Who Is Your Critic?

When you’re creating something, the haters always seem to emerge.

That can’t be done.

Who do you think you are?

That’s not your job.

You’re not qualified.

The only criticism you should ever take to heart are from people in the arena.  Who have put themselves out there and are creating, just like you.  Sure, it’s ok to receive feedback from people, but the real criticism that matters are from fellow creatives.  

Theodore Roosevelt said it best:

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

If you’re not in the arena, then I don’t care.


NHS Startup Part VI – Screw It, Let’s Do It

I’ve just given the green light to my developers to go ahead and start building our product.

It was a bank holiday weekend the last three days and each night I’ve been tossing and turning.  So many thoughts go through your head when you’re about to sink most of your savings into a project.

But at the end of the day there’s no way of knowing if something you’re creating will work or be liked.

I love Seth Godin – he’s a massive inspiration and I really believe he “gets it”.  He gets what being an entrepreneur in the 21st Century means.

He often speaks about “The Marshmallow Test”.  It was a test done on primary school children where they were shown some marshmallows.  The children were left in a room by themselves with a marshmallow in clear view.  They were told that if they did not eat the marshmallow when the examiner left the room, that they would then receive two marshmallows when the examiner returned.

The children were then followed up later in life.  It turned out that the children who did not eat the marshmallow and could delay their gratification until later were better off in all aspects of their life – they were happier, healthier, were academically better, earn more etc.

The moral is that the children who could hold two ideas in their mind – that they might get an extra marshmallow vs they might not – were more successful in adulthood.

So what does this mean for us?

It means that those of us that can hold two ideas in our mind – it might work vs it might not work – are able to really go forward in life and be successful.

I’m completely open to failing right now.  I think that realistically I have about a 10% chance of success in what I’m trying to do.  But I don’t care.  I’m trying to solve a problem that I really believe in.  It might work, it might not work.

Or as Richard Branson would say; screw it, let’s do it.

Are We Going Around In Circles?

I was having induction at my new Family Practice a month ago.  This was so I understood how the practice worked before I started seeing my patients on my own.

Insanely insightful seeing all these patients go on their journey after being seen by the doctor.  Doctors have to collect data and trial a lot of treatments.  We might send you to have some blood tests, have physiotherapy, go for a scan etc etc.

What struck me though was that most patients don’t have a clue about what’s going on.

For example, I was sat in with the healthcare assistant (HCA) one morning as she gave patients their injections and took blood samples the doctors had ordered.

“Why are you having these blood tests done?” the HCA asked.

“To be honest I don’t know.  The doctor said something about vitamins, but I’m really confused.” the patient responded.

That seemed to be the theme of the whole morning.

GPs (Family doctors) have ten minutes to see each patient in England.  We are taught during our GP training that 4 of those minutes should be used to explain the patients diagnosis and create a shared management plan.

Now believe it or not, I think for most things 4 minutes is enough!  If you had, say high cholesterol, which required taking medication, I think I could explain the basics in 4 minutes.

Whether you’d absorb all of that knowledge however is a different matter.  And actually, understanding all the intricacies  that go into cholesterol metabolism and how it affects you and why medications help, what role statistics play (numbers needed to treat etc.) in starting treatment, why we need to monitor your blood test results and what we’re looking out for……well that requires in depth study.

We are often told about patient empowerment and how patients should be taking control of their illnesses.  This is obviously great and a lot of patients with certain conditions do indeed understand their condition better than their physician.

However, for most patients it seems like medicine is still very paternalistic and in their cases it’s probably a good thing!  It seems that most people simply don’t understand or don’t want to understand and take control of their own conditions.

This is ironic as most of the major illnesses today are due to lifestyle factors and patients not taking responsibility of their health in the first place.

Are we going around in circles here?  Should I as a physician care?  And what am I meant to do to help these patients?

Needless to say I left my morning induction more dazed and confused than pretty much any other day I’ve been a doctor!

Focus On the Negative 

Why is it that when the phone rings we assume the worst?

Ring ring.

“Hello, Rakeeb, I need to talk to you about a patient you saw yesterday.  Please can you see me after your clinic is over?”

The narrative in my mind started immediately.  “I must have done something wrong…I hope they didn’t end up in the hospital…oh gosh even worse in ICU!  That means I’ll get reported to the General Medical Council and I’ll end up losing my job, my house, my life and then I’ll die!”

It’s interesting how we as human beings are great at making up a narrative, which most of the time has no basis in reality.  We take a small part of the truth and then fill the rest of it with fear.  We tell ourselves all sorts of stories all the time which keep us down and stifle us immensely.  When the phone rings and it’s your boss you never think “Oh!  She’s ringing to tell me what a wonderful job I’ve done!”.

As it turned out my supervisor just wanted to give me an update on a patient I had seen who was perfectly well, but she thought that I’d be interested in knowing how she was getting on.

Steven Pressfield calls it the Resistance.  Seth Godin calls it the Lizard Brain.  Brene Brown calls it fear.  Marcus Aurelius calls it stoicism.

I call it irrationally stifling yourself.

You Can Choose

You can wake up one day and choose to be sad.  There’ll be a voice in your mind that will say “you’re too thin”, “you’re not smart enough”, “you’re not the right colour”, “you’re not the right gender”, “you’re ugly”, “you don’t have any friends”…..

You  can wake up one morning and choose to be happy.  There’ll be a voice in your mind that will say “you’ve got your good health”, “you have a loving family”, “you have great friends”, “your job is actually really useful and helps people”, “you have a beautiful partner”, “you have all the money you need to live comfortably”…..

No matter what you think you can back that thought up.  So you might as well choose to focus on the positive.

How To Reflect

I really love writing this blog.  It’s so much fun being able to just put your honest thoughts and insights down.  As long as I don’t name names and keep things as apolitical as possible, it seems that I can write about anything I want!

It’s funny though, I have to also do “reflections” as part of being a doctor.  I have to sit in front of the computer, think of things that happened at work, talk about how it made me feel, what I learnt and what I’d do differently in the future.

Ok, that’s actually quite reasonable.  I think doctors in particular are a bunch of people who have often taken themselves far too seriously and are generally “know it alls” who should be brought down back to Earth from time to time and actually think about what it is they’re doing to their patients.

Isn’t it ironic then that we also get told how to reflect?  

We are actually told by our supervisors and training directors what we should reflect about and how we should reflect…

We are literally being told what to think about and how to think about it.  Is that what reflection actually is?

If for example, I see a patient with poor control of their asthma and my real honest reflection after seeing the patient is that they’re being very irresponsible by continuing to smoke and not attending their reviews, but then after I have made my reflection (which gets stored on my eportfolio) I get left a comment by a trainer saying something along the lines of; “what made them come to see you now?  Why are they smoking?  What’s their inhaler technique like?”.  Then what am I meant to answer back?

These are all valid comments by the way, but they’re just not my reflections on the scenario.  Our professional development in terms of knowledge is meant to be via case studies and examinations.  Our reflections are meant to be for our own personal growth and introspection.

I think there’s an alternative motive behind why we are literally made to sit down and reflect in such a non-sensical way.  It’s to keep tabs on doctors.  It’s to make sure we’re not purposefully killing people and have some form of documentation about that.  It’s also so that when things do go wrong we can be held accountable.  One GP trainee who got taken to court actually had his reflections used against him!  

You know that’s fine, but why doesn’t the Royal College of General Practitioners just be honest and tell us the truth about why we’re doing what we’re doing, instead of telling us to “reflect”.

He Didn’t Remember

I remember when I was working in General Surgery and I was having fleeting thoughts of surgery as a career.  There was one moment that made me realise that I definitely didn’t want to do it.  

I was a SHO in general surgery at this point.  I was referred a patient from the ED to assess whether he needed an emergency operation.  

He did.  

I looked through the patients medical records and noticed that the Consultant General Surgeon (Attending Surgeon) for the day was someone that had carried out another operation on him previously.

“Oh, it seems that Mr Soandso did your emergency hernia operation last year.”


“Mr Soandso!  Erm…..”

“I can’t remember him”

It made me realise that I was contemplating surgery as I wanted to have an impact on peoples lives.  And of course you do have impact being a surgeon!  Acute operations are often life saving!  But patients forget.  They’re so disorientated in the hospital during these acute admissions that they can hardly remember anyone after an admission!

Meh, not for me.  I want to have a real impact on peoples lives and also be rememebered by them.  I think it’s important to be honest with yourself and be honest with what actually drives you to do what you do.