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Duties of care

A recent article in the health section of The Guardian, titled ‘I worry I can’t be a good mother and a good doctor’, got me thinking. The piece by an anonymous author was published on the week that marked International Women’s Day.

As I’m writing this, I am half-way through my pregnancy and while both excited and nervous, I found that many of the worries expressed by the author of this piece resonated with me.

She told how, as she left the scene of her first house call of the morning to review a patient who ended up being transferred to hospital, she received a text from her husband to inform her that — let’s just say a ‘foreign body’ unexpectedly presented itself during her toddler’s trip to the bathroom.

This set off a cascade of thoughts and worries, ranging from ‘is she okay?’ to ‘do I have the right to tell the child-minder how to mind her if I’m out at work myself?’ All of these thoughts whirling through her brain while trying to manage her patient caseload for the day. Two full-time jobs divided into one person.

I remember some of the responses I got from friends, colleagues and family when I told them that I’d secured a place on a GP training scheme some years ago. A chorus of ‘oh, well done’, followed by ‘that will be a good choice for when you want to start a family’.

At that stage, I had only started going out with my then boyfriend and I hadn’t thought beyond our next date, never mind marriage and kids. I received these congratulations and affirmations warmly, but thought (and still do) it was an odd thing to say to somebody who’d excitedly shared news about their career choice. Is this something any of our male GPs were met with?

Is this really the message we want to promote? That yes, of course you’ve trained long and hard and committed many hours, days, weekends, to becoming a doctor in your chosen field, but you’ll only be truly worth anything if you can manage to fit in raising a family around it?

Female doctors are still not equally represented in fields such as surgery and fewer still go on to hold full-time posts in academic medicine. And while there are many reasons for this lack of parity, the struggle to maintain a commitment to full-time practice, an on-call rota and teaching, etc, while trying to manage full-time family schedules, is undoubtedly a huge factor.

How many women are discouraged from applying for consultant posts due to lack of flexibility in working hours and practice? Of course, there are then the double standards not only imposed upon us by others, but by ourselves. In the run-up to disclosing to my employers that I was pregnant, I didn’t even have to wonder whether my husband would feel a similar mix of trepidation and excitement when breaking the news to his own boss.

I calculated my dates, wondered whether I could think of reliable colleagues who may be available for locum cover, planning whether I could return to work in the same capacity upon finishing up on maternity leave, etc. Thankfully, my bosses are lovely and warmly received the news, but my stomach was still turning on itself when I popped my head around the door at the end of surgery and asked ‘could I have a word?’

I can’t even compare my working situation to that of a single-handed female GP who can often find themselves returning to full-time practice just weeks after having their baby, due to difficulties in securing locums to cover their practice.

Since that moment, I have jumped through several mental hoops, including: ‘Would it be better to have childcare located closer to work or to home?’; ‘What if I’m in the middle of clinic with a patient and there’s an emergency with the baby?’; ‘What happens when I’m sleep-deprived and trying to focus at work. What if I miss something?’ or ‘If I need to work late, who’s going to mind them?’

These are questions I ask myself with the support of a husband who works in a non-medical field on a standard Monday-to-Friday basis. What about the logistics of a parenting combination of two doctors? Working in different hospitals or practices miles apart; on different rotas?

The Medical Council also makes little allowance for a parent taking time off work to mind their child, in respect of CPD requirements.

Most female doctors who become parents will decide to take 26 weeks of statutory maternity leave and therefore not be engaged in clinical practice. However, the Council’s rules stipulate that these doctors must achieve the full complement of CPD points.

This is unfair and does little to promote a fair working attitude towards doctors, both female and male, who need to take time off from work to manage family commitments.

It is worth reflecting on the unique position that female doctors still find themselves in, in 2017, despite being told of the ‘feminisation of medicine’. We have an unwavering duty of care to our patients, to our careers, and still, most importantly to ourselves and our families, whatever form that takes.

We owe it to future generations of female doctors to challenge attitudes, training and working practices as hard as we seem to continually challenge ourselves.

  1. Dr Ruairi Hanley on April 10, 2017 at 2:26 pm

    Dear Editor / Dr Morgan

    I refer to your column above in which it is stated

    “The Medical Council also makes little allowance for a parent taking time off work to mind their child, in respect of CPD requirements.
    Most female doctors who become parents will decide to take 26 weeks of statutory maternity leave and therefore not be engaged in clinical practice. However, the Council’s rules stipulate that these doctors must achieve the full complement of CPD points”

    I am writing in a personal capacity, but as you may be aware I am an elected member of the IMC. Since I was elected in 2013 I have highlighted this issue at council as I pledged to do

    I am pleased to inform Dr Morgan (and every pregnant colleague reading this) that the above description of the position of the IMC is inaccurate

    Broadly speaking, (and this is my clear personal understanding – I am not speaking officially on behalf of IMC) any colleague who is on maternity leave will not be subjected to sanction/inquiry if they fall short of their CPD requirements. They are encouraged to try to make up any CPD deficiency over 5 years but I emphasise again this group will always be treated fairly. That has been the position for a number of years now

    I have requested that the IMC make this explicitly and publicly clear and the ICGP (and other colleges) should also be doing so. Regrettably, judging by this column, the message is just not getting out there

    In any case, I would recommend that colleagues should notify their college (in this case the ICGP) of their maternity leave so that it can be taken fully into account in the event of any audit

    It would be extremely regrettable if this issue created fear and anxiety for colleagues on maternity leave and I hope this response provides reassurance for them with respect to CPD/CME

    Finally, I would like to extend best wishes to every colleague going on maternity leave

    Yours Sincerely

    Dr Ruairi Hanley

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