Microbiology (Clinical)

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

girlymicro General, Healthcare Science, Microbiology (Clinical)

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

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

girlymicro Healthcare Science, Microbiology (Clinical), Microbiology (Research), Science Communication

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

Continue reading →

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

girlymicro Microbiology (Clinical)

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

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

girlymicro Healthcare Science, Microbiology (Clinical)

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

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

girlymicro Academic Life, General, Microbiology (Clinical), Research/Academia, Science Communication

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

girlymicro Academic Life, General, Microbiology (Clinical), Research/Academia, Science Communication

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

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

girlymicro Microbiology (Clinical)

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

Time for Some Real Talk: I have the best job in the world & even I don’t know how much more I can take

girlymicro General, Microbiology (Clinical), Science Communication

Let me start with the positive and please bear this is mind as you read this post. I adore my job, I can’t imagine doing anything else. In a way that is probably a little unhealthy, it is a lot of what defines me. I found my place and my calling and I’m not going anywhere. That said the last 2 years have been filled with extremely long days and unpaid weekends leading me to be more exhausted and broken than either a PhD or FRCPath exams achieved, partly because for both of those you knew when it would end. So I want to shine a light on how I feel in order for others to feel less alone if they are feeling the same way, and to remind us all that, despite how it feels right now, it has not always been like this and that this too shall pass.

Last night in a press conference our Prime Minster uttered the words ‘extraordinary effort’. It wasn’t in praise, it was a request for all of us in healthcare to make one more effort, to step up to the plate yet again and give it our all for the sake of the country. The thing is, phrasing a request like this doesn’t feel like a call to action to me anymore, it feels more like an insult. Although I acknowledge people’s experiences of the pandemic have been vastly variable, for most healthcare workers we’ve been making an ‘extraordinary effort’ for almost 2 years. Two years of changing guidance, 2 years of practically no down time and in recent times, experiencing both abuse and bad temper, alongside belittling of the things we are doing to find a way out of this i.e. requests to wear masks and to get vaccinated.

Given it is undoubtedly hard right now what can we do to get each other through this (other than make press conference statements – yes I may be a little bitter). This post isn’t based on evidence, I’m just going to talk here from personal experience. I know this is what I tell others off for as anecdotes aren’t facts. However as this is about feelings I can only truly tell it from my perspective.

Acknowledge all burdens are not equal and any single solution won’t fix everything

As a lot of people have pointed out, we may be in the same storm but we are all in very different boats, our experience and well as stressors throughout this aren’t the same. As leaders, colleagues and friends it therefore crucial that we take time to understand the things that are adding to stress levels and impacting our colleagues. For instance, because of my health it is easier for me if I can work from home a couple of days a week. It saves me a 3 hour return commute and gives me space to mentally focus on tasks without interruption. For someone else however, they might find working from home in itself a stressor, they may wish to have distinct work and home separation, they may have a lack of space or family reasons why this makes it harder for them not easier. We need to work on how to check in with our colleagues about what it is that they find difficult and then, where possible, customise our approaches to support them. It takes longer and requires more resource, but if we’re serious about helping each other through this than that is what it is going to take. I believe we should be finding equity rather than equality in our solutions, although fairness is important:

  • Equality is providing the same level of opportunity and assistance to all
  • Equity is providing various levels of support and assistance depending on specific needs

A little respect goes a long way

At times of stress and challenge it is really easy to close down in terms of empathy and compassion. I hold up my hands to raising my voice in a meeting last week. I did immediately apologise, but it is really difficult with the cognitive and emotional load everyone is experiencing, coupled with me being so tired to always remember to think of others. Every little moment like that if not addressed chips away at the others in the room and adds an unnecessary additional burden. At the moment, in those moments where we may not feel like it, it is even more important enough to be kind to each other.

Whether you are in a formal or informal leadership position, it is also really important right now to acknowledge the work of those around you. It’s easy to have tunnel vision and revert to task thinking when we are all so overwhelmed but people are doing A LOT based on good will. If we want people to go above and beyond then we need to acknowledge it and respect the fact that it is not a given that it will always happen. Saying thank you is still a powerful tool.

The system isn’t set up to support us so lets change it

Two years into the pandemic the system is still not set up to support the work demands that are being placed on the workforce. I have colleagues who have not had a full day off in two years. I do weekends on-call without any acknowledgement in terms of pay or returned time. From conversations I’ve had most IPC teams do not have systems in place to support on-call working, despite the fact that we have just about all had to do it over the last 2 years. We’ve all been doing this because we focus on the needs of the patient and the service, but at some point the service and the system that it sits within needs to be fixed. Services shouldn’t constantly rely on good will and changes need to me made so the system is empowered to support those who work within it. When emergencies and major incidents first happen it takes a while for the infrastructure and the system as a whole to respond, at this point however we need to be looking to the future and working to fix the system we work within. This won’t be the last time we have to face these kind of challenges, although hopefully not over such a protracted period, lets learn the lessons and get measures in place to make it better for everyone moving forward.

The workforce issues are going to get worse before they get better

As I said, I’m not going anywhere, but it would be naïve to say that this is the wider attitude amongst healthcare workers. A number of my colleagues who could retire have done so, more have moved either into non operational roles or out of healthcare all together. I don’t feel we have reached the peak of this yet. I think a lot of people will stay until they feel this aspect is over and then make decisions about what is best for them moving forward, burn out is a real thing right now. This will place even more pressure on those of us who remain. Its takes ~11 years to train a me, there aren’t a lot of people waiting in the wings to swoop in and support. My guess is also that a fair amount of trainees will be included in the numbers who are considering alternative choices. Those of us who remain need to know what the plan is? How are the exhausted workforce who remain going to be supported so they don’t have to then do the work of the 2 people who have left as well as their own? Are we, as we all predict, going to be hit my massive catch up targets when the pandemic is finally over which means there will be no respite to support recovery. The focus of the system seems to (understandably) be on right now but to give people hope for the future we need to know that there is a plan on how we will make it through not just today, but tomorrow and next year.

This isn’t a war, no matter how much our politicians language make it sound like it is

A lot of the language people have utilised linked to the pandemic has very deliberately utilised language reflective of going to war. In some ways this creates a nice psychological short cut in terms of significance and in peoples minds. The problem with it is that most healthcare professionals didn’t enlist to be part of a war, they are not obligated to stay and fight it out. The support systems are not part of the existing infrastructure to enable them to deal with the stress and emotional load we have put upon them. Most of them have given extra hours and supported extra job roles as part of good will, a gift if you like from them to wider society. However, like all gifts these can and should not be taken for granted, they are under no obligation to just keep on giving. We have moved from an emergency situation to a state of life, as much as we don’t want to acknowledge it. It’s a state of life that will not last forever but we cannot expect people to continuously act like they are in emergency response anymore. Plans and language aimed at healthcare workers need to acknowledge this otherwise we are not recognising the reality of most of their lives.

Wellness programmes are not going to fix this

I’ve already come out as not being the biggest fan of wellness programmes, although I know what they are trying to achieve. I’ve talked before about the fact that I think the NHS system has to address the issues and not continuously put the responsibility on individuals to fix. That said I don’t think the system is going to ‘White Knight’ for me anytime soon. I have come up with a strategy for me that means when I reach the point that all I want to do is walk out or walk away I have a bathroom disco. For those of you who don’t know I have a converted bathroom cubicle as my office, hence bathroom disco. I frequently fail to make time for food or even a couple of tea, back in the day I used to have a walk around the block or settle down for a cup of tea, I drink my tea black it takes 20 minutes to cool, when things became too much. There’s no time for any of that right now. When it becomes overwhelming I’ve decided I will allow myself a ~3minute bathroom disco break. I lock the door, put on an energising track and dance like a loon. It not only brings me joy but stops me spiralling and wakes me up enough to re-set myself for the challenge ahead. If we have going to survive this we all need to find a bathroom disco equivalent to get us through the next 5 minutes some days, let alone the next 5 months.

So there it is. I’m going to put on my big girl pants and prepare again for my ‘extraordinary effort’. Those making these requests however should remember that I am so fortunate to know that I will eventually get back to a job I love. Others were not so fortunate prior to this and so they are right now making different choices in response to your plea. Lets follow our words with actions that also enable them to stay!

All opinions on this blog are my own

Absence Makes the Heart Grow Fonder?: My month spent with shingles and the Varicella Zoster virus

girlymicro Microbiology (Clinical)

Well my friends, it’s been an age. I think I have a reasonable excuse but I am sorry to have left everyone in the lurch by not being well enough to post. I’ve been laid up with Shingles. It was the first time I’ve had it, although as many as 1/3 of us (who have previously had Chickenpox) might have it at some point in our lives. My father pointed out that this whole event might be karma (I believe he was *mostly* joking) as he had Shingles for the first time earlier this year and I responded as a typical medical child in terms of management, without really acknowledging the pain and discomfort. I’m now 4 weeks in and functioning OK most of the time on pain killers but it has certainly been much more of an experience than I had accounted for when I saw the rash appear. Working in what I do I knew a lot about the Shingles experience on paper. Having now been through it however; I thought I would share not only some Shingles facts but also about the difference between ‘knowing’ and ‘Knowing’, as there are probably lessons to be reminded of for all of us when we see all our patients (or in my case supporting my father).

Shingles, otherwise known as Zoster, is caused by the Varicella Zoster virus or VZV. VZV is also the causative agent of Chickenpox, which is also known as Varicella. VZV looks like a fried egg under electron microscopy (a high powered way of viewing virus) and is part of the human herpes virus family, related to the same viruses that cause cold sores. Chickenpox and Shingles are intrinsically linked, with Varicella being the primary infection and Zoster being the reactivation of the virus.

See the source image
Herpes viruses have a fried egg appearance under electron microscopy

What do these terms actually mean? Well, to ever get Shingles you need to have had Chickenpox at some point in your life, you can’t get Shingles without ever having the other. Once you have been infected with the virus for the first time (primary infection) and develop Chickenpox the virus then goes dormant when you recover in the nervous system (trigeminal and dorsal root ganglia). The virus is held in check (held dormant) and stopped from replicating by the immune system. It is when this immune system fails to hold the virus in check that it begins replicating again (reactivation), leading to the development of Shingles.

Most people is temperate climates i.e. non tropical, tend to get Chickenpox in childhood, but the infection is much more severe if acquired in adulthood. When you get your first infection you are infectious by the respiratory route for 48 hours before the vesicular (pus filled) lesions appear. After this the main infectious route is via contact with the rash itself, although some groups are still an airborne risk. Those exposed to the virus have an incubation period of 8 days (10 till rash appearance) – 21 days, with up to 28 days if prophylactically treated as a contact. Groups such as the immunosuppressed and pregnant woman are at increased risk of complications, such as pneumonia if infected.

See the source image

Shingles presents in a similar way to Chickenpox, but is more localised. In my case I had sore and painful area on my back, which over the course of ~ 5 days spread around to my front, all on my right side. On Friday I went shopping with my mum and when I arrived home at 5pm I was so exhausted all I could do was sleep. I wasn’t feeling great the next day and by the evening the painful area of skin began to be itchy and I noticed a small red patch. I’m super allergic to just about everything under the sun so I assumed it was a local reaction. When i woke the next morning the rash had spread and I had a characteristic set of lesions, which meant I called 111 and got a referral for treatment. The pain then increased alongside the itching and 4 weeks later I am still suffering from radiating pain down my right arm, sensitive and painful skin where the rash has just about healed and tiredness.

How is it diagnosed?

The Shingles rash is fairly characteristic. It appears in a band along something called a dermatome (see image). The dermatome where the lesions are present are linked to the nerve where the virus has reactivated and is replicating, which leads to the virus travelling to the skin and forming lesions. The pictures of the rash below are some of my lesions on day 1 when I presented to the GP. Over the course of several days more lesions appeared and the rash continued to spread, in what we call cropping. It always stays on one side of the body and is highly localised.

Often, as the presentation is fairly clear, diagnosis can be made just by taking a history and examining the rash. Vesicular fluid can also be taken from the lesions themselves by removing the top of the lesion and using a swab to get at the fluid; which is then placed into viral transport medium (VTM) for further processing. Historically this was via tissue culture and visualisation of the virus, but more commonly now is by polymerase chain reaction (or PCR), so looking for the DNA of the virus itself. This is much more sensitive and rapid. These additional tests are usually only undertaken in cases where the presentation is less clear cut i.e. the immunosuppressed or to allow follow up in case of vaccine failure/response.

What is the treatment/management?

I hate going to any form of healthcare, I think I’ve mentioned this before. The fact that I called 111 was therefore a huge thing for me, so why did I? One of the biggest risks linked to Shingles is the risk of post herpetic neuralgia i.e. nerve pain. There has been data collected to show that treatment, in the form of aciclovir, can help reduce the risk of this, but only if commenced within the first 72 hours. A Cochrane Review in 2014 stated that oral aciclovir did not significantly reduce the risk of long term pain but helped in reducing it during the 1st 4 weeks. My rash was so classic that I knew either way that I needed to ensure I started treatment as soon as possible for either outcome to be impacted.

Interestingly when I said to my father that the pain could easily last 6 weeks + I didn’t know why he sounded so horrified, now I do. Although the pain hadn’t properly kicked in at the point where I got treatment, if it hadn’t started to reduce by the point I’m now writing this I wouldn’t have known what to do. One of the main delays in getting any blog out has been the significant pain when using my right arm, and I’ve only just been getting through work. This blog for instance even now has had to be written in small chunks across a day, whereas I would normally have just knocked it out. I am therefore super glad that I started treatment as soon as possible, even though the tablets were ENORMOUS!

How do I stop myself having a recurrence?

There are vaccines available to help prevent Shingles which are aimed at those aged 70 to 79. The vaccines should aid in prevention of shingles for ~5 years and there are 2 shingles vaccines used in the UK:

  • Zostavax, a live vaccine given as 1 dose (similar, but not identical to the Chickenpox vaccine)
  • Shingrix, a non-live vaccine given as 2 doses, 2 months apart (used for those people who can’t have the live vaccine)

I have spoken previously about having poor viral immunity and so it’s been recommended that I should consider having the Shingrix vaccine by my local immunologist; which may be a way forward. The main way to reduce the risk of this happening again however is to learn to take better care of myself so that I don’t get so run down. This is easier said than done, being an Infection Control Doctor during a global pandemic, but I need to make room to sleep and at least eat better when I’m not on service. I always worry that if I stop I may never get going again, but this recent experience has shown me that if I don’t make time for some rest and relaxation by body will take that choice away from me.

Top tips:

  • Beware of whom you come into contact with whilst you have Shingles, non Chickenpox immune people may be at transmission risk
  • Make sure you loosely cover the rash if you can to prevent risk of contact transmission to others
  • If you have a rash develop on your face ensure that you see medical support
  • If you suspect you have Shingles make sure you get it reviewed within 72 hours to support management
  • If eligible for the vaccine make sure you get it to reduce your risk of developing Shingles in the first place
  • The pain is substantial and if you are a daughter, probably don’t minimise it’s impact to your father 🙂

Anyway, I’m back, even if not 100% and I’m so glad to be posting again. I may just need to take it a little slower for a while. If you are on the edge of exhaustion, learn the lesson I did not and take some time for you, you owe it to yourself!

All opinions in this blog are my own.

Celebrating National Pathology Week: What is a clinical microbiologist?

girlymicro Microbiology (Clinical), Science Communication

To celebrate this week being National Pathology Week , I thought I should take some time to post about what a clinical microbiologist is. I do this because, when I was at university, I really didn’t know that this career path existed. So here is a shout out to all those students who are trying to decide their next steps. You too will find your way.

When I googled microbiologist this is the first item that comes up

Microbiologists study microorganisms (microbes) in order to understand how they affect our lives and how we can exploit them

Prospects.ac.uk

This seems like a pretty good cover-all description. It goes on to discuss that there are microbiologists in many different areas:

  • medicine.
  • healthcare (I’m not sure how they differentiate this from medicine or visa versa).
  • research.
  • agriculture and food safety.
  • environment and climate change.

I must admit that when I was at university most of the options I encountered were linked to the food and drink industry or pure research. I think that their list missed things like Pharmaceuticals (although they may count that as medicine) and other forms of production, i.e. cosmetics.

At university I only did one module of microbiology (I was reading Zoology) and that module was about environmental bacteria and plating out bacteria onto agar plates to see what grew.

How did I go from Zoology to Microbiology?

I really wanted to work in an area of science where I could work to make a difference. I wanted to work somewhere that I could see that difference being made. Working in research felt too abstract to me. When I discovered, through a friend, that I could become a scientist in healthcare I knew it was what I wanted to be.

The National Careers service says you need to have two to three A-levels to become a microbiologist, plus a post-graduate degree. That is mostly true. However, in a world of apprenticeships and T-Levels, that is no longer the only route.

When I became a Healthcare Scientist I became a Clinical Microbiology trainee. So, what was the difference between that and what I’d done at University? The main difference with clinical microbiology is that I focus on organisms that cause infection: parasites, viruses, fungi and bacteria.

I also discovered that there was so much more to microbiology than agar plates. Although – don’t get me wrong – agar plates are still a mainstay of life within the bacteriology laboratory.

One of the techniques I learnt to love was polymerase chain reaction (PCR), which enables us to look for the DNA or RNA of a microorganism instead of growing it. Viruses and parasites don’t grow on agar plates and bacteria and fungi may not grow well if exposed to antibiotics or if present in low levels. PCR allows us to diagnose patients with infections that would not be diagnosed otherwise, or to speed up the process so patients get put on the right treatment faster.

Variable number tandem repeat typing of Klebsiella pneumoniae

PCR also enables us to do things that are harder to do using traditional bacterial techniques such as culture. The picture is of patterns that are like bacterial fingerprints so that they can be clustered into similar groups. This enables me, as a clinical microbiologist, to tell whether bacteria within the same species are the same or not. This is important when deciding whether a bacteria has spread from one patient to another. It helps in acting like a hospital detective, which is a lot of my work in Infection Prevention and Control.

As a trainee I spent four years rotating within laboratory settings. I spent one year in a molecular laboratory, diagnosing patients using PCR. I then spent six months rotating between benches (each sample type has its own laboratory bench) in bacteriology: wounds, respiratory samples, faecal samples, blood cultures, urines, fluids (cerebral spinal fluid etc.) and the primary bench where samples were put onto agar plates. Six months in virology, a year in research and time in food and water, parasitology and mycology (fungal) labs.

The diagnostic process is pretty similar in principle between the specialisms:

  • collect specimen from possible site of infection.
  • select the most appropriate test to detect any organisms (agar plate for bacteria, PCR primers for viruses, etc.)
  • evaluate whether the result (positive or negative) is accurate and whether there are other tests that should be done, i.e. further characterisation of positives such as antimicrobial sensitivity.
  • decide on treatment or management of the infectious cause, i.e. antimicrobials or non-antibiotic management such as surgery.
  • advise on infection control if actions are needed to investigate where the infection came from or to protect others from risk.

During my first four years I spent most of my time in the laboratory doing the first three bullet points.

Time goes on. I’ve been in the NHS for 17 years. Most of my time is spent at my desk in the on-call bathroom. Since 2010, most of my time has been spent either in Infection Prevention and Control undertaking the final bullet point or increasing my skills by gaining Fellowship of the Royal College of Pathologists to do bullet point four.

I still support the lab and, occasionally, get my lab coat on – but not as much as I’d like. It is, therefore, possible to be a clinical microbiologist and be anywhere on the spectrum. You can go as far as you’d like and do the type of work that makes you happy. It’s why being a clinical microbiologist is a great career!

Modernising Scientific Careers Framework

All opinions on this blog are my own

Laboratory Testing for SARS CoV2 (COVID-19): Is all testing the same and why should I care?

girlymicro Microbiology (Clinical), Science Communication

Why Am I Posting This Now?

In light of the news that came out yesterday linked to the withdrawal of the testing service in Wolverhampton, I think that this post from April still has relevance so I have decided to re-post.

Every tube is a person

This week Panorama aired an episode about how testing is undertaken in some community testing laboratories. They didn’t really cover the differences in testing between hospital and community testing streams.and I’m concerned, as others are, that this programme will create the impression that all testing is done in the way it was portrayed in this episode.

BBC iPlayer – Panorama – Undercover: Inside the Covid Testing Lab

Mention is made in passing to the high quality NHS system that existed prior to the COVID-19 pandemic and is still providing world class care. It doesn’t go into the difference between the 2 parallel lab systems in any way that would be clear to the audience, or reassuring to those not being treated by the so called ‘mega labs’. They also only really refer to academics vs the recent science graduates running laboratories. No mention is made of the army of highly trained, highly qualified Healthcare Scientists who have spent years providing high quality, rapid, advanced testing who have been the backbone of scientific testing in healthcare for decades. No Healthcare Scientists were even featured to comment on the practice.This is such an upsetting oversight that it I felt like I needed to put something out there in order to raise awareness of how all of this works in practice.

This hidden profession deserves to be seen and recognised for the amazing work they do, and not conflated with the bad practice seen in this programme

Before I go any further, I need to be clear that this post isn’t talking about point of care testing (POCT) i.e. the lateral flow testing which I am going to cover in another post; nor is it looking at the technical aspects such as how PCR works as I’ve already covered this in another post. This post is about the different testing streams and why the service and quality they offer may not be the same in all circumstances. This is clearly only my view of the situation and others may see it differently.

How Did We Get Here and How Does the Testing System Work?

When the pandemic started, the government released a document called Coronavirus (COVID-19): scaling up our testing programmes. This document was last updated in April 2020, basically setting out how we were going to enable the country to go from testing a few hundred virus samples a day in each local hospital for patient management to 700,000 plus swabs per day: from both hospitals and the community for: patient management (pillar 1) and epidemiology and surveillance (pillar 2).

The decision was made not to scale up the local hospital and public health networks that already existed (pillar 1), but to bring on line a second parallel system for community testing which would be called pillar 2.

English Government Testing

Tests in the UK are carried out through a number of different routes:

  • pillar 1: swab testing in Public Health England (PHE) labs and NHS hospitals for those with a clinical need, and health and care workers.
  • pillar 2: swab testing for the wider population, as set out in government guidance.
  • pillar 3: serology testing to show if people have antibodies from having had COVID-19.
  • pillar 4: blood and swab testing for national surveillance supported by PHE, the Office for National Statistics (ONS), and research, academic, and scientific partners to learn more about the prevalence and spread of the virus and for other testing research purposes, such as the accuracy and ease of use of home testing.
The 5 pillars of testing shown as a building

The decision to scale up using multiple pillars was made to improve capacity and was supposed to be designed with the following in mind:

  • Accuracy and reliability of tests.
  • Getting the right supply of people, lab space, equipment and chemicals.
  • Logistics.

What Points Did the Panorama Programme Make?

The Panorama programme asked the question, ‘Can we trust testing to keep people safe’. As mentioned , it focussed on pillar 2 testing in one of the ‘mega labs’, a not for profit lab in Milton Keynes set up to process 70,000 samples a day. The 7 lighthouse labs should between them be able to process 700,000 tests a day. To put this in context my lab in pillar 1 processes up to 600 SARS CoV2 tests a day at maximum capacity, but it is a comparatively small lab. I know other centres are running 10,000 tests, but still the numbers are smaller: mostly due to the context in which we are running, i.e. patient management and staff testing.

The woman who investigated worked 18 shifts over the course of the programme and was a life science graduate given 4 and 1/2 days of training before she started on the job (bear this in mind when we talk staffing and training later).

The programme showed a large number of quality and technical issues (I needed a glass of gin afterwards), such as failing to check sample details so samples needed to be discarded, safety failings in the way they were using hoods and dealing with leaking samples and substantial issues with quality controlling results prior to release. This last point meant that the reliability of the result given could be questioned, with a number of potentially false positives being sent out.

Many of these issues are linked to what we call quality assurance, so here’s the CDC definition:

Laboratory Quality Assurance (QA) encompasses a range of activities that enable laboratories to achieve and maintain high levels of accuracy and proficiency despite changes in test methods and the volume of specimens tested. A good QA system does these four things:

  • establishes standard operating procedures (SOPs) for each step of the laboratory testing process, ranging from specimen handling to instrument performance validation.
  • defines administrative requirements, such as mandatory recordkeeping, data evaluation, and internal audits to monitor adherence to SOPs.
  • specifies corrective actions, documentation, and the persons responsible for carrying out corrective actions when problems are identified.
  • sustains high-quality employee performance.

In summary, it’s how we feel sure that the result we give you is the right one, is accurate, and is given within an acceptable time frame that means it is useful to you.

The issues shown were mostly therefore linked with the pillar 2 lab failing at being able to undertake the quality assurance that meant that you got the right result on the right person at the right time. This links back to the stated aims in the government document linked to the need for ‘Accuracy and reliability of tests‘. So why did this happen and why is this quality assurance different in pillar 1 testing?

Why are There Differences Between the Labs in Pillar 1 Testing and the Labs in Pillar 2?

It is worth stating here that (my understanding) the aims of pillar 1 and pillar 2 testing are different. I am in no way excusing the poor practice as discussed in the episode but it is worth remembering that. Pillar 1 testing requires highly accurate repeatable results on an individual level as we are using it to monitor and make clinical decisions such as treatment options for the individual. The level of accuracy and repeatability required is therefore extremely high. Pillar 2 testing feels, to me, to have different aims. Although individual results are processed through the community system, in many ways it feels like it is there to get national and regional data to inform policy decision making on a large scale, such as containment choices. This is much more of an epidemiological approach where individual results matter less, as the data input into the system reaches hundreds of thousands. The focus on each tube being a patient therefore feels like it gets lost.

Staffing and Training

Pillar 1 testing is run and managed by Healthcare Scientists. To become a Healthcare Scientist requires at least degree level qualification and most of my staff have masters degrees. Healthcare Scientists in laboratories also need to be registered in a similar way to nurses and doctors on a professional register where their fitness to practice is monitored. This register is called the Health and Care Professionals Council (HCPC) register and you can either be on it as a Biomedical Scientist or a Clinical Scientist, depending on how much clinical advice you give, but both groups are Healthcare Scientists. Registration take a minimum of a year post degree (and for some routes 6 years plus) with completion of training competencies. Then as part of this professional registration you have to maintain your training, but also fulfil scientific and professional standards. This would mean that some of the things seen in the programme could result in professional sanction and possibly loss of license to practice.

Pillar 2 testing was initially mainly run by academics who were able to be seconded over or volunteer due to university closures. As a Clinical Academic I live in both worlds and my academic colleagues are amazing. However, they are used to working in very different environments without the same standardization and quality assurance checks that are utilised in a clinical laboratories. Most of these highly-skilled academics have now returned to working at their universities as courses have re-opened and so it appears much less experienced graduates have taken their place. This means that despite best intentions and good will they are unlikely to have the experience and training required to fulfil the complex and high standards of laboratory practice required in clinical settings.

This is why the ‘getting the right supply of people‘ piece in the document is so key. Healthcare Scientists like medical staff, however, require years of training prior to independent practice and so I acknowledge that within the timescales we have faced this has been a challenge and is a strategic issue that needs addressing in the years to come.

Quality Monitoring

In theory there should be no difference in the quality monitoring or quality assurance between pillar 1 and pillar 2 testing. It was stated in the documentary that the lab featured has been recommended for accreditation, but what does this mean?

Within England labs are assessed against a set of standards known as ISO 15189 Medical laboratories. These standards set out a list of requirements for quality and competence and were developed by the International Organisation for Standardization’s Technical Committee. If a lab demonstrates they meet these standards they are known as accredited labs, meaning that they are able to provide high quality accurate results. The accreditation body is called UKAS and it works in a similar way to the CQC for hospitals and OFSTED for schools.

All pillar 1 clinical laboratories are required to have UKAS accreditation to run. The process of getting accreditation is highly time-consuming, requires specialist knowledge, and a LOT of paperwork. Most labs have at least one full-time quality lead in order to keep on top of it, and to undertake crucial monitoring like auditing to provide the assurance part of quality assurance.

To set up the monitoring systems and get accreditation, even for one test, is not fast and it seemed to me that this is where the lab featured was failing. It is almost impossible to do high quality work when it is undertaken in a factory setting with hourly targets and when the staff present aren’t trained to a high enough level (4 and 1/2 days). Obviously, this is just a view from a set of data given through the lens of a specific piece of reporting. Having been through the accreditation process numerous times myself, it is of no surprise to me that centres set up so quickly with limited staff training are struggling to comply or even to truly understand the issues.

So Where Does that Leave Us?

Firstly I want to clearly state that this post is not an attack on the people working in the mega labs, they are doing their best under tremendous strain with what they have available.It isn’t even an attack on the mega labs themselves as I understand how we have gotten to where we are with them. This is a post to explain what we already had in place and how we might in the immediate and longer term look to do things differently.

These labs have been created at pace and utilising what resource could be sourced to set up a completely separate stream. In many ways I understand this, as just the logistics of getting 70,000 specimens a day into a building in terms of vehicle access are huge. Healthcare Scientists also cannot be magicked out of thin air. The problem is that this is being treated as a factory, without (it feels) acknowledging that the work we do is highly-skilled and technical: that this needs to be acknowledged in order to achieve high quality outputs.

As stated in the programme:
‘If we’d spent the money supporting the existing system we would have been better off’

That may not have been possible for reasons of speed and logistics at the start, but it is certainly possible now. The answer to the question in the programme ‘Can we trust testing to keep people safe?’ is yes, but maybe not in the situation we’re in right now. So let’s acknowledge the workforce that have the expertise in this, who can deliver the quality required and build the infrastructure to ensure that no matter where you are tested, for whatever reason a sample is taken, you are acknowledged as the patient behind the tube!

As to whether you should care about testing and where your sample is processed. We should all care: results and quality should not depend upon testing site. We should also care about the plans for how this is done in the future, as this will be a key legacy that the pandemic leaves behind.

All opinions in this blog are my own.

Embarking on My 17th Year as a Healthcare Scientist: What have I learnt?

girlymicro General, Microbiology (Clinical)

When I applied to become a Clinical Scientist (the term Healthcare Scientist didn’t exist then) in 2004 I have to admit I didn’t even know what one was. This lack of awareness that such a wonderful position existed has been a real driver for me ad became an ongoing passion to raise the profile of this, all too often invisible work force, that impacts across patient pathways and is so key to patient outcomes. If the great future scientists out there don’t know that they can join us, they never will.

Life has changed a lot since I walked in on my first day with very little idea how to pipette, what Staphylococcus aureus was, or how to spell Erythromycin. I (mostly) know what I’m talking about now, I’ve got married, brought a house, got a PhD, passed FRCPath and been awarded a New Years Honour. Importantly for me I found my passion, I know my why and I’m privileged to work with amazing people doing the best job on the planet.

My NHS career turned 17 on the 4th October 2021 and so is old enough to learn to drive. In continuing this metaphor I thought I’d write about the journey so far and what I’ve learnt.

Things to know as you start out on your journey

Have a plan

Your plan will change and evolve over time but if you want to make the most of the opportunities presented to you it’s worth having an idea of what boxes you need to tick in order to get to various fixed points along the way. Do you ultimately want a consultant post? You’ll need FRCPath, what will you need to be able to get there? Do you want to be a lab manager? You’ll need some leadership, recruitment and management experience, what opportunities can you access to help you?

Having a plan doesn’t mean you should feel boxed in and trapped by these ideas, but you can use them to help you prioritise chances that are presented to you. Not only that but can use it to ground yourself when everything feels a little overwhelming. You can also use this awareness to find champions and coaches/mentors that will help support you along the way. Invest a little time early on to make the most of your time later.

It’s OK to re-plan your route

Opportunities will come about and open up that you can’t predict when you start out. The term Healthcare Scientist didn’t exist when I joined the NHS, therefore there certainly weren’t any lead Healthcare Scientists. Getting a PhD wasn’t part of my plan, as when I joined there wasn’t a clear route through to being a Consultant, and so I didn’t know that I needed one. The National Institute of Health Research (NIHR) has been a massive part of my scientific career, enabling me to have a role as a Clinical Academic, but they didn’t even exist until 3 years+ into my career.

So have a plan, but don’t be so tied to it and so linear that you miss out on things that will change your life and career. Having the right people as part of your networks can help you realise when you need to take a leap of faith into one of these alternate routes is key.

Sometimes you may take a wrong turn, the extra journey will not be wasted

There will be times during your career when things don’t go to plan. Road blocks will spring up, paths that seemed clear will be obscured, and to be frank sometimes the car will just break down. The thing to bear in mind at these points is that none of this time is wasted as long as you learn from the experiences being offered to you. Sometimes these experiences are not particularly pleasant whilst you are going through them. I would be lying to you if I said there wouldn’t be challenges along the way. You will however emerge stronger and more knowledgeable from them, as long as you see them for what they are, learning opportunities. So deep breaths, make that cup of tea and know that this is still an important part of your journey.

For those of you mid-trip here are some things I learnt somewhere post registration

Remember you are part of a system at every level and take the time to understand how it works

It was only when I started on my leadership journey as part of the GOSH Gateway to Leadership programme, that I really began to appreciate the importance of systems. As a trainee I was very focussed on my department, with a few links to my professional community at a national level, via the Association of Clinical Biochemists and Laboratory Medicine. It was only when I was on this cross disciplinary programme that I met people who were outside of my silo that I began to understand what the drivers for other peoples behaviour might be.

Now I spend a lot of time in national strategic committees and working with different professional backgrounds and it has enriched not only my practice, but also enabled me to work towards impact on a level I could never achieve as an individual. If you really want to be a driver for change then understanding the landscape within which you are working and making those changes will only make you more successful.

Influence is not about seniority

For a long time when I was starting out I believed that titles and seniority were key to influencing others and therefore supporting change and improvements. It took a while for me to learn about the difference between formal authority and informal authority. Informal authority is actually really key in order to win people over and get engagement with proposals. It’s built up over time, requires work and effort to maintain and is based on your credibility. Formal authority is given to you in the form of job title and role. You can make huge impact where ever you are RIGHT NOW, you don’t need to wait to be given authority. Put in some time and develop the informal authority to enable you to make things happen.

Don’t compete with anyone but yourself, your journey is your own

The world of Healthcare Science is a small one, it can feel like everyone is trying for the same end points and therefore is competing over the same limited opportunities. In my opinion this isn’t actually the truth. It feels like it, but it isn’t. When you speak to people, very rarely do they want the exact same thing as you. This competitive drive can mean that as a community we don’t support each other enough. Once you realise that others are not really competition, it dawns on you that your only competition is actually yourself. You can tick the boxes you need to tick with principles and grace, these don’t require anyone to lose out. Also, if we do these things as a community together we also often achieve more. If we form FRCPath study groups to help us pass then we are not losing out on consultant posts, as more people have FRCPath, we are increasing our chances of succeeding together. There will be enough consultant posts as we are not all looking for the same things in a job, the ideal post for one person will not be the same for another. Don’t spend too much time focussed on what others are doing and achieving, keep an eye on your road map.

We rise by lifting others

Part of succeeding as a community is to really function as a community. Twitter and #IBMSChat are great examples of this, sharing opportunities, knowledge and experiences for the good of everyone. No matter where you are with your journey there will be people behind you who you can sign post and offer support to. This is part of the reason I believe outreach and public engagement is so important, we need to support people at all parts of their pathway.

The other thing is, that it is crucial that as your formal authority increases you consciously make the decision to send the elevator back down, or ride share where you can. As leaders we are obliged (in my opinion) to amplify the voices of those who may not otherwise be heard. If you are lucky enough to have a voice then you need to use it, not just for yourself, but for everyone that either doesn’t have one or holds one that is unheard or ignored.

You will never be liked by everyone, and that’s ok

Amplifying the voice of others or being a driver for change, frequently does not increase your popularity. I’ve always been a people pleaser, I want people to like me, I want positive feedback, I want positive reinforcement. Sadly I have discovered that not everyone is going to like me. I am not going to be everyones favourite person. Being someone who likes change and disrupts the status quo will lead to benefits, but will also make people feel uncomfortable and that will sometimes drive challenging behaviour. Sometimes clinically it’s also my job to hold the line, to deliver bad news, to not be the popular one. Not everyone is going to like me, but I’ve discovered that it is rarely personal. It’s mostly about the response to the role or the situation and some key learning for me has been learning to separate these from who I am, in order to not take it personally.

What to do when you hit your original destination

Know your why, why are you doing this? What are you passionate about? Where are you going?

When you reach your planned destination, there’s only one thing to do and that’s plan for the next stop along the way. It’s really important therefore to check in with yourself and know your why? Why did you pick this original target and how are you now going to build upon all of the hard work that has got you to this point? What is your driving purpose and how are you going to stay true to that in the next phase of your career?

It’s worth doing some of this thinking as you approach your destination so that you can be ready once you’ve re-stocked on drinks, snacks and mix tapes/downloaded Spotify playlists to hit the road again.

Sit back, smell the roses and take time to celebrate

Finally, to complete the metaphor. It’s important to look in the back mirror every now and again to assess just how far you’ve come. Celebrating can feel indulgent and like boasting, in fact it’s the opposite. It’s inspiring to those that are following behind you and is important to show to others that they to can achieve. People can’t be what they can’t see and so by talking about the journey you will enable others to make informed choices about their own. On long journeys it can feel like you still have miles to go but by looking back you can see how far you’ve come and put it into some kind of context.

I’ve been listening to Hamilton a lot lately and these words have a particular resonance for me. Whatever your journey, it is yours and no one elses, therefore it will come together at the time that is right for you. So celebrate the moments, large and small, after all the journey is most of the fun.

I am the one thing in life I can control
(Wait for it, wait for it, wait for it, wait for it)
I am inimitable
I am an original

I’m not falling behind or running late
(Wait for it, wait for it, wait for it, wait for it)
I’m not standing still
I am lying in wait (Wait, wait, wait)

Wait For It – Hamilton

All opinions on this blog are my own

Keeping Things in Perspective: My attempt at seeing the glass as half full with a list of pandemic positives

girlymicro General, Microbiology (Clinical)

It’s been a long 18+ months in the world of Healthcare Science and Infection Prevention and Control. I’ve posted quite a lot about the pandemic here and how hard it’s been, especially coming into winter and the challenges that will bring. Challenges now acknowledged, it’s a Friday night, I have music playing and so I also wanted to reflect on what the pandemic has brought us that isn’t all negative.

Raised the profile of my profession

For many years I have had to try to explain what my job involved to the public, explain what polymerase chain reaction (PCR), and I’ve frequently been met with slightly glazed expressions. This is no ones fault, it’s just that those terms haven’t really meant anything for most peoples day to day life until the last couple of years. Suddenly public interest and awareness in not only testing and infection control, but also in the science behind these processes, has really been increased. Now I can hardly ever get a cab without being asked about how things work and what the current clinical situation is. If we engage well with this interest and awareness we will be able to have conversations about science and its impact on individuals and society for years to come, in a way we haven’t been able to before.

We’ve been invited into the room

Despite my love for my subject, microbiology has never been a sexy discipline. It’s never a topic that gets you into many strategic meetings where key decisions are being made, pathology as a whole is often left out in the cold when big decisions happen. Suddenly pathology, and microbiology in particular, have become a focus for decision makers. Healthcare Scientists as a professional group have often struggled to be invited to meetings, or even know that they were occurring. There has been a definite pivot over the last 18 months, with consideration of the importance of diagnostics in patient management. 80% of patient pathways rely on diagnostic impact at some point, it’s logical therefore that pathways can’t truly be optimised without considering diagnostics. So I for one am happy about the fact that by having a seat at the table we can work together to make this better, not just for SARS CoV2 but across all patient pathways.

The scientific and infrastructure legacy

Implementation of research techniques into clinical settings is always challenging, it requires access to space, finances and expert knowledge. We’ve always been very fortunate in the NHS, in that we have a lot of wonderful scientists who are really well placed to respond to scientific and clinical challenges by not just improving what they have, but by bringing in the latest research approaches. The things we have always struggled with are access to financial support to develop services and space in which to locate the new platforms required. One thing that has really struck me over the last 18 months is that the conversations in this regard have changed. Instead of flat out no, the discussion is about which is the best way forward and how can we make it work. This doesn’t mean that the answer is always yes, but it means that many of us have access to the infrastructure we need to really maximise patient care. The big question for us all now is how we maximise the legacy of that infrastructure to improve across challenges when this particular one is less enormous. This is a great problem to have and we need to ensure we actually spend some time thinking about the answer, rather than drifting into a solution.

Developed networks across boundaries and silos

It’s too easy in times of challenge and stress to react by becoming insular and regressing into known comfortable places, reinforcing silos and boundary based working. One of the things I’m proudest of for my profession and clinical colleagues is that instead of regressing into the known during the pandemic, they have instead reached across divides in order to form networks and learn from each other. This can’t have been easy to manage and yet the impact this has made has been really clear to me. At no time before as a scientist have I have been at a table with so many different professions, all with their own expertise, discussing, listening and learning from each other. I really hope that those networks and relationships that have been forged under such pressure will continue when we move back to a more standard healthcare model, as being part of those discussions has given me real pleasure.

I’ve got to know my colleagues much better

I am fortunate enough to be part of some exceptional teams (research, HCS education, IPC and microbiology). I’m not saying that the pandemic hasn’t on occasions challenged us and relationships within those teams, how can it not. The gift of those challenges has been however that we have come to know and understand each other in a way that would never have occured in a more standard situation. I spend more time with my teams than my family, I’ve known many of them for over 10 years, in many ways they are parts of my family. I’m super grateful therefore for the way we have bonded and deepened those relationships over the last 18 months, and it will only make us stronger to face whatever challenge happens next.

I’ve learnt so much about myself and my preferences/drives

Not only have I learnt more about my colleagues, but I feel I’ve learnt an awful lot about myself. The things that really matter to me, the things that drive me, the things that energise me and the things that drain me. For instance I have learnt that for me planning for the future is energising, whilst existing in constant responsive mode is draining. I miss sitting and planning research events, outreach events, teaching and developing the service. All of those things fuel my need for creativity and change. Living every working day in responsive mode where non of those things can happen I find incredibly draining, which is why my battery feels constantly empty. It’s why this blog has been a lifeline, even though it time consuming and yet another thing on my to do list.

The other thing I’ve learnt about myself is that despite appearances I’m more of an introvert than I knew. I’ve loved just spending time at home with my husband and not having the demands of a social life. I always knew that I could turn on ‘extrovert me’ for a given number of hours but then would reach a point where I needed to stop. Now I’ve discovered how happy and comfortable I am without the need to deal with those social demands in my world. I think I may try to keep my limited social circle up for some time to come as I feel happier and less anxious in small groups.

I’ve learnt so much and upskilled in so many areas

I didn’t realise until I came to sit down and write this blog how many new experiences I’ve had as a result of the pandemic that I would never have experienced otherwise. I’ve been involved with a life drawing class posing (fully clothed) as part of their pandemic professionals series. I’ve has my COVID-19 dreams painted as part of the Dream Appreciation process by DreamsID, the product of which I not only have for my office as an amazing piece of art, but has also been exhibited at the Freud Museum in London as well as other places. I’ve even been persuaded to take part in a stand up comedy show after training for National Pathology Week. These experiences have all developed skills and left me with memories that will last far longer than the pandemic. Many of them would never have happened if it wasn’t for the pandemic pushing creativity and causing people to work and develop projects in new ways. Even this blog was started as a way of being able to still channel creativity and sharing in the pandemic. So I guess I’ve learnt a lot, and not just about viruses.

Enjoying the genius of responses from companies and professional bodies

This may be a weird one but I have rather enjoyed seeing companies and other professional groups trying to come to terms with the pandemic. It’s been really interesting and enjoyable for me to see people tackle difficult and sometimes repetitive messaging in a way that brings humour or innovation into the mix. I’ve also found it pleasing when big business or big names have channelled some of their resources into learning and other messaging to support the pandemic approach. It has often renewed my faith in mankind when other sections of the population have been busy destroying it.

Leicester General Hospital Genius Signage

If we can survive this we can deal with anything that’s thrown at us

Finally, I think it’s easy to forget how much we’ve achieved and how far we’ve come. No matter what your job, or the reason you’ve spent a few moments of your valuable time reading this blog – know that you have come far, that you have achieved much and that you are making a difference and having an impact. Sometimes you just need to step far enough back that you can see it. So thank you, all of you.

All opinions on this blog are my own

Knowing Your Why: Why I’m passionate about how we talk with our paediatric patients

girlymicro Microbiology (Clinical)

Some of the clearest memories of my childhood are about things that happened to me in hospital, and to be frank most of them are not of good experiences with healthcare and clinicians. Those experiences have shaped my current relationship with medicine, for both good and ill. Yet when we are having interactions with our paediatric patients we rarely think about (outside the paeds world) what the legacy of those interactions will be. For some reason I’ve been reflecting on that legacy for me recently and have begun to start unpicking why its a driver for much that I am passionate about as an clinician.

What experience led me here

I didn’t deliberately choose to work in a paediatric setting but over the years I’ve had plenty of opportunities to leave and work in a more general setting. I’ve never really been able to articulate why maintaining my work in paediatrics has been so important and aligned to my personal values. Over the last 6 months however I’ve been involved in designing our new children’s cancer centre and the conversations have triggered some realisations about why it matters so much to me.

When I was nine I was in primary school (about 5 years before the picture of myself, my brother and sister above). At lunch time I started to cough, by PE class at the end of the day I was coughing so much I sat out the class, and remember watching the others running in the sun from the classroom window. I walked home after school, at which point the coughing was continuous. My father took me to the GP who offered to call an ambulance but said it might be quicker for him to just drive me to A and E with a letter from him. The GP didn’t speak to me, I just listened to him talk to my father.

I arrived at A and E. It was late, I was tired and my chest was really hurting with coughing so much. I didn’t really know why I was there, after all it was only a cough. I was placed in (what I now know) is a side room and 15 doctors/medical staff came into the room. They looked at me, they prodded me, they talked about giving me an emergency tracheostomy, no one spoke to me. I couldn’t even see my father due to the number of people. The only person in the room who talked to me was a nurse I remember to this day called Maxine. I remember her as this was the start of many journeys to A and E over the coming years and Maxine was almost always there and without fail was the only one who spoke to me.

The next thing I know my father is no longer there. I’ve been rolled into (again what I now know) is a theatre suite. Someone has put a massive black mask on my face and the world is swirling, people are going in and out of focus. It felt like a horror movie. I woke up in a dark room on my own. I was unable to move, unable to speak (I now know I was intubated). The only thing I could see was that right in front of me was a window to another room. The curtains were open and there was an adult in the other bed. He must have crashed as they were attempting resuscitation. There was beeping all around him and me. He died and I watched unable to move or speak.

Over the next week I stayed in a cubicle on an adult intensive care until. Frequently on my own I had my toy popple and I would shake the tail to try and get attention. My mum was often there and I was mostly sedated but I don’t remember any member of the medical team apart from the odd nurse ever speaking to me. I was given a book to write in and on one night they brought in a TV so that I could watch Agatha Christie’s Poirot. I fell asleep as I was sedated. When I woke up the TV was still there and on. Hours has passed and a horror movie was on, I couldn’t turn it off and no one came. Again I just lay there scared.

So why am I telling you this? Afterall medicine must have changed a lot in the last 30 years and this wouldn’t happen now.

This was the start for me of years of being ignored in rooms and having procedures undertaken without being included in the decision. It was part of time spent in hospital without being able to get out of a bed or interact with anyone else, no access to school or even a space to play when feeling better. Although things have improved I’m not sure things have truly changed in many spaces. That’s the reason I’m writing this post. To raise awareness of the importance of not just seeing children as little adults in healthcare but as people with specific needs that need to be catered to.

How do we do things differently?

I recently posted about how I felt we needed to challenge ourselves more on delivering patient centred care. When children and families are involved however I think many people feel even less skilled to adapt what they are doing in order to engage the patient as well as their families in discussions and decision making.

There is a great course run out of GOSH called MeFirst which I try to encourage my Healthcare Science staff to engage with and which I strongly believe would beneficially to anyone working I healthcare. Even if you don’t work in paediatrics you are likely to need to communicate with children and young people at some point. It provides a communication model which will support us in putting children and young people first in any interaction. If you come through the standard medical and nursing training route you are likely to have much more embedded training in this than those of use who belong to other healthcare professions. It is especially important therefore for those of use who haven’t had this training as part of our standard curriculum to search out opportunities to upskill ourselves and improve our practice.

What tips do I try to use in my practice?

  • Speak to the patient as well as their families when you’re introducing who you are and starting your conversation:
  • Try using images and cue cards to support patients articulating how they feel about options, decisions and interventions – if appropriate for the patient
  • Spend time with the patient and family to try to understand their level of understanding in order to make them feel heard, not patronised or baffled by information
  • Avoid using technical terminology whilst not dumbing down what you are saying
  • Remember to use active listening to try to really hear what it is that patients and their families want. They will all have different prioritise and things that are really important to them. Plans should not be one size fits all

My interactions with healthcare as a child led to me being completely terrified of engaging with healthcare as an adult. I experience a really primal fear reaction which no amount of rationalisation can overcome. I think its why I got the job I have, now in hospital I am the person who feels able to make decisions and who is in control and listened to, rather than ignored and scared. Most importantly however I am also the person who can sit in a room and advocate for us to do it better. In my world I have the lowest skill level as I’m surrounded by brilliant paediatricians who are better at this than I will ever be. However if I can make a difference for one child to feel less scared then that is success for me!

All opinions on this blog are my own

Things I Wish I’d Known When I Was a Trainee: My top ten tips for making the most of your journey

girlymicro Academic Life, Microbiology (Clinical), Microbiology (Research), Research/Academia

It’s an exciting time for a lot of people right now, a lot of people are planning new phases of study starting in September/October. In the world of Healthcare Science we have people starting PhDs as part of HSST (people training towards becoming Consultants) and new STPs (people training to be become Healthcare Scientists) all beginning their new journeys. It feels like a really good time to talk about all the things I wish I’d known when I started out in order to make people feel less alone, as well as encouraging them to make the most of every part of this next stage.

It’s never about being the smartest person in the room

When I first started in my role as a trainee Clinical Scientist, and then as a PhD student, I just remember being over awed by everyone is the room. Everyone had amazing titles, years of experience and just an aura that suggested competence and knowledge. Even all these years later I sometimes feel that way, especially in rooms I haven’t been in before. It took me a long time to understand that my contribution wasn’t about being smarter than anyone else, I’ve never been the smartest person in any room. Your contribution will be about offering a new perspective that is unique to you. Sometimes that’s from a technical scientific point of view. Sometimes that will be by who you can connect the people in the room with. Sometimes that will be by offering a different lens through which the situation can be seen, being new to an environment means you will be able to review things without historical bias.

Manage your training officer/supervisor

I’ve been on both sides of the fence. I’ve been the PhD student who couldn’t get time with their supervisor and the Clinical Scientist trainee who just wanted to be included. I am now the PhD supervisor/training officer whose diary looks like a train wreck and who feels constantly guilty about not having enough time to devote to those who she’s training. One of the key skills that I had to develop as a trainee, and now encourage in those I supervise, is to develop skills in supervisor management. This includes things like understanding what your own needs are: do you like micromanagement/close support, or are you more interested in a light touch. Ask how your supervisor works: are they someone who likes drop ins, or are they like me i.e. if it isn’t in the diary it won’t happen. Learn how to support the process by keeping notes of the meetings and emailing them for record keeping/prompts. Finally, spend the time to think about what you want from each face to face to make sure you maximise your time. Also, don’t repeatedly stand them up – it sends out ALL the wrong signals and if you don’t value my time I will value our meetings less.

We all fail, frequently

No one really talks about it but we all fail, I fail all the time. Now sometimes those failures are big and sometimes they are small and minor, like not having a conversation well. I wasted a lot of time at the start of my training by trying to be perfect and as a consequence I feel I didn’t maximise the learning in those first few years. If I discovered an error I quickly (and safely) corrected it, but I had such anxiety over it I didn’t really reflect on it, I wanted to fix it and move on. I also (apart from safety reporting) didn’t really talk about it with my supervisor. This meant that the team as a whole missed out on learning from system based failures. If mistakes happen, especially serious errors, they tend to be compound events linked to multiple failures along a pathway. The best way to avoid these errors to identify the weak points in the system when minor issues occur singly, so it reduces the chance of a compound failure later on. Long and short, don’t be afraid of failure, focus on learning from it and know we are all in this together.

There are no stupid questions

I love people that ask questions, it makes me think, it makes me remember why I’ve made decisions and assess if they are still relevant. When I started out I was worried that asking questions would just demonstrate my ignorance, and at the start of my training I was concerned about what people thought about me coming in as a non microbiologist and being behind everyone else. It takes courage to ask questions and be part of the discussion. As a trainer it is very difficult to evaluate whether you are covering knowledge gaps or pitching what you are doing correctly if the dialogue is one way. As your confidence grows it is also good to question and challenge, there are many different ways of doing things and only by having dialogue can you really understand why certain decisions get made under some circumstances and not in others. If you are an introvert and not comfortable asking questions openly, make notes, email and discuss your findings, find a way that works for you and work for your mentor.

Make copious notes

You will be given a LOT of information when you start, well to be honest all the way through your training, but the start can present information overload. When I look back at my notes from the first week of my training I obviously didn’t know what some of the words meant, let alone the context. By taking copious notes throughout however it meant that once I had found my feet I could review those notes and gain new information I was unable to take in the first time. By reviewing notes when you come back to something, after a break or rotation else where, you will be able to make connections which may not have been obvious to you the first time around. It will also enable you to ask questions better (see above) and have more enriched meetings with you mentor/trainer/supervisor as you will have access to specifics. Not only that but it will mean that you demonstrate attention and will enable you to ask questions that add to your experience. Plus when you look back at your notes from 10 years ago it will make your realise how far you’ve come and how much you have achieved!

Be the master of your own destiny

Every trainee/student is different. Hopefully you will get a supervisor who will have the time to help you reflect on your learning needs, but you need to also be able to develop the skills to do this yourself as you won’t always have access to someone to do it with you. Most training programmes are quite structured but there are always many different ways to deliver on the same learning outcomes. This is a career and every career journey is personal, so the sooner you can get into the habit of thinking about what your strengths and weaknesses are, and what your specialist areas of interest could be, the more you will get out of any opportunities you are offered. Within academia and the NHS you will often not be offered opportunities on a plate, but if you know what you want and find the opportunity out, you will very rarely get blocked from accessing them. Start thinking early about what could enrich your training and find ways to access those experiences.

Sadly this is not a 9-5 but you can do this and have a life

I’ve sat in a lot of lectures from very senior people who talk to trainees about clinical and academic work not being 9 – 5, it’s true but in many ways this saddens me. It gets spoken about as if you can’t have a life, you either choose devotion to this vocation or it isn’t for you. There will definitely be points where you have to commit more than the standard hours, exam revision, dissertation writing etc, but this shouldn’t be all the time. I encourage my guys to take on extra curricula activities such as STEM engagement, which often happen on the weekend, but this is a few times a year. Training shouldn’t be about burn out. To fully learn and develop it is crucial to have mental space to reflect and recovery time. You need to early on find strategies that work for you to manage your time. Do you want to block out every Friday afternoon for paper reading? If you do need to put in some extra hours would you rather do it at your desk to maintain work home separation, or work on the sofa. Be aware early of working to manage stress rather than to manage task and develop strategies to enable yourself to walk away and unwind (my trainees and students will be laughing at the hypocrisy of me writing this line, but do as I say not do as I do, I too am constantly learning).

Have a plan for what’s next

3 years feels like a long time when you start but it’s not really. Before you know, it will be 18 months in and you will need to start thinking about what the next stage of your career may look like. As part of your progress it is therefore important to make sure you regularly check in with yourself about what you’ve enjoyed and you’re aspirations to make sure you’re on track for the career you want. The more you do this, the more you will be able to mould your training around the experiences and networks you will need to help you succeed. A lot of us fall into career choices, but if you can be deliberate it will help you find happiness as well as success.

Reach out and connect

It’s not what you know but who you know. This isn’t entirely correct, but finding opportunities often depends on knowing the people who are making them or have access to them. This is often difficult when you are starting out in a new field or career as you don’t know who people are in order to hear about things. This goes for job posts as well as learning and accessing skills. There are now some ways where you can do this on your own, such as social media, which are less reliant on introductions – join us on Twitter. However this is where extra curricula’s can really help. Join your professional body, find a trainee network, engage in patient and public engagement, go for coffee with your fellow trainees and PhD students. Relationships and connections forged now will pay dividends later and are worth the investment, even if you are busy with other things.

Enjoy the ride

I was so focused on the end goal that I didn’t enjoy the journey as much as I should have. I spent 17 years focussed on making consultant, ticking boxes along the way like PhD and FRCPath, that I didn’t live in the moment. I was always focussed on the next step, the next target and so I didn’t enjoy the freedom that my training presented me with. Being supernumerary only occurs early in your career and gives you a freedom to make decisions and enjoy experiences you just won’t get later on. Learning is your focus right now, free of the demands of the inbox, meetings and other peoples agendas. Make sure you relish every moment as you will have less and less time to just enjoy learning as your career progresses.

All opinions on this blog are my own

Fulfilling A Promise: Why we need to talk about whether we are actually delivering on patient centred care

girlymicro General, Microbiology (Clinical)

Warning – This is a long one and I’m not even a little bit sorry as I think we need to talk about this

Lets get this bit but out of the way first. I don’t believe that any of us for one second mean to provide anything less than the best care we are empowered to give. I do however believe that there are a couple of key components that may mean that we don’t always provide the care we aspire to. In my head there are three key reasons behind this:

  • Empowered to give is the key phrase here. Are we supported in delivering the best care? Do we have the right staff, equipment, training etc?
  • Does the organisational culture support delivery of patient centred care, in terms of high level decision making, expectation setting and provision to challenge?
  • Are we as individuals aware of the behavioural patterns we fall into during times of stress i.e. if we trained during a hierarchical medical era is this where we shift to in our practice in times of psychological challenge, such as a pandemic?

This post isn’t a criticism of individuals or centres, but it is a challenge to ensure we are thinking and questioning as part of our everyday practice. An encouragement to question whether we are providing the best in patient care, or at least actively identifying areas where the system has fallen down. We can only improve if we question, question ourselves, the situation and the system.

So why am I posting this now?

I’ve had more to do with being on the other side of healthcare than I’d like over the last three weeks. The outcome was pretty dire and I made a promise to the amazing person who was the patient that I would use whatever influence I have to remind people that we get the principles of person centred care wrong it is the patient that suffers. In my case it meant that the patient suffered loss of dignity and the final weeks of their life without the support of family and friends.

I work in paediatrics and I must admit I had fallen into the trap myself of thinking that every world was like my world, not that I’m claiming my world is perfect. Paediatrics is however more family focussed by it’s very nature as we need families to support us in providing care. We also need to listen differently as many of our patients can’t articulate their clinical condition and so the input of non verbals and families into their care is especially important. My sojourn in the world of adult healthcare was therefore a considerable shock to my system and has left me both reeling and questioning my own practice.

Impacts on dignity and right to choose

The NHS Constitution clearly sets out key principles that we should be using in all of out interactions, with each other and with our patients. These include clear statements on respect and dignity. For us really to fulfil this pledge though we need to hear what patients are saying to us.

For example, if as part of a patients’ care they are experiencing loose stools and they are not supported to access the bathroom, and instead left lying in a contaminated bed, they will not only be at increased risk of infection (from the femoral line they have in), but they are also likely to become less compliant with their care in general. Are we under these circumstances really demonstrating through our actions that we care for the patient in front of us?

As healthcare professionals we are often a bit non-plussed about faecal contamination, for those not in our world however we need to remember that to many individuals this is a humiliating event. If we compound scenarios like this with not explaining why medically we are making it worse by adding in medication, such as laxatives, which make the situation more likely to reoccur, then are we really thinking about how we are impacting on patients psychological health, or undertaking holistic healthcare?

Is this really seeing patients as equal participants in their care choices if we aren’t giving them the information to inform those judgements?

Too often we make decisions based on our knowledge and do not engage with the patients and families in front of us in order to support their engagement with their own care. How often do we ask them what matters to them? Only by asking this question can we establish what dignity and the right to choose really means for the patient impacted.

Importance of communication assumptions about levels of understanding

Communication is especially important right now. Due to the pandemic patients are frequently isolated from support mechanisms. This lack of support may mean they don’t challenge their care, it also means if that challenge is unheard that they don’t necessarily have access to escalation procedures, or even worse access to sign posting about what to do next. They are effectively in a very lonely bubble, with the only people to support them a bunch of strangers who may or may not have the time to develop connections or truly support.

When I was finally allowed to visit the healthcare centre (a story for the next section) not a single person, apart from the palliative care team, introduced themselves until the last day when to be honest it all felt too late. Not one ‘hello my name is’, not one explanation to the person before them or us their family as to why they were there and what they were doing. Because of my job I felt like I could explain things and to ask the questions that needed asking, but most people do not have a healthcare professional as part of their family. This was apparently the way the whole episode of care had occurred. I thought we had come so far in terms of not just seeing patients as anatomy and conditions, but this just showed me how wrong I was. On the day of his death everyone was brilliant, supportive and demonstrated amazing communication skills (apart from the medics who didn’t even come in) but the impact of those skills would have been so much greater if used when someone was able to respond and participate.

The Palliative Care and Support team came to visit on the day before he died. They said ‘hello my name is’, they didn’t however explain what palliative care was or even really check my family knew what the reality of that visit meant. When I spoke to my family after they had gone they were shocked when I explained. We have to remember that not everyone lives in a world where those words have meaning, we need to stop hiding between titles as barriers and truly check that what we believe has been heard is actually what was received. The other extreme is the ‘infantilising nature of healthcare’ where we assume that people don’t have the knowledge and capacity to be involved in their care or decision making. It takes time to get a feel for the level of a patients engagement/understanding and pitch your content appropriately. Some patients have a considerable amount of knowledge about their own condition, but whatever their level of knowledge we should be talking to people at the level that is appropriate for them, not what is appropriate for us.

Long and short is that I’m saying how we communicate matters, not just what we communicate, and that we should all spend time (me included) reflecting on how we do this in practice. I’m as guilty as anyone for rushing in, delivering the information in my head and then rushing onto the next task, but is that what is actually needed of me? Take the time to get patients names right, learn who they are not just the reason for admission, and make sure we communicate in a way that works for them.

See the source image

Who are we making COVID-19 decisions for?

The hospital in which all this occurred has banned all visiting because of COVID-19. Not only that, they had removed all entertainment centres, and thus a big means of distraction, for all patients. This may seem really trivial, what does it matter if someone can’t watch TV. It matters because England got to the European final and football, as trivial as it may seem, is super significant in some peoples identities. Dying without being able to engage in one of the few seminal moments you are still able to experience is significant. It matters because if you have unexpectedly found out you have only weeks to live and you have no visitation to provide support then distraction is probably one of the few things that may aid you processing that information.

The same hospital that banned visiting had less than 20% of the staff on the ward wearing masks. If a patient is in a cubicle I can see no barrier to visitation from an IPC perspective, just get them to wear a mask. If we are insisting on banning visitation in order to prevent in-patient acquisition then staff need to be also protecting their patients. If staff are not wearing masks and protecting their patients then I question what is the point in banning visitation? Who are we protecting? What is the purpose of this policy that leaves someone at the worst time of their lives alone without support?

Visitation was allowed during end of life care. Sadly end of life care wasn’t from the moment they said you were going to face a life limiting condition, it was for the hours/days where death could be imminent. Sadly it is during these times when the patient themselves becomes less cognisant of their surroundings. It is beyond the time when you can have conversations about wills, final wishes, funeral arrangements. It is passed the time you can have most impact in terms of psychological support. Visitation also involved battling every day at reception for the password to be permitted to visit. Battling because no one had ever put the name in the book that allowed them to issue it. Delaying by 15 to 30 minutes when you would get to the ward. Extending a period of incredible stress as you wouldn’t know what you might find. All because no one had filled in a form. I of all people understand how busy everyone is and that it seems like a minor thing, but I can tell you as the person who uncharacteristically could have screamed at a stranger in those moments, a minor thing for us can have significant consequences for others.

So after this outpouring which I’m hoping will make us all think, what do I believe that we should be doing differently, myself included:

  • Make every conversation and encounter matter. Think about what you are delivering and how it has been received, has it been understood? Have we really listened to the response rather than just delivered information?
  • Even during a pandemic patients are more than their conditions. Against their will they are living in our world. A world that they don’t necessarily understand the rules or the language of. We are their translators, a key role that we need to understand we fulfil. Simple things like explaining our roles can make all the difference.
  • Challenge where needed systems and processes that don’t feel like they are supporting patient centred care. Sometimes the people making the rule/policy will not understand the true impact of it unless they get the feedback about it’s impact. We all need to be part of the change.
  • Take the time. Understand how you react to stress and how that response impacts on your practice. It’s hard to reflect on our practice right now but it’s rarely been needed more.

All opinion on this blog are my own

Just One More Sleep: Why ‘Freedom Day’ doesn’t feel like Christmas to those in infection prevention

girlymicro General, Microbiology (Clinical)

Working in Infection Prevention and Control is basically about assessing risk. It’s pretty much what I do, what I eat and breath. So today I wanted to post (with that in mind) why I’m tired to the core of my being when I hear the joyful proclamations about the 19th July and so called Freedom Day, and it’s not just me others are definitely feeling it too.

This doesn’t mean that I don’t understand the strong urge to ‘get back to normal’. This is a very human trait. We all like to feel in control and this has been a prolonged period of high stress and uncertainty. I suppose my frustration is with the failure to really communicate that normality comes with a cost. It will likely bring economic benefits but it will cost some people their lives and NHS workers just a little bit more of their sanity. If as a society we agreed that the economics were worth it I would grudgingly keep my mouth shut but we’re not even having the conversation. There is no such thing as a free lunch and at the moment society is passing me the bill when I’m not sure I’ve brought my wallet.

It’s All About the Shades of Grey

For cognitive comfort we tend to feel comfortable seeing the world in black and white. The reality is (as with most things) that the world and decisions are made up of shades of grey. It is possible to live in a world where we are neither in complete lock down nor where everything is effectively considered back to normal and presenting increased risk.

When I’m dealing with an outbreak in a hospital setting (I acknowledge the situations aren’t identical) I bring in a series of measures to find the source and stop transmission. Often because of the risk to patients and staff you do all these things at the same time, in order to maximise your risk reduction. Then once you have identified the source and stopped further cases being identified you gradually reduce your measures.

You do your intervention reductions in this way for a number of reasons:

  • You often don’t know what is having the greatest impact so a step wise reduction enables you to learn more about how you might control a similar outbreak better in the future. You will know which interventions are most important.
  • Reducing your measures one at a time enables you to continue to monitor your cases. If they come back you know you need to maintain that intervention for longer and maybe step down others with a lesser impact first.
  • It tells you more about whether you have effectively dealt with your source without putting large amounts of people at risk again.
  • It stops you going all the way back to square one if you aren’t where you thought you were. You’ve worked hard to get things under control, so you don’t want to return to where you have an escalating scenario.

Stopping basically all of your public health measures in one go, masking, social distancing, most contact isolation etc without taking a staggered approach means that not only are you rolling the dice on your main intervention (vaccination) working in isolation, but also you are failing to gather the information you need to support staggered reintroduction of key control measures moving forward if it doesn’t.

Risk Assessment and Personal Choice

One of the things that has really struck me is that we are moving from a place where that risk assessment and risk reduction is guided at national level to personal assessment.

In many ways there is nothing fundamentally wrong with personal risk assessment. We ask healthcare staff to do this in clinical situations on a daily basis. What do I mean when I’m talking about personal risk assessment. In healthcare it could be something like: You are going in to take blood from a 4 year old child. Before you go into the room you might gather the following information in order to assess the risk and take steps to reduce it:

  • Is the child on its own?
  • Do they react badly to needles – are they scared?
  • Do you know the child? Do you have a relationship where they are more likely to trust you?
  • Do you have safety needles available to reduce the risk of a sharps injury?

The difference with the government approach to risk assessment and personal responsibility is that we are asking people to do this who are:

  • not necessarily used to undertaking this kind of assessment in relation to infection
  • not necessarily accessing the information/evidence to enable them to make such an assessment

It is hard enough working your way through the information and evidence that is related to SARS CoV2 even if it is your job. We are asking the entire of England to be able to do this with little or no support. The quality of information out there is highly variable and often not context specific to make it particularly usable. There is plenty of misinformation out there which could lead to individuals with the best of intentions making bad decisions.

Mixed Messages

This then brings me onto the mixed messages. The government is telling people to use the evidence to make their own risk assessments and then supporting events that are contrary to a lot of the information we are saying is important in making those risk assessments.

The evidence still shows that masks will be important in confined spaces or in areas with high people density. We are at the same time encourage events where people in their thousands meet without those measures included. You can say that the research events are there so you could obtain data to improve future measures and risk assessments, although when only 15% of those attending complete the post event testing the outcomes become dubious. Outside of the research events however, large numbers of people are gathering in public settings, such as Trafalgar and Leicester Square, with no testing or monitoring. These events cannot be said to support the same goal.

It is not rocket science that combining alcohol and emotion can lead to the abandonment of key sections of the risk assessment process.

One of the other things we need to talk about is that personal risk assessments are fine, but in this particular circumstance your risk assessment and behaviour directly also impacts my risk. Mask wearing is about protecting others, so if you opt out of wearing a mask and I wear mine, I bear the brunt of your decision.

We are also not talking enough about how the knowledge linked to vaccination may impact on risk assessment. I know a lot of people who feel like SARS CoV2 doesn’t impact on them any more because they are double vaccinated. In healthcare we are seeing a lot of people who are still getting pretty unwell despite their vaccination status. They are not hospital unwell, but they are still pretty unwell, can’t get off the sofa unwell. They are also still able to pass on the virus to others in their household, at work, or elsewhere. Some of the people then exposed will not be able to have the vaccine, such as children or those with certain underlying conditions. They can therefore still get very sick. Again, the transmitter may not experience such extreme personal consequences but they can cause them for others.

The government messaging doesn’t strongly support prevention of harm to others. Personal choice makes it sound all about the person. A pandemic response however is about as much of a group effort as you can imagine mounting. Personal choice undermines all of what we have been trying to message and removes that shared responsibility.

If we are truly serious about supporting individuals to make their own risk assessments then we need to do a much better job of giving them a framework and high quality information in order to make it. We also need them to understand the consequences of making an incorrect risk assessment. I have no answers on this one, just anxiety and fear about where the current approach is leading us.

All opinions in this blog are my own

What It’s Like To Know Too Much (Whilst Still Not Enough): The Difficulties of Having Health Conversations Outside of Your Day Job

girlymicro Microbiology (Clinical), Science Communication

This week’s post is about some of the challenges of having healthcare conversations when not in a work context. With increasing frequency I get asked to give medical advice and guidance in social settings, often indirectly: i.e. being asked not by the affected individual. When I’m talking about conversations today I’m not talking about the ‘I’ve been prescribed X antibiotic what does it do?’ queries. These kind of queries are about giving information and signposting, rather than diagnosis or critical review. The conversations I’m talking about here are the, ‘my aunt has just been diagnosed with pancreatic cancer, can I send you her biopsy picture?’ type of dialogue. I’m writing this because sometimes, when I back out of these more significant conversations, I worry that it can come across as showing a lack of interest or as being callous and uncaring. The opposite is true, but there are constraints as to how much I can become involved. And some very good reasons why it might be inappropriate… I thought it might be good to share.

First things first. I’m not a medical doctor, I’m a Healthcare Scientist with a PhD and the same post-graduate qualifications as my medical microbiology colleagues. This means that I am qualified to give advice within specific confines linked to infection and infection control. I do not, however, have their broad breadth of experience or – therefore – associated expertise outside of this area. I think it’s really important to be aware of professional boundaries. That said, compared to many members of the public and due to working in infection control (which sits across subject areas), I have an awareness of healthcare linked to a number of disciplines. I thought it was important to write this here because I think if you work in healthcare this delineation is taken for granted. We often forget it’s not as clear to those who don’t.

Are You Talking to Dream or Dr Cloutman-Green?

Many of you who read this blog regularly will know I go by four main names. My friends have called me Dream since I was a teenager, as I was always day-dreaming and walking into things. I get called Elaine by work colleagues and, when I’m in trouble, by my family. My brother and sister have always called me Laney when they are not mad at me. Then there is Dr Cloutman-Green, who you’ll meet in a professional context.

Now I’m no Beyonce/Sasha Fierce, but I do think that there is some context-specific nature to the way I engage with the outside world. I try to be authentically me no matter what context you engage me in, but Dream isn’t the same as Dr Cloutman-Green. Dream drinks shots, enjoys trashy TV and has been known to dance on the odd table. Dr Cloutman-Green deals with making significant and serious decisions all day, everyday, and so has to deal with a fair amount of pressure and stress. As Dream, I do my best to leave that at the door when I come home. It is always quite jarring when Dream gets asked questions and is involved in conversations that are in Dr Cloutman-Green territory.

How Much do You Really Want to Know?

The main issue with Dream having conversations that would normally be had by Dr Cloutman-Green is that Dr Cloutman-Green has access to all kinds of information and resources that Dream doesn’t. Examples of these are when you get called up by a friend or relative asking if they can send you photos/tell you about a friends medical condition. One of the cornerstones of professional practice is understanding when you don’t have all the information and when you are stepping outside the scope of your experience. If I have those encounters in my day job, I have access to medical records, expert colleagues, test results and the ability to recommend follow up investigations. As Dream I have access to none of those things, as well as second hand information given by someone else without knowledge of individual consent.

The other reason that these conversations can be challenging is that you may be aware of the potential serious outcomes of the information you are being given for the individual without the information to determine likelihood. For instance, I am aware of poor outcomes associated with certain cancers. If the person involved has not been prepared for that conversation by their medical professional, or if the conversation has happened and they have not been able to process. Is it appropriate for me to wade in, unaware of the complete story, in what is the professional remit of another healthcare professional?

Finally, if the news is not good there is a reason that these conversations are undertaken by a healthcare professional with some distance from the situation, rather than your friend/relative. Emotions can be targeted, whether justified or not, at the person delivering the news. There is a reason we talk about ‘don’t shoot the messenger’ and ‘being the bearer of bad tidings’. Being involved in these conversations, whilst not being so involved as to have all the information, can result in permanently changed relationships on both sides. It strikes me that in these circumstances I should mostly be there to signpost and support as a friend, not acting as their medical professional.

Having laid out my rationale you would have thought it would be fairly simple to keep these worlds siloed, but it isn’t. These conversations are often sudden or sprung in unusual situations where you’re not expecting them and, therefore, take time to adapt and respond to. Hence the fear of coming across as distant.

But I Thought I Was Just Here to Party?

Stepping away from the more serious conversations, there is just one more setting where I find this topic difficult:

The Art Of Parties.

Now I work in a paediatric setting and so, understandably, many people want to talk to me about paediatric infections. That sits well within my ball park of expertise. There have been occasions, however, that despite this, and the situation not requiring serious conversations, I’ve not wanted to engage. I was once invited to a party (it was supposed to be child free) and when I arrived, apart from my husband and I, everyone there was a family unit with kids in tow. That’s fine – I’m OK with that. As the afternoon/evening progressed, however, I became progressively less happy. I was basically on a conversation carousel of parents who wanted to talk about herbal remedies for their kids cold, whether the fact that their child had had three colds that year warranted paediatric referral, or whether vaccination X should wait because of their trip to Y. After 6 hours I had managed not a single Dream conversation. Nothing on a non-healthcare subject. Not one conversation about movies, books, geekery or the things I enjoy talking about outside of work. Not only that, but because I kept being pulled into these conversations, I felt less and less like I was at a party and more and more like I was work.

When all is said and done, I expect to talk and love talking about science, medicine and my day job. After all, I have the best job in the world. There are just also times when I need to talk about things that aren’t linked to these. I struggle with small talk and therefore really don’t help myself as sometimes (well quite often) my work is all-encompassing. It is therefore frequently my own fault and actually just a way that people use to try and connect with me. It’s something I need to work on. If we do meet in a social setting though, please talk to me about tea, cake, your favourite novel/film/TV show and help me be Dream/Elaine rather than Dr Cloutman-Green. I’m keen to know more about you.

Also, if we meet and you do want a serious health-based conversation, understand that, if I don’t fully engage, it’s not because I don’t care about you. It’s because I care about you enough that I want you to have medical advice from the person who has access to all the information and resources to take the best care of you, your healthcare professional. Also know its because I value you and our relationship enough that I don’t want to risk it being damaged by changing the context of that relationship to something that should be more distant and professionally limited. I’m still here for you, and I still want to support and signpost, but let me be your friend rather than your Dr.

All opinions on this blog are my own

Talking About the Taboos: My Journey to being an ‘Obstinate Headstrong Girl’ Whilst Working in Science

girlymicro Academic Life, General, Microbiology (Clinical), Microbiology (Research), Research/Academia

I’ve had a few encounters recently that have led me to write this blog. I’m not writing it as an expert; This isn’t anywhere near my field. I’m writing to share my experiences and learning in case it helps others. Apologies, as it’s not a short read.

I’m challenged by some people I that I’m too worried about raising the profile of women in science, of talking too much about ‘female’ issues, and of challenging my colleagues too frequently. A really respected mentor once said to me that he didn’t think actions against women in the workplace still happened. I shared some stories and pointed out that they still did, they just didn’t happen to him, where he could see them or when he was paying attention to them. I count myself lucky that nothing really serious has ever happened to me at work, but I shouldn’t have to count myself as lucky: they just shouldn’t happen.

I have another post brewing about everyday sexism in the workplace, but this one is different. This one is about why I set out becoming the ‘obstinate head strong girl’ that I aspire to be!

I finished my undergraduate degree in 2002 and spent a year working before returning to undertake an MRes. This was my first experience of full-time ‘proper’ work. I took a six month temp contract for a council, working in their business development office. It was a mostly male floor, supported by myself, two other part time admin staff (both female students) and a lovely older lady who managed the team. My job was to support the officers in tasks such as typing up letters. Yes, they wrote by hand as some of them still didn’t know how to use a computer; I also ran reception, took minutes, that kind of thing.

The Problem is that You are Too Friendly

I’d been there about a month when I was in the post/stationary room stamping that day’s mail. One of my older male colleagues came up behind me and stuck his erection in my back and grabbed my breasts. I stood there, stock still, in complete shock. I didn’t know what to do. These things didn’t happen to me: I was the nerdy girl not the pretty girl, I had no experience of how to handle this kind of breach (I am not implying that pretty girls should know, or have to put up with this either). After what felt like hours (but was more likely a few minutes) where he spoke to me about what we should do next, I shoved him away and ran out of the room.

I went to my boss, the person responsible for me, and told her what had happened. She said she would speak to her boss, who also happened to be the boss of everyone on the floor. I recovered from my shock and got angry whilst I waited, but I was sure there would be censure and we could all put this behind us. She came back and we talked. She explained to me that I was overtly-smiley and chatty with my colleagues. This could be misconstrued and, in future, I should probably just take steps to not be alone with the man that had done it. That was it. The married man with multiple children could do what he wished as it was my friendly demeanour that was the issue.

I spent the next four months being hyper-aware of when I could go into rooms on my own, to be friendly, but not too friendly. As my contract end-date rolled up, I experienced a similar repeat performance from the same individual. It wasn’t as bad this time as I had learned from the first event, but I just couldn’t let it go. What if he went further with someone else, what if he did it to someone else who wasn’t in the privileged position I was in to ‘let it go’. On my last week with the council I emailed HR directly to express my sadness over the way the situation had been handled. They told me to get a cab down and speak to them. I did. I recounted the event, the way it had been handled, the way I felt. The guy got suspended on full pay whilst an investigation was undertaken. I was called back in to repeatedly account for the event and my actions. It was determined that as it was my word against his nothing could be done. I learnt early that even when people listen, accountability is not always the result. No policy was changed. At least the guy had a note on his record in case he did it again so that it was no longer the ‘future girls’ word against his.

I’m ‘lucky’: that was the worse thing in a workplace that has ever happened to me. We all the know of the labs where you wouldn’t apply to work at because of the way the PI behaves, or the ‘expectations’ placed on the post docs if they want to advance. It didn’t interfere with my progression. It did, however, teach me an important lesson about the importance of bystanders. However annoying the bad behaviour of the individual was, the worse thing for me was that the people I trusted and who held responsibility for my safety at work chose to make it about me being too smiley, rather than address the action of the person who had breached barriers and made me feel unsafe. I swore that I would never be that bystander and I would support others so they would not feel as alone as I did in that workplace.

The Problem is that You Are Not Friendly Enough

Roll on some years and I’m now working as a scientist with a part-time academic contract. I’ve learnt the lesson taught to me about not being too friendly, about boundaries at work, about always keeping it professional so my actions couldn’t be used against me. I’m working as the only microbiologist on a research project. The PI on the grant begins to spend a lot of time with the other female researcher. Late night drinks, wine in the office, that kind of thing. I stick to my guns about being valued for what I can add to a project: that doesn’t require me to be available to have drinks with the boss at 9pm. Suddenly, protocols are written that are not technically appropriate, papers are written without a standard authorship order, and presentations and conference trips are handed on the basis of time spent with the PI. When queries and issues are raised, I’m now told that I’m not committed enough, not friendly enough, I’ve not invested enough in building relationships outside of work structures. Unlike before, my future is impacted because I have not walked the tightrope of being approachable well enough. The difference this time is that, although I cried, I simultaneously empowered myself to leave by looking for funding to support an exit. Again, I was fortunate enough to have a way out, to be a clinical academic rather than academia being my only option. I had also started to learn the power of finding my tribe, and making sure that I always had support from other embedded around me. This enabled constructive challenge of my perceptions, but also assurance when things went awry.

Why are you Reacting to Such Little Things? It’s only people being friendly/joking

I’ve now been working as a scientist for 17 years. Issues crop up less frequently the higher you climb up the ladder. However, when they do they always feel like high stakes. I’m no longer in a position where I could easily find another post, co-applicants on grants are harder to switch around as the world we inhabit is small, and relationship building is a key part of my role. So do things still happen?

Sadly, the answer is yes. The thing that makes the incidents happening now worse, in many ways, is that they get laughed off as being linked to me being overly sensitive. I still try to embody the friendly girl I was at 22 without opening myself up to unwelcome physical acts at work. I have, however, on 3 occasions being kissed full on on the mouth in unsolicited encounters with male members of staff. None of it threatening, like when I was in my first job, but still unwelcome. Blocked doorways that, as you’ve tried to go through, have resulted in a facial assault because ‘its Christmas’ or because it’s someone’s ‘last day and they just want to say thank you’. I’m by no means prudish but the only person who gets to kiss me on the mouth is my husband! Uninvited physical intimacy is just not OK. It always comes as a shock and it always takes me back to being a 20 year old with no coping mechanisms standing in a post room.

What happens most frequently however are the comments. Just before the pandemic I was in Paris at an academic meeting. The organiser forgot to book my second night in the hotel. I’m sitting there in a room full of senior male academics at the dinner when the organiser came through and said I had no room. The most senior man in the room responded by saying ‘don’t worry about booking her in the extra night, we’re in Paris, there are more than enough brothels where she could go and work in’. Every man in that room laughed. No one called him out, no one indicated that the comment was humiliating and inappropriate. I didn’t know what to say and so sat there in silence as they laughed away. This isn’t a one-off event. The ‘little ladies’, ‘sweethearts’ etc. may feel innocuous enough but are too frequently used in conversations to undermine women in the room. That’s not to say I’m anti-endearment. I have plenty of colleagues where we have built up relationships over the time where I welcome this reinforcement of our relationship. It is different to do it when your relationship capital doesn’t justify it, or when you are doing it in order to enforce power or hierarchy.

So why have I written this post? I want to let people know that these behaviours happen. It’s unwelcome and it’s not up to the women involved to modify who they are in order to not tempt others to behave badly.

Here, therefore, are a few of my thoughts about how we can all act differently:

  • Don’t be a bystander! Know that if you are in the room you have a duty to act as the impacted individual may not be in a position to do so.
  • Find your tribe so you have support for when (and hopefully if) these events occur.
  • Talk about your experiences so that we can raise awareness, share learning, lead improvements and, most importantly, so others don’t feel alone.
  • Know that you have more power than you feel like you do. There are people out there who are ready, willing, and able to support you.
  • If someone comes to you with their story remember that you have a duty of care. Don’t brush things under the carpet because it is easier to do nothing than deal with a situation.

Finally, to all my obstinate headstrong women out there who are standing up and challenging, I applaud you. I appreciate all you are doing now, I appreciate the fact that you are leading the way and that you are members of my tribe. To all those who consider me difficult for calling out these situations when I see them, I understand why I make you uncomfortable, but I have no plans to change. In fact I plan to grow into this role more. In my opinion we could all do with a channelling a little Elizabeth Bennett from time to time.

All opinions in this blog are my own