I was puzzled. I didn’t recognise the name, but when I checked the number it was a hospital area code. A little detective work discovered that it was indeed an NHS department ringing me about an appointment. The person addressing me so cheerily by my first name as if we were old pals was someone I have never met and don’t know. Hey-ho. Perhaps it’s old fashioned of me to feel slightly nettled by such over-familiarity and take it as disrespect rather than friendliness. I still call my patients by their titles as I was trained to do, and I suppose I shouldn’t mind being called by my first name by out-patient departments, mobile phone companies and any other public authority that has occasion  to phone me. But I do mind. I find it patronising. The nuances of title and how to address people carry all sorts of subtle messages, and despite universal first-naming they are still there and can be used in all sorts of ways to convey respect and status – or the reverse.I did like Germaine Greer’s anecdote on “Grumpy Old Women” of objecting to being called “love” by a workman, who then snarled “So what should I call you then, love?” and was met with “‘Professor Greer’ will be fine.”

My late mother absolutely loathed being called by her first name by nurses and other professionals fifty years younger than herself. She was of the generation where the title “Mrs” carried considerable kudos, and those ladies who had often actively chosen not to marry took just as fierce a pride in being called “Miss”.  As a young doctor I learned the hard way a few times that patients did actually mind what you called them, and also learned that if you weren’t sure it was a good idea just to ask. Unfamiliarity with non-European naming systems left us in the foolish and discourteous position of sometimes effectively addressing someone as “Mrs Mrs” until we worked out the difference between a  name and a title. I once had a patient from a Middle-European country almost burst into tears because I had pronounced her surname correctly, having noticed the cedilla and understood what it meant. Her pleasure was out of all proportion to the amount of effort it had taken, and it was mostly luck. Having a slightly unusual name myself and spent a lifetime explaining to people what I’m actually called, as well as having been at school with lots of people called things like Siobhan and Mhairi and Eoghann, I perhaps have a heightened awareness of how irritating it is having to start off every interaction by either correcting the pronunciation of your name or gritting your teeth and trying not to mind when people get it wrong.

Perhaps because English no longer has the grammatical structures that delineate intimacy in the way that other European languages still do, we have to find other ways to convey that a relationship has become sufficiently close to justify the use of familiar language, and the use of first names at an early stage or even right from the beginning is how we do it. However it does not make the divisions, gradations or hierarchies go away, and in some ways it possibly  makes  them even more confusing. You may be on first-name terms with your boss, but it is likely that he or she will have other ways of enforcing their status than by having you call them “Sir” or “Ma’am”, and if you try to take liberties you will soon find out that all this chumminess has its limits………..

It was one of those interesting little paradoxes that the only organisation that did not address me as “Doctor” when writing to me was my NHS employer. It was another interesting paradox that the Occupational Health department wrote to male doctors as “Dr.” and female doctors as “Ms” or “Mrs.” Women will move into the majority on the medical register in 2013, so you would think that NHS departments might by now have got their heads round the idea that some of the women who work in the NHS are medically qualified. Or maybe they think we’re all surgeons? Surely they know that female surgeons are addressed as “Miss”, including obstetricians in England but not in Scotland where the O & G specialists are still called “Dr”?

Well, you can see why the temptation just to lose patience and call everyone “Fred” or “Janet” creeps in……………..who can be bothered to remember whether it’s Sir Professor or Professor Sir? As a child I was fascinated by our old dictionary that had at the back a list of the Orders of Precedence and the ways in which one should address the second wife of a third baronet’s fourth son, should one ever be called upon to do so. There are clearly still some settings in which these things are terribly important, and one visualises the minions sweating and agonising over the seating plan for the Royal Wedding and worrying over whether some obscure princelet was going to feel terribly insulted at being placed in the second row rather than the first.

I still have my place-card from our graduation dinner, and remember the thrill of seeing the handle “Dr.” in front of my name for the first time. The joke is that we are the only group allowed to call ourselves “Doctor” without actually having a doctorate, which some of our academic colleagues who are “real doctors” might feel quite irritated about. Like many new graduates, I proudly added it to my bank account, driving licence and other official paperwork – the transformation from shiftless worthless wild messy medical student into a pillar of society took a while to sink in, but I certainly noticed a sudden change in the way people treated me, which was everything to do with the title and nothing to do with the person. I realised this when I bought my first flat, and went into a posh department store to buy a fridge. I was in my usual off-duty uniform of jeans and sweatshirt, so it took a while to attract the saleslady’s attention, as I clearly did not look like the kind of customer she was expecting. I eventually managed to convey that I actually wanted to buy something, and handed over my bank card. She looked at the card, with the handle, and she looked at me………………….and then said “Is this yours?”   I said in my frostiest voice that I was hardly likely to be using someone else’s.  There was one of those moments as she mentally computed the difference between the scruff before her and her stereotypical expectations of what a doctor looked like, and then there was a sudden flurry of Doctor this and Doctor that and I’m so sorry Doctor I didn’t realise, etc etc…………….

At the time I thought it was funny, while feeling annoyed by her snobbery and the notion that she would treat someone differently because of what they did for a living. It was amusing to watch her expectations based on my accent and the way I was dressed undergo a sudden shift because another piece of information became available. Presumably she felt that there were certain categories of customers she could ignore and talk down to and others who were more deserving of attention. Most of the time such prejudices and assumptions are just a matter of courtesy and kindness, and the way we address people is just about manners. But it’s always good to remember that such prejudices and assumptions have the potential to harden into something really dangerous. In the dark days of apartheid in South Africa, I met a young black minister who was over visiting Scotland, and he told me about going into a shop in Glasgow where the assistant had come up to him and said “Hello, sir, can I help you?”

“I was amazed” he said, “You see, nobody had ever called me ‘sir’ before.”

Every woman sitting on those comfy chairs either has breast cancer, or thinks she does. Being a doctor does not make the experience any less terrifying. The paradox of breast cancer is that the disease may well be asymptomatic, it’s the treatment that makes you ill. Going through the slash, burn and poison routine of surgery, radiotherapy and chemo leaves patients very ill indeed and takes years to recover from. Besides the physical beating, there’s the psychological trauma: the fear of death, the pain, the uncertainty, the agonising waiting for results, then the sudden plunge off the cliff when all the treatment stops and you try to stagger back to your life and get on with things. Discovering that life has changed irrevocably, and you can’t actually go back. Coming to terms with weakness and disability, a different body that refuses to do all the things you want it to as effortlessly as it used to. Coping with other people’s reactions, especially those who want to regale you with the hair-raising story of their friend who had a dreadful time with her cancer treatment and then died, which may be true but is not uplifting. Trying not to lose patience with the “But you look so well!” brigade who are only trying to help, and don’t really want you to snarl “I’m sure I do but I feel like shit, I’m in pain all the time and I can’t  lift the bloody kettle so forgive me for finding it a bit of a struggle to be positive………….”

And then there is the return to work. My Occupational Health department managed to make an assessment of my fitness for work without collecting any information from my treating team or GP,  looking at my workplace or job description, examining me, or indeed doing anything other than look at me, which is pretty impressive – but I had not until then realised that the two categories of fitness for NHS staff are “upright and breathing, fit for work” or “incapacitated, off sick” and you aren’t allowed any shades in between. The culture of “unreasonable adjustments” in which disabled staff not only have no allowances made for their health conditions but are actively placed in settings which they have pointed out will make them worse is excellent too – cue lots of capacity processes and staff who have beaten their illnesses and triumphantly come back to work dumped on the scrapheap angry, isolated and betrayed.  Unemployment is bad for people as we know, and the most damaging complication of breast cancer for me was losing my job – isolation, loss of routine and fitness, deskilling, depression, and the long, long, hard struggle to find a way back………………

Well done, says your treatment team, everything’s fine.  See you next year. Clutching your appointment card, down the stairs, through the doors, along the corridor, back out into the sunshine away from the hospital’s fluorescent lights, full of relief and gratitude at another year’s reprieve, quick glance at the balcony where the in-patients are out for a breath of air and feeling a mixture of guilt and thankfulness at not being one of them any more…………and hopefully  never having to be one of them again……….

What’s more, the banking culture has infected NHS management to the extent that dishonesty about actual reality on the ground is considered perfectly acceptable……………….to quote a colleague, “It doesn’t matter what’s really happening as long as it looks all right.” A manager I worked with used to refer to the reception staff as the “front-of-house team” – presumably under the impression that we were a theatre. The Trust magazine is known on the ground as “Pravda”, so full is it of pictures of happy smiling staff having a wonderful time and doing a brilliant job. Of course there has to be some antidote to the constant drone of low-level whingeing that constitutes the daily chat of many workplaces, and it is important that staff are praised and rewarded for the good they do. It’s when it tips over into a “We only want to hear the good news” culture that things begin to drift away from reality…………..

It should be no surprise that the more glitteringly illustrious the reputation of an NHS Trust, the more viciously it will  react to anyone who points out that it ain’t necessarily so. Success breeds success………………..and it also breeds extraordinary salaries for those furthest away from the patients.  Being part of the senior management of such a famous organisation carries tremendous kudos – hung over from the long-gone days when people loved their local hospital and showered it with gratitude for saving their lives and those of their children in the early days of the NHS. Therefore, any admission of anything less than perfection is not acceptable because it damages the brand. Unfortunately, patients do not always appreciate the need for the hospital to meet its targets, and do all sorts of unco-operative things like missing appointments, being iller than expected and staying in too long, and generally being unwell, chaotic, vulnerable and needy. It would all function so much better if they just weren’t there. Real businesses such as supermarkets are as successful as they are because they tailor their activity very efficiently to the population they serve, gathering huge amounts of data about their customer base, knowing what people buy, how much they spend, how they behave. So to put it simply, different stores stock different things to provide what the local population want to buy. But the NHS approach is usually very much the other way round…………….here’s what we’ve got, take it or leave it, and if you find the system difficult to access, unfriendly, inefficient and unwieldy, tough. When Great Ormond Street  took over the management of a clinic in an extremely deprived area, how much time was spent looking at the needs of the local population and working out how best to serve them? Working with “the poor and deprived” sounds very lovely and PC but has its own particular set of challenges which need to be provided for, and what works in leafy suburbia will not necessarily work in areas of great need. But when the paediatricians who were actually trying to work there began to point out that it just wasn’t functioning, what happened?

I have worked in a few places that have got into the sort of NHS death spiral that hits badly-managed units – what a friend refers to as “corporate burnout”. * Sometimes all that has happened is that a few key staff have left, got ill or gone through personal crises simultaneously………………many a GP practice is held together almost entirely by the practice manager and if he or she gets ill the wheels come off very rapidly. The difference in that setting is that the “senior management” – the partners – have a vested interest and an obligation to keep the show on the road because it directly affects their income. So although there may be much muttering and grumbling and some outside help may be required, it is rare for a practice to completely implode unless the problem *is* the partners. It is not actually possible for the “senior management” in a GP practice to become distanced from the patients because the partners have to interact with them on a daily basis and be told what issues are affecting them in no uncertain terms. No sitting in luxurious offices miles away from the punters relying on pretty graphs and PowerPoints to tell you what’s happening. The Stafford inquiry continues to provide daily horrific evidence of what happens when money and targets take priority………………staff simply fiddle the figures, and what’s more are rewarded for doing so. Those who pipe up and say “I can’t put that, it’s not true,” are liable to  find out quite rapidly that the end apparently justifies the means.

Even if a unit has become so understaffed and under-resourced that it has effectively ceased to function, appearances must be kept up. I once went to work in a setting where this had actually happened: so many staff had left or gone long-term sick that those remaining could not keep up with the workload and waiting times were getting longer and longer. But what was the response? I was puzzled that there did not seem to be any analysis going on of how we had got into such a mess. Should we not be standing back and taking a look at our working practices to see what needed to change? It was hardly a ringing endorsement of the way things had been. But no – we just recruited more staff and carried on as before. What’s more, we continued to accept referrals knowing full well that we had no clinicians to see the patients. I was even more puzzled – another unit, having got to a similar point, had issued a statement that it could only accept emergency referrals while it sorted itself out.  Should we not tell our GP colleagues that we were struggling and ask for their support and co-operation while we got through the bad patch? But no, we couldn’t. It would have been an admission of failure. Senior management would not like it:  the press might get hold of it and there would be bad headlines.  So the letters carried on arriving, and the patients waited………..and waited………….and waited………….

In order to solve a problem it is first necessary to admit, accept and agree that you have one, and then decide on its nature. If you are in a “We are utterly wonderful and we don’t have problems” culture, however, you are a bit stuck. So what GOSH did when Dr Holt and her colleagues raised the alarm is what Trusts generally do: get the diagnosis wrong. Not: “This senior consultant is pointing out a problem and suggesting solutions – what’s wrong with our service?” but “This senior consultant is pointing out a problem and suggesting solutions – what’s wrong with her?”

The process that follows soon ensures that if the doctor was not mentally ill before they very soon end up that way. It’s called “gaslighting”, after the old movie “Gaslight” where the evil husband attempts to drive his wife mad by altering things around the house and denying having done so. ** The clinician is confronted by the “Emperor’s clothes” experience of struggling every day in a highly stressful work setting where none of those charged with managing it appear to be able to see anything wrong, to the point of flat denials of actual events. Not only are they not believed, but insinuations begin to be made that they are dishonest or deluded.  This is extremely similar to the pattern experienced by families living with an alcoholic, and can be conceptualised in the same way – the institutional addiction to wealth, reputation and appearance leads those caught up in it to simply refuse to see what is really happening and swear blind that it isn’t, perhaps even believe it.  Did you drink that bottle of whisky? – No, absolutely not, how could you suggest such a thing. This clinic is dangerous – No, it isn’t, we provide an excellent service to all our patients, so you don’t know what you’re talking about Doctor.

And what of those guardians of patient safety, the BMA, the GMC and the medical defence unions? Well, let us just say that they did not cover themselves in glory when Dr Holt tried to speak up for her little patients, and the GMC yet again came down on the wrong side by its disgraceful scapegoating of Dr al-Zayyat, the hapless locum paediatrician who was left holding the parcel when the music stopped. One of Kim’s most telling comments in her interview was that while the medical establishment cold-shouldered her, those outside it including the press understood exactly what she was on about.

When Dr Holt took her Hippocratic oath, I would guess that, like most of us, she meant it – perhaps not realising the pain to which her commitment to the welfare of vulnerable children would bring her, but emerging with authority to challenge the culture that pays lip service to patient safety while putting the needs of those addicted to wealth and power first. she and others like her have a real determination to stop the hounding of health professionals who raise concerns and hold the regulators and health service unions to their stated aims of supporting them.  So perhaps every newly -qualified doctor should add another essential piece of equipment to their shopping-list along with the stethoscope, the tendon hammer and the diagnostic set. Perhaps it should have the initials of the GMC, the BMA  and their defence union engraved on it. Perhaps it should be big and shiny, and they should wear it round their neck at all times to remind their patients whose side they are on.

It should be a whistle.

http://www.patientsfirst.org.uk

* Thanks to Rev. Tom Gordon for the use of this phrase

** Thanks to Dr Cathy Symonds for introducing me to this expression

Meetings in GP-land were generally stuffed in between surgeries, interrupted by phone calls, and conducted with the practice accounts in one hand and a sandwich in the other. So when I moved to a salaried job with the local Trust I was quite startled at the leisurely pace at which meetings were conducted, the number of meetings there were, and the lack of clarity as to what they were actually for. They hoovered up a massive amount of what would otherwise have been clinical time, thereby rendering all the clinical staff unavailable to their patients for an entire morning or afternoon. No wonder the waiting-lists were so long. But it reflected a culture in which “management” was seen as more important than direct patient care. Managers do not see patients: they have meetings. Clinicians are expected to do both, but cannot do both simultaneously, and the meetings take priority. Let’s look at how this works in practice…………….

In an NHS workplace that shall be nameless, the “management meeting” took place on a Friday afternoon. Many people might well feel that the end of the week when people were a.) tired and b.) wanting to tie up loose ends before the weekend was not the best time for all the senior clinical staff to be trapped in a meeting for three hours. It took the only doctor on-site away from the patients and left the admin staff battling with prescription requests and sudden crises without anyone to resolve them. In fact the real purpose of it was to stop anyone from leaving before five o’clock, as the manager was obsessed with the notion that the clinical staff were lazy naughty children who had to be kept firmly in check. The agenda ran to two A4 pages containing about 35 items (with sub-clauses), with the important things at the end, by which time everyone had lost the will to live and would have agreed to selling  their mothers to be made into cat food if it meant the meeting could at last come to an end. Much time would be spent on debating things on which there was no actual decision to be made – for example, the visit of a government minister recurred on the agenda for weeks. First we talked about how nice it was that the minister was coming, then we talked about how nice it was that he had come, and then we talked about how nice it was for him to have sent a letter saying what a good time he’d had, while issues like staffing levels, salaries etc remained firmly at the bottom of the agenda and somehow never came up for discussion. I earned the manager’s undying enmity by suggesting that perhaps we could circulate the minutes and agenda in advance, and divide items into “for information” and “for decision” so that we didn’t spend endless time going round in circles and could finish earlier to have time for pre-weekend mopping-up.  I had misunderstood. This workplace was a dictatorship, not a democracy, and the management handbook says “have meetings”. The fact that the meetings were actually getting in the way of our primary purpose of delivering care to our patients was completely irrelevant.  It was an absolutely classic example of how *not* to run a meeting, assuming that your intention is to deploy your resources wisely and efficiently rather than bully, control and waste the time of your senior staff – which, of course, it wasn’t.

Meeting games include the manipulation of agendas and circulation lists so that some people mysteriously always get left out and don’t get the minutes or even hear about the meeting in the first place, rewriting minutes so that they bear no resemblace to what was actually said or decided, or not taking minutes at all. Witness another “medics meeting” that collected eight consultants and two senior GP’s on a Wednesday afternoon for purposes unknown, apart from the one person who was never informed about it and the one who had said they really wanted to come but couldn’t do Wednesday.  While it was nice for us all to have “face time” with each other, it was never entirely clear why we were there – some people wanted to discuss difficult cases and seek advice, some wanted to discuss holiday cover and admin issues, some wanted a journal club. Whatever the purpose of the meeting, the boss forgot the first rule of chairmanship, which is to switch off your mobile phone. However there is no point in being the boss if you can’t be so terribly busy and important that you must always take the call – which is why a whole room full of senior medical staff sat in patient silence while the boss had a discussion about dog fostering. It’s always useful to remind your subordinates where they stand in the animal hierarchy. After a while , of course, the patient silence disintegrated as a small sub-meeting broke out at one end of the table, an argument at the other, and the rest started wandering off to get cups of tea. Calling the meeting back to order after that little lot took some time…………..

I have been at meetings which were cordial, efficient and expertly chaired, but they were generally not within the NHS. They were in organisations that treated the participants with respect, valued their time and their contributions, and had clear ideas of why the meeting was taking place and what the outcomes and objectives were. They were vehicles for achieving the primary purpose of the organisation, not avoiding it. In the Workplace from Hell nothing would have been any different if the meetings had all suddenly stopped happening, apart from the fact that the staff would have had more time with the patients. So is your meeting really necessary?

As a very new doctor, I worked with two surgeons, and it is interesting to reflect on what might be happening to them had we been working in the brave new world of today’s obsessive over-regulation. Mr A was what people might think of as a typical “surgical personality” – aggressive, impatient, exacting and very, very shouty. I was too low a lifeform for him to bother with, but he took out his aggression on the two male junior surgeons, regularly screaming at them on ward rounds, shouting and bawling in theatre and generally creating an atmosphere of terror and panic as soon as he hove in sight. In consequence I took care to have all his results and X-rays available and scurried around like a fieldmouse on speed, trying to avoid the rough edge of his tongue. However I noted that not everyone responded like that: one of the most satisfying moments of the year was watching the diminutive Nursing Officer steam into the ward and tear a strip off him in front of the whole ward round because he had shouted at a student nurse.  “Don’t you DARE talk to one of My Nurses like that again!” she yelled, and he shrivelled like a deflated balloon.  He even apologised to the student nurse.  So it was possible for someone with enough clout to stand up to him, but it still didn’t change the kind of man he was. In later years as a GP I still referred my patients to him, but at least one came back and said “Don’t ever send me to see That Man again”, so clearly the years had not mellowed him…………..

Mr B, on the other hand, was a lovely man, and his patients adored him. He was kind and polite, and would sit on the beds and chat for ages – his rounds were long, but the atmosphere was relaxed and comfortable, with plenty of time for a cup of tea afterwards and a paternal concern for how the juniors were getting on. The only problem was, he was the most utterly hopeless surgeon I had ever seen. Despite my very limited experience, one trip to theatre told me that…………………….when I arrived the patient had already been on the table for hours for what should have been a fairly straightforward operation, and I wondered why Mr B was slowly and deliberately oversewing a hole in the small bowel. It was because he had made the hole. I watched with increasing horror as he stuck a scalpel into a swelling on the kidney to see what it was – it being a cyst, a load of infected fluid poured into the peritoneum, the anaesthetist went white and started fiddling with the machines, and I realised that the reason I had been called to theatre was that the op had already been going on for so long that my senior assisting needed to leave to do the afternoon out-patient clinic. Mr B was slow, clumsy and incompetent, and his patients took multiple trips to theatre in attempts to reverse the damage caused by minor procedures that went horribly wrong. Why did nobody stop him operating? Mr A may have been a complete swine to work with, but his technical competence was not in question, his stitches held together and his patients went home rather than languishing on the ward for months or dying.

Mr A, however, would be unlikely to survive today’s emphasis on “team working” and “communication”; of the two, he would probably be by far the more likely to come to the attention of the GMC because he was so unlikeable. I would have loved to read his “multi-source feedback” – although whether knowing that everyone hated him would have improved his “performance” is debatable.  Mr B’s mortality rate would have been picked up as an “outlier” much earlier, but rather than being struck off he would have been gently eased into “management” in the erroneous belief that an incompetent doctor could do no harm there, when it actually confers the ability to  trash entire populations rather than single individuals. Bad managers kill people too, they just do it a different way.  Perhaps rolling the two of them together would have produced one decent surgeon who was nice to work with – such creatures do exist, and the belief that surgeons have to shout is as erroneous as all the other medical stereotypes. Surgeons have to have good hands, first and foremost – despite his obvious character flaws, if it came to an operation for me or my loved ones, Mr A would have been the choice for anyone who valued their lives. The question would be whether he was capable of modifying his behaviour – or whether he was a sort of surgical equivalent of John McEnroe, needing to scream and bawl to psych himself up for the very frightening prospect of holding a patient’s life at the end of the scalpel and knowing that if you get it wrong they might die. Perhaps he was anxious, realising the heavy responsibility he carried, shouting because he wanted things to be perfect in an imperfect system. Perhaps Mr B’s amiability lay in a selfish denial that his patients were suffering, that he was not the best person to treat them no matter how much he still enjoyed gowning up and being a “Mr”, that being a nice chap was not enough.

The GMC’s obsession with “fitness to practise” concentrates on “fitness” as in “worthiness” and is heavily punitive towards “immoral” behaviours, while getting itself all in a mess over what to do with doctors who underperform because their physical fitness has declined through age or illness. Mr B was most likely simply too old – loss of dexterity, poor vision, slowed reaction times, normal effects of ageing that nobody had had the heart to tell him meant he couldn’t operate any more. The revalidation proposals contain no requirement for doctors to have regular medical examinations. Disability discrimination within the profession is the norm rather than the exception, leading doctors who are struggling with health issues to conceal them for fear of being labelled a liability or a burden on their colleagues. The Royal College of General Practitioners’ training on “Health for Health Professionals” is promulgating the ridiculous notion that the main health issues in doctors are the “three D’s – Drink, Drugs, Depression” – as if we didn’t get arthritis and hypertension and cancer and diabetes like everyone else.  Training is now so rigid that it is much more difficult for a young doctor who realises that they are not physically or mentally suited to their chosen speciality to move to another. Retraining and remediation is always expressed in shaming terms of “difficulty” or “failing”, and how on earth did we end up calling flexible training “less than full-time”, as if doctors with family, health or caring commitments were some kind of “less than” species of doctor?

I suspect that the unwieldy bureaucracy of revalidation will be killed by the cost. Imagine the chaos if all drivers were told that they would have to “revalidate” by completing tons of paperwork every year and resitting their driving-test every five. Imagine the army of people required to read through piles and piles of “reflective learning” without dying of boredom, administer the testing, the courses, the re-testing, the court cases. Of course, picking up drivers early who were drugged or blind or too arthritic to change gear would save a lot more lives, the most dangerous part of any car being the nut behind the wheel, but it would be too costly and too political so it won’t happen.

Revalidation Lite: one question to all the doctor’s colleagues, as follows. “Would you let this doctor treat you or your family?”

Three possible answers:  “Yes, certainly”   “Absolutely not”  or “Weeeeeeeeellllllllll…………..”

First group: immediate relicensing

Second group: licence on hold pending further inquiry

Third group: approved revalidation course as per speciality, and ask again

That would sort the Mr A’s from the Mr B’s……………….

                From the twenty-first century viewpoint, of course, it is obvious that the processes were biased and unfair, so much so that the term “witch-hunt” has come to be synonymous with the persecution of innocent people by hysterical  tabloid headlines or totalitarian show trials. However when I read those heart-rending speeches by the martyrs of Salem, I had no idea that I would soon be feeling the same sense of helpless despair, the knowledge that nothing I could say or do would exonerate me because the verdict was already decided.  I was not on trial for my life, fortunately, but for my career and livelihood, my personal and professional reputation and my self-esteem.  I was undergoing an investigation by an NHS employer for “bullying”.

                The aim of “Dignity at Work” policies is laudable – to eradicate bullying, harassment and discrimination from NHS workplaces.  Like most doctors in training, I had certainly experienced my fair share of being shouted and bawled at and terrorised by notorious “characters”, had mentally noted certain behaviours and sworn to myself that I would never get like that.  There was not a great deal of role-modelling of good working relationships, but I do remember with gratitude the few seniors who were understanding and supportive. Working in an exceedingly stressful environment where everyone is stretched to the limit it is difficult to act with perfect courtesy at all times, and only the most dishonest of doctors would fail to admit that they might occasionally have been a bit ratty. I have never yet met a doctor who was perfect. Conflict is inevitable when people work together, and part of the essence of good management is to deal with it as soon as it arises without scapegoating individuals or allowing it to fester.

                Good management, unfortunately, is in short supply in many corners of the NHS. I had witnessed a colleague being put through the witch-hunting process, and had tried to support her, so I had seen how it worked and was semi-prepared for it when it happened to me. The catch-22 about an accusation of bullying is that the only “evidence” required is the feelings of the alleged victim, which of course are entirely subjective and based on their own beliefs, attitudes and interpretations of the alleged bully’s behaviour.  Nobody can argue with someone having “felt bullied” – as the policy states, it is the impact on the victim that matters, not the intention of the perpetrator.  Indeed, the perpetrator does not actually have to have had any harmful intention at all. This means that one may be guilty of “bullying” on the basis of a tone of voice, a gesture, or even a joke taken out of context.  The only way out is to “confess” and promise to modify one’s behaviour, as any protestations are taken as evidence of lack of insight or arrogance.  The fact that one may not actually have done or said the things reported is neither here nor there.

                It is difficult to convey in words how devastated and ashamed I felt when I read the witness statements that were sent to me. They were a mish-mash of gossip, hearsay and opinion, and the spite behind them steamed off the pages.  They arrived when I was alone in the house, and the cruel comments embedded themselves into my brain and played over and over again. Was that really how I came across to people?  The conflict hinged around a certain meeting, but many of those interviewed had not been present at the meeting, had never worked with me and in one or two cases had actually not even met me. Others who had been present were not interviewed – presumably because they might have said they hadn’t seen me bully anybody.  The investigation was heavily biased, unfocused and had extended its remit way beyond my personal behaviour and practice – the complainant had been unhappy with the work situation long before I arrived and had indeed shared some of that unhappiness with me in the many workplace chats that were now repeated and twisted in the statement.  Casenotes and diaries that would have exposed the lies for what they were were not examined. All the miseries had been there before I came, and the complainant had had the same issues with my predecessor.

Needless to say, there was no mention of the fact that I had recently returned to work after a life-threatening illness, having been “redeployed” after trying to raise concerns about a dangerous colleague.  No doubt my card was marked. The team were hostile and suspicious from the start, greeting my questions about how things worked extremely defensively, and in the case of one colleague, losing control to the point of shouting and screaming at me.  I just wanted to go to work, do my job, and go home, but they clearly felt immensely threatened.  The one person who had spoken in my defence had not been interviewed because, as the report stated, “it would have made no difference to the outcome”.  There had been no attempt at mediation because the “victim” had refused to attend.; nobody thought to tell me that, so I waited patiently for a mediation process that never happened.  The team had simply decided that they were not prepared to work with me and wanted me out, and they got their wish. They had been gathering the “evidence” for months – before any of my terrible “mistakes” had actually happened, in fact! I was happy to move – they had made it extremely clear from the beginning that I wasn’t welcome and had made my day-to-day work very difficult in all those subtle ways that unco-operative colleagues can, culminating in sending me to Coventry and the silent treatment.  It was, in fact, a textbook example of the form of workplace bullying known as “mobbing” or “ganging-up”, where an individual is targeted by the group, harassed and driven out.  Most of us have witnessed or experienced this sort of thing at school, and there have been cases of children driven to suicide by the severity of the social injury at a time when they most desperately need to fit in with their peers. It is no less devastating to have it happen to you as an adult.

The irony is that I am one of the very kind of people that Dignity at Work and equality and diversity policies are intended to protect – gay and carrying a disability – so to have the legislation twisted round and used against me was almost beyond belief.  The investigation did not examine the attitudes, prejudices and beliefs of the complainant, even in spite of evidence from another witness of homophobic joking and gossip going on behind my back. Most of those involved were in breach of their professional codes of conduct as well as the employer’s policies and the law of the land, but none of them were brought to account. I could have counter-complained, of course, but since every single thing I said and did was twisted round and used against me I knew it would just be taken as further evidence that I “lacked insight” and was “unwilling to change”.  And having experienced the “investigation”, I could not actually bear the idea of putting another doctor or nurse through the same thing.

The role of the BMA appeared to be to sit and watch all this happening and do nothing, so I had no effective defence. Abuses of process were not called to account, so the Trust had carte blanche to drag the process out for months and months, mess with my salary, ignore its own policies, breach confidentiality and generally make the rules up as it went along.

The quotation in the title is from Benjamin Britten’s opera “Peter Grimes”, an ambiguous work that tells the tale of an outsider hounded to death by a small community – the irony being that the gossip is not put on trial, Peter is convicted by the “court of public opinion”.  The Salem trials were ostensibly based on religious belief but actually on personal grudges and spite, neighbours accusing each other for fear of being the next one accused.  Until word began to leak out to the outside world of what was going on, residents of the small community were faced with the awful choice of either joining in with the accusations or becoming one of the accused.  

I survived.  No doubt these things have always happened in the NHS, they were just happening to someone else.  The victims changed speciality, or emigrated, or left the profession, or just disappeared.  These witch-hunts can go on for years and leave the subject so damaged that they never return to work – what athletes call a “career-threatening injury”.  For me, the most devastating thing was discovering that the standards and principles of the NHS to which I had devoted my professional life were meaningless, that I had for 20+ years paid money to a “trade union” that just sat there and watched all this and offered no effective support, being apparently completely powerless to hold the employer to its own policies or even recognise that the complaint was malicious.

It took a long, long time to recover. Naturally I thought it was my fault, and wondered what I had done to make these people hate me so much.  The involvement of someone I had considered a close friend was the most painful blow of all, but when power and ambition are at stake, personal loyalty and compassion are not on the agenda. Now I know that it wasn’t actually about me – somebody somewhere had decided I was persona non grata and on my way to the door, no doubt for financial or political reasons, and I was just collateral damage.  I will be eternally grateful to the friends – mostly non-medical – who supported me and were horrified by the blatant injustice of the process. I was not the only one whose faith in the ethics of the NHS was severely shaken. I will certainly be contributing to the ongoing discussion on revalidation for doctors and the danger to minority doctors  of such tools as “multisource feedback” when the feedback is not reciprocal and is not validated against equality and diversity legislation.

We do not need huge public inquiries to find out why NHS staff do not blow the whistle on poor practice.  We already know. It’s because we’ve seen what happens to those who do.  We are trying to work in a hideous blame culture that is a greater risk to patient safety than MRSA. 

 It has been reassuring to meet other staff who have been through this kind of thing and realise that there’s a pattern. You lose your job, but you keep your integrity; most of those you thought were friends run for the hills or join in the backstabbing,  but some do not, and they are worth their weight in gold.  With their support you recover your self-worth and confidence – perhaps enough to get another job if the bullies haven’t gone so far as to damage your registration.   You notice that there are a few former colleagues about who don’t seem to be able to look you in the eye.  Some of the things you tried to raise concerns about begin to change, although the changes do not have your name attached to them.  Life goes on…………………..another colleague rumoured to be a bit “difficult” or “outspoken” suddenly disappears, suspended or on sick leave, and you worry a bit about what’s happening to them but they now have the professional equivalent of leprosy so nobody makes contact with them and they never come back…………………..

The callous comment attributed to Marie Antoinette when confronted by the suffering of the poor, like so many “characteristic” remarks of historical personages, was unlikely ever to have been uttered by her. But it has come to epitomize a mixture of ignorance and cruelty which is certainly alive and well today – a form of blindness which simply does not see the reality in which others have to live.  Whichever royal princess really did say it may not have meant it to be as heartless as it sounds – but may just have been completely unable to conceptualise a life in which the choice was not between different kinds of bread, but between nothing and nothing. Similarly, the vicious froth whipped up by the tabloids against “bogus asylum seekers”  and “scroungers” serves to convince the general public that “these people” are getting what they deserve when we detain them and their children for years or make them destitute to force them to go “home”, and throw already poor people off their measly benefits in the belief that it will make them get jobs that do not exist. In order to tolerate  the massive inequalities in our society and our world, we have to be convinced that the poor are poor because they are feckless, lazy and stupid, and indeed some kind of different species who have somehow chosen their situation and are continuing to do so. So the way to make them pull their socks up is to withdraw the pittances they are already struggling to manage on and make them poorer. How is this logical? Does the Government not know that it was the failure of laissez-faire and philanthropy that led to the foundations of the welfare state, or does it just not care?

The most bizarre form of this distorted thinking is the notion that wealthy people are “incentivized” by paying them more and more, and poor people are incentivized by paying them less and less. It has now got to the stage where the discourse on top salaries and bonuses is actually quite mad.  The banking culture has infected the public services to the extent that the people who sit in boardrooms and offices presumably really believe that they are worth more than the people dealing with the public on the ground. Otherwise how could they live with themselves? Witness the wonderful suggestion from the Chief Exec of Epsom and St Helier NHS Trust (as reported in the “Daily Mail of 14.12.10) that staff should “donate” some of their annual leave to help the Trust with its financial problems. Not surprisingly, this has attracted some quite robust responses on the comments page, mainly to the effect that clinical and other staff already work for nothing a lot of the time, staying on beyond their contracted hours and working in their own time, and also to the effect that someone on £157,000 per annum including last year’s 46.5% pay rise is in no position to tell the lowest-paid members of the workforce that they should give their time for free. It does not seem to cross her mind that the Trust could buy quite a lot of nurses for £157000, and might think that they were better value for money.  She is obviously also not following the mid-Staffs inquirywhich is revealing in horrifying detail just what happens when Trust Boards make cost-cutting decisions in the belief that the staff on the ground are expendable. What do they think all these people actually do? Why are nurses, doctors and admin staff considered a waste of money when inefficient and incompetent Chief Execs aren’t? What proportion of that £30 million overspend was actually spent on direct patient care?

A nurse or doctor who killed a patient through negligence, malice  or incompetence would be struck off and never allowed to work as a nurse or doctor again.  A Chief Executive who kills a bank  or a hospital or another institution entrusted to his or her care by the public suffers no penalty, and usually waltzes off with a golden goodbye to another lucrative job.  How is competence measured in this strange world of theirs? Is having made an utter mess of things and driven your organisation into bankruptcy somehow regarded as a qualification? – you would almost think so, as the financial equivalents of  Attila the Hun swim from Board to Board, Trust to Trust, quango to quango.  What penalties will befall the governors of the once-renowned Edinburgh College of Art who allegedly “borrowed” from the student scholarship fund to bail out other bits of the organisation? I had never come across the word “vire” until my rare forays into NHS management meetings – it means moving money from one account or budget into another. Perhaps someone somewhere thought that what most of us would call “robbing Peter to pay Paul” sounded better in French.

I would be more inclined to believe that we were all in it together if all the millionaires in the current cabinet decided to forego their minsterial salaries on the grounds that they didn’t need more money and donated them to the charities they expect to pick up the pieces when the welfare state collapses. Maybe that NHS Chief Executive would like to spend her annual leave admitted to one of her own  wards and see at first hand the effects of short-staffing and low morale. It would be most educational. Then perhaps she might be better able to decide whether nurses, doctors, ward clerks and cleaners are a luxury the Trust can’t afford, or a necessity.

However, given the vast amount of data already amassed by the supermarkets on the customers’ buying patterns, there’s a much easier way to help them get healthier without needing expensive doctors in the store.  After all, we know that patients don’t take our advice most of the time anyway. There’s a much better way to do the necessary “behaviour shaping”, and all it requires is a few minor modifications to existing checkout  technology. We have affinity cards that measure what we buy, and lifts,  petrol pumps and self-service checkouts that talk to us. The supermarket of the future will be equipped to replace primary care altogether, and your 21st-century shopping trip will go like this:

You stand  in line with your trolley as the lady in front of you steps nervously on to the weighing pad beside the checkout. All the operators have been made redundant, and the system is now fully automated, designed to maximise profits for the supermarket while simultaneously minimising health costs for the government.  A little arm comes out and rests on the top of her head; various lights flash and the checkout announces in a very loud voice “Mrs Jane Bloggs: Body Mass Index  37.9     AHHAHAHAHAHAHA!  Carry on, Fatso!”  The customer goes beetroot, muttering  “It was 35 last week, I’m just wearing a heavy coat”  and reluctantly rolls up her sleeve as the auto-sphyg swings out and clamps itself round her arm. You hear one of the other checkouts laughing maniacally and yelling “Put that cream cake back this instant, chubby-chops!” and hope that your diet has worked. The new policy of relaying customers’  BMI’s  over the tannoys – the bigger the number, the louder the announcement – is thought to incentivise people to lose weight. The shame of having everyone in the store know how porky they are and having their shopping scanned for unhealthy foodstuffs seems to be having an effect. However after a few nasty discrimination cases involving pregnant women you thought they had toned the mockery down a bit…………..but you note that there is now an “eating for two” button on the “mitigating factors”  pad that allows you to enter various exclusion codes …………

The checkout next door  says “Mr Patrick Thynne………….BMI 25 AT LAST!! Well done sir!”  and plays “For He’s A Jolly Good Fellow. ” The customer beams proudly as the checkout prints out a voucher for a bag of apples and a new pair of trousers that he can now fit into. The lady in front has had her blood-pressure test and swiped her medical record – medication card, and the checkout has dropped a bottle of pills and a set of dumbells into her trolley and delivered a short lecture on compliance.  She is now putting her finger into the biotest unit for the obligatory blood test and blowing into the breathalyser.  As the unit analyses her results she attempts to scan her shopping, but gets no further than the first item. A horrible loud siren goes off and the customer freezes as another arm with a set of pincers on the end of it swings out and reaches into her trolley.

“What do you think you’re doing?” snaps the checkout in Anne Robinson’s voice. (A selection of celebrity voices is available, somehow not including Dawn French and Sophie Dahl.) The pincers are clasping an incriminating packet of apple turnovers.

“They’re healthy” says the customer  defiantly. “They’ve got fruit in them.”

“You can’t have them. You’re diabetic. Go and get some oatcakes. “

“I’m allowed one pie a week. “

“You bought a whole packet last week. You’ve got dental caries, gallstones, arthritic knees and submammary candidiasis. PUT THEM BACK. And while you’re at it, don’t think you’re going to get that big packet of pasta and the four-cheese sauce through, or those pork scratchings. And maybe you can’t believe it’s not butter, but I believe it IS butter and you’re not having it. Did you not read the print-out from last week, with the diet plan and exercises? Now, you’ll have to start again, you’re holding up the whole queue. Six laps of the store, get rid of those items,  get some pears and a bag of spinach and we’ll have another go, shall we?  ” 

Mrs Bloggs heaves a resentful sigh and shuffles off to the Ladies to change into her running kit – mandatory on all supermarket trips so that customers can make use of the in-store gym if required to do so – which means that it is now your turn…………..

The difficulty about the new  healthcare system is that people now wait just as long in the supermarket as they used to in various surgeries and out-patient departments. Some customers have been known to be there all night, vainly trying to smuggle a packet of liquorice allsorts or a bottle of gin through the checkout’s beady scanner. Supermarkets have tried to get round it by introducing fast-track systems for those whose medical history cards showed nothing significant until it was noticed that loads of kids seemed to be doing the weekly shop while their parents lurked outside. Sales of alcohol and cigarettes have fallen so catastrophically that the checkouts had to be adjusted to suggest to healthy customers that a little snifter with a cigar would do them good, but on the other hand the hugely increased sale of fruit and veg has revived the local farming communities and saved several varieties of heritage potato.  Everyone is now so healthy that the training of junior doctors and nurses is suffering because there aren’t enough ill people for them to learn on, and the mountains of Scotland are being worn away by legions of super-fit pensioners bagging Munros.  McDonald’s has ceased trading, and Hyde Park has been turned into allotments full of organic veg. Pharmaceutical companies and various transnational companies are frantically lobbying the Government to stop all this behaviour shaping and just go back to nagging and letting the populace do as they pleased…………………

I read with interest your column in last week’s “…………………….”, as I always do.  As you’ll remember you expressed concern that no professionals had been held responsible for the death of   ………………     I agree that it is indeed extremely distressing to have to hear of the murder of yet another innocent small child who was known to social services but apparently not protected by all the huge apparatus of “child protection” which once again failed to gather sufficient information about his parents or having done so, failed to act on it.

                Social services, however, do not operate in a vacuum but are part of the society we live in.  Professionals cannot be solely responsible for the protection of children. So here are some questions for you.

Are there any of your colleagues, friends, family members or acquaintances who you think have a problem with drugs and/or alcohol?

If so, do they have children?

If so, do you have any concerns about what effect their addiction may be having on their children?

If so, have you sat down with them and expressed those concerns – not to shame or frighten them, but to offer help and support, and suggest to them that their illness is likely to be having a bad effect on their kids’ welfare and they need to address it?

Such a conversation might well be quite difficult. Your friend might well tell you to **** off and mind your own business.  You might notice that the kids still seem unhappy, neglected and frightened – so what do you do next?

                I would guess that besides his family, lots and lots of people may have had contact with  ………..  ; might well have felt worried about him.  What did they do about it? What should they do about it? Unfortunately your article reinforces the notion that “the professionals” alone are responsible for protecting our kids, and enables your readers to retain the belief that the unfit parent is always someone else.

Scotland is in the grip of an epidemic of addiction,  that has implications for every single member of the community. The press and journalists like yourself have a really important role to play in influencing the tone of the discourse, so that people do not hear questions about their own drug and alcohol use as “trying to spoil everyone’s fun” or “wanting to take away their kids”, but as expressing a concern for their health and a desire to support them to get well. I’ve worked in the addictions field for some years, and I’ve been in recovery from my own addictive illness for 14 years. I have no doubt that it’s an illness, and it’s common, so there are very few people who have not experienced its impact on themselves or a member of their family. Those of us who are professionals in the field need people like you to support a change in the language – starting with the abandonment of the word “abstinence” which makes it sound as though people are being deprived of something when they achieve sobriety – and reinforcing the idea that addiction is a health issue, not a criminal justice one. That is not to deny that people in the grip of active addiction are literally capable of murder as well as all kinds of violence, and where professionals have frequently gone wrong is in giving too much sympathy and support to the addict (who is usually the index patient/client and making the most noise) and not enough to the family. The thing that swung public opinion in favour of the smoking ban was hearing from the silent majority of people who did not smoke but were being affected by it……………..even smokers began to recognise the right of others to breathe clean air. Addictive drug/alcohol use is a problem for everyone, not just the professionals who work in the field, and we all need to take responsibility for creating a climate of recovery. I look forward to hearing how the conversation with your colleague or friend goes!

                                                                                                                With very best wishes,

Never got a reply………………………

In April 2008, the esteemed British Medical Journal ran an edition with the strapline on the cover, “Are Women Doctors Bad For Medicine?” I am ashamed to say that the paper in support of the contention that we were emanated from the University Department of General Practice of that same university from which I had so proudly graduated.  I was so angry that I almost sent back my degree. Almost, but not quite………..after all, I knew what it had cost me to get it.  The Rapid Response pages of the BMJ fizzed with rage as some of my female colleagues rapidly responded in no uncertain terms.  The “problem” now, of course, is that women doctors are becoming the majority.  My year had about 40% of women students – still the minority so that was OK – but the modern medical school intake is closer to 60%. So much harrumphing and agonising is going on about this terrible “problem” and what to do about it. Undeterred, the anti-women brigade have changed the argument – from “Medicine is far too difficult and women’s brains are too small” to “Women are overtaking the men and winning all the medals,  it can’t be that difficult after all if they’re so good at it and that’s why the profession is losing status.” The fact that the nursing profession has always had a largely female workforce without these terrible “problems” arising reveals the true nature of the underlying argument: it’s about power. Nurses have historically been undervalued and underpaid while doctors treated them like idiots and kept their claws on the power and money; now that a few daintily -painted female claws are reaching for the levers of power, the boys are panicking. If the dice aren’t loaded in their favour, they start to lose, and then the game starts to become “unfair” and measures must be taken to redress the balance.

The general thrust of the argument was the usual old chestnut about women not working hard enough. We don’t “pull our weight”. Too many of us are part-time. We’re not “committed” enough. We keep taking time off to have babies or look after our elderly parents or other such flimsy excuses. We go into specialities where the hours are regular so that we can collect our kids from school. We may even feel that our families take precedence over our patients when the chips are down. It is, after all, just a job.

Most of the women doctors I know are actually working so insanely hard that they simply couldn’t fit one more thing into their day – the fact that they don’t get paid for some of it doesn’t mean it isn’t work. What the first generations of women doctors did, however, was to look at the prevailing medical culture that they arrived into and say “This is completely insane. Why do we have to work so hard that not only can we not think straight but we don’t recognise our children and we’re all drinking ourselves to death?” Study after study on the health of doctors had demonstrated that the traditional medical lifestyle was deeply unhealthy. The ” medical family” of yore consisted of an absent medical father who was always either not there or too tired to attend to his children, and a lonely and neglected wife who would loyally put up with being a married single parent and answer the phone.  It was understood that the workaholic doctor would receive much praise and honour for his “dedication” to his patients, although the question of whether the patients were best served by being looked after by such emotionally stunted unempathic creatures never seemed to come into it.  Anyway, nurses did the “caring”.  

This model of medicine wasn’t good for anybody, and being indoctrinated into it was more like joining the Army than entering a so-called caring profession. The brutalising process started with hurling a whole class of teenage students into the dissecting-room and weeding out those who fainted or had nightmares, and went on like that for five hellish years. The training offered to my cohort was beginning to include some grudging nods to soft skills and “communication”, but we still had months and months of surgery attachments with all the community specialities in which most of us would end up working crammed into a few brief weeks. And when one of my female fellow students said she wanted to be a surgeon everybody still laughed. Don’t be silly, dear, now run along and be a pathologist…………

 As a young woman it was quite difficult to know how to pitch yourself in this environment, as revealed by the ambiguous figure of Dr Claire Maitland in the 90′s TV drama “Cardiac Arrest”.  Like most watching medics I loved Claire and admired her wit and chutzpah, but I certainly wouldn’t have wanted to be her. I recognised her, though, and I’ve worked with people just like her. The most disturbing aspect of her character is her calculated cruelty to the struggling female house officer whose increasingly desperate cries for help she treats with contempt, bullying and criticising her until she breaks down completely. Claire’s survival skillset includes a fierce denial of  her own feelings of vulnerability, hence her vicious attack against a younger woman who is openly expressing the anxiety and distress against which she is so defended. Anyone who thinks that women doctors are automatically “more caring”  has never met the likes of Dr Maitland – fortunately her behaviour pattern is not typical though not uncommon either, but she represents a generation of women doctors trying to figure out what being “a doctor” means in a deeply misogynistic environment. She copes by becoming more misogynistic than the men - excluded from the old-boy network of patronage that protects incompetent male colleagues, using the only power she perceives herself to have, her sexuality, to manipulate and punish her male colleagues and medicate her loneliness and self-hatred.

So where would Claire be now I wonder? Would she have managed to fight her way to a consultant post and relaxed a bit, no longer needing to prove herself to be a hundred times smarter and nastier than her male colleagues?  Or would she have realised that the fight was making her miserable, required too many compromises of her integrity, values and personal life, and chosen a less gruelling career path? That copying the worst of macho medicine didn’t really suit her personality or make her feel proud of herself? That being a rounded human being who knows the realities of family life and close relationships contributes more to your medical education than any number of postnominals?

Perhaps she’d even have joined the Medical Women’s Federation and resolved that, rather than bullying her junior female colleagues, she was going to support them, encourage them, and fight for them to have the rights that her generation of women doctors had not had. Perhaps she’d have realised that our belief that the battles were all won was not true. Perhaps she’d have fumed over the fact that the BMJ had even asked whether we were “bad for medicine”, and fumed some more when she read the MWF/BMA report on equal pay and discovered that even in the 21st century, women doctors are still earning less than male doctors for doing the same job. Perhaps she would be turning her fire and intelligence towards pointing out that increasing numbers of women within the profession is a good thing not a “problem”, that women doctors are safer, and that having children and caring for them is not some bizarre abnormality but necessary for the survival of the species and teaches you a lot more about obstetrics and paediatrics than you learn from a book.

http://www.medicalwomensfederation.org.uk/files/pay%20gap%20report.pdf