#CompassionateCulture

Guest Blog by Dr Pete Aird: “A time to heal”

A Time to Heal

This week I came across Hugh McLeave’s biography of Professor Ian Aird entitled ‘A Time to Heal’. In it Aird is described as having been ‘a brilliant surgeon, an inspired teacher and one of the great medical personalities of his generation’.

He was also, if I have my family tree correct, my grandfather's cousin.

Born in 1905 in Edinburgh he attended George Watson’s College where school certificates record he never achieved anything less than ‘Excellent’ and where contemporaries described him as one who ‘could not help himself, being a perfectionist’. He subsequent studied medicine at Edinburgh University and embarked on a career which, in time, saw him rise to become Professor of Surgery at the Hammersmith Postgraduate Medical School. Here he became best known for separating Siamese twins, most notably the Nigerian pair of Boko and Tomu. Dying in 1962, five years before I was born, meant I never met him but photographs of him are strangely familiar as, in appearance, he bore a striking similarity to my Uncle John.

Few, despite his pioneering work, remember him today and I have only once in my own career come across anybody for whom his name meant anything. My first house job was in Bristol, working as part of a urological firm in Southmead Hospital. The consultant under whom I worked, Mr Roger Feneley, had himself studied from Aird’s Textbook of Surgery, and he took some delight in imagining he was nurturing ‘the young Aird’ to become a fine surgeon in his own right. Disappointingly, I suspect, for Mr Feneley, I was in no way cut out for surgery and happily chose instead an equally satisfying career as a GP.

That textbook of surgery was not the last thing that Ian Aird wrote. His final words were found in a notebook alongside a Bible opened at Ecclesiastes 3 where he appeared to have been reading these words: ‘To everything there is a season, and a time to every purpose under the heaven: a time to be born and a time to die’. This is what, in a ‘bold and unequivocal hand’, he had written:

‘To the Hammersmith Coroner: I have taken a fairly substantial dose of barbiturates. I have never taken a drug before in my life. I have passed my apogee. My skill is going and I am in deep despair. I find myself in unmitigated gloom. Although I am a sincere and practising Christian, I cannot continue. I have burnt myself out. There is too much to do. I cannot write my book again. My department has produced the electronic control of patients in operating theatres, done the first intra-cardiac operations, transplanted the first kidney homografts in Britain, shown the connection between blood groups and disease - and there has been no distinction given to us...Ian Aird’

McLeave, who knew Aird well, interpreted that final comment, not as an embittered comment at the lack of personal recognition, such was not his nature, but rather as a reflection of the struggles he’d long had in attracting funding for his work and the active discouragement he’d experienced from within the medical profession.

The frustration that he was not achieving all that he could, together with his own excessively high standards that fuelled that frustration, culminated in producing the emotional distress with which he no longer felt able to cope. The conclusion McLeave drew was that ‘Had [Aird] taken a holiday, sought medical advice or resigned himself to living at a slower tempo, he might have lived - but he demanded nothing less than perfection in himself’.

Though I never knew Professor Aird, I recognise, both inside and outside of medicine, that same perfectionism that demands of individuals more than they are able to give and renders them both guilt ridden and unhappy. As expectations increase, both from within and without, what Atul Gawande describes as our ‘inevitable fallibility’ leaves us imagining we are moral failures simply because of our inherent ordinariness. We, and those with whom we live alongside, need to be kinder to one another, acknowledge our humanness, and stop insisting that we are more than we could ever become. There are many reasons that drive individuals to take their own life, and none but those who follow this drastic course can fully understand those reasons, even indeed if they themselves can ever understand them - but amongst those reasons lie unhelpful and unrealistic demands and expectations. Hannah Arendt had it right when she said ‘In order to go on living one must try to escape the death involved in perfectionism’.

In life, Ian Aird was fond of quoting Shakespeare’s words spoken by Cardinal Wolsey in Henry VIII:

And, when I am forgotten, as I shall be,

And sleep in dull cold marble, where no mention

Of me more must be made of, say I taught thee.

A fitting memorial for my long forgotten relative would be that he did indeed teach, and that we learnt, that perfectionism, and the demand for it, kills, just as it surely, at least partly, killed him.

Written by Dr Pete Aird General Practitioner.

This blog was originally posted on Resilent GP a closed facebook forum that aims to support GPs 8/6/19

Guest Blog: Dr Jermaine Bamfo "Experiences of being a BAME medic"

EXPERIENCES OF BEING A BAME MEDIC

Being a BAME (Black, Asian & Minority Ethnic) medic comes with its rewards and challenges. Having been raised in the cultural melting-pot of East London, my experiences of interacting with other ethnic minorities in my formative years provided me with a rich array of differing conduits through which I can form a rapport with a wide variety of patients. In saying this, there have also been challenges that I have personally faced in my medical journey, problems that my fellow BAME colleagues have experienced and many more systemic issues which have slowly become more apparent. And it is these challenges that I will be focusing on in this article…

Microaggressions are experiences which I’m sure most BAME doctors and medical students are only too aware of. There are stories about inappropriate anecdotes made during teaching sessions, the ‘politics’ of Afro-Caribbean hair and having to justify one’s appearance. Tales of having to confirm one’s role to a patient who can’t fathom that you could possibly be a doctor and feeling frustrated at how difficult it can be for someone to reconcile your ethnicity with your competency. Microaggressions are rife in our everyday experience and can easily leave one feeling drained, and demoralised.

There are further issues concerning equality. In 2016, the NHS Equality and Diversity Council released the Workforce Race and Equality Standard (WRES) report which surveyed the experiences of BAME and white staff and found that BAME staff were much more likely to be victims of harassment, bullying and abuse by staff or patients regardless of the trust’s location.  BAME staff felt more likely to be discriminated against and that equal opportunities did not exist in their place of work. A minor media storm arose in late 2018 when NHS Digital published findings exposing the pay disparity between black and white staff across the entire range of roles in the NHS. Black NHS doctors were found to be paid on average almost £10000 a year less than their white counterparts! Dr Chaand Nagpaul, the chair of the British Medical Association (BMA) said:

“BAME doctors make up more than a third of the medical workforce and play a vital role, day in day out, delivering care to patients across the country. Yet these figures confirm that they…continue to face unacceptable barriers, penalties and discrimination in the health service.”

The BMA also highlighted that pay differentials are just one marker of BAME discrimination in Medicine, with BAME doctors having reported feeling they are at greater risk of harassment and bullying at work, and only 7% of senior managers in the NHS found to come from BAME backgrounds. The BMA also found that BAME doctors are more likely to face referral to the General Medical Council, more likely to be investigated and face harsher sanctions following investigation. Dr Hadiza Bawa-Garba is a key recent case which comes to mind; a previously flawless doctor became the poster-child and scapegoat of systemic failure and the wider exceptional pressures most doctors are all too aware of. How much did her background influence the ferociousness with which she was initially investigated and sanctioned? 

Such inequalities should not exist in 2019, as everyone should have equal opportunity to reach their potential regardless of their background. Yes, there has been great progress in recent years regarding gender inequalities for example, but the need for change in resolving racial inequalities in Medicine have either for too long been ignored, or changes not seen to the extent or pace required.

Medical schools, the NHS and their affiliated management structures need to do more to empower BAME employee and student voices to inform change, while also addressing the unconscious biases and overt discriminations which exist. There needs to be practical support provided to aid race pay-gap reporting, so these discrepancies can be addressed. There needs to be work done to address the differential attainment in medical education and training, to widen access to the progression, to help secure a greater degree of fairness in fitness to practice proceedings and prevent disproportionate disciplinary action. These and more will go a long way in creating a more supportive and inclusive environment for BAME doctors and medical students.

For these reasons and more, I’m proud to be associated with Melanin Medics - a not-for-profit organisation dedicated to supporting the UK community of African-Caribbean aspiring medics, medical students and medical professionals, while also tackling the underrepresentation of African-Caribbean’s in the UK Medicine. Melanin Medics is focused on implementing practical, effective and positive solutions to help to overcome ethnic minority underrepresentation and the multiple socio-economic barriers which exist in the medical profession.

BAME doctors have cited a lack of role models as a barrier to progression, and they are more likely to feel that their background negatively affects their development opportunities. It is said that you cannot be what you cannot see, and this is why BAME representation in Medicine is key. Changes are needed to make Medicine more appealing to BAME youths, to engineer more support for BAME medical students and to strengthen the communal links of power between those already working on the frontlines and those looking to join them as they train. By increasing the exposure of young BAME doctors and placing the spotlight on those BAME doctors making major waves in the profession, and by creating a network between BAME professionals for the sharing of ideas and experiences, we can demonstrate what is required and what is achievable.

The demographic of our nation has changed significantly over the past 25 years. And while the numbers of BAME representation in Medicine have gradually increased, there is still more work to be done to further change the face of Medicine. As demonstrated in this article, there are many barriers standing in the way of a BAME medic. Despite this, we at Melanin Medics believe there is no barrier which is insurmountable. Despite the various adversities which lie in our paths, we must choose to pursue excellence!

It inspires me to see the recent influx of groups focused on increasing BAME representation in Medicine, groups looking to foster working relationships in those communities and shine spotlights on outstanding BAME medical representatives. It is great to have initiatives like the GMC’s BME Doctor’s Forum which aims to help the GMC’s regulatory work respond better to the needs of UK BAME doctors.

It cannot be denied that a great number of significant barriers to race equality in Medicine still exist – from the ‘cradle to the grave’ i.e. from the opportunity to enter medical school all the way through to the end of one’s medical career. We need to do more. We need to strive to do more. There are many roadblocks which need to be broken down and many more glass ceilings which need to be broken through; but having already seen much progress made over the last 25 years, it is entirely possible that with new movements in the offing the BAME community will get closer to parity in the near future. The NHS is held together by a rich tapestry of talent, with its various strands provided by people from all backgrounds and communities; for this reason, we must endeavour more to allow the facilitation and celebration of diversity at all levels of the NHS.

Written by Dr Jermaine Bamfo. Psychiatry Registrar.

Mentioned Links

Melanin Medics: Website https://www.melaninmedics.com Twitter @melaninmedics Instagram @melaninmedics

GMC’s BME Doctor’s Forum: https://www.gmc-uk.org/about/how-we-work/equality-and-diversity/black-and-minority-ethnic-doctors-forum