Here is my final guest post for May. A massive thank you to Jenny for a fabulous post on encouraging diversity in medicine, and how important it is for doctors to be supported with their mental health, just like we should be supporting our patients. Over to Jenny:
This is me. Celebrating diversity and staying alive.
“Hello, my name is Jenny and I’m your doctor”. This is the standard line I use as I walk in to the cubicle in the emergency department (or, depending on how busy things are, stand by the side of a trolley in the corridor) and meet my patient for the first time. I make eye contact, smile to try and take away some of the fear, impatience or frustration the patient and their relatives may be feeling. During those few seconds of introduction, as is human, assumptions and conclusions will be reached about me based purely on my outward appearance.
A few years ago, when my dad was in the throes of dementia and had moved in to a nursing home, I created a “This is me” photo album for him. This was, in part, for me to go through with him and try to keep his memories alive, but more so that the care home staff (who, I must say, were amazing with him) would see him not as the dementia-struck old man, but the man I knew; the climber, the father, the son, the brother, the boat-builder, the planning engineer, the fisherman, the sailor, the skier. I wanted to show the depths of him, not just what was seen on the outside.
At times I wish that I had a book like that for me, that people could see all of me and not just that which is visible at that moment. Being a doctor, as in many professions, people make judgements based on my job, such as what my educational and family background is, that is, once they’ve accepted that I’m the doctor and not the nurse.
A few months ago an email was sent to all the junior doctors, and their responsible consultants, in the hospital that I work bemoaning the state of dress of junior doctors. It was remarked, after detailing how a doctor had been dressed, that “For all I know he may be the finest, hardest-working Dr in the hospital but that’s not my point.” But that is precisely the point. We should be judged on our work, not on how we dress or look. There are some patients who feel that women shouldn’t be doctors, who would look down on me for being gay, for the scars on my arms, and for my love of cats. At a previous hospital where I trained there were patients who were vocal about not wanting to be treated by a non-British doctor. We should be gently challenging such prejudices from our patients by celebrating our diversity.
I completely agree that we should be smart and act professionally, but there needs to be an acceptance that the modern-day intake of doctors comes from a wide range of backgrounds which may well be reflected in our appearance.
The judgements also come from those we work with. If a doctor is appraising their colleagues for their clothing, their tattoos or their hair colour, then what does that say about how they are critiquing their patients and their own prejudices? We live in an increasingly diverse society and in an age where medicine is becoming more patient-focused. Surely it will only benefit the development of the patient-doctor relationship (and thus engage patients more in protecting their own health) if we reflect that diversity within our workforce?
I think all health care professionals should reflect the diversity of their patients and be allowed to display their own individuality. Throughout medical school and my early years as a doctor I dramatically changed my physical appearance due to pressure, expectations and dress codes. In doing that I felt that I lost a part of me. Whilst brightly coloured hair and clothing may seem a small thing, those outside characteristics reflected the culture that had been such a strong part of my life for so many years and were a part of me. Going to medical school and becoming a doctor, whilst an incredible privilege, also felt like a betrayal in some ways as I had to compromise some of my beliefs and not speak out/act when I would have done previously. I also missed “me”.
The original email about dress codes, and my reply, tried to stay light-hearted, but there is a serious side too to these expectations. We all need to accept that doctors come from diverse backgrounds, and we need to also acknowledge and accept that doctors too are human: we laugh, cry, get angry, say inappropriate things at times, make mistakes, make great cakes, we have hobbies and a life outside of medicine and, like one in four of our patients, we suffer from mental health problems. There is so much silence about this among doctors and there is still a huge amount of stigma and discrimination, from both patients and colleagues which has led to a high rate of depression and suicide among doctors (I’m not going to launch in to a rant here about the pressures that doctors are under due to the underfunded NHS, but, you know, we are…)
I’ve been battling my demons for much of my life and I don’t have the choice to hide my mental health issues from my colleagues or my patients. I have scars on my arms that due to the “bare below the elbow” policy at work are on show every day. When I was teaching first aid to children and women’s groups in Kenya, I covered them up – not wanting to detract from the lessons we were teaching. One day when I went to the shops I forgot to wear a long sleeved top and Caroline, the shopkeeper, asked me if they were tribal marks. I kind of shrugged it off, but later on I realised that what she had said was right, in a way. They are the marks of my life, of my story, of what has happened to me and, most importantly, of what I have survived.
But doctors are dying. In my first two years as a doctor I personally know of six others in my region who died by suicide. We are dying from a lack of empathy, from stigma, from discrimination and from secrecy. We are dying because we are scared of speaking out and asking for help for fear of the impact that this will have on our careers and of how we will be judged. When I started at medical school I had an occupational health meeting where the nurse, when asking about my scars said outright that people who self-harmed were more likely to hurt their patients (there is no evidence, anecdotal or real to back up her statement). This created an expectation in me that if I sought help when things were bad, that I would be kicked out of medical school, or, once I qualified, I would be struck off, at times this stopped me seeking support which would have made life more bearable. Thankfully, aside from a few ridiculous and ignorant exceptions, most of the reaction when I’ve not been doing well and have asked for help, has been very supportive, for which I am grateful. Other friends and colleagues have not had such a positive experience; it should be the norm, rather than the exception.
Which brings me to the phrase (or similar ones) that you can’t love others until you love yourself, implying that only someone with perfect mental health can do good in the world. Whilst I’m sure this is said with the greatest of intentions – giving the person permission to not be ok, or trying to motivate them to “get well”, it is actually incredibly disempowering and quite frankly rubbish (feel free to insert other phrase here that I’m too polite to write). I’m not proud of having mental health issues by any stretch of the imagination. But, I’m not ashamed of them either, in the same way I’m not ashamed by my physical health problems although both frustrate me. What I am proud of is that I’ve survived my mental health problems, I’ve been so low it felt like I couldn’t go on and I’ve hit rock bottom. But I dragged myself up, with the support of amazing friends, family members, the NHS and various charities. I’ve integrated my problems in to my life. Whilst falling apart and hating myself to the extreme at times, I have achieved so many amazing things – from helping to set up a charity in Palestine, to teaching first aid there and in Africa, to getting through medical school and foundation training and being an awesome aunty to three beautiful children. I am more than just the scars on my arms and the demons in my head.
In the past few months I’ve returned more to who I am. I have blue in my hair, I’m dressing more like “me”, and I’m speaking out more; and you know something, I’m still a good doctor. When I see my blue hair in the mirror, it makes me smile, not because I’m rebelling, but because, instead of feeling that I should hide parts of me, I’m proudly being myself and celebrating diversity.
This is me: I am your blue-haired, gay, tattooed, unicorn-sock-wearing, free-soloing, pole-dancing, cat-loving, fire-breathing, cake-baking and scarred doctor.