In case you missed it and want to have a read, here is a blog post I wrote for a GP magazine on the language we use in healthcare and the importance it might have.
I was a medical student and I was in a clinic with one of my favourite doctors. He had a two-eared stethoscope (the only one I have ever seen to this day), would often hand me the drug chart during bed side teaching and ask me for a differential diagnosis and he called me Faiza for a year because I once sat in Faiza’s chair. He was so nice I didn’t mind that after six months he’s still called me Faiza.
One day in clinic we were trying to contact a GP surgery to get more information for the patient who was in front of us, a confused breathless man. We called several times but the line was engaged and then no one would pick up. No luck that afternoon.
‘No response from GP land’.
This was the first time I had heard the term and since then it’s not been an uncommon term for me to hear around the hospital.
When I first heard it, it reminded me of something akin to the telletubbies: ‘Over the hills and far away the GPs come out to play?’
Language and choice of words interest me. GP land is banded about all the time. In general conversation, in on call rooms, in multi-disciplinary team discussions, but do the words we have have an impact on how we view certain specialities?
GP land is far away from us ‘the hospital’. GP land is unrelated and like the telletubies say, over the hills and far far away. Once the patient is there they are very much someone else’s responsibility, the GP’s, there to pick up the pieces after a hospital admission at the mercy of a discharge letter for information.
The patient, who every physician will agree is at the centre of their efforts, has interactions with so many different specialities but the ‘us’ and ‘them’ attitude between doctors in every speciality still surprises me. It doesn’t help. Being a junior doctor you quickly move around specialities and you straddle the line between us and them. One day you’re ‘with the surgeons’ and the next you can be in ‘GP land’. Same patient, same you, but a different hat and different outcome even though ultimately we all want the same thing; the best outcome for the patient.
One of the hardest hats to wear is that of a GP’s in GP land. The hats there don’t have the fancy gadgets of the hospital.
In an ideal world patients would move seamlessly between primary and secondary care but as long as ‘GP land’ and the ‘big bad hospital’ attitude exists we as clinicians don’t help things. Yes there are bigger reasons behind the sometimes not so seamless primary to secondary care exchange, but sometimes something as simple as the language we use can shift attitudes a little and change thinking from ‘us’ and ‘them’ to ‘we’.
As part of my blog I have had a little long running series called inspirational women. Today I am breaking the gender restrictions. But Giles is worth the exception. You will see why if you read to the end.
I met Giles when I started out at medical school. We had tutorials together every week on society health and medicine. I still remember the first piece of work I ever did, reading a paper on the psychosocial impact of a positive diagnosis of chlamydia trachomatis in women!
I was a clueless 18 year old and just about navigating supermarket shopping on my own the washing machine and Giles was worldly. Giles rode a bike. Giles had traveled. Giles know there was more to life than studying and university. As such he was an easy figure for me to look up to. He was also ridiculously nice and had great insights in tutorial.
I intercalated and dropped back to the year below and Giles graduated before me. Recently I saw a status on Facebook that he was tagged in which mentioned a small stroke he had. I had no idea and scrolling though this Facebook feed, the marathons and general awesomeness still continue.
The man came back from a stroke, continues to work as a doctor and has only gone and written a book about his experiences.
You can see why I had to open up the inspirational section to men now can’t you.
Have a read of a little interview I had with Giles. Share his story with people who you think may benefit. We could all do with being a bit more Giles. Oh and do the right thing. Buy his book ( paperback and e-book).
For people who don’t know you, tell us a bit about your self
Thanks for that introduction Salma! So I’m 34 and decided to study medicine when I was 27 after various experiences of working and travelling around the world. After leaving school I did an English Literature degree and then worked for an amazing company helping organise rural volunteering projects in places such as Peru, Ghana and Fiji. We’d also then take the volunteers trekking to places like Macchu Pichu or on overland road trips to Timbuktu.
Prior to medical school I was Project Director of Vorovoro Island in Fiji, an eco tourist resort where we were trying to build an eco-village from scratch whilst living alongside the locals Growing our own food, catching rain water for drinking and living on the beach in huts made of bamboo. It was amazing.
Then medical school happened and I got into long distance running and cycling. By the end I had done an Iron Man triathlon and had run 100km in one day. In my early summer holidays I led groups trekking and mountaineering to Peru before taking part in mental health projects in Sierra Leone and with Syrian refuges in Lebanon.
Now I‘m living in Hereford as an F2, having recently got married to the amazing Amy last year and start GP training program next year.
So.. up until this point in my life, things were going well.
What’s it like suddenly switching roles from doctor to patient?
It’s bizarre. As a doctor you walk around hospital with such certainty and sense of direction. You are very much part of the place and have a sense of control about your day. Although you get on well with your patients there seems quite a defined line between them and you. Yes, you know you could get ill and be in their place, but it never seems to happen.
Yet crossing over the divide is a very powerful experience. Suddenly the lines of the corridors become sharper, the echoes from the hard floor louder. Any perceived softness of the place evaporates and it begins to feel cold, functional and like a machine. Even staff having a laugh with each other as you are waiting for important tests begins to feel a little isolating.
I’ll never forget waiting for my MRI brain scan, sitting alone in the waiting area. At that point it could have been a brain tumour, MS or a stroke. The hospital seemed such a big, angular and scary place. I felt lonely in a way that I had never experienced before whilst the frantic pace of the department continued around me. I have sent so many patients for scans, even walked past them as they are waiting. I’m not sure I ever realised how terrified they might be.
Crucially what defines the change is the loss of control. As a doctor you feel like you have it all, as a patient you must surrender yourself into the hands of those (and there are many) who will then care for you.
One the main things I’ve learnt from all this is actually how much less I truly empathised with my patients than I thought. I don’t mean this in a negative way; more that I was blown to bits by my stroke in a way that I had never even appreciated could be possible. While I still care (perhaps more than ever) about the well-being of my patients, it’s made me realise how hard it is to truly understand what another person goes through when they suffer. With that in mind it has me made want to simply listen more rather than offer any immediate answers.
Illness and its consequences are relative to each patient, what they feel and suffer will be unique to them based on their journey to that point and what their life means to them. I hope I never forget this.
Where do you get your drive to keep pushing through from?
Good question! One that probably has many answers to be honest. I have a deep sense of how brief and fleeting life is. Increasingly (and now in my own life) there are just no guarantees. I suppose in many ways I don’t want to waste a moment.
Not only that but when I was younger I didn’t have much belief or confidence in myself. It is only since my mid-twenties that I have started to believe in myself more. This has led me to state of perpetual curiosity of what life has to offer. What more is there to learn, what more am I capable of, what are the limits of mind and body?
I love a challenge and the exploration and experience that come with that. Life just seems like one long wonderful chance to learn, both about oneself and the world in which we live. I suppose in many ways I fear becoming set in my ways and the inevitable stagnation that will accompany that. Being out of our comfort zones allows us to grow, even though it might not be fun at the time!
How did you fall into writing and how did it help you?
I did an English degree first in my early twenties which I loved as it basically involved reading books all day. I never had a passion for writing so much then though. That only started coming as I worked for Travel Company helping with their marketing and I would put together their brochures, websites and blogs. With practice I became more confident and enjoyed it.
A few years ago I started carrying a small book to write down thoughts and observations about life. I’d carry it in my bag either at Uni or travelling. It soon started filling up and I would while away long bus journeys exploring my thoughts. Then one day about 2 years ago while in India I wrote my first poem as an experiment. I really enjoyed it and wrote some more. Over time I became braver and started to send them to people, one thing led to another and I’ve self-published a couple of collections with travel photos to give to friends and family.
So when the stroke happened I found writing to be an extremely cathartic and healing way of exploring the many different facets and moments of it. In the aftermath I wrote quite a few poems as they helped me look deeper into what I was feeling and crucially try and communicate it to others. Being ill can be very lonely, and I found this helped a lot.
Eventually I had over 20 and thought it might be nice to make another collection. However rather than pictures I wondered if written reflections might go better with them. I set myself the task of writing about each poem and before I knew it I had a small 40,000 word book on my hands.
Writing Brushstrokes has been an incredibly healing and useful thing to do. Allowing me to grapple with the pain of the experience and come to terms with what has happened. Much of how I think about the stroke and came to be at peace with it was formed in the writing of it.
Sitting still (not by choice!) yet creating something from the experience was a large part of helping me recover. It was a very useful way of exploring the muddle in my head that had replaced what was there before!
Hopefully it conveys some of the story and may be of benefit to others who find themselves having their world turned upside down.
Massive thanks to Giles for sharing his story on my blog.
I often get questions from people about applying to medical school and I though a blog post was in order.
Recently I was contacted by Isha who wrote this blog post. Have a read of the information about her below and some of the questions she asked me. If you’re thinking of applying to medical school (high five my friend) and have any questions, then reach out to me and I will be happy to help. I have spoke to Isha on the phone and can read over personal statements or help with interview practice if you need it.
Over to Isha…
My name is Isha, and I live on a small (I really mean tiny) island in Northern Scotland. I am currently entering my 4th year of high school and I hope to study medicine in the future, although remaining optimistic, I am working hard to make sure that I make an informed choice – hence why I contacted Salma!
It was quite a journey finding Salma’s blog, but I’m sure glad I did! I was browsing online trying to explore medicine as a career, and this is when I came across a post on Salma’s story on how she got into Medical school (getintomedicine). From reading this, I was eager to ask some questions and I luckily then came across her on Twitter which then lead to me to find her blog.
1. What sort of work experience should I do?
Anything that gives you experience of what a doctor does is good work experience. Medicine is a broad field and you have many options. I would say try and get time in a GP practice and a hospital. Having said that I only did work experience in a hospital and that was sufficient. You need to demonstrate that you have experience of what a being a doctor is like so anything that you can use to show that is good. Doing work experience in a hospital shadowing a doctor is the obvious example but doctors also work in labs and you could try and get some experience there.
2. When should I start looking into getting work experience?
I would say as soon as you are considering medicine try and get some work experience. The process can be long, with CRB checks and a limited number of places. Also for yourself and not just for your personal experience, it’s a good idea to see practically what it is like being a doctor before you attempt to commit yourself. When I did work experience half of the people hated it and decided medicine wasn’t for them. Better to know early on.
3. Is there any summer schools that you would recommend?
Some universities do summer schools which are tailored to people wanting to do medicine. My old flatmate actually did one for medicine at bristol and then went on to study medicine at bristol. These are usually open to student aged 17 and are advertised at the start of the year. Keep an eye out and ask your careers advisor. If there isn’t one local to you, consider traveling. These are a fantastic opportunity.
4. What type of volunteering is recommended doing?
I don’t think it really matters which type. Anything that shows that you have interpersonal skills is good. I would add that something done for a longer period of time is better than just a week here and there. I use to volunteer in a mental health unit every week and at an AIDS support services.
5. Would it give me an advantage by doing some work experience/charity work in a developing country?
I would say that this is useful but not necessary. You can show a commitment and interest in medicine without leaving the country by getting some work experience and showing an understanding about what medical school will be like and what being a doctor is all about. Having said that, if you are going abroad anyway, this won’t hurt your application. It can give you something to talk about at interview and it’s always interesting seeing how other health care systems operate. Work experience may also be easier for you to get abroad aswell.
In short, if you can do this, great. If not, I wouldn’t lose any sleep over it.
6. How important are extra-curricular activities?
Medical school and then being a doctor is demanding. Extra-curricular activities will SAVE YOU in medicine by keeping you sane and demonstrate to someone reading your personal statement that you can not only get great graded but know how to keep a balanced life. That being said, don’t pick up things for the sake it at the expense of your grades. I did everything at school, drama productions, sports teams, athletics, I was that student volunteering to show parents around during the other years parents evening (judge me). But I enjoyed it.
Anything that can show you are a well rounded individual is good. But you can think outside the box. If you have to look after your younger siblings and don’t have time for much else, you can talk about that at interview. It shows responsibility and that you are able to balance that responsibility with school work.
7. Is there anything which I could be doing now that may give me an edge over my application in the future?
Make sure you have as good an idea as possible of what medicine is like. Not just for your application but for yourself. If you really want to do medicine you will make it work.
The thing that will make YOU stand out is being brilliant and being YOU.
When I was at my interview, there was a girl who had a lever arch folder of notes she was revising- all clippings and medicine related stories. I looked at her and thought the only thing that I have over her is that I’m me.
I didn’t go to a fancy school and no one coached me for interviews but I was me and I had confidence in myself that this was the right degree for me. I just had to make the interviewer see that.
I gave it my best shot and got in. Medicine is competitive but so what, you have as good a shot as anyone else so best foot forward and best of luck!
Today is the laziest day I have had in just over 2 weeks. 12 days of acute medicine. 3 days off spend in 5 different cities. 3 nights shifts and the first real day of rest today.
I was just scrolling through my Instagram feed and saw a picture from a fabulous doctor I follow about a conversation she had with one her friends about burn out and almost leaving medicine.
It inspired me to write this blog post.
We all go through so much in medicine and we speak about some of it, but so much happens in one day it’s impossible to talk through it all. We don’t need to everyday but when you work hard for a long period of time things build up. I truly believe we all need to wind down. Good food, family, friends. There lovely things in life are an essential part of being a half decent doctor, or whatever else makes you happy.
Happy Salma is a much better doctor than overworked tired Salma, I’m very aware of this. But we have all experiences that feeling of burnout. I recently thought I worked so hard so having a brilliant social life for 3 days was necessary. And it was to an extent but I also needed some rest. After my past few days my mind and body NEED a break which I am very conscious of and taking now. Otherwise burnout is too easy. It’s early days with this doctor jig for me and I’m learning the the importance of these things as I muddle through.
Have a read below for some of the stories from doctors about burnout for them and the other side. Have a great day. Salma xxx
We all like to think that the world resolves around us (at least a bit) whether we like to admit it or not. I am not exception this. This is why I care about women in medicine, women in leadership and women reaching the top of whatever they are doing. These are all aspirations I have for myself. I have a vested interest in caring.
I am also Muslim. From an ethnic minority immigrant family. Of course I care about inequality.
I grew up in a family when I was never told I wasn’t capable of doing what I wanted to do. I don’t have any brothers (I am the youngest of two sisters) so there was never a male sibling for me to be compared to, but I suspect it would have made little difference. I have had nothing but encouragement. My dad has told me to keep up my writing whilst I am working and recently told me I needed to improve my diction (for that time I would have to give a talk). He also said that I should try and do a PhD. As for the typical asian thing of telling your child to get married asap, no one would ever say that to me. The focus is and has always been on me doing what makes me happy. I got pretty lucky with my family.
Looking back thought, it is sad to think that the limiting factor in me getting to where I want to be has sometimes been myself. The very person who should be pushing for the best.
I can so clearly remember the first time that I realised, truly, how hard I was on myself. There is that good being hard on yourself that pushed you and then there was what I was doing. That Salma was crazy and nothing would have ever been good enough for her. I realised this during some teaching in 4th year on paediatrics. Not only did I struggle to name a single good thing I did I also saw a massive difference in confidence level between me and my male colleague.
We can’t and shouldn’t stereotype, but this is a pattern I have seen over and over again.
I’m talking about two people matched equally on paper and the male, 9 times out of 10 having more confidence or at leat appearing to have so.
I think a lot of women have a lot of negative ruminations going on. Or at least I did, but I never identified them. When I did, everything changed. You have to identify a behaviour if you want to change it. I don’t second guess myself anymore. If I don’t know I say so. If I know I know.
In my new job I have been told I am confident and ambitious. These compliments probably wouldn’t have come my way if I continues as I was.
What self talk do you have when you’re in a group? Do you tell yourself your question is a stupid one? Or hold back from giving the answer even when you know it? If you do. Think about why. If you are happy to go on this way, then carry on my friend, but if not then think about how you will change. I honestly think that identification of the issue in the biggest hurdle.
Saying cheerio to self doubt has been one of the best things I have ever done. Only then can you just be. And excel.
the state of being scarce or in short supply; shortage.
Before I decided to write this blog post, I thought that these were all my own thoughts. Turns out that there is a whole body of thought discussing scarcity vs abundance thinking. There are many much more eloquent writing on this topic. This blog point isn’t that but just my thoughts on the topic.
I noticed that I thought differently to some of the people around me. And I had even been told so and sometimes was looked upon as a bit strange.
If we look at medicine for example, if I was going to a great conference or a someone asked me to introduce them to a contact, I would have no issue in connecting them. From what I have seen this isn’t always the “norm”. The way that I look at things, there is enough to go around. If Cindy my colleague is very successful, to me all it means is that Cindy is successful. It has no bearing on my ability to succeed. Cindy being successful doesn’t mean that I can’t be.
The way that I think about things isn’t from a state of poverty. I never think “someone has something so I can’t have it”.Ever. About anything. And if that is how you think then you aren’t going to be running forward to help that person are you? They become your competition and you have less time to focus on your self. I crime in my eyes.
It might only seem like a small a thing, but have a look at how you look at things. It has a bigger impact than you think.
Over the past few weeks I have been getting messages from friends in the year below about tips for finals so I thought a blog post would be in order.
Firstly, congratulations. Making it to the final year of medical school is no easy feat and if you have got this far, you can breath a little sigh of relief. Let’s be honest. You have had to sit for many long hours hitting those books and at times it has felt like an uphill battle. You have re-considered your decision to do medicine more than a few times around exam time and now that most of your friends are working and living fabulous lives in the city, being a broke student is getting a little old.
Thankfully, these days will almost be over for you!!
One final hurdle.
If I had a little sibling, this is the advice that I would give them.
1-Get your head straight
I have never received so many messages asking for advice as I have for “final year”. People look at it differently. It’s different in that it is a big exam, but it is still just an exam.
Do not panic. Just how you have sat many exams before, finals is just another one. It is nothing that is beyond you. The title of finals just makes it sounds like something fancy. Don’t let that phase you. Approach this year how you would any other.
2-Get tunnel vision
Finals are like other exams, but the content you have to cover is probably more than you have had to before. You need to be focused. This should be your biggest priority. Have fun, do the things that keep you sane, but be careful how you use your time. A random weekend wasted away is fine here and there, but closer to exams that time is precious. You might kill for an extra hour. Do things that will help you in the long term. Your work is your priority. If you have to re-do an exam or fail, that is on you. You can’t blame anyone else, so be aware of how you are using your time early on.
3- Don’t listen to other people
If I had a pound for the amount of times I heard “I did like no work” from a medical student I would be minted. Unfortunately, people in medicine don’t always say it how it is. Maybe they want to look “cool”. “I spent 10 hours on haematology and I still don’t get it” doesn’t get you many LAD points. My advice to you would be: smile and let it wash over your. Do what YOU need to do. Maybe you can adsorb information by sleeping on a book. Good for you. The majority of us (me included) need to work hard. Let that be your focus. Don’t pay ANY attention to the mindless “I just painted my nails over the weekend and then got drunk and did no work”. Good for them.
4- Get a syllabus or make one
Most medical schools will have some sort of syllabus for finals. If they don’t, or if it’s really vague, then try and make one. You need some sort of structure to your revision. Make sure you keep looking back at this to make sure you have enough time to cover everything and are on the right track. Passing finals is about being a safe F1 and not to be an expert in the intricacies of sentinel node biopsy. You need to cover a breath of specialities.
If you are struggling with this then get in contact and I can try and help you out.
This is a no brainer. We are all intelligent enough to be pass exams but people who do well are organised. A weekend spent getting your notes together, can be done in the holidays. It’s up to you. I didn’t do that, but I wish that I had. Anything that you can do to make your life easier in the future is an investment in yourself. And you are number one so make your life easier for yourself.
6- Get hold of some good notes
I got my hands on some great notes which I memorised. They are basically the Oxford Handbook of Clinical Medicine typed up but they were easier to print off than to keep using the book. If you want me to send you these notes, just e-mail me and I will happily send them over.
7- Learn in layers with emergencies first
Say for example, you are revising cardiology. I would learn in order in priority. Firstly the emergencies, then the common conditions and then the stuff you might know and then the weird and wonderful.
If you learn in this layered way, you might not have time to cover the weird and wonderful. If you do great, but in this way you don’t miss important topics which as a soon to be doctor, you should know about.
8- Get some form of question bank and start NOW
I wish I did this earlier than I did.There are loads, PASTEST, on examination and many more. They all vary slightly but I wouldn’t get overstressed about which one you are using. I got passtest which was good because I could download the app and then do questions wherever I was. I use to do questions before I went to sleep in bed on my phone. Sad times really, but it was useful!
I guess I am a bit of a perfectionist with my revision and I don’t want to test myself until I know I will get the right answer. But this is NOT the way to go friends. Start as EARLY with past questions as you can. You will learn LOTS and LOTS and “revising” a topic doesn’t mean that you know a topic. This is Medicine, always more to learn 😉
9- If it’s all going wrong- get help as soon as you can
All of the above is all well and good , and if you do it before you start 5th year, you are laughing. I WISH I did that but I didn’t have anyone to tell me all of that or the good sense to realised it myself! Oh well, I landed on my feet.
If you are reading this half way though finals or at a later point and you are flagging please don’t delay getting help.
If you are feeling down and a bit depressed talk to someone. Don’t wait for things to get better on their own. A friend or a sympathetic GP are all wonderful. You are not the first stressed out medical student and you won’t be the last. The earlier you seek help the earlier you can be helped. Being a medical student doesn’t make you immune to anything. And the added stress can take its tole. If you take anything away, please just talk to someone so you can be helped. Passing finals is the aim but NOTHING is more important than your sanity and happiness. We all go a bit loco around exam time but make sure you look after yourself.
If you are struggling with organisation, ask someone who seems to have a good plan doing to help you out. Or ask me and I might be able to help.
The take home is whatever it is, identify the issue and get help.
10- The bigger picture
In all the crap of revision, it’s easy to lose sight of the bigger picture. You went to med school to become a doctor which you will soon be. I am only a month in, but I don’t think 17 year old Salma could have made a better decision. You are in a privileged position and the pain of finals is temporary.