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Archive for the ‘Mental Health’ Category

Resisting the Hidden Curriculum

I first heard the term “hidden curriculum” mentioned in my first year of clinical training at medical school. The majority of first year medical students are extremely excited to finally be at medical school, after years of planning and work, exams and interiews. They are keen to meet patients and idealistic about what the life of a doctor is like.

We were warned that as we progressed through medical school and into the clinical workplace, we would see doctors who were cynical, disengaged from their patients, who didn’t appear to “care” as much any more, and whose practice might be somewhat ethically questionable.We were warned that if we were not careful, we’d end up like them. Some authors go further than that and warn that if we are not resistant to this erosion of ethical values we put ourselves at risk of repeating the atrocities of the Nazi regime. These changes are not what medical school aims to teach, but things that people pick up along the way, learning from the examples set by more senior doctors, and so it gets called the “hidden” curriculum.

As I’ve gone through medical school I have seen friends of mine become more cynical.  Some seem to see patients as a chore. I know of people who seem to think that being a doctor makes you superior to other people, or that being a particular kind of doctor makes you superior to other kinds of doctors as well as everyone else.

Medical culture has lots of insidious norms, some of which I’ve written about before – the idea that you’re a bad doctor if you’re happy to go home at the end of the day, or if you’re not willing to work hours and hours of unpaid overtime. That if your priority in life is to be happy, you can’t have a career as a surgeon. That “patients” are a class of people and are somehow different from us, or that patient is problem to be solved rather than a person asking for help.

That doctors somehow never get ill.

I don’t think any of you will be surprised to learn that throughout my medical career I’ve put considerable effort into trying NOT to become indoctrinated (‘scuse the pun) into medical culture. I’ve tried not to become cynical, and to continue to treat my patients as people, and to be open about my health affecting my ability to work, and to resist when people try to tell me that being a doctor means making all these compromises that I’m not willing to make.

I will be writing more about specific parts of medical culture that I find troubling, but for now I’m going to leave it at that. I would really like to hear of other people’s experiences of workplace culture, and medical culture, any problems you’ve come across, and any solutions or ways of coping that you’ve come up with.


Why I love roller derby, and why I’m not going back to skating (for now)

A bit of context: I started roller derby 2 years ago in Newcastle Upon Tyne, UK. I have since moved to Middlesbrough, just over a year ago, and broke my leg at a skate practice in January, have been “off-skates” ever since. If you want to know more about how the sport itself works, look here.

Roller derby is punk – it is counterculture. It is women of all shapes and sizes getting together and making something for themselves, and not subscribing to conventional ideas of what a “good” woman is. And that makes it radical. It is women being muscular, aggressive, and hitting each other. It is women being tactical, working together in a team and not being bothered about what their teammates look like but what they can do.  Roller derby bouts are fun, noisy events. They have suicide seats (sitting on the floor close to the track, with a real risk of ending up with a roller girl in your lap), fast food, stalls for independent local businesses, half-time entertainments. They are (in Britain at least) a very different way of doing sport.

When I first started roller derby, it was at a kind of difficult time in my life. I’d been recently diagnosed with depression, and having a community and regular exercise to go to was pretty therapeutic for me. I loved the friendliness of my local team (Newcastle Roller Girls) and the league was growing pretty fast at the time so it was all very exciting.

Roller derby is a growing sport. It is a grassroots, bottom up movement that is made by the people who build the leagues, go to the practices, organise bouts themselves, etc. Each league needs a mix of people – not just the top athletes who want to be the best skaters in the world, but the people who have good coaching skills, who welcome new players, who can design posters/flyers, who know how to handle money, etc.

Some players wish that roller derby were taken more “seriously”. They want to get rid of “boutfits” and instead have uniforms. The don’t want to have punning bout names (Block to the Future, Crouching Blocker Hidden Jammer, Sweet Home Alajammer) and instead give the bouts numbers. This is not the roller derby I signed up for! I LOVE that roller derby is a radical, grassroots sport organised by women for women. I do not need roller derby to be “sanitised” so that the mainstream will “take it seriously”. Roller derby is the first ever sport that I’ve actually felt interested in playing/following, precisely BECAUSE it is a fun sport, because it isn’t snobby, because it welcomes with open arms women of all shapes, sizes and socio-economic backgrounds. Individuals get to express their skate persona through their name, number, makeup and outfit. I’m all for people being able to express themselves by not having a skate persona, not wearing makeup, not wearing fishnets or a tutu, etc, but some people in roller derby want to get rid of what, in my opinion, makes roller derby great.

I have read articles by people who did give everything to their league – spent all their time on it, thought about skating 24/7, and after a few years had a bit of a shock when they looked around and realised that they’d been neglecting everything else in their life. I don’t want roller derby to be a sport which makes people do that. I want it to be a sport which improves people, physically and mentally. And I think that in order to do so it has to be a sport which doesn’t eat people up and spit them out, but which nurtures. I’ve seen people stop skating altogether because they couldn’t come to every single practice, they couldn’t give as much as some of the other people in the league, due to things like having kids, or a job that goes in shifts. This is sad because, although they might not have the time to become the best skater in their league, they still had something to give and I think the league was worse off without them. There is a danger of having a culture in roller derby that makes people burn out, and that isn’t good for the people involved, for their leagues, for the sport in general.

Right now I have a lot of things going on in my life – trying to get through my training at work, working a shift pattern, looking after myself and my cats, trying to have a social life in Middlesbrough, and my mental health has not been great. My leg isn’t broken any more, but it isn’t anywhere near back to normal. I can’t give as much to my local league as I would like, and my local league is currently one of the ones trying to make roller derby ‘serious’. So for now, I’m hanging up my boots, and hoping for a time when I can give my best to a league which has the kind of community and values that first brought me to the sport.

On being a doctor with limited spoons

Recommended reading

I have depression, and this means that for the last couple of years I’ve been operating on limited spoons. This is why I’m working part-time. It means that some days I run out of spoons and have to just spend the evening trying to recover some of my energy. It means that I have to remember to take medicine every day in order to not turn into an angry crying mess. I am very lucky to have a family and friends who support me through my bad patches, and who understand that sometimes I will cancel on them at the last minute, or have difficulty committing to things.

It makes me less giving, and I worry that people see me as being selfish. When I went back to work after having broken my leg, a couple of my consultants fed back that I was “unwilling to stay beyond 5pm” and that they saw that as not being appropriate for a junior doctor. At the time I was completely supernumerary and my depression was flaring up due to having broken my leg, so I don’t think that trying to hang on to my spoons was inappropriate at that point, nor did I feel that it was necessary to disclose my health status to every single person that I worked with to pre-empt them judging me for not working unpaid overtime. But doctors are expected to want to be at work all the time, and for many specialities, the training requires you to work a LOT of unpaid overtime just to get exposure to the kinds of cases that you need to know about in order to develop your skills and knowledge base.

When colleagues ask me what I want to do with my life, I often answer “be happy” rather than specify my career intentions. The range of responses this has provoked is very interesting:

“Oh, you want to be a GP then? Most GPs work part time”

“You’re not going to be a surgeon then.”

“Well, you know you can do flexible training in lots of different specialities so you don’t just have to be a GP”

or, saddest of all

“Aww, I want to be a surgeon :-(”

Most of the people who assumed that wanting to be happy and wanting to be a surgeon were incompatible were surgeons themselves!

Some people live to work, and that is fine. A lot of doctors have that kind of attitude to work, because it used to be that ALL doctors lived to work – there was no other option. If you were a GP in a one-man (and it was one man) practice, then you were on-call *all the time*. If someone got ill in the night and needed you, you had to be there. Fortunately (from my perspective at least) things are not like that any more and while there are arguments against doctors working shifts, the fact is that my job is shift work.

I work to live – having a job enables me to have the resources I need to be able to spend time with the people who are most important to me, doing the things I most enjoy. I took a year out before university, I took a year out from medical school and did a Postgraduate Diploma, and now I’m working part-time. I’m ok with the fact that I’m not climbing the career ladder as fast as is humanly possible, because I know that if I were trying to do that, I would be less happy.

I try to be open at work about the fact that I’m working part time and the reasons for it, and for the most part I think that has been a good thing. I want to be visible to other people who have less spoons so that they know that they are not alone, and I want to be visible as a person with mental health problems in order to try to challenge the stigma that people with mental illness face.

Video: What does “appearing professional” mean for doctors in minority groups?

Click through to the YouTube page for links to more articles.

Video: Depression, Mental Health Professionals, and Genderqueer

Video: Ponies as Art Therapy

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