A Year in the U.K. Looking back on my professional life

I would be fooling myself if I said I am at the top of the world. Well, yes, I am in a much-coveted place, that is true. However, when it comes to defining where I am on a professional level, I must say that I have a way to go, indeed. The reason I am writing thus is that it has been a challenge for me to adjust to the way the NHS works and the way the British people communicate with each other. 

Of course, I have "improved", which means I am now doing things the way they should be done in the U.K. (which is not always the right way of doing things) and the process of unlearning what I previously knew about Pediatrics has been more than a little difficult. To make light of it, I am now practising "Paediatrics" and not Pediatrics. What this means is that the British method of healthcare is different not just in the spelling, but also in the details. I have often wondered how it is that medical care can vary so much in the details even though both systems of medicine across the Atlantic rely on much the same sources of knowledge and the same sources of research. Then I realised the difference lies in the basic way of approaching illness. Whereas the American system of medicine relies heavily on acute care, the British method is all about hanging in while the patient roughs it out through the ups and downs of his/her illness. Also, the NHS is a government-facilitated system where the citizen pays nothing. Hence, a cash crunch causes a very difficult problem of not being able to deliver healthcare where it is needed most. On the other hand, the American system is mostly based on private enterprise. 

But beyond all this, at the root of it all, is the way the healthcare is tailored in consonance with the wishes of the patient. In this most important respect, the NHS is completely different from medical care anywhere else I have worked. The patient has the right to agree to, disagree with, question, and critique any care they may be receiving or be about to receive. They can, if they are mentally competent, reject treatment of any kind, no matter how strong the evidence for the use of that modality of treatment may be. The only exception is when the patient has lost their mental faculties or where a certain treatment is life-saving. This act of "putting the patient first" and keeping them in the "centre" of care makes the NHS so different. A woman may not want to breastfeed her baby even if she has a lot of milk coming in, and that is her right. In the same way, if a patient chooses not to have chemo for his malignancy, that is his right. The fear of medico-legal issues is very strong too, so if you as a healthcare giver goes against the patient's wishes, you can be penalised or even prosecuted. 

On a more personal level, how has it been for me. It has been a year of mixed fortunes, but I am, as I said previously, slowly inching towards professional competence. I still have some issues that need sorting out, but I am hopeful I will be able to cross those hurdles over the next several months. At some point, I should be able to return to my middle-grade level. I am hoping this does not take more than six months more, or else, it will be difficult to sustain myself at a junior level. It will also make future promotions and move to any other country that much more difficult. So, let's see how that goes. 

And that's it for this post. Do share your views and comments if you wish. Thank you for reading this and for your encouragement that I will constantly need. 

Back on the job, and advent of winter

It has been over a fortnight now since my family vacation ended. And yet, it seems as if it was only yesterday! What a time I had. We had never taken such a long vacation and it was definitely worth it. And the funny part is that we never realised how time flew. We saw over 15 different places, and some of them were unplanned route diversions where we saw and did amazing things. Above all, this hugely enjoyable vacation did not even cost a big amount of money. I must have spent about 6500 GBP in all, a very reasonable sum indeed. 

And now, it's back to work. The autumnal fall of leaves is now done with, and trees are almost barren. There is a cold nip in the air, the more so in the past few days. In fact, it has rained quite a bit in the past 48 hours or so. Darkness descends upon the firmament as early as, say, 5 o'clock in the evening. When you wake up in the morning, you just don't feel like shrugging off the duvet and rising and shining! What keeps you going, though, is the awareness that if you don't wake up and start soon, you will most likely be late to reach your place of work. This can be a tricky situation, especially if your bosses are aware that you pretty much stay on the hospital campus - and are still late, even if by a few minutes. 

It has been a busy week or two, with the Paediatric ward filling up with infants and children experiencing breathing problems right, left and centre. The best thing that happened to me was that I was placed as the only junior doctor looking after the neonates in the special care newborn unit. Of course, there was a consultant who took the rounds with me, but on a couple of days, no consultant was available, and I took the entire round by myself. On that particular day, I felt as if I had stepped up a bit. I continued doing the neonatal rounds until the end of the week, which was earlier today. 

And that is how it goes. I will probably not be gainfully employed over the weekend, but, as they say, tomorrow is another day. 

Brief note on my last month - vacation and fun with family in the U.K.

My family arrived to spend three weeks with me in the UK on the 30th of September. We had a great time travelling across thousands of miles of England, visiting over 10 destinations. We even saw a bit of Scotland. It was three weeks well spent. I returned to my duty on the 18th, but my family stayed with me in Blackpool for a further two days, enjoying the local attractions and going on a spree of shopping. When I finally left them at Manchester airport on the morning of the 21st, it was a bitter-sweet parting. My return to work had already effected a few days earlier, but on those last two days, my heart had been with my dear wife and daughters. When I returned to work on the 21st, I plunged myself again into my work, and it has been over a week now. 

Where did we go? We visited Bath, Oxford, Stonehenge, Castle Comb, London, Cambridge, York, Durham, Edinburgh, Ambleside, Windermere and finally, Blackpool. We also made day trips to Liverpool and my family went to Manchester as well. We also visited Preston to see the Birds of Prey Sanctuary at Turbary Woods and Hadrian's Wall and the Roman Vindalonda Village while we were en route to Edinburgh. Finally, we did a day-long bus trip to the Scottish Highlands to reach the southern end of Loch Ness. A really fantastic schedule - and it all went off without any major hitch. 

There were a few minor issues, though. At Bath, while checking out, I fell down a flight of steps, my large bag following me down the steps and staying just short of landing atop my head. My back took a beating, though, and even as I write this, I still get the odd jolt of pain down the spine. The other setback was that I had a minor scratch on a rented car ... and had to pay some damages to the rental company. Other than these two incidents, a great time was had by us all. 

To read more about this phenomenal trip, do await the link backs from my travel blog. Thank you for your patience. 

To see a few snapshots from the long vacation, do visit this link.

Learning and Teaching - two sides of the same coin

There is a student inside all of us. And a teacher as well. Everything that we see is a form of learning. Everything that we do is a form of teaching, provided there is someone who is with you at that moment. For me, the presence of anyone who is receptive enough is stimulus to want to teach. Conversely, if I think I need to learn something, I would explore whatever is happening around me to seek the best and imbibe the information.

Guys, you all know me. I am always curious to learn. My chief go-to sites are www.coursera.org and www.edx.org. They conduct several MOOCs - (Massive Open Online Courses) in all areas of teaching and from universities from all over the world. Joining and auditing the entire course is, of course, free. The courses run for about 5-10 weeks. It consists of mandatory stuff  like taking a pre-course survey, attempting the end-of-the-week writing assignments or quizzes, watching all the video lectures, etc. The amount of time you need to do the "homework" is about 4-7 hours/week. If you want to collect an authentic certificate of having done the course, you might need to send a payment using your credit or debit card etc. These payments are really not large. For example, in the UK, it works out to around 40-60 pounds for the "Verified Certificate".

So, which courses am I currently doing? On Coursera, I am doing a course on Astronomy. On FreeLearn, I am currently doing a Patient Safety and Quality course from the University of Bath. And, finally, from the  edx site, I am enrolled on the "Humanitarian Response to Conflict and Disaster" - a close look at the global problem of providing effective humanitarian aid to those at the forefront of a war that they did not bring upon themselves. 

Three courses simultaneously, did you ask? The answer to this is YES. It does get a bit busy sometimes, but I am coping with it all. And really enjoying myself. 

Which brings me to the second side of the coin of education, i.e, teaching. As I am not a trainee, I do not do formal training. However, I do a lot of informal teaching. I taught a pair of IIIrd year medical students today itself. It was a bedside teaching on lumbar puncture in neonates. When you teach, you get the immense satisfaction of sharing your knowledge with others. It almost feels like you are donating to someone else. A sort of charity, if you may call it that. But it's more than that. When you teach, you also learn. And this line is for those who teach. You revise your knowledge, of course, but you are also forced to check your knowledge in real time. By doing this, you become an even better teacher than what you had been before.

Tell me your own experience as a teacher and as a student. Thank you for reading this installment.

My first drive in the UK

It was something I had to do in preparation for my family's upcoming visit to the UK next weekend. I already had an International Driving Permit. Now, all I had to do was to rent out a car. The previous week, I had gone to the one and only car rental agency located in the town - Enterprise Rent A Car - but I was refused a car as they did not have a car to spare. Hence, I booked a car online on last Wednesday, and I picked it up as per the online booking on Saturday morning at around half past nine. 

It was an Opel (Vauxhall in the UK) Corsa with manual transmission, but this is where its simplicity ends. It was a 3-door hatchback, with one door on the trunk and two side doors. It was in excellent condition. I attached a satnav from Garmin on to its front glass and drove it initially to the hospital and to my home, and then, all the way via Motorway to North Manchester, where I had to go to do a locum shift for one afternoon. 

The car performed very well. I reached my destination in about an hour and a half, and this included a few stops - once for petrol and once for a few purchases from a convenience store. My duty shift ran from 16:00 hours until 23:00 hours. My return to Blackpool was from 23:15 hours until 00:40 hours. I reached my home safely, and without any major difficulties. 

The entire journey and the two extra days that I kept the car with me (from Saturday morning until Monday evening) cost me about 80 quid. But at the end of it, I am confident I can drive anywhere in the UK with, or without family. 

Ten thousand views... and growing

Thank you, dear readers. Your support has allowed my blog to reach an amazing figure of 10K views. Yes, sharing my posts with social media helps. What I want is for you all to read my posts and to take away what you think is beneficial to you. Some of you are inspired by my writing skills; yet others are searching for some help before they, too, take a plunge to come to the U.K. for work; some simply want to keep a brotherly/sisterly/friendly eye on their friend/colleague; yet others are looking to see how a lone person can enjoy himself in spite of the many challenges that he faces day in and day out. Be whatever it may - I am here to inform, entertain and inspire you all. 

Through my earlier blog on my life in Saudi Arabia, I have definitely inspired many of my Paediatric colleagues to work in the Middle East. One of them is now in Saudi Arabia; another, in Bahrain. A third is making plans even as I write this. With this new blog - the one you are reading - I hope to inspire a whole new bunch of doctors. These doctors have the knowledge to work anywhere in the world. Some are hesitant because it is unlike their own culture; others are worried that their incomes will fall; still others are scared about the racist undertones of British society. I am always available to help you understand. However, the final decision must be yours. 

Earlier today evening, a Muslim Egyptian doctor who has now cleared his MRCPCH called me to tell me that he has a job offer from a hospital in Wales. His dilemma is very clear: he wants the freedom to work in an advanced country like the U.K. (currently he is in Dammam, KSA), but he is worried about the cultural differences between the Islamic culture that he and his family are used to, and the permissive, Christian culture that prevails in the U.K. While I did explain to him the shortcomings of this advanced country to give his family the shield that he so desires. He is not sure if he will find a mosque; if he will be able to access Halal food; if his wife will be able to adjust in an open society; if his children can stay away from the harmful influence of a disruptive, over-permissive society; and so on.

These are valid questions, and there are no easy answers. I tried to explain whatever I knew to the best of my ability. However, I could not answer all his questions because there are some areas I am myself unaware about. I request you, dear reader, to help me with your input wherever you can. Thank you so much.

Please leave your comments and enter your insight. I need your answer to just one question. How does my blog affect you: does it entertain? inform? educate? inspire? Are you someone who is my friend/relative/colleague in real life? Are you here to make sure I am all right? Do my words comfort you? Do they make you anxious? Worried? Thanks in advance for your input.

Completed a year since leaving Saudi Arabia ... and why NHS is so admirable.

This is a reminder to me that I left the Kingdom of Saudi Arabia on the 3rd of September 2015. Hopefully, it would be my first and only stint of working in the Kingdom. The major takeaways of that stint of nearly 4 years were  the fact that I was able to perform Umrahs and Hajj; that I was able to save some money; that I was able to emancipate my family from being dependent on me; and that I completed the exams that would serve as my stepping stone to enter the United Kingdom (I am talking about the M.R.C.P.C.H.). 

I am unable to say which of these four achievements have led to the maximum benefit to me and my family. I would probably say each of them had their own merits. Spiritually, I came closer to Allah with my Umrahs and Hajj. Mentally, I was able to study further and get qualified with an additional, U.K. approved, post-graduate qualification. My family's "independence" served to liberate me as well. Today, my wife Nishrin and my children, Inas and Hannah have become largely independent and only occasionally have to consult me. Finally, the bank balance has permitted me to take positions in some investments within my country, something that I could not have done earlier.

Since my arrival here in the U.K., I have learned to adjust with the entirely new and unfamiliar system of medical practice. I have realised that I have a long way to go before I will get accepted by my bosses. I am currently learning a lot of skills by working at different trusts in the North Western part of England (and occasionally at other trusts in the U.K.). These skills include communication skills, cannulations, lumbar punctures, planning therapy, child protection, and a lot more.

Over and above this, I am beginning to understand how the English health system (the NHS) functions below the belt. Its underbelly, if you understand what I mean. Initially, I struggled to work, especially when it came to managing the out-patient clinics. Now, don't get me wrong. I have had a clinic for nearly 25 years in India before I went to Saudi Arabia. Nothing prepared me, however, for the kind of patients you see in the U.K. There is acute paediatrics, of course. In the clinics, however, it is all about chronic stuff. Things that can stay in a child's life for years, if not decades. Until 16 years of their life, they are ours to see. In some cases, especially with children having chronic, incurable illnesses, we continue to manage them even when they cross that age. After this, however, they transition to adult medicine. In India, the most we could do was to see them until they turned 13. I did have a few of my old loyal parents who came to me with their 15 and 18-year-olds to have them treated by me, but it was legally untenable. 

However, it is not just about age, or the chronicity of problems. It is about the range of diseases and problems that are totally different from a tropical country like India. Additionally, it is the inherent knowledge patients have about their own illnesses and about their own biological stuff. Finally, it is about how to communicate with them. British sensibilities are completely different from ours. What we discuss with patients openly in India has to be said privately and with much more empathy, for example. The risk of being sued in courts always hangs upon you wherever you work, but it is definitely much more in the U.K. compared to India. 

There is yet another, very crucial difference. In the U.K.. there is a huge infrastructure of community and outreach services that have no comparable example in India. A child with cerebral palsy, for example, has to spend huge amounts to even reach a level of mediocre care in an advanced city like Delhi or Mumbai. Even then, when it comes to successfully rehabilitating that child and integrating him with society, we can hardly do anything. In the U.K.. the system is so advanced that the child gets automatically eligible for a range of rehabilitative services. For example. even his home can be modified at government expense to get him to have a ramp to ride his wheelchair on. If a child with excessive illness related to pollution applies, he and his family can be given an entirely new place to stay by the government. Of course, the family will pay off whatever they can over years and years, but care to the child will not stop because the family does not have the means to fund it.

Child protection is a big thing and abuse of a child sets off a chain of governmental remedial actions that include but are not limited to removing the child from the influence of his abusive relatives, handing him over to an appropriate foster parent, or hand him over to court, which will then place him appropriately, police action that is swift and commensurate with the degree of the abuse, and so on. Social care services will then continue to monitor the whole thing ... until the child can be, if feasible, returned to the family - or be kept away for as long as is needed. 

With such services spread nationally, it is not difficult to understand why the U.K.'s NHS is considered to be one of the best health services in the world. And the services are 90% free to the people - not just British or English citizens, but also legal residents and immigrants after their stay has been legally sanctioned. 

This is all I will be writing about in this post. Do leave your comments below. 

Thanks for visiting, reading and interacting with me.