Dr Lucia Gannon
How a relaxing Sunday drive led me to reflect on gender bias One Sunday morning in late July, I left…
The Carlow literary event provides plenty of food for thought On a damp and sunny Friday afternoon, I drove from…
Dr Lucia Gannon writes that hair is not a trivial topic for many people, but an important part of their…
Doctors should be aware of what they can and can’t change for a happy and effective professional life, writes Dr…
Dr Lucia Gannon gives an account of how writing a book has provided her with a valuable perspective on her…
Her recent nomination for an RCGP Fellowship showed Dr Lucia Gannon that awards need not necessarily be reserved for the…
Being kind to yourself and others is a hallmark of the Christmas period, writes Dr Lucia Gannon
Choose wisely and you might just keep your New Year resolutions, writes Dr Lucia Gannon
Dr Lucia Gannon argues that the structural integrity of general practice has been irreparably compromised by deliberately destructive Government policies
Earlier this year, Dr Sarah Fitzgibbon, a Cork GP, posted a tweet asking her followers if there was any appetite for an organisation specifically for women doctors in Ireland. The response was a resounding ‘yes’. In no time at all, Sarah had founded the organisation, named it ‘Women in Medicine in Ireland Network’ (WIMIN) and organised the inaugural WIMIN conference. This took place in The Marker Hotel, Dublin, in September and attracted over 100 women doctors and medical students.
For me, the conference was a very positive experience. A chance to explore the challenges of being a female doctor, to applaud women’s resilience and creativity, in managing family and career and to encourage younger doctors to forge their own paths in what can be a very rewarding and satisfying career.
If I had one regret, it was that the medical student who asked the panel the last question of the day, “what advice would you give to female medical students as we start out on our career?” had not asked this much earlier. I have no doubt it would have brought forth a wealth of wisdom from the participants.
Dr Emily O’Conor, an emergency department consultant and President of the Irish Association for Emergency Medicine, a woman well-qualified to give advice, responded to the question. Along with other words of wisdom, she stressed the fact that medicine involves hard work and being a woman is not an excuse for putting in less effort. Medicine involves hard work, whether you are male or female, but it is worth it. So many women, both now and in the past, have not had the opportunity to experience such job satisfaction.
As I drove the two-hour journey home, I resisted the urge to turn on the car radio and reflected instead on the advice I would be likely to give a young female, or indeed male, on the brink of their career. I came up with the following list.
Have a grand plan but do not hold it too tightly. Expect that your needs will change, and so will your goals. The only time to be absolutely certain about what you want is when you are in front of an interview board, trying to convince them you are the best person for the job.
Savour the progress you make towards your goals. Sometimes, the achievement of the goal is not as rewarding as the experiences you had along the way.
If you think of your career as climbing a ladder, it will always feel like an uphill struggle. Think of it as a pond, dotted with lily pads. There are lots of possible routes to the other side. If you need to rest a while to take stock, choose somewhere you feel safe and secure. If you have trouble getting to the next one, look for an outstretched hand and be prepared to clasp it.
If you want a clean house, and like me, do not consider cleaning a therapeutic activity, hire a cleaner. It will still be cheaper than therapy. It’s the little things that cause the greatest stress.
Stay interested in your career, even when not in paid employment. Attend conferences, local CME meetings, complete online learning modules and keep in touch with your working colleagues.
Do not let breast-feeding stop you from attending events. Most small babies take up less space than your over-sized handbag and can be fed discreetly, in any setting. If you have older children, ask for crèche facilities. You may not get them, but at least you will have started a conversation.
Surround yourself with men and women who support and encourage you. Men may not understand your challenges, but neither do they see your self-imposed limitations. It has often been men who have encouraged me to step outside my comfort zone and told me I could and should do something that I would not have considered trying, due to lack of confidence.
If you have a partner, try to respect their view on gender roles, while at the same time being honest about your own. Subconscious beliefs, ingrained from childhood, need to be exposed and explored before they can be reconciled.
Ask for what you need, both at home and at work. It is impossible for others to know what you want unless you tell them. You may not get it, but there is no harm in asking.
Remember that the greatest obstacle to achieving what we want is often ourselves. Challenge your belief in your own abilities and recognise when it is these beliefs, rather than external circumstances, that are holding you back.
I look forward to being part of the WIMIN journey and I am grateful to Sarah for setting up the organisation. For more information, or to join, go to www.wimin.ie.
Many years ago, when I was a medical student, I went to stay in a friend’s house for a weekend. Her brother, ‘Seamus’ (the names and exact circumstances have been altered), had just qualified as a doctor and was working as an intern. On Saturday morning, when Seamus arrived home, having been on-call on Friday night, his mother asked him if he would mind visiting Paddy, a neighbour and lifelong friend of the family, who had been unwell all week.
I stole a furtive glance at Seamus, to gauge his reaction to this request but was careful not to catch his mother’s eye, in case she decided that it would be a good idea for his sister, also a medical student, and I, to weigh-in on the medical consultation.
‘Was that how it worked?’, I wondered. ‘Was that what was involved in being a doctor? Being asked to examine friends, neighbours and family members any time they were ill?’
Seamus agreed to see Paddy but I could sense his unease and confusion which, at the time, I put down to lack of confidence in his new doctor role. He was, after all, only just qualified. Later in the afternoon, he reluctantly took his stethoscope from his bag (as yet, I didn’t own one but made a mental note that once I did, I would carry it with me always for times like this), he suggested that his sister and I come along. I am not sure if he thought we might learn something, or if he simply wanted moral support. Seamus seemed awkward as he entered the house and said hello to Paddy. Not at all as you would expect him to behave towards a life-long friend of the family.
“Ah, Dr O’Conghaile,” Paddy called out, extending his hand in greeting. “I’m delighted you came to see me. And how are you getting on in your new job?”
Seamus engaged in hesitant chit-chat but remained standing, looking more and more ill-at-ease. Eventually, he asked Paddy about his illness, a series of closed questions. Afterwards, the young doctor produced his stethoscope and performed a first-class honours respiratory and cardiovascular examination, after which he slowly and thoughtfully removed his stethoscope from his ears and bundled it up and put it in his pocket.
“So, what’s the verdict?” Paddy asked, sitting back on his chair, completely at ease.
Seamus diagnosed a chest infection and recommended antibiotics. As he did not have a prescription pad, he said he would go to the chemist and see if they would give him some. Paddy thanked him and proceeded to engage us all in conversation but Seamus was suddenly keen to get away and muttered something about needing to get to the chemist before it closed, even though it was only 3.30 in the afternoon. At the time, I thought Seamus was unhappy with the outcome, or worried about missing something. It wasn’t until after I qualified and found myself in similar situations that I began to understand something of his discomfort.
There are certain situations where doctors need to be allowed not to be doctors. There are certain situations where being asked for medical advice feels like an abuse, a violation, a breach of trust. Simply having a medical degree and a stethoscope does not mean that we are always ‘open for business’. Just as a doctor must adhere to a professional code of conduct, there ought to be a code of ethics for those seeking medical advice. A newly-qualified accountant would not be expected to check a neighbour’s accounts. A teacher would not be asked to help out with a child’s homework. Yet doctors are forever being asked to give an opinion, have a look and suggest a treatment, as if it is something that can be done with the slightest of effort and doesn’t cost a thought.
I am now pretty experienced at not engaging in these interactions. A short quip about not working for free, or a simple, ‘I don’t know anything about that’ usually puts an end to any further discussion on the matter. But I am always wary of those who slip easily into patient mode and see me as a doctor rather than just myself and I usually give these individuals a wide berth. But despite this, whenever I am faced with an unexpected medical request, I can’t help but feel a sense of betrayal, an invasion of boundaries, and find myself feeling defensive with a strong urge to get away, just as Seamus did that Saturday afternoon so many years ago.
Edward de Bono’s thinking methods have helped sort out many a circular discussion in our house. So when the question of whether or not we should resign from the GMS arose recently, due to the now familiar problem of not being able to find holiday locum cover for the practice, the logical thing to do was to examine this course of action using de Bono’s ‘Six Thinking Hats’.
The Six Thinking Hats tool is a simple, effective, parallel thinking process that separates thinking into six clear functions and roles. Each function is represented by a symbolic coloured hat, as outlined below. The abridged discussion went something like this:
White Hat: This hat calls for information, known or needed. The most important consideration is whether or not it would be possible to make a reasonable income without a GMS contract. Information needed includes other potential sources of income for an experienced GP in their mid-50s, current practice income and expenditure.
Yellow Hat: This hat symbolises optimism and calls for exploration of the positives and benefits of a particular course of action. One positive outcome of resignation would be that time off could be planned and taken as desired. Finding alternative work would not be a problem, as there is always a demand for locum or sessional work. Not running a practice would result in reduced overheads, administrative work and staff management.
Black Hat: This hat calls for exploration of all the negative aspects of a course of action. Patients may have to travel further for medical care, as it is unlikely a full-time doctor will be appointed in Killenaule. There will be more ambulance call-outs, increased and longer hospital admissions, more medication errors. The local pharmacy will reduce its staff or close. There will be job losses from our surgery. It would be difficult to explain our decision to our patients, as they are also our neighbours and friends and they have come to trust us. It could take a long time to regain that trust as a non-GP member of the community. There would be loss of the security of the GMS contract, a risk of reduced income and a risk of loss of self-esteem that comes from the perception of self as a ‘failed business-owner’.
Red Hat: This signifies feelings, hunches and intuition. We would feel sad that 22 years of financial and emotional investment ended in failure. Sad to finally admit that long-term personal care, by the same doctor, which has been shown to significantly reduce mortality rates, is no longer available to the people of Killenaule. Worried that we have let people down by not managing to make this practice sustainable. Fearful about such a change at this stage of our lives and uncertainty about the future. Relief that we are no longer solely responsible for the running of a GP practice in difficult circumstances with no reason to believe that these circumstances will improve. Happy to be able to plan time off and know it will not have to be cancelled or delayed at the last minute. A sense of freedom at releasing ourselves from an archaic and punitive contract of employment that can be altered at any time at the pleasure of the Minister.
Green Hat: This hat focuses on creativity and growth and calls for exploration of new ideas and possibilities. Perhaps the resignation of two committed and outwardly successful doctors will help highlight the plight of Irish general practice, leading to some attempt by Government to improve it. This is probably magical thinking, but this is allowed when wearing the Green Hat.
Blue Hat: This is the ‘managing hat’ that ensures the thinking tool is used correctly and brings the discussion to a close. There are many factors to consider in trying to come to a decision, not least examination of outstanding White Hat information. We decided to re-examine our options once we had accumulated this information.
Carrying out this exercise uncovered two important factors, the first being that we are not responsible for the current state of general practice. Failure to reverse FEMPI is one of the main reasons that there is a shortage of GPs in Ireland and until this is reversed, nothing will improve. The second is that the only reason we are still in business is that we are resilient individuals who work hard to overcome both personal and professional challenges. But resilience, while it allows us to survive and thrive, does not tackle the underlying problem of abuse of GPs by Government. Resilience has not resulted in attracting young doctors into our practice. Resilience, coupled with magical thinking, may be the reason that many of us ‘keep on keeping on’ long after we should have quit.