Monday, May 30, 2016

A week down the line, and I am beginning to change ...

One of the wisest things I have understood is that Change must begin with one's own self. This is something that, despite knowing about it, does not get readily accepted by many who nurse their ego instead of recognising that this is the ONLY way to develop oneself. With me, it has been a gradual process that began about 4-5 months ago as I continued to struggle with the skills of a middle-grade doctor. At that time, I thought that I would improve merely by watching others at work and by being humble and willing to learn. I read a lot, took online courses on different topics pertaining to paediatrics, and, at times, stayed after duty hours to continue to learn on the job. 

How little I knew at that time that while these were good methods to acquire knowledge, they weren't enough. What I needed was to be able to handle the required tasks myself, with professional supervision, so that my skills improved. Yet another insight that I got over the past few months was that I had perhaps been wrong to accept a middle-grade job without mastering skills of a more junior grade doctor. All the things I had been doing were nothing compared to the essential need to perform tasks that described my job in a competent way. 

It was at  that point that I decided to really think hard about where I was going. I was assisted in this by my consultants who shaped my thinking and made me accept that I should probably be better off seeking to work as a more junior grade doctor and then climb back up. The process led me to meet my line manager and submit a letter of resignation with a plea to allow me to look for a job elsewhere, since, according to him, there were no vacancies at the junior level in Blackpool.

I began to apply for a new job about a fortnight ago; so far, I have appeared for a few interviews and am still waiting to be accepted by one of them. I do not know if this effort will, or will not, be successful. However, I will keep on trying till someone, somewhere, recognises my abilities and is willing to supervise me to work in their institute as a junior doctor.

An Indian medico friend of mine asked me why I was struggling this way when I could well be a consultant in India. I told him that this was an effort on my part to work in the UK with the NHS, one of the world's best, most rigorous health care system. Yes, it is true that the NHS is reeling from financial difficulties, and the managers are looking to rejuvenate it by a) cutting expenses and b) partly privatising it. None of this has come to pass as yet, but this is where the thinking is at the moment. My desire is to be a better doctor professionally. I am not worried if I have to return to India at some point in my life, as I know that the skills and training I acquire in the NHS will only make me a better doctor and be looked upon as being so.

I have also been working as a junior grade doctor on weekends. I did two night duties a couple of weeks ago, and have just done a few day duties this weekend. Both these were at the Royal Preston Hospital's department of Neonatology. This hospital has an advanced neonatal unit that looks after the smallest and the sickest of the sick newborns in the region. The experience has been really eye-opening. The work was not very taxing, but I have learned a lot of new stuff while listening to the consultants and watching them, the registrars, and the expert neonatal nurses go about performing their tasks. 

And that's basically it, for now. Thanks for reading. I will welcome your comments and feedback as usual.

Sunday, May 22, 2016

Job-hunting begins

As stated in my previous post, I am now looking to relocate to another job. Where my job-hunt will take me, I do not know as yet. I have tendered my resignation to my boss, and it is a matter of time - perhaps a few months - before I bid adieu to Blackpool and look for a job elsewhere. The experience of working for the first time in NHS has been humbling and I have realised that no amount of experience of working in India as a consultant prepared me for this complex system of shared care. In the UK, as perhaps in most developed nations, a lot of emphasis is on safety in health care; well, I haven't been overtly unsafe so far. However, I have had to course-correct on managing illnesses here in a very, very cautious way. While we rely on experience in managing day-to-day problems in India, evidence is what they look for. A hint of something that doesn't match an illness profile, and they will run to add more tests and more treatment till the evidence states otherwise. 

Hence, we have so many children undergoing expensive investigations and procedures; so many are started on antibiotics till the results of tests become available; so many are hospitalised just so that nothing is missed; so many undergo specialised tests and referrals to tertiary centres where there is even a shred of doubt to something unusual happening.

Being skilled in one's practical procedures is an important part of one's job requirements. In Paediatrics, for example, this means being skilled at putting needles and cannulas into veins of chubby and fractious children, being able to perform lumbar punctures (where they put in a tiny needle into the back to withdraw a small quantity of fluid for examination), and being able to revive a struggling newborn as it prepares to breathe for the first time when it is born. I have definitely improved in these skills, but still have a long way to go before I will be ready to move on to the next stage of competency. One of the reasons for my relative inexperience was the fact that I haven't performed these basic procedures since the mid-eighties when I was a resident doctor myself. Right from 1987, when I started my consulting practice, I have relied on my junior residents or nurses to do all these things.

Above all, communication is so important that erring in giving the right information, or giving superfluous information, can be one's undoing. Being inappropriately flippant when a serious tone is called for, being verbose without explaining properly, being ignorant about risks and percentages - they can all backfire on you when it comes to appraising you for your adequacy as a medical practitioner.

For me, this experience has been demonstrative of all the above.  I have now decided to apply for a more junior cadre of work so that I have less responsibility and stress of performing, and more freedom to learn. This may mean a slightly lower salary, but I am ready to forgo some money to be able to acquire more skills. At least that is the case for now. I cannot say what my thinking will be in the months to come. 

Every new adventure cannot be a guaranteed success. It is in our hands to try, and if you fail, to try again. It is not the end of the world, and, as they say in parables, success comes only to those who keep trying. 

Thanks for reading. 

Friday, May 20, 2016

Change of job is possible

As my readers already know, my struggle to cope with the requirements of a registrar has been an ongoing issue. I have remained optimistic until recently, but now, it seems, that there is a distinct possibility of my having to leave my current job at Blackpool and look for a slightly less demanding job in another location within the UK. I have decided that I need to have a firm grounding into the job before I move up to being a middle-grade doctor (as I am currently). This hard decision has been the result of so many difficulties that I cannot begin to enumerate them here individually.

Part of my difficulty is my inability to understand the working of the NHS. This is a very complex healthcare system indeed. Although the basics of medical practice are not different from that which prevail all over the world, the way patients are handled and the way they move through the system is definitely way different from all that I have done before in my professional career. Add to this the fact that each consultant has a different way of working, and you will see that adjusting with each one of them can get a bit complicated. None of them are wrong, it's just that they are different. To their credit, though, I must say that they have all been very supportive and have tried their best to see me clamber up the steps and become capable of remaining where I have been.

The other difficulty is in communication. Time and again, I have stumbled there. In the UK, every word one utters is carefully weighed up and then judged on its appropriateness, accuracy and all else that words are expected to do. Several of my remarks - some to patients' carers, and some to colleagues have been hopelessly misinterpreted to mean something quite different from what they were originally intended to mean. For example, a simple suggestion to an overweight colleague to check out a certain health website was misinterpreted as an attempt to harass that person and to be personal. Another example might be an issue with a parent where I told them about the possible differential diagnoses in their child - and this was misinterpreted as "my being out to scare them with scary labels", All this is, of course, reported back to the consultants, who have taken the view that poor communication can put the institute in a poor light, and hence, it might be best for me to consider looking for a new place to work.

I am not, for a moment, thinking that changing my place of work is going to solve all my problems. Of course, that would be the wrong way to think. I am, however, going to grab the bull by its horns and make a fresh attempt to go down a rung of the work ladder and try and climb it once again. And I will definitely need all your good wishes to be able to succeed.

Thank you for reading this entry. In a way, this is the most significant blog entry I have ever made in this, or in any other blogs that I write.

Tuesday, May 17, 2016

Strung between the rank of a registrar and a house-officer

This is a very candid admission that I am finding the job of being a registrar in the NHS pretty difficult. Although, yes, my skills are improving, I am still not there. I mean that I am still struggling to be recognised as a safe registrar in my department. Things have come to a stage where my departmental head wants me to downgrade to a house-officer level so that I am able to carry on. I have agreed to do so. To help me to understand the complexities of NHS. 

I have even begun to do locum jobs as a house officer. I did two nights in Neonatology at Preston last Friday and Saturday. This was an enjoyable experience for two reasons. I have always enjoyed working in neonatal units - just a personal preference, really. Secondly, the consultant who was with me on both the nights was a real nice guy by the name of Dr. Egbeama. He is a Nigerian Neonatology consultant. I was happy to be guided by him as his entire demeanour was very good. He is supportive and shows the right approach for doing things. The interesting thing is that I was supposed to do just Friday night, but the department needed me for one more night, so I ended up coordinating the second night with my locum agency. This worked out right. I even got a room on the campus to stay the day out. I probably will make some money from these two nights' extra work, but more than the money, it was the exposure to a new setup that I will cherish in time to come.

On Saturday morning as well as on Sunday morning, I spent some time to travel by bus to R K Sweets, the "gujju" eating out place on Plungington Road near the Lancashire University complex. Now, I have reviewed this place on Tripadvisor and on Google Maps, and I must say that it continues to be a top favourite with me. I usually end up purchasing stuff to take back with me to Blackpool. Also, I always have their masala dosa. This time, though, I had a breakfast of Idli sambar chatni on Saturday, and their full lunch thali on Sunday. Both these were marvellous. The lunch thali had kadhi, pulao, puris, 2 vegetables ( I chose paneer mutter and undhiyu) as also a serving of savoury (I had an onion bhajiya) and a sweet (which I exchanged for another savoury, a batata wada). It was a delicious meal.

In other news, back home, it looks like my younger daughter Hannah, who was between jobs for the past month has found herself a new job! She will be working as a social media content writer for a company called Insomniacs. It's good news indeed. Inas and my wife Nishrin are on their usual routines. Mom continues to be all right after a short period of illness last month for which she had to be hospitalised for a few days.

And that's about it. Do continue to visit my blog and comment!

Wednesday, May 4, 2016

Nearly half a year: what is life like in the UK?

In a week or so, I will have reached half a year of stay in the Kingdom. There will, of course, be the retrospection. However, if I were to sum up what I have done so far and where I am, I would say the following:

  1. My financial position is worse off than when I was in the other Kingdom, namely the Kingdom of Saudi Arabia. Not only is my income reduced, a lot of my income gets cut in taxes. This was not the case with Saudi Arabia.
  2. My professional knowledge is increasing by leaps and bounds. I am now getting more and more comfortable with handling complex patients, doing procedures, understanding how the world-famous NHS works, and so on.
  3. I am still struggling with the finer nuances of the cultural gap between where I have been for the last 55+ years and where I am since the past five and a half months. While the people here are quite "advanced" and "liberated" in their thinking, there are serious issues of privacy and what may or may not be considered acceptable during social intercourse.
  4. People are not what they always seem to be. You can have someone who shows you how nice they are on the outside but be very critical on the inside; conversely, you can have someone who looks unfriendly on the outside but is rooting for you on the inside.
  5. There is no such thing as a British stiff upper lip. Every individual is different. There will be guys and gals who are open minded but close-hearted, and those who are open-hearted and welcoming. 
  6. One can get genuinely hooked to British food, especially fish and chips.
  7. The society here is highly multi-cultural. The Irish people head the non-UK pack, followed by Polish, other East-European countries, then Indians, Pakistanis, Nigerians, Sudanese, Iraqis, Egyptians, Malaysians, Chinese, etc. 
  8. As good food is easily available in stores as well as ordered from restaurants, the incentive to cook food in one's home is indeed limited.
  9. It is very difficult to find non-porcine items in the menus of smaller eating establishments.
  10. My adventures and hobbies are simply going up. I have visited nearly 7-8 different towns and parks and have experienced so many delightful things wherever I have gone. This has included visits to cities, bird parks, countryside, etc.
  11. It is an expensive way of life. Make no mistake. There is a premium on everything here. It is hard to believe that while developing countries like India have abolished the TV and radio licence, people still have to pay the licence annually to simply watch the television - even if they want to see just the free channels (known here as Freeview).
  12. Working with people from different cultures continues to broaden my mind. In Saudi Arabia, I worked mostly with Asians and Middle-Eastern people, plus a few from Africa and nurses from the Philippines. Here, we see people from all these places PLUS a lot of European people - from Poland, Bulgaria, Romania, Czechoslovakia, Russia, etc. These are people who have the freedom to work in the UK without a visa or other strict requirements as the UK, like them, is part of the Eurozone. 
  13. Having one's own passport with one's own self and being able to book a ticket and fly wherever you want after getting one's leave sanctioned from work is the kind of freedom that I sorely missed when I was in the earlier Kingdom. If you are travelling to your home country, all you have to do is buy your flight ticket and fly once you have the necessary leave.
  14. I still miss my family.
  15. Almost 50-60% of people here are fitness conscious and wear a fitness gadget such as a pedometer or a fitness wrist-watch when they work. In spite of this, it is a shame that obesity is on the rise here. This may have something to do with the very unhealthy diets that Britishers have out here. They are hooked on fried potato chips and on sweets of all kinds from cakes, shortbreads and cookies to sweet biscuits, complex desserts and sweet drinks and ice creams.
This is all I have for you today. Do let me know what you think of this retrospective entry. Join in the conversation by:
  • commenting on my post
  • sharing it with your friends on Facebook, Twitter or other social media
  • Linking to my posts through your own blogs or writings. Let me know and I will link back to you.
  • Entering your email ID in the "Follow" section so that you will be abreast of my most recent and new posts.
Thank you. 

Sunday, May 1, 2016

Taking it a week at a time

Dear Readers,

I have been differently busy all these past 10-odd days since I last visited the blog. I say differently because it is about learning skills on the ward and brushing up on knowledge through online studying at home. The aim continues to be to achieve a higher standard of skills. I worked on a night shift from half past eight to about three a.m. on the first of the two Fridays that have elapsed in the last 11 days. It was an unusual and very helpful experience. Then, yesterday, I attended part of the evening to practice some more skills. I tried a venous cannulation (sticking a needle and keeping it in to give IV fluids) on a newborn - and did not succeed. It was really depressing. Tonight, I plan to do another night of work. The aim is to keep trying till I reach a level of efficiency that will be considered satisfactory and acceptable to my bosses. 

I am continually improving my ability to tackle patients in the out-patient clinics, and also in the wards, I am happy to say. There have not been many outings except for my extraordinary visit to the Turbary Woods Owl and Birds of Prey Natural Sanctuary on the last Sunday. This place is located on the outskirts of Preston. It was a cinch to reach there, thanks to the excellent GPS services in this country. However, it was a long way from the station. I had to catch a bus, and after an18-minute ride, walk another few miles before I arrived there. 

En route, I captured the beautiful countryside as it is in and around private gardens. Flowers are growing all around these areas, in particular, well-planted tulips, daffodil beds, and so on. 

At the end of the long walk, you are on Chainhouse lane in the Whitestake area of Preston. There is no signboard to guide you to the actual Owl reserve, but you do get a Duxbury Garden Centre signage. The GPS tells you that your destination is at the same place! And it was, but tucked away behind the garden centre. You have to walk past the sales areas of the garden centre, and then into a wooded area before you see the signboard that tells you, you have arrived at the Reserve,

This is a relatively small place, but they have several different species of owls and some other birds of prey here. Most are in enclosures, but some are chained to posts and left out in the open area for visitors to see and interact with. It was a delight to look at owls, eagles, kestrels, falcons and kites. This place is run by volunteers who operate a not-for-profit organisation to help rehabilitate and protect these remarkable birds - especially rescue them when they are found injured or lost.

I spent nearly four hours there. In between, I had a leisurely lunch at the Maple Leaf Cafe - just outside the Turbary area but inside the complex. This was a really busy cafe, with a full British menu. I had a breaded plaice with chips and a coffee for my lunch. At 1 p.m., I witnessed an interesting live show of the birds. The birds were brought out one by one, and allowed to fly free and return to their trainers for food. Also, some of the owls there were trained to fly to whosoever had a source of food in their hands - to me, for instance, when a kestrel flew down to my hand and took food I had grasped in it, There was a whole contingent of school-kids from China, and they had a great time interacting with the show birds. Of course, there were English families as well, so it was a large crowd that had collected for the noon show. Unfortunately, the show had to be cut short as the weather turned inclement. I finally left the reserve after a coffee at the cafe. 

Some photos of the birds I saw:

Kestrel on my forearm

Northern Hawk Owl

Bengal eagle owl

American Kestrel

Large Grey Owl

Mottled wood owl

Eurasian Kestrel

African horned owl

Bengal eagle owl stretches its wings

Brown wood owl

Laggar falcon

This is a hybrid between an African and an European falcon

Snowy owl

Burrowing owl

Tawny owl

Harris' hawk
That's it for now. Thanks for reading.