Fewer than ten per cent of women doctors are
surgeons. Perhaps it's a lack of role-models, the
unpredictable working patterns, and fewer part-time working
opportunities.
I retired as a practising surgeon in 2009. I
was one of only five women to be vice-president of the Royal
College of Surgeons of England - there is yet to be a woman
president - and was awarded a CBE.
My speciality was peripheral vascular surgery:
plumbing. If it gets blocked, unblock it or bypass it; if
it bursts, replace it.
As well as being a consultant and professor,
I'm also the new president of the Liverpool Medical Institution, a
Fellow of the Academy of Medical Educators and the Royal Society of
Medicine, a member of the Travelling Surgical Society, trustee of
the British Institute of Radiology, and I serve on the research
committee of the Healing Foundation charity.
I was appointed in 1988 to the Countess of Chester
Hospital, as a consultant general surgeon with the
specific aim to set up a peripheral vascular speciality service at
the Trust. The hospital is only the second endovascular surgery
site in Merseyside.
I operated on patients with abdominal aortic
aneurysms, people with limbs threatened with amputation
owing to poor blood supply, and patients with transient strokes who
required unblocking of the artery in the neck.
My special interests were reconstructive
surgery for patients with life-, limb-, or
brain-threatening vascular disease, and developing new vascular
techniques which minimise harm to the body when carrying out
complex procedures.
It is a very people-orientated job. I liked
that. I liked the fact that sometimes you could do something to
relieve a person's problem - even save a life.
There's an apocryphal survey about the difference
between surgeons and physicians. It claims that there
isn't much difference, actually, except that surgeons are more
religious. It might be true - because they deal with life and death
all the time.
The thing I miss most is the clinic, where I
really enjoyed meeting patients and trying to sort out their
problems. Some cheered me up after a difficult day - and sometimes
these were the patients with problems I couldn't make better.
I work now at the Countess of Chester Hospital NHS
Foundation Trust as director of medical education (every
hospital has one). Also, with my colleague, Della Fish, and the
University of Chester, I'm championing the development of the
teachers of postgraduate doctors.
We influence doctors and the surgical team by who we
are, how we respond to our responsibilities as clinical
practitioners, and the efforts we make as clinical teachers. I want
to encourage well-supported but open-ended development that allows
the best clinicians to fly, the more steady to grow
proportionately, and the more needy to review, recover, and
remediate their difficulties.
Wise doctors know themselves, and are prepared
to do what is best for the patient, or student doctor, in front of
them - even if it is not necessarily what others might think is the
right thing. You help to develop one another by exploring the
values and expectations of a learner, and building their character.
I wrote Cultivating a Thinking Surgeon in 2005, and
Developing the Wise Doctor in 2007, with Della.
Just because people have passed exams, they're
not necessarily a good doctor. Part of doing the job is getting on
with patients and colleagues in a frenetic hospital
environment.
The thing that is often forgotten is that doctors who
qualify don't actually reach a status when they can
practise as a consultant independently for many years; so they
remain in training in their specialty for quite a long time. The
Royal College of Surgeons set out to write a special post-graduate
curriculum for surgeons. Della and I wrote this, and she's very
interested in the values, which had got lost in the mire of
competencies, targets, and contracts.
Our rather more values-based approach to postgraduate
medical education doesn't fit with the current mindset of
"tips for teachers" and "training on the run".
The passion of doctors for the work has been
quashed by the control laid on them by the rather
tyrannical bureaucracy which the NHS now is. Our young doctors have
become very oppressed by managers. "I can't do that. My manager
won't let me."
Della and I set up a Master's programme
focusing on a moral mode of practice, trying to develop the person,
with the moral responsibility on the teacher. It has resonated very
well, and the doctors who have taken it said that looking at
medicine in this way has changed the way they teach, and also
practise, medicine.
A colleague's putting their own interests above that of
a medical student was what last made me angry.
Since young doctors are working fewer hours,
the way they're taught and developed is different. There's been a
resistance to making education a significant part of the process.
Managers see it as a tiresome add-on, not intrinsic to how people's
care is given in hospital.
That's my one wish for the NHS - that our
leaders would realise how important teaching is. If I could have a
second wish, it would be for a courageous leader who believes that
we can afford the NHS, and that we must protect it from the wiles
of political and financial exploitation - though we mustn't rest on
our laurels: there's appropriate competition and innovation.
I feel very strongly that people are important
- that's what I've enjoyed most in medicine.
Much of the space in hospital is now taken over by
management offices. Consultants are told they don't need
offices now - or can share them. Sometimes it's very difficult to
find a place that's quiet. Thank goodness for the chapel - if there
still is one. The idea that you should sit quietly and think has
been eroded out of practice - a moment of not having to respond to
the noisy environment.
I say to my young doctors: "You are on a
course: come to the education centre: we'll find you a quiet room
where you can read and think." It's not something they come to
naturally. If they are not encouraged to do it, they don't develop
any habits.
The phrase I hate most is "work-life balance".
This has separated medicine from you as a person - rather than
saying that you need to seek balance within your work.
Your soul shapes your character and your body -
if you listen to it. The real person you are is inside your body,
and your body is responsible for looking after your soul in its
earthly form. I think there is a spiritual being in all people -
how much they see it is the difference. Talking about these
important matters among doctors doesn't happen as much as it used
to. They don't find it easy.
Family and close friends are fundamentally important to
my well-being now, and have always been.
My biggest regret was missing my first godson's
christening. I was on call, and my husband stood in. I've
made a pact with myself not to miss funerals.
Professor Averil Mansfield influenced me
greatly. She was a vascular consultant in Liverpool, where
I worked with her, and then professor of surgery (the first woman
in the UK) at Imperial College. She developed excellent rapport
with her patients, made wise decisions about whether an operation
was the right thing, and at the end of each major procedure would
call the next of kin on the telephone from the tea room in theatre,
and tell them how it had gone. She never lost that feeling for
patients.
I'd like to be remembered for caring. I wasn't
able to live up to the telephone conversation in my practice, but I
made a very big effort to be available to families and next of
kin.
I love The Little Prince by Antoine de
Saint-Exupéry, and The Courage to Teach by Parker
Palmer.
My favourite place is at home in the garden,
and I'm happiest when I'm cooking for people.
Favourite Bible passage: "The Lord is my
shepherd: I shall not want." It never fails. I like less the book
of Leviticus with protocols and laws, and the rather vengeful God
portrayed in the Old Testament.
My most reassuring sound? The pulse in the foot
of a patient at the end of a bypass operation.
I pray for the strength to see things through.
I often pray for people, friends, and acquaintances when it seems
they need a bit of extra help.
I'd like to get locked in a church with Pope
Francis. He seems to have come into the Catholic Church
with a completely different idea of what being a pope is, and I'd
like to know how he is going to deal with the politics. He seems to
be right on the ground, and I can't help believing that he'll be
driving everyone in the Vatican completely barmy. I'm interested to
learn what his game plan is.
Professor de Cossart was talking to Terence Handley
MacMath.
