I am simply another statistic. I am ‘1’ out of the very many the NHS needs to address ‘rota gaps’ in medicine. I’d like you to read this especially if you’re a national leader or a local TPD, in case you’re curious why people like me aren’t in the NHS workforce even though we deeply want to be. I am, of course, deeply ashamed of my alcoholism, firmly in the past, but I am now in recovery, and I would like to be given a second chance.
The taxpayer in fact paid for me entirely to be trained in undergraduate medicine at Cambridge for six years. I completed my house jobs in 2001, in Cambridge and Norwich, such that I was officially registered as a medical practitioner a year after graduating.
It is now 2019.
I am very fortunate in that I have a small part time rôle as a special advisor for the NHS Practitioner Health in disability. I consider this to be a huge privilege to help doctors like me, and it is fantastic to work with Disabled Doctors Network. I went up to Manchester to sit and pass their revalidation assessment at foundation level in July 2019, and I indeed successfully went through my annual appraisal with my ‘designated employer’ in December 2019. In real terms, I have no unspent convictions etc., and I have a full license to practise without any conditions etc. I do not even have to work in ‘approved practise settings’ any more.
As a personal reaction to a protracted GMC investigation in 2003-6, and then becoming struck off in 2006, and then becoming even more alcoholic for a year with no income or social company, I then had a sudden cardiac arrest, epileptic seizure, respiratory arrest in 2007. I then was successfully resuscitated by the Royal Free NHS Hampstead, in fact with a cardiac arrest team led by a junior I was exact contemporary with at a London NHS hospital. In that hospital, my consultant, for whom I did not have a log book or written down personal development plan, later said he had been unaware that I was suffering from an alcohol dependence syndrome, and yet wrote a very damning statement about my problem drinking to the GMC. I was never advised to go to Occupational Health. But now is not the time for recriminations. In fact, I consider my truncated junior doctor training with no educational plan, comprising stand alone jobs, poorly overseen in the entirety. As a result of 2007, I became physically disabled for the first time. I was not allowed to see patients while struck off, so I completely retrained. Whilst in a wheelchair, and with my late father accompanying me to classes with a huge amount of effort, I graduated with my Bachelor of Law in 2009. I later completed by distance learning my Master of Law in 2010, and I attended classes to graduate successfully with my Master of Business Administration in 2012. My MBA, I feel, was not insubstantial, in that I studied in detail marketing, strategy analysis and implementation, innovation management, organisations and leadership. I have in fact subsequently co-authored a highly successful exploration of courage in healthcare systems. I sincerely thank Rebecca Myers for her incredible support at that time, as I was literally by my mum’s bedside in hospital half-blind writing my contribution late.
I completed my Ph.D. in psychiatry from Cambridge without corrections in 2001, on the diagnosis of the behavioural variant of frontotemporal dementia. My paper in 1999 has four other co-authors who are now all Professors, and in fact cited in the Oxford Textbook of Medicine’s Ch 24 2 2. I have in fact completed around 30 mostly first-author research papers, including from a time at the Institute of Neurology as a researcher in movement disorders, over a period of time of nearly twenty years, including a number of groundbreaking books on clinical geriatrics. My first book, ‘Living well with dementia: the importance of the person and the environment’ indeed won the best book of the year award for 2015 for the BMJ Book Awards.
I have even tried to give ‘something back’. In my time when I was early recovering from alcoholism, I wrote 3 books, one book on each part of the MRCP(UK) diploma assessment.
I have latterly become proud of my contribution to delirium education. This is a ‘labour of love’ for me, as I witnessed at close quarters my mum’s hospital admission with it. I am honoured that Prof Sharon Inouye from Harvard and Prof Alasdair MacLullich have written introductions to my delirium book to be published on June 18th 2020, in the same way I was deeply honoured that Prof Ken Rockwood wrote one of my forewords to my frailty book published in 2018. The truth is that, whilst the books are substantial educational contributions, they do not earn any money for me.
A lot is said about the ‘workforce shortage’ in the NHS.
The fact is: I am desperate to do a training post. The best thing that can happen for my health and wellbeing is for me to be a productive employee of society. I would like to give something back to patients. I think also this will alleviate a major stress of my life – a lack of salaried income (I do not of course qualify for any NHS pension). It will also produce much balance in my life, because otherwise my life is consumed by my mum who is now living with severe frailty and advanced dementia.
I just don’t feel my skills are recognised, either in medicine, but not even in change management or research. And I don’t feel I should aspire to a life on benefits. I passed my MRCP(UK) totally in 2005, and, having written books on it, I feel as if I know this quite well. The link to the list in the Clinical Medicine journal published by RCP London is here.
So what is stopping me from getting a job?
I’m told a lack of recent experience.
I am prepared to work unpaid, entirely pro bono. If I make a mistake, I can always be reported to the GMC (but I would obviously be preferred to be supervised as a junior doctor this time around.) I would like to be seen as a ‘free’ set of hands, willing to help at any place with clinical work on a supernumerary basis, and even help out with quality improvement, teaching, training and research, all of which matter hugely to me. I’m on the British Geriatrics Society special interest group in frailty in urgent settings.
I am deeply indebted to Health Education England London for taking me on to give me a chance to apply in the final year for their ‘Relaunch’ scheme, the aim of which was to enter a FY3 supernumerary post to re-enter the workforce. I am not eligible for their SuPPorT scheme as I am not a trainee, and/or my leave was not planned or anticipated. In my defence, I did pass the computerised assessments which I paid to sit in a Pearson Vue assessment centre in clinical problems and professional dilemmas (a situational judgment test of the type which long predates my undergraduate qualification in 2001). The clinical problems test was apparently of a similar standard to the GP recruitment exam. Unfortunately, I was not able to pass their clinical interview. I paid a few thousand £ to attend MRCGP CSA courses as the assessment was of a consultation as would be done by a GP trainee. But the problem with this was that I have never been a GP trainee ever, never done any component of the MRCGP, never been supervised in GP consultations, and, despite asking over a lengthy period of time, I was never given a document explaining the scope or mark scheme of the assessment. The assessment was never video-recorded. So I never got to do my F3 post, and it was a dream which died. I am not blaming HEE, but I think there is no national infrastructure for people like me, who were taken off the GMC register and subsequently restored after full recovery from my ill health. The GMC have told me, correctly, that they are not an ’employment agency’, but they have to all intents and purposes wiped their hands of the situation, despite their statutory underpinning under s.1(1A) Medical Act (1983) of a duty to promote patient safety.
But as I say, I am deeply indebted to HEE for this opportunity. I was able to do work experience in AMU at UCLH which I organised with the help of one of their consultants, which I loved. I have also done a stint of work experience in Highgate Mental Health Centre in 2018, which I adored. I forgot to mention that I took for fun, and passed, my Paper A of the MRCPsych exam. I did this as Prof Rob Howard thought it would be a good idea to get out of my flat once in a while – and I salute Rob for his support always.
I’m due to go on my immediate life support course in January 2020, my one -day crash course in phlebotomy and cannulation also the following day, and my Advanced Life Support (ALS) course in April 2020. Why am I doing a crash course in phlebotomy? Because I now have disability as a result of what happened to me in 2007 unlike when I was a junior doctor the first time around, and I paid £100 to go on this course because every email I sent to local NHS Trusts asking to re-skill me was ignored. I believe I can ‘reskill’. After all, I’ve successfully learnt how to drive again in the last two weeks over the xmas break, having surrendered my license voluntarily in 2005.
In summary, I am offering to work for a NHS Trust entirely for free.
What do I get out of it? I can improve my confidence while re-skilling and learning some real clinical medicine from others, including soft skills such as team work, time management and leadership. I believe strongly in the Osler adage is that being a Doctor without seeing patients is like a sailor who never goes out to sea (or I would say like a taxi driver who doesn’t like to drive a car.)
If successful, I can then get my certificate of foundation competences to be signed off, and then I can get on with the rest of my life, including applying for CT training preferably in psychiatry. I am hoping of course to pass the ALS in the meantime. The irony is that you don’t need to be competent in doing a GP consultation to clerk a patient in a hospital. The two I feel are very different skills – look at this excellent piece by Dr Gordon Caldwell on being ‘free to think’ about the consultation from Clinical Medicine magazine, here.
I promise to work really hard. After all I’ve been through, I am not at all big-headed or arrogant. I’ve spent close to 15 years ‘just about managing’. I am trying to rebuild my future. I’d like to be given a chance.
Please contact me on Twitter if you have any helpful or constructive comments (@dr_shibley).