On this late summer day with the sun shining and the promise of rain, I reflect on my career in paediatrics which has been as varied and unpredictable as the seasons. My thoughts go back to my first week as a junior resident in paediatrics in India when I encountered a few babies with malnutrition who died on admission. I recall the feeling of helplessness and despair and almost resigned from the speciality. Fortunately, I was asked to reconsider.
I am grateful for the opportunity that led me to a career that has been so fulfilling.
Moving to Britain, the illnesses changed but the opportunities for growth and learning have been with me throughout my 20-year career as a consultant in a District General Hospital in South Yorkshire. I have found that changing the focus of my involvement every few years is a great way to keep the work interesting and my own approach free of cynicism. I would like to share some of these experiences and hopefully give you an insight into their richness.
Keeping the children and families at the centre is a great way to maintain a focus when difficult choices come along. For example, when a decision had to be made locally whether all registrar clinics ought to be supervised directly by a consultant (as opposed to remote supervision), leading to a reduction in clinic activity, we put patient safety and trainee support first - and we set up these direct supervision clinics. Developing the skill of zooming out and adopting a “balcony view” helps with a solutions-focused approach to “wicked problems”.
Compassion... is the most promising antidote to stress
I have often recalled the General Medical Council good medical practice guidance: make the care of your patient your first concern. I believe that getting involved in management to improve patient care is imperative. Team approaches have helped deal with workload and rota gaps and designing huddles has aided communication and patient safety.
I also realised that acute care can be enhanced by well designed community services. I have worked in a “hybrid” job for most of my career as an acute paediatrician with community responsibilities. We developed a care closer to home steering group which helped set up a GP hub pilot and pathways for the care of acutely unwell children.
Compassion often gets buried under workload, but is the most promising antidote to stress. I have learnt that it is a necessary skill in patient care and in team working - and that it can be developed. I remember a mother who was so grateful because I took time to listen to the hopelessness she felt at her son’s diagnosis. I suggested she write a diary. It was pleasing to hear that this simple tip helped her tide over a difficult time.
I developed a keen interest in medical education and have been a Training Programme Director for the past 10 years. This has given me the opportunity to help develop surviving and thriving days prompted by my experience at ARCPs (Annual Reviews of Competence Progression) where I realised that alongside trainee support, self care is a key factor in trainee wellbeing.
One needs to nurture a personal and professional network. My family and friends have been my rock and my lighthouse at difficult times.I have also found volunteering for the College very rewarding and great for networking. We spend a lot of time at work and unhappiness is very contagious; a well bonded and cohesive team, rather, is vital to one’s wellbeing.
You need to enjoy the journey to Ithaka as the legendary poem by Cavafy suggests. You need to allow the child in you to surface from time to time, perhaps taking a cue from children who have a delightful present moment awareness even in times of distress.
Each experience leaves its signature on our lives and adds to the rich kaleidoscope of a paediatric career
I have had my fair share of complaints and criticisms - this is the stuff of any career. One complaint related to a case of FII (fabricated and/or induced illness) where the safeguarding processes led to a reduction in the child’s symptoms. Another was a case of missed biliary atresia. I see complaints as humbling events and great learning opportunities. I have also had the joy of treating an infant with group B streptococcus meningitis (the MRI scan suggested a very poor outcome) who turned out only to have a mild hemiplegia and a slight squint. Each experience leaves its signature on our lives and adds to the rich kaleidoscope of a paediatric career.
In terms of navigating through life, I have found the ‘Five ways to wellbeing’ very helpful and ask myself often:
- Have I been active?
- Have I connected?
- Have I taken notice?
- Have I given?
- Have I learnt?
I am reminded of the lines from Desiderata by Max Ehrmann who expresses this wisdom so beautifully: “Enjoy your achievements as well as your plans. Keep interested in your career however humble; it is a real possession in the changing fortunes of time...”
Imagine the triple win - you love your career, others respect you for what you do and you get paid for it - what could be a better recipe for fulfilment?
If you have any questions for Sanjay, he can be reached at firstname.lastname@example.org.