I first worked for St Mark’s Hospital back when it moved to Northwick Park from City Road – from 1995 to 1997, I was a research fellow at the Polyposis Registry, which I now lead. I was involved in the day when we shuttled the patients at the old St Mark’s site to the new hospital in ambulances along with fire extinguishers…
After that I went to finish my surgical training, but I came back as a fellow in colorectal surgery in 2002. I returned in March 2006 as a consultant, and have now been here for 13 years.
I wanted to work for the Polyposis Registry because I went to a training day with Robin Phillips, who became my mentor, and found it absolutely fascinating. I went up to him at the end and asked, “How can I work with you?” The work is a really interesting mixture of genetics, medicine, and surgery. There are very different aspects to what you do in a day or a week – I do standard colorectal surgery, but I also do lots of genomics as well.
The Registry is an early example of using genetics in medicine. St Mark’s has been doing it since 1924 – before DNA was even discovered. They could see that people had inherited diseases and traits, and offered their version of screening and treatment. These days it’s a powerful example of using genetic information to improve care.
My experience of training as a woman in surgery was absolutely fine – I think I came along just at the right time. For my generation, everyone accepted that we needed more women surgical trainees. In almost every job I applied for, they hadn’t had a female trainee before. I think sometimes they were quite relieved when I walked through the door, because I did a lot of activities like yacht racing that the surgeons could relate to. So I think they thought, “We have to have a trainee, we need a woman – she’ll do.”
All these young male trainees would stand up and talk at meetings, but because I was the only woman in the room, they all remembered me!
I think problems do arise when people want to work flexibly or part time. Surgery is very hard work – you can do it if you have a family, but it is much more difficult. A big pelvic operation, for example, takes 12 to 14 hours, which means that you can’t pick up your kids from school, you can’t do activities with them, because you’re operating. And of course you have to have very robust childcare arrangements.
It’s tough to train part time in surgery because of the amount you have to learn. There’s all the medicine, but then in addition you have to learn your surgical techniques. And of course it’s a practical skill, which means that you if you aren’t working for any length of time, you’re rusty when you come back. Surgeons have traditionally been more resistant to people working part time, but this is all something our training and workforce is going to have to adapt to.
There are more women in surgery now – the numbers are still low but they’re rising. It helps that people have role models, and can see that women really can succeed.
Something I’ve realised over the years is that many of my trainees tell me that I’m a role model for them. I’m not actually sure that my generation is a good model for them. We were moulded in an environment where the hours we worked were probably wrong. For five years, I was the Dean of the St Mark’s Academic Institute, which was a whole other role on top of my job, and I worked – and still work – late into the evening and most weekends to look after everything. We need to ensure that our next generation of surgeons live in a balanced, healthy way.
Lots of surgeons like things to be simple. We like to write one letter, do one operation, fix the problem. But we have to accept that lots of our patients have very complex problems. At St Mark’s, we’re really good at managing complexity - we have specialist nurses, therapists, all sorts of people who can help provide that expertise.
We have lots of multidisciplinary teams [a team of different types of health professionals who work together on a patient’s care] at St Mark’s – from our Inflammatory Bowel Disease team to our Intestinal Rehabilitation Unit. If you didn’t like managing complex cases, you wouldn’t work here. They provide the range of different perspectives which help us look after complex patients well – it’s a good example of how different ways of looking at the world helps us offer better care.
I think my trainees value seeing what an experienced clinician looks like, what it really means to take clinical responsibility for patients. But the other thing they value is honesty. I give a lot of careers advice, and sometimes I think training can be a bit like a conveyor belt – while you’re on it, it’s hard to see the wood for the trees. You need to step away for a moment and really consider what you want from your career.
That would be my advice to people who are setting out on a surgical career: really think about what you want your life to look like when you’re an established professional. It’s very easy to go to a lecture or a meeting, see a professional you admire, and say, I want to be like you. But you have to think very carefully about whether you actually want the lifestyle that involves – it can be incredibly rewarding, but it also comes with limitations and sacrifices.
You should think right down to where you want to live – do you want to be in the countryside with leafy green fields, or do you want to be in a city where there are more opportunities for research? It’s amazing how few people have really thought about what’s most important to them. And it’s so important to get it right so that we can feel content.