If Not You Then Who? Why seizing the opportunities that come your way is so important

We’ve all had the emails arrive with requests. We are looking for a new member of X committee, a training rep for X group or would you like to give a lecture to Y. For many year when these dropped into my inbox I ignored them. They were being sent to everyone and so ‘they’ weren’t actually looking for someone like me. I wasn’t experienced enough knowledgeable enough, connected enough to ever find success in replying to something like this. Then one year I took a chance and replied. I volunteered to become the HSST lead for the Microbiology Professionals Committee of the Association of Biochemistry and Laboratory Medicine (a LOT of letters I know). They couldn’t reply fast enough with how happy they were I’d replied.

Don’t get me wrong, the ACB weren’t particularly excited that I’d replied……..more they were excited that anyone had. What I’ve learnt since from sending out these emails myself, is that hardly anyone does. The world is full of people who doubt that they would succeed and so don’t put themselves out there and give it a shot. So today I want to talk about all the reasons why, when that email arrives, you should click reply, open the next door in your career and step through it boldly.

You never know where these things will lead

When I sent that email I had no idea where it would lead. Now I know it was the first in a series of steps that took me from where I started to being considered a leader within my profession. At each step I never could have predicted what the one a couple of steps down further down the road would involve. What I do know is that each one I took, I took with purpose. Sometimes I wanted to give back, sometimes I wanted to increase my skills and sometimes I wanted to gain experience. The choices are your own but also not taking those steps and being purposeful is also a choice.

What I hadn’t realised back then is that people frequently ask people they know to get things done, not necessarily because they are the best person but because they are the person they can identify. This means that visibility and being part of networks is key to getting some of the opportunities that would benefit you and your profession.

In my case, that application to be a HSST rep emboldened me to apply for a bursary to attend my first overseas conference in Denver (see pic). After attending my first SHEA conference I was encouraged to apply to their international ambassador scheme, and became the first UK Ambassador. That then led to them paying for me to attend a conference at Disney in Florida, which was not only amazing, but meant I made the connections to sort out a 2 month sabbatical at Boston Childrens Hospital. This helped my NIHR Clinical Lectureship application. That progression helped give me the confidence and experience to apply to become Trust Lead Healthcare Scientist and to become a Clinical Academic.

Gain experience you won’t get in the day job

There are many reasons why it can be difficult to get the kind of experience that volunteering for professional bodies/guideline groups/any external responsibility can provide:

  • Sometimes its hard to be seen in a different way if we’ve been in post for a while, and therefore it can be hard to get identified for opportunities internally
  • Internal committees may find it difficult to accommodate extra people under existing terms of reference
  • Concepts linked to hierarchy may matter more for exisiting structures versus new groups/committees
  • External groups are often specifically looking to engage new people, garner new views and so it can be easier to align personal desires to be exposed to new experiences with the needs of these groups
  • Experienced provided by external groups may just not be provided internally i.e. experience of being a charity trustee

The activities linked to these groups may provide a lower stakes way to get experience. This can include chairing your first meetings, making decisions linked to the success of small pots of grant funding, inputting into a strategic plan. When doing this as part of our day jobs this can feel high stakes and be daunting. If you can gain experience of similar processes in a lower stakes environment you can participate in the learning without some of the stress and anxiety which might otherwise be present.

Often the experience isn’t limited to the activity itself but the experience of working with new people from different backgrounds. This experience helps make us more rounded professionals as well as supporting us in expanding our networks.

Progression is a series of steps

As I described in ‘not knowing where things will lead’ it is often hard to see where taking a series of these smaller steps will take you to. Frequently engaging in these activities is not about ticking off part of a big life plan but about making small progressions that support the whole. If you are a trainee it can be a really nice way of ticking off competencies, if you are already registered it can bring some variety to your CPD for the year. Meeting new people and making new friends is a benefit in itself.

One of the wonderful things about seeing these encounters as small steps is that you don’t have to feel overwhelmed by the big picture, in fact you don’t have to know what that big picture will look like. I talk a lot about having goals in mind, and I stand by that, but there is also joy in taking small steps into the unknown where you just enjoy and value the step in itself. Where you focus on the learning and the experience of that encounter for what it’s offering you in the moment. Taking multiples of these small steps combine to lead to big changes but the little steps have value in themselves and should be appreciated as such.

Don’t be afraid to be seen

I think on some level we all fear being visible, of sticking our heads above the parapet. It feeds into imposter syndrome and our fear that we aren’t ‘enough’. Fear of failure, of not getting chosen, is embedded in most of us from standing in lines to be picked at school if nothing else. I know and understand these fears. Fear is OK, it’s natural, in some cases in the right amount it can even be helpful. The problem comes when it overwhelms, or when we pay it too much heed and therefore we let it stop us from becoming all that we can. I feel this is especially true if it stops us learning, either from the experience itself or from even engaging in the opportunity to start with.

I often sit in my fear for a bit when I’m trying to move forward. This may sound like a strange phrase or a strange thing to do, but sometimes I need to experience the fear to understand it. I don’t dismiss it as I’ve never been able to make that work, instead I allow myself to feel and to ask myself ‘if this fear is real what is the worst that will happen’. What are the worst case scenarios. Then I ask myself, ‘what does this worst case scenario actually mean for me?’. Is the worst case that someone doesn’t pick me? In which case I’ll be a bit bummed out for a few days but there will be more opportunities. Is the worst case that I will make myself look like a bit of an idiot? To be honest I’ve been there before and whether its for this specific reason or not I am likely to be there again. One thing I’ve learnt it that you and your behaviour/embarrassment has way more longevity in your mind than in others. To be frank you are simply not important enough to most other people for them to remember a stupid comment in 6 months time, and those that you are important enough to probably won’t care. Most of the time when I do this I realise that even in the worst case scenarios the event would have little meaning in my life a few months down the line. Therefore the potential cost is still worth it. I don’t talk myself out of fear, I embrace it and that way it doesn’t control me.

Help your community

Finally, and I think this is so important. Our communities survive because of the fact that we engage as part of them. Guidelines don’t get written if people don’t volunteer to write them, events don’t get organised, outreach doesn’t get undertaken and manuscripts don’t get published. It really is a case of trying to make the sum greater than the parts.

As well as learning experiences in themselves, these opportunities are vital for both our profession and our patients. So much of what we do isn’t ‘paid’ as such, so much of our impact is based on the community choosing to engage and work together towards making things different, and hopefully better than they are today. We reap the benefits from the work of this community whether we volunteer or not, but we benefit so much more if we are part of the process. As each one of us steps forward to support our communities the output benefits, as the contribution comes from a more varied group of people and stands a better chance of therefore representing the society/community it is linked to. So instead of seeing your application as a way to benefit you and feeling stressed or worried about how it is received, see it for what it is, something that will benefit those receiving it and something they will be grateful to open.

Since sending that first email asking to be considered I’ve travelled the world, met amazing people and opened up a world of opportunities I just couldn’t have imagined, just because I hit reply and YES. So give yourself the gift of believing in yourself the way that you believe in others, you deserve it!

All opinions on this blog are my own

Conference Season Is Upon Us: Top tips for anyone who struggles with networking

Firstly apologies, this post was supposed to go up before ECCMID as I was hoping it would help others attending. Work was just too full on and I didn’t have the headspace to get it written. As there are still a lot of events yet to come I’m hoping it will still prove useful however.

We all know how very important networking is, especially at conferences. So much of a career that makes a difference in science is based on who you know and who you collaborate with. The problem is making those connections and getting to know people, especially in the early part of your career, often requires taking the plunge and being the one to open a conversion with someone you’ve never met.

I have an amazing friend called Diane who is a wonder to behold in these setting. She happily goes up to talk to people who she’s never met and just starts talking to them with great enthusiasm. Shes fearless and draws the best out of those she engages with. If you are a Diane you probably need read no further. For me however, there is little worse than that moment when you enter a room at a meeting/event, get your cup of tea and survey the 100s of people before you. In this moment you know that really now is the time, you HAVE to find someone to talk to. How do you choose who? What on earth do you say that means you don’t come across as an idiot? The very thought of it gives me palpitations. So here are some things I’ve learnt that take some of the stress out of networking at conferences.

Find an in

There are some moments and set ups at conferences when it is easier to start a conversation than others. There is always the chance that the person next to you in an interesting session will strike up a conversation to help them process what they’ve heard but in general they will be doing the same as you, ducking into and out of sessions that trigger their fancy, meaning they will be you focused on what comes next not starting a chat.

I find however there are two key moments when people are available for the cold start up conversation.

The first is at food breaks/receptions. During these moments there will be people who are there solo and also looking to develop their networks. I find the best thing to do in these situations is to get there early. There are always a limited number of tables where people can put down drinks, if you can find one and hold a place then people will effectively come to you. If this fails and there are no tables, just being close to the source of the refreshments often does the same job. Food and drink are great removers of hierarchy and being somewhere visible means that those in a similar position to you will be able to see you and hopefully will head your way. Worst case you make some small talk to the group that comes to your table and you can politely extricate yourself if it all feels too weird by saying you’re popping to get another drink.

The other place where people will be desperate to speak to you is during poster sessions. So many people will be waiting at their posters for an hour in the desperate hope that someone will come and show an interest. This is often a great time to make connections/exchange contact details (see NB below) If you scope out the listing you will know you are speaking to people who are interested in the same kind of work as you. This can shortcut some of the small talk you might otherwise need to make. It also enables you to know whether you are making a connection with a peer or whether you are connecting with a potential mentor/future employer.

The other thing to think about prior to these conversations is what you can offer, what is your unique selling point?

  • Knowledge (technique, setting or organism)
  • Access (organism, patients, research equipment)
  • Support (mentorship, peer-peer)
  • Collaboration (shared goals, shared research, shared implementation)

NB one of my biggest tips for all of these situations is to make sure you have some business cards printed – even if you print them yourself – this means that you can have something easy to hand out or pin to posters if you want authors to get in touch

Find your tribe

Anyone who reads this blog regularly will know that I’m a bit of a twitterholic (@girlymicro if we haven’t met). One of the many reasons that I’ve stuck with twitter since I initially signed up is that it has transformed my networking experiences. Twitter has offered me a way to circumvent the cold start up conversation by allowing me to find my tribe.

These days every conference/meeting has a hashtag. By following this hashtag you can find people who are interested in the same things as you, people who are in the same sessions or who even have shared connections. In many ways its an improved version of doing the poster walk.  Not only does this give you a conversational in but also by tweeting yourself linked to the thread before you ever meet in person it allows you to have a low stakes initial introduction.

One of the things I also love about twitter is it enables me to find and arrange to meet up with people who I primarily know online in order to strengthen my networks by getting to know each other better. It also gives me the chance to arrange collaboration events, like podcast recordings, when we just happen to be in the same place for a limited time.  Both of these can obviously be done by email but can be much easier to arrange when at an event when you suddenly have half an hour free. Especially at big conferences you could wander the halls for 4 days and not meet anyone you know, this way you can make the most of every second.

Take a study buddy

I absorb my learning best when I have someone to talk through my thoughts with. I have a couple of trusted study buddies that I will by preference attend events with. These guys help me get the most out of any event by:

  • Encouraging me to be braver – ask those questions I might talk myself out of, talk to that person that I should really try to connect with
  • Providing me with a sounding board for ideas when I’m in the moment
  • Enabling us to divide and conquer – there are often multiple sessions I want to be in at the same time, this way we can split up and meet at whichever session is actually proving most appropriate
  • Knowing me well enough to give me space when I need down time to re-energise
  • Crucially for me they are also there so I can feel safe from a health perspective if I have issues. They’ve helped me manage severe reactions, broken limbs etc and I trust them to get me where I need to be and give healthcare workers the right info if I need care

Mel and Lena have been my colleagues for years and they can not only get me out of a shame spiral if I do something stupid but also, by having them available to have conversations all together with new collaborators, we can make much more rapid progress on projects from the very start.

One of the other great things about going with a great study buddy is that you can also achieve other goals whilst at the conference. You can start to get papers drafted, do that research return or catch up about PhD students. If you do have supervision responsibilities whilst you’re away, as you have trainees with you, you can also share the load in terms of ensuring you have downtime. A lot of my most creative breakthroughs have happened with these guys whilst we’ve been away, surrounded both by new science and the time to reflect on how we could encorporate new thinking into our work.

Do some pre-work

I can get really insecure when going to high stakes meetings, like some of the ones I’ve been to at the House of Commons. I never really feel like I fit in and I have been known to hide in the bathrooms there until 5 minutes prior to an event start so I don’t have to face the ‘meet a stranger’ chit chat. In recent years I’ve learnt the value of doing some pre-work ahead of these meetings. This has taken different forms:

  • Reaching out on social media to see if any of my connections are attending
  • Approaching a professional body, especially if I’m on their guestlist, to find out who else they are sending so I can pre-arrange meeting at the session
  • Researching the event to look at speakers and attendance list (if available) so I can pre plan who I might want to speak to and what I could start a conversation with

In these events part of the value is in expanding your network and so really thinking about why you are going and what you hope to achieve is really worth it. Then you can match your elevator pitch (who you are, what you do and what you can offer) to your goals to help you achieve them.

Become the person others come to speak to

One of the things that has become lovely in recent years is that I’ve realised if you are presenting/organising/chairing people come to speak to you. This removes a whole lot of the stress of networking. As I mentioned above, people will often come to you even when you are presenting posters. Its always worth submitting work therefore to events you are attending, not only to get feedback on get science, but also to support you in developing your networks.

Even if you are not in a position to submit work then you should think about offering to support the organisation of events. Meetings are frequently looking for individuals who are happy to support the event organisation, both ahead of time and to do things like man the desks during the event itself. This will mean that you get to know other people who are supporting event delivery with you and give you an opportunity to network with delegates and speakers in a supported way. These connections can be transformative in terms of giving you further opportunities down the line.

Know your self and your limits

Most people assume I’m an extrovert when they meet me and I definitely have a lot of those traits. The things is, I can only manage networking for a fixed period of time. I’m good for a couple of meetings but then I need to retreat back into my bathroom office and answer some emails, otherwise I just feel progressively drained. The older I get the more I need my own space. This is usually fine but presents a real problem at places like conferences where I may need to be in full on extrovert mode for 16 hours a day. I find it exhausting.

One of the things that I’ve discovered about networking is that I therefore have to schedule it in a way that works for me. I can’t agree to go to lots of dinners on top of full day events, either from a health or a social resource point of view. I therefore pick the moments that work best for me and don’t over commit. This does mean I sometimes worry about missing out and not making the most of every opportunity but it also means that I put myself and my wellbeing first. It means that I don’t leave a conference unable to engage with work when I get back as I’ve already used up all my resources. Therefore my top piece of advice is to understand that networking is key but find a way to do it that works for you. Pick your key moments and do them well, rather than trying to be all things to all people.

All opinions on this blog are my own

FRCPath Notes: Some notes on organism identification and antimicrobials in case useful for others

In 2015 I put a note on twitter offering to share my FRCPath notes if anyone was interested. No one replied and so I assumed that (understandably) that everyone was focussed on making their own. Just recently however someone responded to ask if I still could. Long and short I’m delighted to share, mostly because they took me forever to put together and so them having a life after FRCPath gives them even more value as far as I’m concerned. These notes were put together for my FRCPath lab folder but the individual components may be useful to anyone interested in organism identification.

Note of caution, these notes are from 2015 and they were made for my personal use. They therefore may need updating and sense checking if being used by other people. The images are taken from publicly available sources and so despite the note saying they belong to me they only do in the sense that they were combined by me into their current form.

I have included a couple of blank templates I used as structure for revision notes and short questions. These are in word. The rest of the documents are in PDF. I know that some people may prefer word versions so they can update and edit. If you’d like these in a different format please DM on twitter @girlymicro.

Again, I make no claims that these are amazing, only that they were useful to me

Antimicrobial therapy

A table listing types of antibiotic, target and interactions

A table of treatment options and durations for infections caused by atypical mycobacteria

A table of typical antimicrobial therapy durations by broad condition type

Table of typical antimicrobial therapies listed by micro-organism

Notes on antiparasitic therapy listed by parasite

Gram negative bacterial identification

Identification notes by organism

Plate appearance, identification and Gram stain info by organism

Plate appearance, identification and Gram stain info by organism

Plate appearance, identification and Gram stain info by organism

Gram positive bacterial identification

Identification notes by organism

Identification notes by organism

Plate appearance, identification and Gram stain info by organism

Plate appearance, identification and Gram stain info by organism

Fungal identification

Plate appearance, identification and Gram stain info by organism

Parasite identification

Vector, identification and common presentation info by organism

Viral identification

Vector, identification and common presentation info by organism

Note templates

Example of note templates and completed organism notes in case helpful in terms of headers for other

All opinions on this blog are my own

Girlymicro’s 100th Post: What I’ve learnt in my 1st year as a consultant

It has kind of snuck up on me, but this is the 100th blog post on Girlymicrobiologist.com. I’ve had such tremendous fun and learnt so much about myself writing them. Talking to people about them has also been an unanticipated joy. I don’t therefore think I’d realised how many posts had happened over the last 18 months or so. To mark the occasion I thought about writing some top tips and discussing the things I’d enjoyed most, but I cover a lot of that in my 1 year anniversary blog. Serendipitously this post coincides with me having been in a Consultant post for a year this week, so I thought instead I would share what it’s been like………….

Everything I thought and more

I’d worked with a fairly single minded focus to get here. At some points it really felt like it was never going to happen. The wonderful thing is that it has been everything I hoped for and more, something that isn’t always true for dreams and aspirations.

The interesting thing for me is that the core of my job isn’t really that different from my job before, I kept waiting for it to change but it hasn’t really. The biggest change I think is the weight of responsibility I feel for my team and that, for some of the big decisions, I end up advocating on my own. I am aware some days that I’m on a trapeze without a safety net. That said, as the Consultant Nurse for IPC/DIPC and I talk every day we always have each others back. I can’t imagine having spent the last year in a pandemic doing this solo, and so this relationship has been a god send.

I must however talk about the thing that has been strangest to me. I left work on a Friday and came back on a Monday as a Consultant. From one day to the next a lot of people changed the way they interacted with me. People who had known me in both roles. On the Friday they would challenge me routinely and call me Elaine. When I came back on the Monday, the same people called me Doctor and just agreed to things. When I sent emails that I anticipated would come back with nit picking or challenge from some medical colleagues they just responded with OK thanks. Don’t get me wrong there have been plenty of difficult conversations but far fewer than I had anticipated. Anyone who believes hierarchy doesn’t exist in the NHS should experience this transformation by just sticking Consultant into their job title. I still can’t quite get my head around it.

The other thing that I’d been really fearful of when I switched was using the Infection Control Doctor title and having people telling me I couldn’t as I wasn’t a traditional medical doctor. I agonised about having it in my signature and putting people’s backs up. You know what…..not a single person has mentioned it, let alone said anything bad. I can’t tell you how grateful I am for this. It was that title more than any of the others that held real meaning for me and I was so scared of being rejected in that post. The fact that people haven’t rejected it but in fact embraced it means so much. As someone coming from a different place via a different route it is hard to quantify how much that has meant to me and given me hope for how we embrace change/difference in the future.

The whole truth and nothing but the truth

Now I’d be lying if I said the joy and acceptance described above hasn’t come with a whole of heap of challenges. I’m going to talk about the challenges of becoming an IPC Consultant in the times of COVID-19 below, and some of the bits I’m going to cover here I don’t know whether they are the same or worse because I started in a pandemic. It is worth stating that most of these existed before the big P, but that like many things in a period of change they may have been exacerbated.

I talked about about how much the IPC Doctor role has meant to me, its been the goal for 16+ years afterall. I think because I assign so much mental value to it that I doubt myself and fear that everyone is going to realise the horrible mistake they made on a pretty much daily basis. The shoes I’ve had to fill are massive ones left by such an impressive and knowledgeable individual, you can’t help but worry you will disappoint. Taking over at this point is therefore challenging when there have been big decisions and big changes every week it feels. I’ve talked before about how failure is key to learning but every action right now feels like it is too important to fail. That fuels my inner perfectionist and means I have a tenancy to spiral. Deep breaths and ‘faking it until I become it’ have definitely been my survival tools for my first year in post. I’ll let you know when the ‘become it’ happens.

The acceptance has been great, I’ve been incredibly lucky but on some level I still know I’m never going to be part of the club. My micro consultant colleagues go for coffee and lunch together but I can’t join them. I’m the person setting the guidance that says you shouldn’t mix, even after work. They will always spend more time with each other in hand overs etc which means they have enhanced relationships with each other. This isn’t a bad thing. I have relationships that they don’t have and my job role is different. I guess it’s human nature to want to be accepted and part of the group however. The strength of my position is that it is different and in many ways my strength is that I’ve always followed my own path. There have been times over the last year that I’ve needed to remind myself of that. They have been nothing but supportive and inclusive when I’ve reached out and so it has been a lesson to me that if I need help I just need to ask for it.

This leads me onto the next thing. I’m a stand alone Consultant Clinical Scientist within my department. I have nursing and medical consultants that I work with but no one like me. This has meant that sometimes it requires specific focus for both myself and others to remember the scientist part of that title. Being a scientist is a huge part of who I am and my concept of self. It’s understandable that others may not always remember that. Doing the bits that mean I am still a scientist is hugely important to me, things like undertaking research and advocating for my professional group. Some of this is tied in to re-discovering my identify full stop having focussed for so long on reaching this point. I’ve crossed the finish line and so what does the next goal look like, how does that fit in with my scientific identity. How do I ‘fit’ whilst still maintaining that of which I am proud and makes me different. This one is definitely a work in progress and as I learn more I’ll share whatever conclusions I come to.

Here’s the one that will surprise none of you = the to do list never ends. I feel like I’m constantly running to stand still, working weekends just to keep sight of what’s going on. Some of this I think is linked to me wanting to do my best and being anxious about it, some of it is because I don’t want to let go of some things I used to be involved with, but to be honest I think a LOT of it is trying to do all the pre-pandemic work on top of a pandemic work load. The ever changing guidance and the constant messaging required to keep people safe. If life is like this three years from now I will definitely need to drop things that I would love to still be engaged with, for right now I’m mostly taking each week at a time and hoping at some point to see what a consultant post in non-pandemic times might look like.

IPC doctor in the time of COVID-19

Until that day arrives when SARS CoV2 doesn’t control my every moment I continue to spin that one enormous plate on top of everything else. One of the biggest things I’ve learnt over the last year is that leadership, in all its forms, could not be more important. There have been some pretty tough lessons about seniority that I’ve had to learn as well.

I’m used to being able to make decisions, decisions based on evidence. If the data is sufficient I’m not used to people challenging or not engaging with those decisions. I’m going to post about this more in a future blog I think, but one of the lessons I’ve had to learn is that my ability to influence has limits. That the risk assessment others are making is not necessarily the same as the one that I am, and the weighting of the different factors within it are not necessarily the same as mine. Sometimes my role is to advise but if that advice is not taken up because that risk assessment is different it is not a failure of me in the role that I hold. It is the reality of advising on a single part of a much greater puzzle. Try as I may therefore I have had to acknowledge that this isn’t a battle for an outcome, but a collaboration where the outcome may or may not be the one that I would have chosen. As long as I advocate to the best of my ability, live up to my values and embody the leadership I want to see, that is all I can do. If I see it as a battle we all lose, if I see it as co-production we all win. Changing my point of view on this has been key to my surviving at certain points, especially linked to Omicron.

Talking about leadership, I don’t think embodying that leadership has ever been more important. Everyone is tired and everyone has gone through a period of extraordinary stress. I’m still asking staff to behave in ways that add to that stress i.e. by not having lunch or even drinks with their teams together outside of work. This means that a key way that we normally support each other is no longer available. We haven’t been able to celebrate or commiserate with each other for over 2 years. I’m a really strong believer in not asking others to do what I’m not prepared to do myself. Over the last year that has included me leading the way with opting in openly and discussing the pros and cons of routine asymptomatic lateral flow testing. Being open with people about my reactions to the vaccines and booster but how I went ahead and had them for the protection of myself, my colleagues and my patients anyway. It has also included me missing out on that same support I have deprived others of by reducing their contact with colleagues. To me its about fairness and showing with actions rather than words that we are all in this together.

The importance of paying it forward

There are some people in my world who went all in to get me this post, people who I will never be able to thank enough. Mentors who have been with me every step of the way and who put their names and reputations out there vocally to support me, fought battles for me that I know no detail about. Those people have changed my life. So now it’s my turn. My turn to fight for others. My turn to act as a shield and as a mega phone. I have thanked those that helped me but I don’t think they will ever really understand the difference they made, so now I honour that by vowing to make that same difference to those who follow behind.

So here I am (successfully?) having broken my way through that glass ceiling. If anything this last year has shown me that this isn’t the end of the journey but the start. If I want others to not have to have the same fights as I did, then I have to work to make sure I keep that hole open and drop a ladder through it to help those who want to follow. Those coming after me will have different challenges but it’s important to share what I’ve learnt to help them where I can along the way. It’s one of the many reasons this blog is so important to me. So as a fitting message in this 100th post I wanted to say that for as long as you guys keep reading, I will keep sharing. Sharing so we can rise up, sharing so we can make change and sharing to make sure that we are seen and to help us all work every day to leave the world a slightly better place than we found it.

All opinions on this blog are my own

Prioritising the Needs of the Many: Great communicators let the message do the talking

Let me start by saying that I am by no way a ‘great communicator’. I’m OK, I’ve never been the one who wins best presentation prizes or anything like that. I have however had the privilege of seeing some truly amazing communicators speak. I’ve also sat through more hours than I’d care to mention of bad conversations,  bad presentations and bad interviews. What these combined experiences have shown me is that truly great communicators focus on the message and not how they want you to perceive them. They let the listener feel like they own the communication and thereby feel like the message is personal to them. They make the audience feel valued and like they matter by creating a shared experience.

We can’t all be great at this, it’s not where everyones skill set aligns. The greats also seem to me to have a bit of magic that probably can’t be taught. For the rest of us mere mortals however there are things we can do, in terms of thinking and preparation, that may make us a little bit better. So what can we do differently?

It’s not about appearing to be the smartest person in the room

We’ve all been there. We’ve probably all reviewed papers or seen talks where the communicator focused on appearing smart rather than the message. They used complex sentences and words to demonstrate just how much of a scientist they are. In some ways it feels like they have done just about everything they can to make it harder to engage with their message, by making it clear that most of the audience isn’t smart enough to understand what it is they are trying to convey.

In fact the real skill with highly complex topics is being able to present them in a way where they don’t feel complex at all. Being able to break down a complex topic into pieces that when combined make the whole process understandable can only be achieved if you yourself really understand your subject. It’s why Feyman utilised trying to teach something as a way to better understand his learning gaps.

Working out what your message is

Before you start the process of breaking down what you want to teach and going into detail you really need to start with the message.  Too many of us when we are trying to plan a lesson or lecture, or even a paper, don’t put in the pre work to think about what it is that we are actually trying to communicate.  What story are we trying to tell.  We don’t often think of communicating science as telling a story but in reality we are, and there is lots to be gained from thinking of it in terms of these structures.  A story has a key theme or message that it is trying to be communicated to the audience.  Stories also build, they are comprised of sections, even if these are simply: a beginning, a middle and an end.  Before starting to communicate we should therefore think the same way about the topic we are trying to get someone to take away.  We can make sure that everything else we talk about comes back to and enforces this key message. 

The next thing is to then flesh out this message by planning learning objectives.  What are the 3 – 5 things you would hope that someone who has attended will be able to know/achieve after they leave.  These effectively are used to give you your beginning, middle and end.  Your learning objectives for sessions delivered to different audiences may be at a high level the same i.e. raise awareness of the work of a microbiologist. In order to maximise their effectiveness however you will need to tailor them for different audiences to ensure that they can be achieved i.e. talking about AMR will be different for lay pubic audiences versus researchers. This is where the specific and relevant components really come into play.  Everything you put into your session should be based around these learning outcomes in order to support the audience have a clear sense of direction with your overall message.

Remember who your audience are

If your message is going to land then designing your way of communicating it and the learning objectives with them in mind is key.  If you have an audience of 4 year olds then your method of communication is going to be very different to if you are talking to a room full of post graduate PhD students.  If you have a drop in 15 minutes with a large group at a science outreach stand you will need to have a very different method to if you have a small group for an hour as part of a workshop.  You also need to bear in mind whether these audiences are ones you have a relationship with because they’ve met you before, or are they a one off encounter.

When you are writing items like lay summaries for research grants and papers this is especially important.  Most lay summaries should be aimed at an audience with a reading age of 12.  You need to be very conscious of abbreviations and scientific terms that we may all use without even thinking about them.  There are some good websites that can be used to check wording and language, but even more simply you could ask a member of your family (or even ideally a lay focus group) to read through it and see what the message is that they take away vs the one you think they will take away. The same is true for verbal presentations as well. Think about the language you use and whether it invites the audience in or acts as a barrier for engagement.

Try out a metaphor or two

I’m presenting tonight at an AMR event and I have one slide to talk about my work.  The audience is likely to be mixed and I want to talk about the differences between phenotypic, fragment based sequencing and whole genome sequencing, and how different techniques are best in different circumstances. These are challenging concepts to describe in under 5 minutes and so I’ve picked something I think most people will be familiar with for them to hook their knowledge onto…………cake. A good metaphor puts your audience at ease as you are discussing something familiar. You are also able to take shortcuts in explaining some concepts as you are hooking new knowledge onto a pre-existing framework. Hopefully your audience will walk away with your message and if you’re really lucky as someone they will remember.

Take it one step at a time

No one wants to sit in a talk and feel lost or read an article that makes them feel stupid for not understanding it. It makes the person engaging feel bad about themselves. It also makes them disengage which can be distracting for the audience as a whole, depending on how they behave when it happens. I’ve been that person in immunology talks at conferences. I’ve been fully engaged and listening for 15 minutes and then the presenter either takes a step assuming knowledge I don’t have or I blink for a second and miss something and I spend the next 30 minutes with no idea what on earth is going on playing with my phone.

The lesson for me here is twofold. Make sure that every progression step your audience needs is present, you can rarely make assumptions about your audience. If the information is key to understanding the information to come, make sure you give it however briefly. This is where we come back to knowing your message and learning outcomes. By only having the info in your session that is essential to serve those you buy yourself time to spend on the blocks of info needed. The second lesson is to make sure you refer back to previous building blocks of info in your talk. That means that if someone misses something they are given a repeat opportunity to contextualise and understand prior to you moving on. It also means that you are embedding the previous knowledge because the next step builds upon it.

Know when to present yourself vs your CV

Connection between yourself and the audience is always key to getting your message across. There are times when, as much as I wish it wasn’t, that standing in front of an audience as a living version of your CV is required in order to be taken seriously. When establishing your credentials before you start communicating is key to your message being heard. At these moments I’m Dr Elaine Cloutman-Green who leads X and has Y amount of research funding. When you are trying to speak in a lot of other settings however it’s important to remember that credentials can in fact get in the way of the message you are trying to present. Remember it’s about the message and not about you. If I stand in front of audience to talk about science being for everyone and reel off my list of fellowships and leadership roles I have immediately moved myself into a box of ‘other’. Someone not necessarily like them, someone with different professional experience who doesn’t share their experiences and aspirations, someone that it is hard to connect with. When doing sessions like these I’m definitely not my CV, I’m Elaine or Girlymicro.

The best way to get better is to practice

As I’ve said I encounter people all the time who are so much better at all of this than I am and I’m always super attentive when I hear them speak, not just to hear their message but to also learn ways to do it better myself. There are obviously some people out there who are born great at this, but even they needed to learn and improve how they did it. The best way to do that is to practice. Write blogs and get involved in writing papers with others who you think are good at this. Try out thinking about messaging and designing learning objectives, until it becomes easier because you’re used to it. Most importantly practice talking to people, practice one on one conversations with those you supervise, with your colleagues who are in different disciplines and with your friends. See what bits interest them, which bits they respond to. Be brave and book in to do some outreach and volunteer to give that departmental seminar you’ve been dreading. Doing is in essence how we learn, you can only get so far by reading about something. Once you’ve had a go its then important to take the time to reflect in order to learn how to do it better next time.

The other key part of practicing and learning how to communicate better is to make sure that you are building evaluation into your sessions/activities. We often try to guess at what well, what audiences actually heard and what we could improve upon. Guessing is fine to a point but you will never have the backgrounds of everyone you are engaging with. The only way to really know what they are responding to, what worked well and what didn’t is to actually ask them. This is where the measurable part of your learning objectives is important. As scientists we respond well to data, it gives us concrete direction in which to improve. Lets apply that to the way we communicate so that we make the most of every opportunity, every moment, in order to succeed in getting our message across.

All opinions on this blog are my own

An Homage to Douglas Adams: Reaching 42 and therefore becoming the answer to life the universe and everything

I’ve been lucky enough to make it to the big 42 this year. 10 years more than my sister and according to the wise, funny and wonderful Douglas Adams the number which is the answer to life the universe and everything. So as an homage to this great writer and to celebrate I thought I would share the knowledge I have gained whilst turning this wonderful number.

It will never make sense, that’s part of what makes it brilliant

When I was a kid I thought that adults knew it all. When I was a teenager and in my 20s I thought I knew it all, whilst simultaneously knowing I was out of my depth and knew nothing. In my 30s I felt like I needed to know it all and put myself under all the pressure that came with that to succeed and to be seen as knowing. Now I’ve reached my 40s I’ve realised that one of the biggest joys is in the not knowing and enjoying that there is still so much more to learn, explore and achieve.

Its not about how fast you get there, its about remembering to enjoy the ride

I spent my 20s and 30s racing towards an imaginary finish line. I had a list of tick boxes and I ticked fast and I ticked hard. Having reached my imaginary line I now realise that the joy was mostly in the journey and not in the completion. I know a lot of people right now in the ticking phase and the thing I most wish they knew was the boxes WILL get ticked, but that they should get the most from ticking them. Sit back and smell the roses, feel the sun and enjoy the pleasure of each achievement for its own sake, rather than immediately looking towards the next.

In a world where you can be anything, be kind

I don’t remember the smartest people, I don’t remember the people who had the most experience or the most knowledge. The people I remember for having the most impact on me and my career are the ones who were kind. The ones who took the time, the ones who lifted me when I stumbled and the ones who had faith in me when I had none in myself. If you want to maximise the impact of your time on this planet then being kind is the way to do it. Be kind when it’s the last thing you want to be, be kind to the people who are pulling you down. People are fighting battles you know nothing about and one act of kindness can change a day or life.

Not everyone will like you and that’s OK

I find this truth hard as I am, by nature, a people pleaser but its true. No matter how hard you work, no matter how hard you try, not everyone is going to love or even like you. That’s ok you won’t love everyone either, the key thing is to not let that drive you. I’ve been described as ‘marmite’ and it taken me some time to grasp the fact that someone doesn’t have to like me to work with me, we just have to set differences aside and find enough common ground to focus on a shared goal for a time. Not everyone needs to be a tea and cake buddy.

Understand what aids you and let the rest of it go

Sadly I don’t think anyone gets this far in life without having some challenges and quite frankly dealing with some shit. These are the fires that forge us. The thing is knowing that those fights and struggles that have got you here have made you who you are, honour that but don’t let it define you. It’s all too easy to carry our scars with a little too much pride and to give them a little too much weight in our present. I’ve learnt to acknowledge the drive they have given me, the armour they have provided, to try and take the good but leave the bad. To let them help make me but not to let them tell me who I am.

Understand what matters to you

What matters changes over time, it isn’t always a static state of being and requires regular reflection. I’m often described as driven but I mostly think that’s a nice way of people saying I’m following my own path, all I do is put one foot in front of the other. What I do know is that there is a continuous signal amongst the noise of my life and that is that what matters most to me is my family. The people I love are my world, they are my centre and keep me grounded. They are the calm in my storm. What I want most is time with them and to live my life without drama, I did ALL the drama in my teens and early 20s and I don’t enjoy it.

My husband and I have a phrase that we use with each other ‘let me just check my bothered pocket’. When I’m getting into a shame spiral when I’m panicking about the conversation I had yesterday or the imagined upset I might have caused him or visa versa it’s a phrase we use to bring some reality back. The answer is almost always ‘its entirely empty’. Everything is almost always completely OK and there is almost always nothing to worry about. This simple phrase grounds me and enables me to focus on what matters most, the people I love.

The struggles you feel now will fade and change into new and different ones

You have probably gathered that I’m not a very chilled out person, as my husband says ‘my mind is a hell to me’. The biggest lesson I’ve learnt is to step back when I’m in the midst of my storm to try to get the distance to understand whether this is something that actually really matters. The ability I have to focus and be tunnel visioned is great to achieve tasks but is somewhat of a hinderance in this and it’s something that I have to practice. I sit and ask myself if the worst case is true would this matter in the way it feels now next week? next month? next year? in ten years? By asking myself these questions I give myself the structure to work out quite how important it is, or if in fact it is not important at all. This also helps me choose the battles that I want to engage in and the ones that I’m happy to walk away from.

Finding your tribe makes it all worth it

We talk a lot about making sure that you have insight from beyond your echo chamber, and this is true. Right now though I’m going to talk about the joy of finding people who just get you, people who are part of your tribe. None of us are strong all the time, none of us can always be our own advocate. Life is an exhausting merry-go-round and sometimes we all need help. Find the people that see you for who you truly are, good and bad, and who like/love you anyway. Find the people who will see your worth even when you can’t and who will lift you when you fall. Once you have them life will never be quite the same as you will be able to share the load. Once you find them never let them go.

Have the courage to choose the unconventional path

We spend a lot of time getting told what should matter to us, where we should want to be, who we should want to be with. I’ve never been very good with instructions. I’m a strong believer in ‘you do you’ as long as what you are doing isn’t hurting others or taking away their right to choose the same way. I don’t really believe in doing things the way others have done them. I’m the only one that wears this skin, I’m the only me, therefore only I can choose the right path for me. Being different, being you takes courage and self belief, but it’s worth it. Choose the right path for you, otherwise you’ll spend your whole life questioning what might have been and that’s a cage that’s hard to escape from.

Travel the road using the 3 Ps and you won’t go far wrong

The 3 Ps are my rules I set myself to live by: purpose, passion and principles. They apply across my professional and personal life. Do the things that make you wake in the morning with a smile on your face, do them consciously and in a way that doesn’t hurt others. For me, if I live by the 3 Ps I don’t question my life choices because I’m following a path, no matter how challenging, that I’ve set on because I believe in it. When life gets hard therefore, and believe me it does, I know at the core of my being why I made the decision I did and it makes it easier to carry on. These Ps are mine but you have a whole alphabet of choice to decide on what your guiding stars might be!

All opinions on this blog are my own

I’m Not Lucky, I’m a Badass: The importance of owning your success

It’s Heathcare Science Week 2022 and I wanted to start the week by posting about something very close to my heart – owning it. I believe very strongly that we should own our failures and use them as learning experiences to make us better. I also believe that we should own our successes, but this is something that I struggle more with getting comfortable with.

Like many people my first response to any form of compliment linked to my career and the success (I feel) I’ve had is to say how lucky I’ve been. This is true, I’ve been incredibly fortunate, I’ve had amazing opportunities and great success. The thing is,  I’ve been thinking recently is this luck? Is it luck or is it because of hard work, tenacity and opportunities made?

The other thing is this. Claiming success and owning it as anything other than luck is a thought process that makes me feel uncomfortable. Not just that but I’ve worked in teams with some amazing people in order to achieve it and so is it mine to own? Just privately thinking how good my success make me feel also makes me realise how much acknowledging that openly would not be a good look. It could be seen as being arrogant. Being considered arrogant we are taught is never a good thing, especially as a woman.

Then I saw the tweet below and it really made me stop and think. What is the problem with us owning our success and the work it took to get there. Is being happy with your success really arrogance? Or is it, in reality, about having the confidence to own it?

Where Does the Fear of Owning Your Success Come From?

Working in healthcare means that very little we achieve is as individuals, we work in teams and I think most of us are very aware of team dynamics. We succeed and fail within those teams and therefore I think it is often difficult to see ourselves as individuals and having individual success within those team dynamics. Now I’m not in anyway saying we shouldn’t be good team players, I’m all about collaboration but I do think it’s OK to recognise your own role in the success that your team has and to be OK with acknowledging that (with due credit given to others). It takes a lot of voices to make a chorus after all.

My evolutionary psychology days are some time ago, but when I think of how we are taught lessons linked to pride and arrogance I always think back to my days studying primate behaviour. Group behaviour, especially female group behaviour, is about co-operation and fitting into hierarchy. Essentially it’s about helping others and not sticking out. Females that stick out make themselves available for conflict and are considered to be challenging the hierarchy. Now, I haven’t studied in this area for a long time but it feels like a lot of our early behavioural lessons are still based on this structure and if, like me, you are not very comfortable with conflict then your position should be ‘to be seen and not heard’.

I was told repeatedly as a child that ‘Pride comes before a fall’. It was drummed into me from a young age that pride/arrogance was a sin and to be frank it just wasn’t a good look. This definitely plays into, or maybe is, part of the source of my imposter syndrome – where I believe that people actually believe I’m not very good at what I do and the only reason I’m here is that people are being kind to me. If you put those two things together you end up with a belief system where you know that being prideful could lead you to screwing up and embarrassing yourself AND that others may cease to like you and so you may also be called out as not being very good. The pressure we place on ourselves to be liked in order to succeed may therefore itself get in the way of us owning the very success it creates.

Confidence is a tool. Arrogance is a weapon. Confidence invites people in and arrogance pushes people away. People use arrogance as a wall to prevent others from challenging them. 

Amy Cuddy 2018

You all know I’m a bit of an Amy Cuddy fangirl and I like the quote above. We live in fear of being considered prideful or arrogance but that is different from being confident. Confidence builds trust, it enables others to feel they are in a safe pair of hands. To me the big difference between confidence and arrogance is how it deals with failure. People who are confident acknowledge their failures and failings and use them as a learning tool, whereas those who display arrogance are about denying weaknesses and failures and therefore don’t learn from encounters. I for one need to accept these differences between arrogance and confidence, acknowledge that there is a fine line to walk, but know that if I don’t display confidence I am doing myself and others a dis-service. Owning my successes is part of this.

Changing Your Mindset

There is a certain irony in trying to work on this at a time when my I’ve been feeling particularly stressed and anxious and therefore my imposter syndrome has been on over drive. I’m working on the internal validation piece in order to see my own self worth but I’m also really glad of some of the external recognition I receive which aids me in benchmarking in a more neutral way. Some of that is from twitter, awards, committee work etc. All of it is important to me as it stops me getting too much into my own head, I think this is something that people who don’t have a strong critical voice struggle to understand. At the same time as needing this validation to help me manage at the moment I struggle to respond all the nice things people say as I don’t want to come off the wrong way. It’s also hard to know how loud to shout about things like grant success as others who are struggling could be placed in a more challenging head space if this information isn’t shared in the right way.

In order to make the leap into owning my success therefore I’ve needed to work out how to change my mindset #workinprogress. Some of this is linked to being in a safe space where you can try on and practice some of the changes in order to feel comfortable. As I’ve decided that a lot of the barriers to me owning my success are linked to my imposter syndrome it’s been important to practice this within the aspects of my role where I feel more confident first. It’s also been important to look at how others are doing this in public spaces, how do they share in a way that is inspirational not challenging?

The biggest shift for me has been trying to move from a position where the best thing to do is not be seen to ‘rub others faces in it by talking about success’ to ‘you can’t be what you can’t see’. As leaders if others can’t see what we are managing to achieve how are we supporting the aspirations of those following behind us? How are we supporting them to dream bigger than we ever have? I’ve given myself permission to be seen by others.

Women often suffer from being said to display arrogance when displaying confidence when if they were male this would be seen as a more positive character trait. That is something that is not going to go away and I for one am not someone who feels confident enough to challenge it on a daily basis. I am however going to be purposeful in owning things linked to me and my success, not in a way to discourage others but as a way to empower them and help us all to shine. My pledges for 2022 are therefore to:

  • Be open about my successes and not hide them from others
  • Not agonise about posting things linked to success on social media
  • Amplify others successes by sharing them, talking about them and congratulating them
  • Encourage others to challenge themselves by talking about routes that I have undertaken which have been successful (and also where I haven’t) to support those coming after me
  • Stop down playing my own successes by defaulting to luck narrative

Our success does not diminish others, it gives us all permission to shine, so pledge like me to own your success and support others in choosing paths to their own. From now on when someone congratulates me I will not respond with ‘thank you, I’ve been so very lucky’ I will respond with ‘thank you, its been a brilliant journey’ and maybe if I’m feeling strong ‘thank you, turns out I’m a bit of a badass!’

All opinions on this blog are my own

Healthcare Science Week 2022 – Join us on Friday 18th March to talk about blogging, communicating and the importance of drama

Healthcare Science Week performance based on the weekly ‘Girlymicro’ blog by Dr Elaine Cloutman-Green, followed by a discussion on blogging

“So, this is my first ever blog post. Bear with me as I don’t really know what I’m doing. I’m what is known as a Clinical Scientist and I work in Infection Control.”

Thus began the first blog post by Dr Elaine Cloutman-Green, Lead Healthcare Scientist at Great Ormond Street Hospital, in December 2015. It would be five years and one pandemic before her second post, in October 2020, began her weekly blog as ‘Girlymicro’ (‘scientist changing the world one swab at a time’).

Girlymicro blogged at first about the job, to promote Healthcare Science, offering professional exam or interview advice for HCS trainees, before ranging more widely, into women in science, the challenges facing HCS, exploring the limits of what overstretched teams and individuals can achieve, saving lives in labs through insight, accuracy and interpretation.

Each blog written in a snatched hour, Girlymicro became a mental space populated with personal reflection, meditation on loss, favourite microbes, special guests, puppet shows, and… zombies; always with Elaine’s trademark humanity and humour.

‘All Opinions In This Blog Are My Own’ is a showcase of a devised work in progress based on the Girlymicro blog by The Nosocomial Project, adapted by Nicola Baldwin, performed by two actors, Becky Simon and Peter Clements, and two Healthcare Scientists, Anthony De Souza and Dr Elaine Cloutman-Green.

The short performance will be followed by a conversation on writing and blogging. Why blog? What might you learn along the way? Does writing create a safe space for reflection? Or create new pressures? To blog or not to blog…. That is the question.

All welcome

Date and time

Fri, 18 March 2022 15:00 – 17:30 GMT

Location

South Wing University College London

IAS Common Ground, South Wing

UCL Gower Street London

London

WC1E 6BT

please register to attend on this link, please take a lateral flow prior to the event and wear a mask

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Two Years On and Responding to Changes in SARS CoV2 Guidance: What can you do now to impact your transmission risk

Its pretty much 2 years today since a pandemic was declared. A lot has changed since then and there are very big other things happening on the global stage. Its tempting to think that with so much going on that COVID-19 is effectively over. I don’t want to be the voice of doom and gloom here, but I do wanted to take a moment to point out that just because the legal situation has changed it doesn’t mean that the pandemic is over.

For us working in healthcare actually nothing has changed at all, I had to do a briefing last week where I basically said the phrase ‘nothing has changed’ on repeat for 45 minutes. In fact although the legal side of things have changed in the community the actual guidance hasn’t changed at all, it’s just its no longer a police matter. The government website still says:

Although nothing has changed, apart from not being fined for non compliance, this doesn’t seem to have been the focus of communication. SARS CoV2 levels are still high in the community, in fact they are likely even higher than being reported as many people aren’t reporting positive lateral flow tests and so these aren’t included in any numbers. The latest ONS survey numbers are looking like ~1 in 25 people are back to bring positive, with the numbers much higher in some regions.

What Can We Do As Individuals to Prevent Spread?

As the government have decided to make the political decision to remove legal measures and the communication strategy in terms of maintaining public health measures is poor, what can we do to have an impact and reduce risk to ourselves and others?

Know the current symptoms

I have regular calls with people who aren’t aware that the omicon symptoms are pretty different, even when speaking to healthcare professionals. The current  variant often has much more generic symptoms associated with it than those seen when we first encountered SARS CoV2. This means that we need to change our risk assessment and also be much more aware of what to look out for, rather than relying on the triumvirate of Anosmia (loss of taste and smell), temp >38 and new onset cough.

I know how tricky this is because actually so many respiratory viruses have similar symptoms. In many ways its starts more like a general ‘flu like’ illness. Using testing to support making decisions is therefore still going to be really important in working out the cause.

Ensure you have capacity to test

Sadly we are losing the ability to access the more sensitive and specific way to test i.e. PCR, as you can’t order these in advance, store and keep for when needed. Even the free provision of lateral flow kits (LFTs) ends at the end of the month, but for right now you can still order a new 7 day kit every 72 hours.

https://www.gov.uk/order-coronavirus-rapid-lateral-flow-tests

Make sure that you have ordered enough for you and your family. How many depends on your circumstances, which drive your need to test (see list below).

Being able to test is important for a few situations:

  • Enables you to test before you see people who are vulnerable, regardless of whether you have symptoms
  • Supports risk assessment by enabling you to test if you get generic symptoms so you know when to self isolate
  • Helps you know when you are safe to see others again if you test positive. Your risk will be lower (though not non existent) if you are lateral flow negative. I would also advise being symptom free.

NB I am not supporting stock piling here just being sensible.

https://www.gov.uk/coronavirus

Remember that if you test positive you should (under guidance but not law) be undertaking daily LFTs to reduce your risk to others and you will need enough in case this happens to you.

Having testing supplies is especially important if you are a healthcare worker. Currently if you are a SARS CoV2 contact you still need to get an exemption to work and LFT test daily. You should also still be testing twice weekly and I haven’t heard how these will be supplied post switch from .Gov ordering.

Remember that not socialising with others when you feel unwell is key

Visualising how viral spread works can sometimes be tricky, afterall viruses are invisible to the naked eye. Most people can imagine coughs and sneezes spreading as we’ve all been in a room where a cloud has been visible when someone has sneezed. I think its harder with Omicron, where you might just have a runny nose and sore throat, to imagine how it could spread so far. Myth Busters have done a great job of this in the video below. They set up a 30 minute dinner party and show just how far the virus could spread.

It’s really important that we are all sensible about how we interact and what we do if we have symptoms. Top tips from this video include:

  • Remember to undertake regular hand hygiene
  • Limit touching:
    • Don’t share cups or other high risk items
    • Be aware of face touching and the need for tissues etc to minimise the temptation
    • Limit physical contact (if appropriate for the scenario – hard to do this with your kids)

Make sure you still have a plan

My vulnerable mum and brother have just caught COVID-19 for the first time. Something I definitely blame on the change in guidance BTW. They had been prepared in terms of a plan but even they have struggled because they weren’t as prepared as they had been as they had avoided it for the last 2 years. Like them a lot of us had plans early on but have let them lapse. Now with the switch from public health to personal responsibility it is important we prepare for what the means for us as individuals and dust off those plans.

If like me (and until recently my close family) you have managed the last 2 years without catching SARS CoV2 and it all feels a bit inevitable now what can you do?

  • Have a plan for getting food brought to you, either via a support network or via delivery
  • Have pre-planned what that food might look like. Easy food that can either be put in the oven without further prep or food that doesn’t require cooking. COVID-19 brain is real and you may struggle to make decisions whilst unwell
  • Ensure you have all the medications you might need (both for COVID-19 and otherwise) for 2 weeks. Think symptom relief paracetamol/lemsip etc
  • Plan for distraction, especially if you have children. If you have a short attention span and are bed/sofa confined how will you distract yourself. Personally im planning to re-watch the whole of the Golden Girls on Disney Plus. I’ve deliberately held off 😁
  • If you have to split your household into exposed and non exposed how could you do it – the answer may simpky be that you can’t but its worth some thought

Keep risk assessment in your mind

Most of what this post is about is linked to risk assessment and risk control. If you work in healthcare should you be having that lunch with your colleagues? If you are going to see your grand mother have you recently been to a night club? If you’re commuting in an area of ever increasing prevalence i.e. London should you be wearing a mask on the tube? If you haven’t found time to get that booster, now is your moment!

The decision to move to personal responsibility is just that, it’s about every one of us thinking about our own risk and choosing to take responsibility to protect both ourselves and others. We can’t be passengers in this, the govenment change doesn’t mean there is no longer risk, just that it is our risk to own and control. We can only do that by working together. So listen to the science rather than the politicians and make sure we continue to protect those who are most at risk. After all that is what a civilised society is supposed to do.

All opinions on this blog are my own

How Do We Stop, When the Person We Are Competing Against is Ourselves?

I’ve talked a lot previously about the fact that we should only really compete with ourselves. We are all different as are our lives and therefore it makes sense that all of our success criteria will be different too. It’s too tempting to bench mark against others and find yourself wanting. This can be a great driver but it is also something that I for one find difficult some days as I don’t know if it can be turned on and off.

Three years ago today I ended up in a cast from shoulder to wrist. I fell out of a lift at work and protected my work laptop and phone and failed somewhat to protect myself. I’d never broken anything before and so was convinced I’d just sprained something (despite not being able to straighten my arm). I therefore took ibuprofen and paracetamol, went to three more meetings and told everyone I’d be back on Monday – this was a Friday morning. On Saturday morning I was forced to admit that maybe there was something wrong and finally went to A & E (after checking my emails). There I was told I broken my elbow and that I’d have a fracture clinic appointment in the week. I shrugged and said well it’s only and elbow and so worked from home as that didn’t mean I couldn’t type……..right. I finally turned up at fracture clinic and I had broken not only my elbow but also my wrist and then put a full arm cast on me and signed me off sick for 6 weeks. I’d never had a sick note before, I hyperventilated in the appointment and burst into tears saying that they couldn’t do it. They pointed out they could, insisted I took codeine for the pain and put me in the hands of my friend to take me home. What’s my point? My point is that that I don’t know when to stop. I was told by multiple people I should have gone to A & E on the day. I was told by many more to go home and not go to meetings? My husband was adamant that I was in pain and shouldn’t work prior to the fracture clinic as I had a broken arm. I made my wrist much worse and heal out of alignment because I typed on it for almost a week because I couldn’t stop.

So how do we stop when the person who is driving us to continue is ourselves?

I posted last week about the fact that I am often not that well, in fact today I am writing this post in bed as I just feel pretty rough. I’m used to needing to push through because if I didn’t I wouldn’t ever achieve anything very much. What’s probably worse is that I think I’m a fundamentally lazy person. Honestly if I could I would lie on a chaise longue in a library all day reading books and drinking tea. As I’m painfully aware of this aspect of my personality I do try (although my hubby may point out not always successfully) to counter it by being pro-active about doing things. The combination of these two mean that I don’t often know when it’s OK to take my foot off the gas and rest and when I need to knuckle down and push on.

There are times when this is useful

There are times when not knowing when to stop is actually useful. Pre-pandemic I used to run, badly. I’m not good at it, I’m not fast. What I am is stubborn. I continue to put one foot in front of the other no matter what. I’ve finished marathons and half marathons with blood up to calves and enormous holes in my feet but I get into a zone where I just put one foot in front of the other and the pain doesn’t matter so much.

When it comes to working in healthcare I find the same thing happens mentally as well as physically, you just keep going. No matter what the warning signs in terms of burn out of physical health, you keep going because that’s what we do. My auto immune condition entered a whole new phase when I was doing my PhD and I’d just finished a half marathon (whilst in my 3rd year of PhD) when my husband noticed I’d lost a patch of my hair. None of it stopped me. I still submitted my PhD a year early so I could do FRCPath and complete my consultant training.

I succeeded because I just pushed on, because of the habit of putting one foot in front of another. At the time finishing was everything, now I wonder if there were more sensible ways and if I should have listened to those around me, but I was on mile 9 (which I hate) and I just wanted to get the equivalent of mile 13.

Medicine and healthcare are hard places to break the habit

I work in an amazing organisation, filled with the most amazing people. They are all also super smart and world leading experts. I’ve worked there for almost 18 years, I trained there, I’ve grown into an adult there. Being surrounded by people that smart, that successful becomes an embedded driver in itself. You want to succeed for yourself but you also want to succeed for them. As someone who thrives on doing things differently I wanted to follow my own path, break glass ceilings and set the way. To do that however you have to succeed, you have to tick the boxes that people think you can’t tick and so you have to find the drive to continue even when it feels impossible.

As a Healthcare Scientist there is track that needs completing in order to reach the consultant end point I was determined to achieve, for me it was supposed to look something like this:

  • Masters (years 1 – 3)
  • State registration (year 4)
  • Membership of the Royal College of Pathologists (year 4)
  • PhD (years 5 – 10)
  • Fellowship of the Royal College of Pathologists (year 11)

Even though I’ve talked about not benchmarking against others the need to complete these goals become embedded in your psyche. You become very focussed on the track that you are on, in the same way that I run, you get into the zone and take one step at a time. Sometimes however when you are in that zone it’s hard to hear the voices that say you could do it differently, that you could take a break between stages, that you could take that afternoon off to refresh. In my case it was hard because I was on fixed term contracts for the first 13 years of my career, until after I had my PhD and FRCPath. There was therefore a ticking clock in my brain that if I didn’t demonstrate enough commitment, get enough done, that I would lose my job and a career I loved. Not only was I competing against myself but I was competing against time.

So how do we stop?

All of this drive has definitely had its benefits, as I said there are times when this self-competition is really helpful. I would not have managed to get a consultant post or tick all the boxes that needed ticking without it. The issue is that how do you stop when it is no longer useful or even harmful?

I’m still working on this one but here are some things that I’ve found useful. The first one being is to listen to the balancing voices. There’s a lot of good in social media but it’s sometimes easy to only hear the things that re-enforce the fact that we should be working harder and doing more. There are other voices out there however that should make you stop and think about whether you can stop and take a break or just do it in a different way altogether, try and pay as much attention to these as the ones that drive you to keep doing what you’re doing.

Think more about who you are listening to when getting face to face advice. The day I broke my arm at least 3 people told me to go to A and E. I knew something wasn’t right but I listened to others that re-enforced my inner voice to keep going. It was my friends and family who were the ones that said to stop, the ones who prioritise me over Dr Cloutman-Green. Do yourself a favour and listen to these people more. Their priority is you, not the roster, not the deadlines and not the work. Amplify their voices in your mind rather than listening to others.

Finally I’m trying to become my own critical friend. If I was giving advice to someone on the situation I find myself in, would I tell them to push on or would I tell them to stop and rest so they can come back stronger? This is definitely a skill and I am definitely at amateur level right now, but I am working on giving myself permission, permission to leave on time, permission to eat lunch and permission to do things I enjoy that have nothing to do with work. I know some of you out there are so much better than I am at this, and as I said, I am a work in progress. I’m trying to remember therefore to enjoy the learning and the journey. Life after all is just a ride.

All opinions on this blog are my own

I Rarely ‘Feel’ Well: Let’s talk about health privilege in the time of COVID-19 and why SARS CoV2 solutions are not ‘simple’

Firstly let’s get out of the way. This isn’t a pity post, I live a full and amazing life and can achieve anything I want to achieve. It’s just sometimes I achieve it in a different way or I accept there might be some health consequences if I choose to do so – much like other people accept the possibility of a hang over if they open a second bottle of wine. I don’t have a severe condition, I’ve not got cancer or anything major but I have a mild auto immune condition that means I rarely feel ‘well’. Most days I have at least some variety of discomfort, swelling, mild temps, bad chest, sore throat, nausea. On bad days my limbs and face swell and I can’t eat or sometimes drink. This is just life, it doesn’t stop me living and as I said it’s mild and hasn’t hospitalised me in my adult life.

If it is not a show stopper then why am I posting about it? I’ve noticed a lot of healthcare colleagues posting in recent times about the problem of presenteeism and that we should just switch to symptom based isolation for SARS CoV2 and do away with testing outside of healthcare. They make these tweets as if this is the simplest solution and is completely logical. The thing is this choice might be both the simple and logical thing IF you make it from a position of health privilege. What I mean by that is that this is simple IF you are fortunate enough to be a position where 5 days out of seven you don’t have to manage your symptoms, and IF you don’t not have to worry about how you feel on any given day as you find it easy to tell when you’re sick. For someone like me who can’t readily differentiate from the list of SARS CoV2 symptoms and my everyday life you would make my life and existence even harder.

Turning up for work

Every day in Infection Prevention and Control (IPC) we make calls linked to new staff positives so we can make risk assessments linked to patient or staff exposures. Every day we get people who find that they have been at work whilst symptomatic and every day we sigh and roll our eyes, even I do it. We top up on caffeine and wonder why it is so hard for people to recognise when they have the below symptoms and why they don’t just stay off work if the answer to any of the below is yes:

Imagine what it’s like therefore to work and be implementing guidance linked to this knowing that if you obeyed the letter of the law I would effectively be taking PCR tests every 3 days on top of daily lateral flows just to navigate getting to work. I of all people should not therefore roll my eyes but should demonstrate some compassion. If its is hard for them then I need to demonstrate both compassion to them and to myself by recognise how challenging this is. Symptom based detection has become especially an issue during Omicron with the very generic symptom list, people have pretty mild symptoms at the start and they are no where near as identifiable as the alpha symptoms. It’s much harder therefore, especially in winter respiratory season, for people to clock that they have symptoms they need to act on.

People put a lot of emphasis on presenteeism being an issue in the NHS and that that is the reason why people are attending. I think that’s true, everyone feels the pressure to be available right now. In some ways being able to work remotely and therefore being ‘always on’ has made this even harder. I also think it’s not just that. Everyone I know at work is physically broken in some way or other after 2 years of this, even if they don’t have an underlying condition. Therefore it is just harder to know when feeling physical symptoms are linked to just being a heathcare professional during a pandemic or because this is something different.

I’ve been working in Infection Prevention and Control for 18 years now and I can say that the last 2 years have been incredibly challenging. That’s not to say it hasn’t been hard for everyone. For me it’s been 2 years of constant change, long hours and weekends, challenging conversations and continuous decision making. I know IPC colleagues who haven’t had a day off in 2 years. That’s just isn’t sustainable even if you don’t have something already going on, for people like me who have conditions exacerbated by tiredness and stress the miracle would probably have been if I didn’t feel this way. I for one am so far away from ‘a two week holiday will make this better’ that it’s sometimes hard to imagine ever feeling like me again. Yet we turn up, because that is what is needed of us and that is what we require of ourselves. Let’s just acknowledge that it’s more complicated than any of us are talking about in the context of symptom based diagnostics.

Its unpredictable and so I can’t work from a baseline

If you are a healthcare worker exposed to SARS CoV2 in the community or in your household the rules are different to those if you are not. Working in healthcare if I am exposed I need to get a negative PCR test before I return and lateral flow test every day for 10 days. I then need to submit a declaration daily that I am still symptom free and upload my lateral flow test result prior to attending to work. Whilst at work I need to take all my breaks alone so that I don’t risk exposing my colleagues and I can’t take off my mask around others (I obviously would never take my mask off around patients at any point – for their protection and for my own). Again, this seems really straight forward and super sensible. It is, I’ve done a lot of work with implementation on this and it’s a sensible system that prevents chains of transmission and ensure safety. It’s also really hard for people like me. I’m not in a position to be able to declare symptom free and therefore I’m not in a position where I can be granted an exemption. That means that if I’m exposed I have to work from home. Although it is theoretically possible for me to do this for chunks of time it leaves my colleagues unsupported and therefore I don’t feel like it’s something I can risk. I therefore have spent most of the last 2 years as a hermit, not just to protect myself, but because I don’t want to place additional strain on an already stretched system because I decided to have a life. If I was in a position where I could say what my baseline symptoms are and could therefore detect a change it might be different, but I can’t, every day is different and so there is a constant choice about how much life I live and how much exposure I can risk.

One of my colleagues this week asked me why I don’t just remove the COVID tracker app. I said it’s for a couple of reasons:

  • I think that we have a responsibility to walk the walk, it is the safe and responsible thing to do in terms of public health and how can I expect others to do it when I’m not prepared to do it myself
  • I keep it precisely because I can’t easily detect if I have symptoms, when I get alerted I switch from screening every other day to daily in order to manage the increased risk. This means that there will be a shorter period of me putting others at risk if I do become positive. I also ensure I take a PCR test, which I don’t do routinely as symptom based triggers don’t work for me
  • I’m theoretically at higher risk if I do get sick, even though I’ve been vaccinated, the earlier I know the sooner I can try to ensure I manage my safety and the risk to my household

What will happen if I do get sick?

I was ventilated for acute viral respiratory illness as a child, I’ve done the waking up in intensive care as I posted about before. I have some lung damage which means that I get respiratory symptoms and chest infections easily. These also make auto immune condition worse and so all in all I’m not looking forward to my (inevitable) COVID-19 experience. I’ve spent the pandemic working myself into near exhaustion and there is always that part of my mind that worries about what would happen when my number comes up. I’ve been extremely fortunate to not have caught SARS CoV2 so far and I feel better about my risk now having been triple vaccinated. I also know that I don’t mount a good vaccine response and that 2021 was the first year I was so worn down that I got shingles, which probably doesn’t reflect that I’m in a massively good place immunologically.

At work my health is a bit of a running joke as I’m always symptomatic. When people hear me hacking it’s a running gag that people can always hear me coming and my standard response of ‘having functioning lungs is over rated’ is probably well known. I don’t really know if my fear ever really lands with others as I try to ignore it, but it’s definitely there. I also worry that I wouldn’t be able to step away from work and would therefore make it worse. I never give myself the time to be ill because in my head ‘I’m the sick girl’ and therefore I feel I always have to drive myself harder and prove myself more. This is definitely a ‘me’ thing and fighting through when I should stop is how I’ve managed to get where I am instead of spending my life on the sofa under a duvet, but not knowing when and how to stop is something that means I break myself further when all I needed to do was rest. We work in an NHS that drives these bad traits, between the Bradford Score that determines whether I can be sick and the 600 emails a day, stepping away feels nigh on impossible.

Not just about me

I have the best family, we have each others backs, but we have suffered some real loss and a lot of it is based around our collective health. When I talk about how health privilege and comments linked to symptoms not being simple, it’s not just I’m a healthcare worker. My husband and brother both have ulcerative colitis (their own auto immune conditions) and my mum has similar infection issues to me. We are just one family and there must be thousands like us. We have avoided getting COVID-19 by stopping our lives and relying on public health measures to protect us. With the government moving away from stopping that protection we feel more at risk than ever. Even if symptom based diagnosis worked how many people would adhere to them? I’m lucky, for all that I’ve talked about I have a job with sick pay, I’m not on zero hour contracts where if I don’t work I don’t pay my bills. There are huge groups within our society who will feel true pressure to attend work and leave the house if we change away from diagnostics and isolation supported by sick pay, even more than they already are. That pressure then moves risk onto people like my family who are potentially being condemned to continue to have restrictions on their every day life long term. There are no easy answers to this, as I said in my IPC post someone always has to pay, but as healthcare professionals please lets stop claiming that this is straight forward.

So I will do a better job of managing my condition, I will try and not work weekends, I will leave on time and try to get some sleep. In return if you could try to remember that none of this stuff is ‘simple’ or ‘easy’ and that it only feels that way to if you are fortunate enough to not realise that feeling ‘well’ is a privilege that not all of us are fortunate enough to enjoy.

All opinions on this blog are my own

When Heroes Fall: How the intersection between fandom and public health can change who you root for

Today is the day, we have reached Super Bowl 56 and for those of you who know me well you will know how much I love Super Bowl Sunday. This year its the LA Rams up against the Cincinnati Bengals. We will be a divided household as the Rams are one of my secondary teams and my husband is a lifelong Bengals fan. Now I’ve been a big NFL fan for many years, after my husband introduced me to the game – I describe it as chess with violence. For all of this time I have supported the Green Bay Packers. Unlike in the Premiership because of the divisionary structure you can have secondary teams, such as my liking of the Rams, but the Cheese Heads have always had my heart. One of the reasons for this is because of the ethos of the team, they are owned by the community and include community service in all of their contracts, why oh why therefore would I be secretly quite glad that my team have not made it to the Super Bowl this year?

Who is Aaron Rogers and What Did He Do?

Aaron Rogers is the Quarter Back for the Green Bay Packers, in effect he is the leader of the team. He is currently on a 4 year contract valued at $134 million (remember this number when we talk fines later). In November 2021 it emerged that Aaron Rodgers had COVID-19. These things happen I hear you say, you can get COVID-19 even if vaccinated. All true, what also emerged linked to this however was the Aaron Rodgers had lied/obfuscated about being vaccinated for SARS CoV2. He had also followed NFL guidance for vaccinated players when unvaccinated, leading the Green Bay Packers to also not be compliant with NFL COVID-19 guidance.

The NFL COVID-19 guidance is:

If a vaccinated person tests positive and is asymptomatic, he or she will be isolated and contact tracing will promptly occur. The positive individual will be permitted to return to duty after two negative tests at least 24-hours apart and will thereafter be tested every two weeks or as directed by the medical staffs. Vaccinated individuals will not be subject to quarantine as a result of close contact with an infected person.

If an unvaccinated person tests positive, the protocols from 2020 will remain in effect. The person will be isolated for a period of 10 days and will then be permitted to return to duty if asymptomatic. Unvaccinated individuals will continue to be subject to a five-day quarantine period if they have close contact with an infected individual.

https://operations.nfl.com/updates/football-ops/2021-covid-related-operating-principles/

Everyone makes mistakes. It’s the learning from those mistakes that matters. However when it came out that Aaron Rogers had lied, instead of demonstrating learning he doubled down and used the coverage to talk about his scientific opinions and the research he had done. Again, I support people gathering information. When you gather that information from known discredited sources and use your platform to continue to spread that disinformation however I have an issue. So much so I tweeted about it and how it made me feel as both a scientist and a fan:

So What Did He Say?

Aaron Rogers admitted that he had misled others by avoiding or implying he was vaccinated when he had instead chosen to take a homeopathic approach to COVID-19. He appeared on a Friday night American talk show called The Pat McAfee Show in order to respond to the detail that had been released:

“I believe strongly in bodily autonomy and ability to make choices for your body: Not have to acquiesce to some woke culture or crazed group of individuals who say you have to do something. Health is not a one-size-fits-all for everybody.”

Aaron Rogers – The Pat McAfee Show

Rodgers then went on to say he had received monoclonal antibodies and taken ivermectin for his COVID-19 infection and went on to thank podcast host Joe Rogan – whose podcast has been criticised for spreading SARS CoV2 disinformation.

“I consulted with a now good friend of mine Joe Rogan, after he got Covid, and I’ve been doing a lot of stuff that he recommended,”

Aaron Rogers – The Pat McAfee Show

If you’re not part of the solution you’re part of the problem

A lot of the science quoted by Rogers has been disproven time and time again and it wasn’t just me that was upset that he was spreading mis-information, even when challenged, under the guise of him ‘doing own research’:

When you are acting as a spokes person for information that has been shown to be incorrect then this isn’t a zero sum game. People who look up to you may not have the scientific knowledge or background to unpick what you are saying and challenge that information. Those same people may follow on and take up your advice and so your actions could actively result in harm. I feel this is especially true if you are an athlete and therefore you make money from sponsorship and other activities linked to your physical health, which could be viewed as being based in increased health knowledge/awareness.

It’s a matter of leadership

Quarter backs act as the leaders of their team, Rogers has been in the NFL for a long time and acts as one of it’s senior leaders. Whether you want it or not that position comes with a level of social responsibility. One of the reasons I fell in love with the Packers is that social responsibility is imbedded throughout the culture of the team. It is therefore even more jarring when the leader of such a team goes against that culture. During his interview Rogers even went on to state that his actions were themselves imbedded in his role as a leader:

Rogers claimed he had a “moral obligation to object to unjust rules and rules that make no sense.”

Aaron Rogers – The Pat McAfee Show

My issue with this statement is that if it was true then true leadership would have been standing up and owning your opinions and being open to challenge. He even went on to challenge the NFL and their medical team by saying he had been told that it was impossible to catch COVID-19 if you were vaccinated and it was this untruth that added to his lack of willingness to be vaccinated. The NFL however responded by saying:

“No doctor from the league or the joint NFL-NFLPA infectious disease consultants communicated with the player. If they had, they certainly would have never said anything like that.”

NFL statement on Aaron Rodgers’ claims about a doctor saying COVID-19 can’t be caught, transmitted by vaccinated players.

This interaction makes me question the response that states it was linked to leadership, as leadership to me does not lie well when linked to deceit.

This isn’t all about Rogers to me though. The Packers leadership has also been questionable. From statements made it is clear that they were aware of the way that Aaron was both feeling and behaving. When he came out with comments accusing the NFL or mis-leading scientific commentary the silence was deafening. Both Rogers and the Packers were fined linked to COVID compliance penalties: the Packers $300,000 and Rodgers was fined $14,650. Speaking of leadership however, how does that fine stand up as leadership? It is likely less than a weeks pay for Rogers and a drop in the ocean for the team. Leadership is linked to culture and if that culture allows the behaviour we’ve seen this year then I can’t help but be disappointed.

When you lie its not just you you put at risk, you remove the choice from others

Before the season started, Rodgers was asked if he had been vaccinated and he said he had been “immunized.” In the same answer, he said of unvaccinated players, “I’m not gonna judge those guys,” seeming to imply he had received the jab. Rodgers during his interview insisted he wasn’t lying in that answer, but conceded he didn’t want to answer more questions about vaccination.

“I wanted it to go away,” he admitted. “Everyone on the squad knew I was not vaccinated. Everyone in the organization knew I wasn’t vaccinated. I wasn’t hiding from anybody. I was trying to minimize and mitigate having this conversation going on and on.”

Aaron Rogers – The Pat McAfee Show

Medical information is personal and therefore it is not a matter that the public have the right to ‘know’, to be honest its none of my business as long as you keep it to yourself and don’t use it as a platform. There is a difference however between not getting drawn into a conversation about it and lying/misleading others. If he followed guidance for vaccinated individuals when he was unvaccinated that is deceit, and it is deceit that could have posed a risk to others. It is not the lie that matters as much as the actions that could have affected others. For instance he was filmed attending a party and other events and even on the side lines speaking to journalists where he breached guidelines for unvaccinated players. That means he knowingly put his team mates at risk, as well as risking the performance of the team as a whole if an outbreak had resulted. If the Packers leadership knew that makes it worse, but I remain to be convinced that everyone he exposed was actively consented into that exposure by knowing his status. I doubt he told the cleaners he interacted with, those who served him food in the canteen. Those people may have been at high risk of severe infection or truly unable to be vaccinated and were under the impression their risk was being controlled. When we assume consent we remove choice and that is not acceptable no matter how amazing your throwing arm. When you say you have the right to make a choice for your body that is correct, but not when by doing so you lie and remove that same choice from others.

Should we reward when off pitch behaviour hasn’t kept to the standard we proclaim to hold?

Last weekend Aaron Rogers was awarded the 2022 Most Valuable Player (MVP) award. I must admit to never having been more disappointed. NFL is one of the few sports that claims to care about off pitch conduct and in holding players to account in terms of behaviour. For a player to be awarded MVP in the same season that they were fined for the way they have behaved seems counter intuitive.

To me this whole situation has sent the wrong message. It says that if you are talented enough, rich enough, important enough the rules don’t apply to you. Even if you get caught out you get a minimal slap on the wrist and you will move on with no consequences. Rules are for the many and not for the few, especially public health rules which rely on us all coming together for the good of everyone. If you opt out the consequences are not just yours but ours. This isn’t just an issue for NFL, but for society as a whole. When those who are seen as ‘special’ are allowed to opt out it means that the rest of us are less likely to comply. In a world where compliance has never mattered more leadership is key.

Finally, I want to clear that this post isn’t about cancel culture. I’ve struggled with the way I feel over this. I’ve struggled with the fact that the behaviour of one individual and the lack of censor from the owners of the team has led me to feel less warmly about the other 52 players on that team. The rest of those players for the most part, won’t have the shield that Aaron Rogers is provided because of his talent, most of them will have obeyed the rules and done nothing wrong, even worse some of them will lose their jobs this year as well as the opportunity to get a Super Bowl ring and the opportunities that come with it. I don’t believe the rest of the team should suffer, but I do believe that when leaders in our communities break the rules they should at least learn from the experience. They should not be permitted to use the platform they have to then spread mis-information and pile on the harm and then be rewarded for it at the end of the season because they have talent. To me it gives out all the wrong messages. Leaders have responsibilities, talented people are not immune from the rules of society………be that beating up your girlfriend or putting others at risk of COVID-19. Until we are all held account to the same rules and the same law holds for us all there is no fairness and I for one will no longer count the likes of Aaron Rogers as one of my heroes, I’ll be sticking to the likes of Ruth Bader Ginsburg instead!

All opinions on this blog post are my own

Celebrating International Day of Women and Girls in Science Day: A view from the Girly Side

This topic means a lot to me. It wasn’t by accident that when, in 2012, I chose my twitter handle: I chose Girlymicro/Girlymicrobiologist. It has felt to me, since I started as a working scientist in 2004, that it was considered unprofessional to bring my whole self to work: to like pink and purple, to bake, to talk about science fiction and gaming. It was the start of the journey that I am still on, to show that we are better scientists when we bring our whole selves to work. Anything that acts as a barrier to that not only harms us as individuals, but also harms what we can achieve as a collective.

The Road Is Long
With Many a Winding Turn
That Leads Us to Who Knows Where…

You may not know this, but I started out as a zoologist. I adored it, I loved it, but there were no jobs in it. My undergraduate dissertation was on the ‘Demographics of Witchcraft Accusations from 1625 to 1715’. You may think that has nothing to do with what I do now but you’d be wrong. Studying human and animal behaviour helps me all the time in understanding some of the group decision-making that occurs in healthcare. The hours of my life spent learning how to undertake statistical modelling was not wasted. What I didn’t study a lot of was microbiology: I did a single module of microbiology during my whole degree.

I then went on to study not microbiology but the physics of biological interactions at surfaces as an MRes. This was where I learnt some microbiology and developed a love of applied science. When I started as a trainee Clinical Scientist, I had so much less experience of microbiology than any of the other more traditional trainees. I once asked why they hired me and the wonderful Dr Margaret Sillis, who acted as my mentor, responded ‘We can teach you microbiology, it’s much harder to teach you how to think’. I still think about that and the transferable skills I picked up by studying other disciplines still come in use all the time.

This trend of not following the standard path has continued. It’s why I ended up in Infection Prevention and Control rather than microbiology. Although the traditional paths are in some ways easier, as you will be able to walk the path that others have walked before you, don’t be afraid to wander the path untrodden if you think that it will be a more satisfying journey for you as an individual. You will learn so much along the way and open up new roads for others to follow.

Making the Invisible Visible

During the last 10 years, one of the things I’ve consciously decided to do is to be visible. In 2015 I was asked if I would be filmed for a project that the Royal Society of Biology were organising called ‘Biology: Changing the World’. For some years I had been told, by my lovely (male) boss, that I shouldn’t do media and shouldn’t be seen as ‘courting attention’ as it a) detracted from the work, and b) people were looking to make a story out of you. Don’t get me wrong, there is some truth to this. It also results in a fair amount of negative feedback, often from female colleagues, about grandstanding and attention seeking. You know what it also does, however: it hopefully means that when a girl in 20 years time is asked the question I’m asked in this video about what female scientist inspired her, there is a chance she will have a name. Not that I think I’m going to be that person. I’m not going to win a Noble Prize or have a Wkipedia page. I do, even today, remember very clearly the male science undergraduate who came and spoke to my primary school class about his job, I can be THAT girl. The one that someone meets up close and personal and shows that normal everyday women can work in science. That the door is open to them. I can shine a light and make the career path visible to those who might follow. So, next time you are invited to do that piece of outreach, that radio interview, that blog and your mind questions your worth, ask: if not me, then who? I promise you that the next person will not be more qualified than you, more worthy than you, more appropriate than you. So please say yes.

The Importance of Valuing Difference

The above point brings me onto something a bit trickier. I’ve been fortunate enough to win a number of awards for myself and with my wonderful team and partners for undertaking STEM engagement. Doing this work requires energy and time, both of which are frequently given on weekends and evenings. Or, in the case of today’s blog, annual leave. I feel a moral obligation to do this work as well as it being an important part of maintaining my registration to practice. The interesting thing is that it is frequently not viewed this way in either my clinical or academic environments. It is not seen as ‘work’ and I have on more than one occasion been told that if I was serious about my career progression I needed to ‘do less of that nonsense’. Sadly this isn’t a unique situation for me, but is something that many women in science face, especially in academia. In these areas women spend a greater proportion of their time undertaking public engagement and utilising ‘soft skills’, which are not valued when it comes to promotion panels.

Over time I believe I have started to change perspectives, but it takes even more work and investment in time. I’ve taken on additional positions, such as Joint Trust Lead Healthcare Scientist. This position has enabled me to speak to senior leaders about the benefits of the work in order to raise awareness and to capture impact. By actively working with wonderful colleagues on projects nominated for awards, such as the Advancing Healthcare Award for Reach Out for Healthcare Science, with Dr Philippa May, and with Nicola Baldwin for the Antibiotic Guardian Awards and CSO Awards for Nosocomial, I have started to make inroads into changing the conversation. Awards aren’t everything, but they do support you in re-positioning what you are doing in a way that fits into the ‘traditional way’ success is captured.

Whilst I’m on this particular topic, I would also like to make one of the points I often respond with when talking to colleagues who aren’t so engaged in public engagement and outreach. The days of healthcare workers being considered to be ‘the authority’ are quite rightly coming to an end. Those of us working in healthcare need to be engaging and working collaboratively with patients and the public to co-create what the future of healthcare might be and should look like. We can’t begin this work until we get out there and start having conversations. Rather than being ‘nonsense’, this work is key to future of the NHS and, especially, Healthcare Science.

“Amplification” is Where It’s At

During the Obama administration, despite it’s progressive nature, women found it hard to get their voices heard.

We’ve all been there. The meetings in which you make a comment or a response and you’re ignored, only for a man in the room to repeat the comment and have everyone react as if it is the first time they’ve heard it. As women in science, we are often the only women in the room and so making ourselves heard can be difficult.

The women in the Obama administration came up with an “amplification” strategy, where women in meetings repeated each other’s ideas as well as deliberately crediting the women who came up with them.

I work with some amazing women in Healthcare Science (Jane Freeman, Anna Barnes, Ruth Thomsen, Kerrie Davies and so many more) who do an excellent job of this amplification. I’d like to think that we all have a definite and deliberate attitude of amplifying each others voices and not falling into the trap (that happens way too often) of competing with each other. Be deliberate when you are in spaces with other women who may not be heard, actively listen and repeat. Focus on those moments that could make a difference and ensure that everyone in the room is heard. It requires active effort, but it definitely changes the course of conversations.

So how our male colleagues can help? This is definitely one of those areas. There are often not the women in the room to do this and so having allies who are happy to support in the same way is a definite help.

Change the View for One That is More Pleasing

One day the super-inspirational Dr Lena Ciric and I sat down over a cup of coffee and engaged in one of our regular consolation sessions. This was because, yet again, I had written a grant that had been successfully funded but it didn’t have my name on it. It had the name of one of my male professors. Lena had experienced similar things over the years and also the reviewers’ response of ‘not enough experience’ as a result of grant after grant that didn’t credit us. This cup of coffee was different: it was during this session we decided that, if we couldn’t change the playing field, we could change the view.

What do I mean by this? Academically, we were applying for funding within the clinical microbiology environment. A landscape that was already filled with vastly experienced and (mostly) older male medics. We were not going to succeed in breaking through the glass ceiling by applying within this space. Life lesson: we needed to find another space. So we very deliberately looked across the different funders to see where there was a landscape that wasn’t crowded with people like us and where we could constructively add something. We found it. We ended up putting in our first million pound grant to the EPSRC, an engineering research council who were looking to fund healthcare research and were not getting applications from researchers with enough clinical experience. We got the grant first time! Now we had a million pound grant AND we had the track record that means we can not only continue to apply in the new landscape but that also enables us to apply in the old arena.

Sometimes, if you continue to bang your fist against a closed door all you will get is a bloody fist. In these circumstances you need to take a step back and review whether there is another way to get to where you want to be. If there is, do it, you may not only succeed in your original goal but learn some other valuable skills along the way.

Finally, I wanted to finish with the above image of Shonda Rhimes. I am as guilty as the next person of talking about how lucky and fortunate I am, and it is true. That said, own your success: you’ve earned it, you’ve put in the hours, you’ve sacrificed, you’ve made it happen whilst balancing families, health issues and all kinds of other demands.

Be the badass I know you are!

All views in this blog are my own

Celebrating International Day of Women and Girls in Science Day: A view from the Girly Side

I’ve been asked to write a number of blog posts this year for International Day of Women and Girls in Science. I wanted to write an extra one that wasn’t so much a career guidance document, but more to celebrate some of the great approaches I have seen as a woman working in science. This post is based around some of the points that came out of a twitter conversation last week.

This topic means a lot to me. It wasn’t by accident that when, in 2012, I chose my twitter handle: I chose Girlymicro/Girlymicrobiologist. It has felt to me, since I started as a working scientist in 2004, that it was considered unprofessional to bring my whole self to work: to like pink and purple, to bake, to talk about science fiction and gaming. It was the start of the journey that I am still on, to show that we are better scientists when we bring our whole selves to work. Anything that acts as a barrier to that not only harms us as individuals, but also harms what we can achieve as a collective.

The Road Is Long
With Many a Winding Turn
That Leads Us to Who Knows Where…

You may not know this, but I started out as a zoologist. I adored it, I loved it, but there were no jobs in it. My undergraduate dissertation was on the ‘Demographics of Witchcraft Accusations from 1625 to 1715’. You may think that has nothing to do with what I do now but you’d be wrong. Studying human and animal behaviour helps me all the time in understanding some of the group decision-making that occurs in healthcare. The hours of my life spent learning how to undertake statistical modelling was not wasted. What I didn’t study a lot of was microbiology: I did a single module of microbiology during my whole degree.

I then went on to study not microbiology but the physics of biological interactions at surfaces as an MRes. This was where I learnt some microbiology and developed a love of applied science. When I started as a trainee Clinical Scientist, I had so much less experience of microbiology than any of the other more traditional trainees. I once asked why they hired me and the wonderful Dr Margaret Sillis, who acted as my mentor, responded ‘We can teach you microbiology, it’s much harder to teach you how to think’. I still think about that and the transferable skills I picked up by studying other disciplines still come in use all the time.

This trend of not following the standard path has continued. It’s why I ended up in Infection Prevention and Control rather than microbiology. Although the traditional paths are in some ways easier, as you will be able to walk the path that others have walked before you, don’t be afraid to wander the path untrodden if you think that it will be a more satisfying journey for you as an individual. You will learn so much along the way and open up new roads for others to follow.

Making the Invisible Visible

During the last 10 years, one of the things I’ve consciously decided to do is to be visible. In 2015 I was asked if I would be filmed for a project that the Royal Society of Biology were organising called ‘Biology: Changing the World’. For some years I had been told, by my lovely (male) boss, that I shouldn’t do media and shouldn’t be seen as ‘courting attention’ as it a) detracted from the work, and b) people were looking to make a story out of you. Don’t get me wrong, there is some truth to this. It also results in a fair amount of negative feedback, often from female colleagues, about grandstanding and attention seeking. You know what it also does, however: it hopefully means that when a girl in 20 years time is asked the question I’m asked in this video about what female scientist inspired her, there is a chance she will have a name. Not that I think I’m going to be that person. I’m not going to win a Noble Prize or have a Wkipedia page. I do, even today, remember very clearly the male science undergraduate who came and spoke to my primary school class about his job, I can be THAT girl. The one that someone meets up close and personal and shows that normal everyday women can work in science. That the door is open to them. I can shine a light and make the career path visible to those who might follow. So, next time you are invited to do that piece of outreach, that radio interview, that blog and your mind questions your worth, ask: if not me, then who? I promise you that the next person will not be more qualified than you, more worthy than you, more appropriate than you. So please say yes.

The Importance of Valuing Difference

The above point brings me onto something a bit trickier. I’ve been fortunate enough to win a number of awards for myself and with my wonderful team and partners for undertaking STEM engagement. Doing this work requires energy and time, both of which are frequently given on weekends and evenings. Or, in the case of today’s blog, annual leave. I feel a moral obligation to do this work as well as it being an important part of maintaining my registration to practice. The interesting thing is that it is frequently not viewed this way in either my clinical or academic environments. It is not seen as ‘work’ and I have on more than one occasion been told that if I was serious about my career progression I needed to ‘do less of that nonsense’. Sadly this isn’t a unique situation for me, but is something that many women in science face, especially in academia. In these areas women spend a greater proportion of their time undertaking public engagement and utilising ‘soft skills’, which are not valued when it comes to promotion panels.

Over time I believe I have started to change perspectives, but it takes even more work and investment in time. I’ve taken on additional positions, such as Joint Trust Lead Healthcare Scientist. This position has enabled me to speak to senior leaders about the benefits of the work in order to raise awareness and to capture impact. By actively working with wonderful colleagues to nominate work for awards, such as the Advancing Healthcare Award for Reach Out for Healthcare Science, with Dr Philippa May, and with Nicola Baldwin for the Antibiotic Guardian Awards and CSO Awards for Nosocomial, I have started to make inroads into changing the conversation. Awards aren’t everything, but they do support you in re-positioning what you are doing in a way that fits into the ‘traditional way’ success is captured.

Whilst I’m on this particular topic, I would also like to make one of the points I often respond with when talking to colleagues who aren’t so engaged in public engagement and outreach. The days of healthcare workers being considered to be ‘the authority’ are quite rightly coming to an end. Those of us working in healthcare need to be engaging and working collaboratively with patients and the public to co-create what the future of healthcare might be and should look like. We can’t begin this work until we get out there and start having conversations. Rather than being ‘nonsense’, this work is key to future of the NHS and, especially, Healthcare Science.

“Amplification” is Where It’s At

During the Obama administration, despite it’s progressive nature, women found it hard to get their voices heard.

We’ve all been there. The meetings in which you make a comment or a response and you’re ignored, only for a man in the room to repeat the comment and have everyone react as if it is the first time they’ve heard it. As women in science, we are often the only women in the room and so making ourselves heard can be difficult.

The women in the Obama administration came up with an “amplification” strategy, where women in meetings repeated each other’s ideas as well as deliberately crediting the women who came up with them.

I work with some amazing women in Healthcare Science (Jane Freeman, Anna Barnes, Ruth Thomsen, Kerrie Davies and so many more) who do an excellent job of this amplification. I’d like to think that we all have a definite and deliberate attitude of amplifying each others voices and not falling into the trap (that happens way too often) of competing with each other. Be deliberate when you are in spaces with other women who may not be heard, actively listen and repeat. Focus on those moments that could make a difference and ensure that everyone in the room is heard. It requires active effort, but it definitely changes the course of conversations.

Some of the comments on my twitter feed were about how our male colleagues can help. This is definitely one of those areas. There are often not the women in the room to do this and so having allies who are happy to support in the same way is a definite help.

Change the View for One That is More Pleasing

One day the super-inspirational Dr Lena Ciric and I sat down over a cup of coffee and engaged in one of our regular consolation sessions. This was because, yet again, I had written a grant that had been successfully funded but it didn’t have my name on it. It had the name of one of my male professors. Lena had experienced similar things over the years and also the reviewers’ response of ‘not enough experience’ as a result of grant after grant that didn’t credit us. This cup of coffee was different: it was during this session we decided that, if we couldn’t change the playing field, we could change the view.

What do I mean by this? Academically, we were applying for funding within the clinical microbiology environment. A landscape that was already filled with vastly experienced and (mostly) older male medics. We were not going to succeed in breaking through the glass ceiling by applying within this space. Life lesson: we needed to find another space. So we very deliberately looked across the different funders to see where there was a landscape that wasn’t crowded with people like us and where we could constructively add something. We found it. We ended up putting in our first million pound grant to the EPSRC, an engineering research council who were looking to fund healthcare research and were not getting applications from researchers with enough clinical experience. We got the grant first time! Now we had a million pound grant AND we had the track record that means we can not only continue to apply in the new landscape but that also enables us to apply in the old arena.

Sometimes, if you continue to bang your fist against a closed door all you will get is a bloody fist. In these circumstances you need to take a step back and review whether there is another way to get to where you want to be. If there is, do it, you may not only succeed in your original goal but learn some other valuable skills along the way.

Finally, I wanted to finish with the above image of Shonda Rhimes. I am as guilty as the next person of talking about how lucky and fortunate I am, and it is true. That said, own your success: you’ve earned it, you’ve put in the hours, you’ve sacrificed, you’ve made it happen whilst balancing families, health issues and all kinds of other demands.

Be the badass I know you are!

All views in this blog are my own

Guest Blog by Katy Heaney: Pathology: hidden service or hiding? Lets stop being shy

This weeks guest blog is written by the ever talented Katy Heaney. The blog includes the first announcement of some super top secret work that Katy and #PathologyROAR have been undertaking linked to the #IValueLabStaff and #PathologyROAR recruitment videos. Keep your eyes peeled and followed the hashtags for me information from Wednesday 9th February. I for one (Girlymicro that is) cannot wait to finally find out what they’ve been working on.

Katy is a Consultant Clinical Scientist working for Frimley Health NHS Foundation Trust, part of the Berkshire and Surrey Pathology Services network. Currently part-time seconded to the UKHSA working as the Point of care workflow lead for Operational Supplies. She has a passion for science communication, patient focused pathology testing, baking and painting.

A cup of tea in bed on a Sunday was a rarity for me in 2020. It had been a hard year for my Point of care testing (POCT) pathology service and there didn’t seem to be any let up ahead. Recruitment had been like a revolving door – as fast as we interviewed, people moved on and there didn’t seem to be any HCPC registered pathology staff not already employed.

As I meandered through my social media on a Sunday morning I found posts advertising recruitment in other healthcare fields but with a significant lack of inclusion of pathology.

My burnt-out brain, reflected on my teams, and the monumental national pathology effort in maintaining current pathology services as well as implementing and ramping up Covid-19 testing. I reached out to the pathology Twitter community to sing our own praises; how could we have been forgotten?

But internally I wonder; Are we really the hidden service, are we hiding, or are we shy?

In my career I have enjoyed being involved in National Pathology Week events reaching out beyond our laboratory doors to sing our praises and explain our science. The Royal College of Pathologists have a fantastic web page now of day in a life for pathology, example career pathways and events that take place for all ages. I was also lucky enough to be part of the Lab Tests Online UK team when we released the free app of the website; we held an app launch event and invited anyone we could think of to join us in celebrating pathology. Channel 4’s Embarrassing Bodies’ celebrity doctors joining us was a big highlight!

The Pathology Cake; designed and produced by scientist trainees at the LabTestsOnline UK App launch event. Note: all stock was expired and saved from bin for use on this “art”

Being a POCT specialist – I don’t spend a lot of time behind lab doors, far more walking the clinical floors to see how my kit is working or helping non-lab healthcare staff use the kit for their patients. I spend a lot of time explaining pathology to non-laboratory staff. I have always advocated that science communication is a skill in itself. It takes practice and thought; we cannot expect our most fabulous researchers or complex method specialists to also be able to explain to a member of the public what pathology is without working on how to translate our science jargon and considering understandable words.

We are under-resourced and small in comparison to many other healthcare staff groups. Finding the time to advocate and advertise pathology is hard to fit into the day job. The events organised by our professional bodies give us focus, but in recent years they have been stunted by service pressure.

We have jobs available; but seem to fail to reach the target audience

Recruitment for us is a long term process; when someone joins us we invest our time and energy in their learning and development. Finding the right individuals is important for us. Doing so at pace is even harder.

A real smack in the chops recognition last year for me was – I am no longer our target demographic! In a big birthday year myself, I recognise I am trying to recruit a younger generation who use different media. They have different career goals and the things that attracted me to pathology won’t necessarily be attractive to them.

Pathology in the media is VERY different from reality. The cringe worthy moments when medical drama surgeons decide to go run a pathology test to diagnose the rarest of diseases isn’t reality! The timelines of a drama episode don’t tolerate the timeline for a complex diagnostic pathology test and certainly not the staff that it takes to achieve it. Our real-life healthcare system regretfully doesn’t either; my own GP tells me my routine pathology test will take 5 days, while I internally sigh knowing it will be done by the following morning, but my overworked/overwhelmed GP surgery won’t be able to review and report it back to me to match the service we provide in pathology.

Media portrayal of the lab; Nope, nope, nope.

The pandemic gave the smallest of glimpse into the world of pathology. PCR, lateral flow tests, and antibody levels being discussed in the news every night, but not enough spotlight was given to the 1000s of pathology staff it took to stand up NHS testing of patients. In my non-work social groups the jaw dropping shock of real life of pathology pressure on staff and service.

 If a blood transfusion laboratory stops running, an A&E will be closed to new patients: we are critical for so much more than Covid-19 testing. There is still a lot of public ignorance on pathology. I use the word here in this blog but know that for many it describes testing the dead or forensics. We are so much more.

So what is the reality of pathology?

A team of highly skilled, dedicated and evidence focused healthcare scientists. We employ those with degrees and those without, we train our own and do our own research and development. Most of our work is on the living; their blood, urine, poop, saliva; samples supplied for investigation. Some of our tests take seconds and some take weeks. IT and technology is a big part of our day. Every sample comes from a patient and everything we do is driven toward providing a better service that helps make better and quicker decisions. We are a fascinating workforce; the diversity of pathology is incredible. We are comprised of 17 different disciplines looking at every aspect of the human (and animal) body, and whether it is working and doing what it is meant to do. The tests you have heard of; glucose, urine pregnancy tests, iron, biopsies, smear tests, Covid-19 PCRs…..and 1000s more that you haven’t.

We have so many different entry points from national training programmes like the Scientist Training Programme, local trainee Biomedical Scientist trainee positions and all the support roles we require for pathology services to run; administration, stores, transport and reception support. There is a role for so many; not just the young generation I refer to earlier, but those looking for a change, a swerve in career or even a few shifts working as part of a team.

There is no denying, we need to grow more healthcare scientists. Our numbers are small, it takes time to gain experience and knowledge, and our workloads expand year on year. 1000s of students do Biomedical science degrees but not enough of these come to pathology for their career. If you are a student considering a career in pathology; consider attending the IBMS Student congress event https://congress.ibms.org/student-congress.html for talks on careers, CV writing, placements and meet the staff working in our services.

What did I do about it?

Well that Sunday morning cuppa sparked a group of us working in pathology to recognise our common goal – the desire to roar about pathology and express how much we value lab staff. We wanted that message to get out there; to students, to influencers, to anyone looking for a career change. And we wanted to do so with real-life examples of those who work in pathology to showcase the passion for their work.

On Wednesday 9th February at 8pm we will be showcasing our #IValueLabStaff videos of real pathology staff; wearing their real-life lab coat or at their desk, talking about what they love about their jobs. Join us for the #PathologyROAR and celebrate with us.

All opinion on this blog are my own

Guest Blog by Nicola Baldwin: Where Is Everybody? Patient and public involvement in the time of pandemic

This week we are lucky enough to have a wonderful guest blog from Nicola Baldwin. Nicola is a playwright and scriptwriter, Royal Literary Fund fellow and a Visiting Fellow at UCL, and co-director of The Nosocomial Project with Dr Elaine Cloutman-Green.

https://www.nicolabaldwin.work/

https://www.nosocomial.online/

Where Is Everybody? Patient and Public Involvement (PPI) in the time of pandemic

As a regular reader and devoted fan of Girlymicro’s excellent blog, writing a guest post is exciting and daunting. The project I’m going to consider was a collaboration with Girlymicro, Sue Lee, and – as you’ll hear – many other people. But these reflections are my own.

In February 2020, I stood in front of assembled Healthcare Scientists and researchers at the Precision AMR launch as PPI Coordinator, and enthused over the workshops, discussions, and Festival of public events which would be available to the 25+ research teams participating in this initiative. Within a month, the UK entered lockdown, universities closed to all but Covid research, public buildings lay empty. PPE no longer represented ‘public and patient engagement’ but preventing human contact and keeping yourself and your patients alive. But our project’s funding was time-limited, its purpose was important, and the genuine need to communicate and raise awareness of AMR central to its aims.

Thus began a two-year adventure in the strange new world of PPPI – Pandemic Public and Patient Involvement.

Defining the challenge

After a 4-month hiatus in which seed-funding application deadline and start date were paused, it was time to review our PPI strategy, factoring in the following changes:

  • No face to face workshops
  • No patient groups
  • No contact at all with patients
  • No science fairs, school visits, open days or usual channels for PPI
  • No public spaces or performance venues
  • Many research teams couldn’t start their projects owing to labs, personnel or priorities being reallocated

On top of which…

  • No one wants to hear about another looming global health crisis during a pandemic

During the delayed start, I began trialling our ‘message’ on AMR informally with friends and contacts who were – like me – non-scientists. I discovered that – like me – none of them understood what AMR was. Explaining antimicrobial resistance enough to discuss it, was a 2 or 3 stage process something like this….

Friend:               I’m pretty sure I’m not antibiotic resistant. I hardly ever take antibiotics

Me:                     It’s not that you become resistant, it’s the bacteria themselves

Friend:               The bacteria? Are you sure?

Me (nodding):                The bugs that cause infection after you have a tooth out, or an operation, become resistant to the antimicrobials prescribed to treat them

Friend:               Ok, so from now on, I won’t take antimicrobials, just regular antibiotics

Me:                     They’re the same. And bugs learn to resist them over time.

Friend:               So if I have a tooth out, or an operation in future…?

Me:                     It might take a longer to find a treatment that works, or in a worst case –

Friend: (interrupting)                 THAT’S TERRIBLE! HOW COME NOBODY TOLD US!

Our PPI strategy needed to enable this conversation, over and over, for each new person to absorb what AMR is, and what it might mean for them before any other targeted messaging about antibiotic stewardship or behaviour change could happen.

This forced me to rethink what PPI means. Involving patients and public in research should be more than a tick-box exercise or add-on. It’s about encouraging public and patients to invest time understanding your processes and objectives. When scientists take part in public open days and fairs, they don’t just demonstrate experiments, they demonstrate enthusiasm; talking about their work, inviting participation, sharing ideas – all of which engages patients and public to invest time in understanding.

I’m a playwright. When I began this PPI project, I was an inaugural Creative Fellow at UCL exploring how drama could build new audiences for academic research. There’s a misconception that as a playwright, your medium is words; really, your medium is the audience. Someone once described it as ‘cooking the room’. Every action, every line of dialogue, every kiss, secret or betrayal, every silent pause or heartfelt song is there to raise or lower the emotional temperature in the room and effect a response in the audience; to involve them, make them care.

SOCK THE PUPPET

Designing a strategy

Given the obstacles outlined about, we needed a PPI strategy which could:

  • Be received remotely
  • Be engaging enough to spark conversations around AMR without us being present
  • Provide a PPI legacy that would have value after the project
  • Encourage and equip researchers to create their own digital PPI

We decided to focus on short films. We commissioned actors, writers and filmmakers with an interest in Healthcare Science and encouraged collaborations between scientists working on AMR with artists who could involve the public emotionally. Some of these artists were, or had been, patients potentially impacted by AMR.

And we discovered that, having been forced to micro-manage our overall PPI strategy, we could be more …strategic, by commissioning artists and film makers with knowledge and experience of areas such as migration and migrant health, homelessness, negotiating the health system as a mother without a UK support network, practical experience of working with puppets, or Under 5s. We started the artist films first to encourage researchers to make films, and to relieve the PPI pressure on Healthcare Scientists and researchers who were facing increased clinical or academic workloads during the pandemic.

Over time, another aim was added to the PPI strategy:

  • To actively support researchers, by offering regular contact time

The drop-ins were small, tending to attract only 1- 5 people, but the researchers who went on to not only make short thesis films but present work in person and/ or perform in the festival, all came through these sessions. In hindsight we should have started these sooner.

LA BIOTIQUE

Sue Lee and I ran a weekly lunchtime drop-in session on zoom for any Precision AMR researchers to discuss their PPI, their micro-thesis films, or talk about their projects. This reminded us that the benefits of conversation and involvement which PPI enables, work both ways. Taking part in a science fair or going on a school visit, reminds Healthcare Scientists why they loved this stuff in the first place. Enthusiasm is rekindled. PPI involves you more closely with your research.

Reviewing our results

Looking back almost 2 years, we did everything we promised, albeit in radically different ways. In fact, we did rather more than we originally intended.  We hosted a series of live public engagement events, screenings and discussions in not one, but two, festivals:

  • Rise of the Resistance 1, June 2021, online
  • Rise of the Resistance 2, September 2021, livestreamed from Bloomsbury Theatre
  • 4 Workshops for Seed Project Awardees on PPI training
  • 12 films by artists, 13 films by scientists, 4 zoom debates, three Q&As, a filmed tour and numerous zoom conversations and related video clips
  • 500 people engaged directly with festival events online or in person 
  • PPI participants reported significant changes in their understanding of AMR  
  • Requests for Rise of the Resistance links and AMR content received from Hospital Trusts, charities, schools and nurseries for staff, patients, and pupils, including timetabled activities for 2022 

My personal highlights? Our interactive AMR puppet show for Under 5s, Sock The Puppet performed by Stephanie Houtman (‘Peppa’ from Peppa Pig Live) receiving videos and photos from children of their Sock puppets, or them explaining AMR; Peter Clements’ incredible drag creation / film Klebsiella – both hilarious and 100% scientifically accurate; Rahila Gupta’s La Biotique, an aria from Puccini’s opera La Boheme which updated Mimi from a seamstress in 1830s Paris dying of incurable TB, to a migrant textile worker in the streets of London’s East End in 2022. Each appealed to different audiences and drew them into the AMR conversation. What Is AMR and What Can We Do About It? a show interweaving dramatic scenes, monologues, and Precision AMR research presentations, performed by a combined company of scientists and actors, succeeded in both raising awareness of AMR, and involving audiences in understanding new research – using gold nano-particles, targeted testing, combatting bacteria in hospital showers – which Precision AMR was supporting.

KLEBSIELLA

In Conclusion…?

Having got to the end of the last two years, we are only at the beginning – of a longer conversation with public and patients on AMR, and a global research and stewardship response. Undertaking PPI during a pandemic has made me understand what PPI really is. And how it takes time, planning, effort and commitment on all sides to make involvement happen. It is hard work.

Healthcare Scientists wanting to add a PPI component to their project for the first time really benefit from individual support throughout the process. Public engagement and PPI employ a distinct set of skills for planning and delivery, but ‘cooking the room’ has many similarities with doing an experiment. PPI – especially in a pandemic – asks much of us, but in return offers new insights, new contacts, increased confidence, a sense of personal achievement, and occasionally, amazement at what everyone has achieved.

All opinions on this blog are my own

Guest Blog from Sam Watkin: Starting a PhD in a Pandemic

The wonderful Sam Watkin has volunteered to do a blog post for me this week. He has the dubious fortune of being one of my PhD students and has only known working for me during a global pandemic. He volunteered to share his experience of what this has meant for him and his learning.

I remember on the 4th of January 2021, sitting down at my desk in my bedroom, excited for the first day starting my PhD. I had got a new pad of paper and a fresh set of pens and highlighters. I turned on my laptop, opened my emails and pulled up a paper from the reading list I had been sent a few weeks prior. After about 6 hours of reading and making notes, I turned off my laptop and watched ‘A New Life in the Sun’ on Channel 4.

I had known for a while before being accepted to do a PhD that this was the path I wanted to go down. What I didn’t know was that I would start it remotely in my childhood bedroom. Overall, it felt rather anticlimactic. By this point though, I was pretty used to anticlimactic events. I had written and submitted my master’s thesis, done my masters viva and attended a virtual graduation all from this same desk, mostly wearing pajamas. So, starting my PhD had a similar feeling to it, a sense of “well, that was that I guess”.

From what I had heard from people already deep in their PhD journeys, the beginning few months were mostly spent reading and getting to grips with the subject area. I suppose, looking back on it, the lockdown that was in place at the beginning of 2021 helped with that a fair bit. All there really was to do was read around the subject area… and watch daytime TV. Not that it was a chore to do this (the reading, not watching telly) – it is a subject area I am really interested in and passionate about.

As time went on though, there was a growing feeling of missing out on the “PhD experience”. It wasn’t until around May 2021 that I actually met my supervisors face-to-face, and didn’t meet everyone in the research group till a few weeks after that. It felt as though the social aspect of it had been in slow-motion, never mind the feeling I can only really sum up as “Oh my god I’m almost 6 months in and haven’t picked up a pipette yet!”. Once I was able to start in the lab, the rules in place to make sure it was safe for us all to work in meant that work was, at times, painfully slow. All in all, while I was able to make progress, everything felt slower, more drawn out and more frustrating than I would have thought it would be.

If it isn’t obvious, I sometimes feel pressure to be overly-productive. This is something that I’m fairly sure is common among PhD students – especially as there was a whole lecture series put on about how to manage PhD pressure and workload. I’m horribly paraphrasing it, but the gist of it all was “you’re all good enough, stop stressing!”. I’ve got to give credit to my supervisors though – throughout all of this they have reassured me that this is all fairly normal to feel at the beginning of a PhD and, even with the challenges thrown up by the pandemic, I am making good progress.

While I think it is fair to say the pandemic has made starting a PhD very… different, to how it would have been otherwise, it hasn’t all been stress and doom. A few other people started PhD’s in our research group a few months before me, meaning we all have been going through this “Pandemic PhD” rollercoaster at more-or-less the same pace. Having this shared experience, with all its very unique challenges, has for certain made us closer as a group. At the very least, it has shown us all that we aren’t alone in going through this process, with all the additional stresses and strains a pandemic brings to the first year of a doctorate.

Aside from the work itself, starting this PhD has had some amazingly positive aspects to it. It has afforded me the chance to learn so much more than I thought I could about a subject I am fascinated by, pick up new skills, speak in a theatre production and present my own work at conferences. I was also able to move to London, then move straight back out of London (not enough countryside for me) and meet some of the most interesting and clever people I have ever met. While starting a PhD in a pandemic has presented many challenges, most of which I never expected to come across, the experience has been overall a really rewarding and enjoyable one, and I am looking forward to the next few years of it. Famous last words…

All opinions on this blog are my own

50 Shades of Grey: The realities of working in Infection Prevention and Control

It’s another early start in the world of Infection Prevention and Control (IPC) following on from another rather restless night. The thing that has been playing on my mind a lot lately is the perception of vs the reality of IPC, and medicine in general.

Some of this has been sparked by seeing the discussion, opinions and commentary by medical colleagues on twitter linked to IPC response. I’ve been trying to read them as a member of the public would on this public forum. The thing that strikes me more than anything is that it is no wonder people are confused, we all post from a position of absolutes, often from very contrary stand points. What we do very poorly is communicate the nuance, discuss the technicalities and travel any middle ground. Possibly because its so hard in 240 characters, but also I think because we work with an implicit understanding that we know that nuance exists. On the face of it these conversations therefore come off as black and white positions, when in actuality IPC is very much 50 shades of grey, where there is accuracy in many of the positions in between.

So why is IPC not clear cut? Why might you get a different set if rules and experiences from one Trust to another or even one phone call to another? Well the fundamental tool of IPC is risk assessment. Every scenario includes slightly different exposures, different organisms and different patients, all of which will impact on that risk assessment. Just as no two scenarios are ever really the same therefore, no two risk assessments look identical. This also leads to disagreements on things like social media, as the experience, setting and drivers of those commenting are also just as varied.

What Do I Mean When I Talk About Risk Assessment?

Risk assessment is the process we go through to identify what risks are present to patients, and from patients to staff, visitors and carers. It also includes the things we do to control those risks, things called control measures. I want to start out by saying that I believe we are all aiming for the same goal i.e. providing safe high quality clinical care. Like many things there are often multiple options to deliver this goal and individuals may use slightly different processes in order to achieve it. The below is an example of the way that I structure my thinking.

There are 2 main aspects to risk assessment:

  • For the patient – if an organism is detected in a site on a patient what risk does that pose i.e. an E. coli urinary tract infection if not managed well in certain patients is a risk of progressing to E. coli blood stream infection
  • For other patients, staff and families – what does the detection of an organism mean for others, what counts as an exposure, what would the clinical consequences of acquisition mean for those exposed?

At some point I’ll do a fuller post on risk assessment in IPC and what different options there are for creating your risk assessment tool, but for now these are the kinds of things I consider when putting together risk assessments:

  • Routes of transmission – how do infections spread? Water/Surfaces/Contact/Air
  • Patient loads – when someone has an organism how much do they have, viruses usually higher numbers than bacteria
  • Environmental persistence – how long can an organism survive in water/air/on surfaces
  • Infectious dose – how many copies of an organism does it take to give an infection
  • Colonised/infectious state – can I carry an organism without harm or does it always make me unwell MRSA vs measles for instance
  • Patient susceptibility – is the patient immune i.e. vaccination/prior infection, are they more at risk if they get infected because they have no immune system?
  • Timing of infection (community vs hospital acquired)
  • Endogenous vs exogenous – is the infection spread from one site to another in the same patient i.e. from nose where doing no harm to a surgical wound? Or has the patient got it from outside?
  • Surveillance programmes in place – what kind of searching for organisms is being undertaken i.e. within the environment/based on symptoms, or as part of routine regular testing

When I’m talking about risk assessment for the rest of this blog I’m also going to be including what we call control measures which are linked to that risk assessment. These are things you do to prevent or reduce risk i.e. wearing personal protective equipment, putting patients isolation, prophylaxis etc.

I think we need to acknowledge that as well as different information, there is also an impact from the person handling that information and making the risk assessment. As a Healthcare Scientist I tend to feel much more comfortable focussing on the organism aspects and on control measures such as ventilation. Some of my colleagues will feel more comfortable in other aspects, especially in terms of scenarios such as surgical site infections and dressing management for instance. We all cover the same ground and should have the same core fundamentals, but we should acknowledge that different people will handle information in slightly different ways. This can be a strength, as long as it’s acknowledged.

So Why Do Risk Assessments Change?

As you can see from above, risk assessments are anything but straight forward. They include a lot of information, some of which you won’t always have at the start. There are some scenarios where we have quite a lot of information where responses are pretty much standardised and you would think everyone would do very similar things i.e. detection of MRSA in a surgical patient. Even for something like this that happens often and we have quite a lot of good information about what the risks and the control actions might be, there isn’t a one size fits all approach. In paediatrics we manage these patients differently to how they might be treated when they become adults. This is because their risk of continuing to carry MRSA as they interact more with people and the environment means that trying to remove it with antibiotics and chemicals (decolonisation) may be less effective and they may also have delicate skin which means using these chemicals may cause skin problems. So even in a straight forward situation, setting and scenario matters.

We often get asked why the way we manage something in my hospital may look different to how it might get managed somewhere else, even at another children’s hospital. This can be for a number of reasons. I may have access to resources in terms of cubicles or diagnostics that enable me the option of managing a scenario differently. My Trust is in England and the guidance in other parts of the devolved nations may be different i.e. Scotland and England don’t always do things the same way. Finally, my Trust also looks after children who have complicated conditions and who may have little to no immune system, so the consequences for patients if I get it wrong may be higher than somewhere seeing other types of patients. Setting, not just organism matters.

The other thing is bear in mind is that information and settings are not static. Often in medical dramas something is either X or Y, all of the information comes at the same time. This isn’t how things work in real life, information comes in pieces and the decisions you make about the next question you ask are actually as important as how you manage actions based on the data already in your possession. In some ways House was right…….it could be Lupus.

Although I don’t want this post to be about SARS CoV2, it is a good example of the fact the more information you have the more your decisions might change and you know more about where your risks are. Omicron has led to different risk being recognised when compared to Delta, because of impacts such as staff shortages, but also because of the amount of it that is currently circulating. This has impacted testing decisions and risk vs benefit discussions linked to patient harm. This is particularly challenging as these judgements about risk are actually being made with incomplete data sets as we don’t have the luxury of waiting it out. This makes at least this IPC professional uncomfortable, as lets be honest you are unlikely to love IPC if you aren’t in someway risk averse as a personality type. You don’t always have the luxury of time however and therefore we need to act, do the best we can with the information we have and make sure we also capture the learning as we go to enable improved decisions next time.

Who Pays?

So, resource matters. Everything about IPC comes with a cost. The thing is not all of those costs are financial.

Some examples of when even interventions, like putting patients in isolation can be challenging or have adverse consequences for everyone involved:

  • Its hard to know once you put someone into isolation when the right time is to take them out
  • Putting patients into isolation has been linked with decreases in staff time, increase in perceived concerns over care, and increase in prescribing errors
  • In paediatric patients isolation can affect inpatient developmental milestones. 
  • In adults isolation has been linked to increased levels of anxiety and depression 
  • Isolation can negatively impact on staff caring for patients due to isolation from colleagues and strain of dealing with sick patients single handed

Risk assessments therefore are influenced by who bears the cost. Individuals often pay the price of keeping others safe. This is a social contract that we see playing out on a much larger scale during the pandemic. Other methods to impact risk assessments, such as installation of mechanical ventilation, have a high financial cost that not all centres are able to afford. It is naïve therefore to say that any of these choices are easy, someone somewhere always bears the cost and the impacts of decisions.

After all of the above what is it that I want you take away?

  • Firstly IPC is anything but easy or straight forward, no matter what some of the reporting or social media commentary makes it appear. Decisions are complicated and every single one comes with impacts, be it for patients or budgets.
  • Secondly, the right decision for one centre may not therefore be the right decision for another. Comparison between one centre or one set of scenarios and another are not always valid, as the needs of the patient population or risks involved are unlikely to be identical.
  • Lastly, risk assessments change, they change as scenarios change, they change as more information becomes available. This isn’t a failing, this is responding to evolving situations and although difficult this is a strength

IPC is not black and white, it is 50 shades of grey and dealing with this is both the strength of the amazing people working in this field and the daily challenge they face, embrace and respond to!

All opinions on this blog are my own