there's probably some learning point that I can think I could do that better. I'd be naïve to think I wouldn't. But I don't think that writing reflections down is for everyone.
You'll know some people that kept a diary from when they were a child, and their reflections are quite chronological: 'I woke up today and went to school. Then I had maths, a chicken sandwich, and came home'. They're not really reflections - it's a diary, an event log, and sometimes those events trigger thoughts around things. But writing it down isn't for everyone.
My best reflections are in the shower in the morning! I have a think about the day before. And when I get home at night after a shift, I'll always sit on the sofa for ten minutes, and just have a little think about cases I saw, how I behaved as a leader, how I behaved as a person.
I don't ever write this down. I will also have my annual appraisal where I'll need to submit some reflections, but I'll be honest with my appraiser and I'll say: 'Writing down reflections doesn't come easy to me’, because my thoughts are all over the place. Then I distil them when I'm thinking, either to myself, or in a conversation with a friend or colleague.
Writing it down just doesn't feel easy to me. But through med school there are different reflection tools that we use. As you move into your working lives, have a think about what fits best for you. Is it writing it down? Is it talking about it to yourself? Is it talking it through with a friend? Is it doing it at the time?
Is it pausing at the end of a week and thinking: ‘That was a tough week’. Often, you can be on a hiding to nothing if you don't ever reflect. Either you'll not change your practice when you do need to tweak it, or things will build up without you knowing - and the stress can manifest in different ways, either personal stress or actually not doing your job properly. I'm a fan of reflection.
What does your role as the lead crowd doctor for the Olympic Stadium involve?
One of the advantages of being an emergency physician is you're a generalist and there are lots of different things you can turn your hand to. When I was training, emergency physicians would often do medico-legal reports. There was an expertise, because you saw lots of patients come in.
Many of my senior colleagues were doing things like that. Our careers can go into paediatrics, they can go into pre-hospital, and in medicine, like in any circles, people know people, and they recommend you. You go to training courses, to conferences, and you meet people.
The world of event medicine is a really interesting place. Around 30 years ago, there wasn't such a strict approach to how medicine should be looked after in the pre-hospital arenas.
But sadly, we can all think of tragedies in football stadia, and where events have happened at concerts, where there have been problems, and where healthcare wasn't as appropriate or as available as it could have been. But there's been real progress made in how pre-hospital medicine should be managed.
Many years ago, when I was a second year SHO, I thought I wanted to be a HEMS doctor in a helicopter. Unfortunately, I get incredibly travel sick, even going in a HEMS car, and I remember the team looking like they wanted to leave me on the side because I looked like I was going to vomit all over them!
There weren't many helipads then, but trying to even climb the ladder to go up to a helipad, I felt really wobbly. I remember the doctor looking at me and saying: 'Maybe the ground is the place for you!'
Pre-hospital medicine doesn't just mean being in a fast car or in a helicopter. Event medicine is a really big area.
By chance, I had a wonderful colleague who was working as the Brighton football club doctor, and he was approached to take on the Olympic Stadium when it was reopening in 2014, after the Olympics had finished in 2012. He and I took it on together, and then I took it on solo.
It's such a wonderful project, because we're the doctors - not for the players, the event or the artists, but for the stadium. That means having processes that can look after up to 100,000 people who can be there at one time for a concert.
We've had Jay-Z, Beyoncé, and Guns N' Roses there for concerts. It's amazing to look after concerts like that. And the world international athletics. Really massive events. Then, day to day, West Ham are based there as the football club. The patient population is different from a Beyoncé concert to a West Ham football club game - not quite the same clientele!
I think of myself as a ‘front-door’ doctor in an emergency department. In my time working there I've seen people walk out of a bathroom and have a stroke in front of me. I happened to be literally on the podium when someone was stroking in front of us.
I’ve seen someone having an ectopic pregnancy, who was bleeding in front of us, and someone having a massive heart attack. In five years, we've had five cardiac arrests at the stadium, all of whom we've managed to have return of spontaneous circulation (ROSC) on, because we've had the skills, the team, and the equipment to really deliver resus-room care at the scene.
We're very proud of how we've managed to deliver care at the Olympic Stadium, and it's such an interesting place to think about your governance processes and your clinical skills. Trying to resuscitate a patient at nine o'clock at night in a 65,000-seater stadium while Juan Mata is scoring a goal at one end, and the crowd are screaming, is incredibly difficult because you can't see or hear anything, and it takes a huge skill set.
The ALS is the easy bit - it's understanding what people are saying, and how to convey a patient from the top row of a massive football stadium to a resus room within 45 minutes. It’s hugely challenging but also a huge privilege to be able to work in a setting like this.
Being an emergency physician with generic skills, it's amazing how many people come knocking on your door to say: 'Could you give some advice on this?' or, 'Would you like to come and work in this setting?' As always, if you come into this specialty there are so many opportunities to really thrive and enjoy life.
What does your role as the dean of a medical school involve?
Medical education is something I've been passionate about all the way through my career. I was an average medical student. I was never at the top of the year - nowhere near it. I wasn't at the bottom of the year, but I worked hard.
I tried hard, but what struck me was that it was fortuitous whether you stumbled upon someone who was willing to teach you - who was willing to give you some time - at the bedside. That wasn't something I felt comfortable with. I really wanted to be able to give back.
My father, a paediatrician, was a keen educator as well, and he had the attitude that if someone teaches you something, you should always pass it on. That is the ethos of teaching, isn't it? As physicians, it sits within our oath as well, to ‘pass it on’ and to teach the next generation.
It was something that I was really passionate about doing. So through my career I've always been trying to be involved in medical education. I started teaching as a very junior doctor with just a couple of students at a bedside.
I remember thinking: ‘This is me being an educator’. It was very informal - a shift in King's ED with two fourth-year medical students. I was only about two years above them.
I sometimes blink and don't believe the roles that I have now. But my role at the moment is one I absolutely love doing. I combine it with my clinical role, so I actually do more education than clinical work. I have worked through different roles of being heads of blocks at sites.
I've been heads of blocks at the medical school, and then took on, with our curriculum change, the head of Years 4 and 5, working with Professor Lancaster as one of his deputies. We've had such an interesting time because we've moved to a new curriculum.
We wanted to embed a new curriculum to make it more fit for purpose and to make our trainees ready for practice. That's what medical school should be about - making you ready for day one.
My role is multifactorial. It's a leadership role, making sure that the curriculum we've redesigned is embedded. We have multiple clinical sites, and it's about working with those sites to make sure the culture we want is embedded - that every student is taken seriously and supported.
And that the school feels that even though we have a range of sites, they're still delivering that continuity of teaching. It doesn't matter if you're at a very big or very small hospital, you're still getting your learning outcomes. There's leadership and management there, but Professor Lancaster and I enjoy teaching still.
Even before COVID, webinars were something we enjoyed doing because it allowed us to connect with a bigger group. I will still also try and do bedside teaching during my working week at the Princess Royal University Hospital where I'm based.
The role is great because it allows me to direction-set - hopefully - with an amazing team of faculty that I work with under great leadership, but also to still be a teacher and to be in touch. When I'm on the shop floor with my elective students, it’s nice to see patients together.
What qualities should medical students strive to develop at medical school?
The content that we have to cover in medical school is huge, so first and foremost I would encourage everyone to study hard and to focus on the fact this is a vocational course. This is content that is going to be needed to be utilised, to be enacted, when you are doctors.
I'd also give a word of caution that it's nigh impossible to remember and memorise everything, so I'd encourage students to think about their approach to studying. How do they take this huge amount of knowledge and make sure they have access to that knowledge?
As with many medical schools, exams went to open-book formats. I'm not against that, because that's what the world looks like. We need to have some knowledge and know how to access further knowledge. That's what being a good clinician is.
I'd encourage students to study hard, but also to consider how they study, and how they access knowledge. I'd emphasise communication skills. People will remember how you made them feel. It's really important that we are kind to patients.
I remind myself that when I'm tired, if I've been up 16 hours and I'm seeing a patient. It doesn't matter that it's my last patient of the day - that's their first interaction with a healthcare member, and they deserve the same quality that I gave that first patient.
I think: ‘How would I want my mother to be looked after?’ ‘How would I want my son to be looked after?’ I would implore all of you to remind yourselves that you have to be kind to patients, and that we're in a position of privilege to be able to look after people who are often at their lowest or most vulnerable.
I would also ask you to remember as a senior medical student that there's a long way ahead. Sometimes we are really keen to fill up our CVs and formulate our LinkedIn profiles. You've got 45 or 50 years ahead. I don't see us retiring very soon. It's a long journey. Enjoy it!
Sometimes I worry that we don't take time to take in what we're doing - we're just constantly on this travelator and it becomes a rat race. I encourage a portfolio career. Do lots of little things. Very few of us have just one skill.
Find different things that complement each other. It's what I've done in my career. My med-school life allows me to really thrive when I go into my clinical life. What I do, I hopefully do with passion now, because I'm not just doing one thing where I'm slightly tired or bored. I'd ask you to have some fun, to enjoy life, and to take it in.
Recent years have proven to us that we really need to take time for ourselves, for our friends and family, and to remember that if something doesn't get done today, there'll be another chance. We will all fail from time to time - that's okay. It's about how you pick yourself up.
I've got a quote on my wall: 'Our greatest glory is not in never falling but in rising every time we fall'. That's important, because I've had more failures than I've had successes. But you need to understand ‘that’s life’, and pick yourself up. I worry sometimes that at med school, we foster an approach of: 'You must pass’. Let's just think about what success looks like.
What advice would you give to your younger self?
In certain periods of my life, I jumped on a travelator, and put my head down - I didn't enjoy what I was doing enough at the time. I got caught up in the rat race about having to achieve, to get to that next position. I should have slowed down a little bit and taken in what was around me.
I probably sacrificed opportunities to be with friends, family, for what I thought was career progression. What I've realised - only recently - the last two years of COVID has made me really take stock - that if you work hard and you're good enough, opportunities will always come.
If you turn down an opportunity, actually perhaps that's better than taking on something and diluting yourself down. I'd probably go back to my younger self and say: 'Just slow down and don't worry’. Sometimes you feel like a door closes, and that's it, you've missed it, or you've lost.
But you haven't at all - you'll just get another chance, be it days, weeks or months later. So that would be the best advice I'd give myself - enjoy the ride rather than feeling like I've just got to get to the end.
What habits help you manage your working week?
I oscillate with being quite efficient to being on the verge of disaster all the time, so I'm not saying that my habits are necessarily the best way! I have a notebook and write everything down - it's like an F1 job list. I have little boxes that I tick.
Sometimes I put down things that I've already done, just to tick them, so I can feel like I've achieved something - because otherwise it looks like the job list is going nowhere! I try to be orderly, to be efficient and make lists so that I know what to do.
I try to prioritise. It's one of the things I do in medicine. ‘What's time-critical?’ ‘What do I need to do now?’ ‘What's a project that I can put on the back burner?’ I try to put things in boxes in my head. It's great advice that I've been given from my mentors.
And I’d also advise you to always seek out good mentors that are willing to be honest with you, and tell you when to slow down or when you need a bit of a kick.
I try to factor in time for myself in my diary - it’s scary to look at how busy it is - including two hours of rest. One of my appraisals said: 'You must timetable rest and relaxation’. Lately I’ve been trying to have a little run around the streets. It's more of a plod than a run. But I try to do something for myself.
I try to just sit down and listen to podcasts, to music, to watch telly. I love daytime telly - it's a great thing about being a shift worker. Those are the things that have helped me try to be orderly, but I'm not pretending that it always works.
Some days are better than others, but it’s just thinking about what you do, rather than looking back and thinking: ‘That month's flown by and I don't know what I've done’. It's important to have times where you pause - we'll use that 'reflection' word again - but just take stock and see how you've done.
How do you maintain a healthy work-life balance?
It's really tricky, because when you have one job, you'll know that there are pinch points in your week that will become challenging. For example: ‘I'm on call that day, so it's going to be tricky - I can't do bedtime’. When you have two or three jobs, your diary becomes very complicated.
The best piece of advice I was ever given was by one of my most senior mentors and good friends, Dr Chris Lacy, who was an incredible emergency physician at King's College, and is now enjoying her retirement.
She said: 'You need to know your ‘work-life work line’, and your ‘family-life work line’, and you need to match them up. Because if something is going to compromise your family life, you need to take a good look at yourself as to whether you need to do that or not’. I say this to students, to postgraduates, to senior consultants when I do their appraisals.
I'll say: 'If you're not happy at home, you can't be happy at work, and if you're not happy at work, you can't be happy at home’. So for us not to look at those timelines in parallel is really naïve.
Sometimes, I'll look at my diary and there are key clashes. I’m lucky now, being more senior where I can move things around. That's not always easy when you're a junior doctor, because you have set commitments.
I say to my junior members: 'Look at when the pinch points are’. Let your family know that Tuesday, Wednesday, Thursday, you're going to be on lates - you're not going to be able to get home. Who's going to do the dinner? If you've got kids, who's going to put the kids to bed? Being organised, and remembering that you've got those two lives, helps you to make it work. But balance is a funny thing.
It’s very rare that we're ever perfectly balanced. We're often tipping one way or the other, and it's just about knowing how long that tip is going to be for. If it's for 12, 24 hours, your other half may accept it.
If you see that tip is going to be for five weeks, you've really got to think: ‘What am I going to do before that, so I've got some quality time before or during, to make sure it's as least bad as possible, and afterwards, to really reward myself’.
Sometimes, people put themselves under so much stress without seeing what the endpoints are, and then they will stretch and sometimes break. I've learnt that the hard way. Sometimes I think: ‘You will never get the balance right’. I use the term 'synergy', which is how you can make things work together.
Sometimes shift work can actually make the synergy much better. I drop my children to school three out of five days a week, because I start work slightly later. I can do bedtimes five out of seven days because of my work-life balance. If you get the synergy right, rather than a balance, that can help you.
So have a think about this. And it doesn't matter what stage you are at. It doesn't matter if you are on your own. You will still have your own commitments that will be impacted upon by work. It might be how you get your own dinner together, or how you go and exercise.
It might be how you go and see your friends, or how you just have your own time. But you have to consider both your work life and your personal life, and then you will get the synergy right.
What's your favourite book?
As a child, my grandmother was with us growing up, and she was a passionate reader. I recall going to little Sunday boot-fair markets - and, this shows how old I am - with 5p you could buy a book. She'd give me 5p, or 10p and we'd get two books.
I really loved reading when I was a child, and one of the things I'm most sad about not doing, and that I've asked myself to do, is to read more. I listen to a lot of audio books when I'm driving, and when I used to commute up to London. But there's something really lovely about holding a book and reading like that.
One of my commitments for this year is to read more. My current favourite book is The Boy, the Mole, the Fox and the Horse by Charlie Mackesy. That's because recently, well-being has been really important for me - how I look after myself, and my team. And I hope at med school that students have felt that as a faculty, we are really keen to know how they are in themselves and well.
This is a really beautiful book, and each two pages can be read in isolation as life advice. Or it can be read as a story. It’s a beautiful story for anyone who is struggling in their life - and that struggle can be physical, psychological, or just tiredness. I've now got six copies, because people still think I need this book, so they keep giving it to me! I’d ask you all to either get a copy or to read a copy of it.
Pass it on to someone and let them pass it on to someone else. Let's get this book into circulation. I've got no vested interest in making profit out of it.. It’s just such a beautiful book, because it's so pure.
And it's also a really important book for us as clinicians, because it talks about caring for each other - and that's the role we're in. I'd urge you all to go and get The Boy, the Mole, the Fox and the Horse by Charlie Macksey because he's got some really powerful messages that we can relate to medicine - being a doctor, being a human being, being a partner, and being an individual.
Medspire podcasts are produced by Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov, both full-time junior doctors. They aim to inspire the next generation of doctors and scientists by exploring the career journeys of leading clinicians and researchers.