Pam, can you describe a ‘typical’ week?
My average week contains one or two operating lists, one of which may be a day-case list. It is my routine to visit the 2 or 3 major cases on the ward, either the afternoon before, or the morning of their operation (in the case of an afternoon list). This is to confirm the planned procedure and answer any last minute questions that may have arisen since the last out-patient visit.
The mainstay of surgical assistance is provided by the registrar who is training in the specialty. Most of the operating is done by the consultant in my hospital. Cases selected for the registrar are closely supervised as necessary.
Out-patient clinics overall and the letters generated from them take up well over half my working week. Subspecialisation is increasingly a trend in medicine. My interests are in the fields of uro-gynaecology and colposcopy.
The obstetric component of my job is relatively light. There is just one regular antenatal clinic per week with a small commitment to outlying clinics taking place once or twice a month. My on-call rota is 1 in 3 and often involves being on at night and weekends with a GP trainee SHO.
The working week inevitably involves tasks of an administrative nature, attending committee meetings, audit meetings, liaising with staff of other departments and so on.
What do you dislike the most about obs and gynae?
By far and away the top of the dislike list is getting up at night. Obstetric problems can often be anticipated some hours before the crisis. You might go to bed later, or even sleep with half an ear open in that case. A phone call may sometimes be for advice or to give important information. However, the call that requests immediate attendance on the labour ward at 3am on an icy cold winter morning takes some beating!
The disturbed nights sound painful! How do you cope with them?
Of course there is satisfaction in a job well done - the resolution of a fraught situation by operative assistance of a difficult delivery. There are the wonderful skies as dawn breaks on our way back home on a summer morning. Unfortunately there is usually a full day’s work waiting in a few hours.
What do you enjoy about your job?
I enjoy the flexibility and variety of my job. No one day is ever quite the same as another. Although there are fixed commitments there are also windows of opportunity in the weekly timetable where one can escape for an hour or two. I do not have a regular half-day as such, nor a day-off during the week.
As well as job satisfaction in the treatment of patients, there is also the enjoyment of good working relationships with colleagues. Some are obviously easier than others, some can lead to genuine lasting friendships and opportunities to share one’s faith naturally.
Obs and gynae seems to be a mine-field of ethical dilemmas for Christians. What issue do you see as most pertinent?
Abortion is the over-riding issue to be sorted out. The 1968 Abortion Act contains a Conscience Clause which enables us to opt out. Most consultants respect the views of their juniors and day case work is increasingly consultant-based anyway.
Does the system discriminate against Christians?
There are guidelines for the way consultant posts are advertised and interviewed. However, realistically we have to accept that it is likely that holding anti-abortion views may occasionally go against us.
What do you do when facing the abortion issue?
In obstetrics prenatal screening may detect fetal abnormality. Termination may not always be the parents’ choice - but it usually is. After appropriate counselling such patients under my care are generally transferred to one of my colleagues for their abortion.
What other ethical problems pose as contentious issues?
Ethical problems arise in infertility treatment and in particular, assisted conception. The chief problem area concerns the status of the human embryo. Does it merit full protection, or is it disposable?
Certain contraceptive methods are known to work in an abortifacient manner. Newer treatments such as post-coital contraception and very early medical abortion with mifegyne (RU 486) are more clearly aimed at destroying early human life and raise the same questions as assisted conception and abortion.
How does one become an obstetrician or a gynaecologist?
Registrar and senior registrar posts have been replaced by the SpR (Specialist Registrar) grade. Trainees are now given a number and normally are assured of more structured progress through the next five years. It is usual for Part 2 of the MRCOG (Member of the Royal College of Obstetricians and Gynaecologists) examination to be gained during the first couple of years of SpR posts.
Training requires maximum emotional and physical commitment. Although increasingly junior doctors now live out, the nights on-call are definitely in residence with immediate access to bleep and phone. Rotas of 1 in 2 and 1 in 3 were commonplace but it is now more likely to be 1 in 4 or 5. Shift systems, either full or partial, operate in larger units.
The MRCOG is the only post-graduate qualification absolutely necessary although it is common to also have an MD (Doctor of Medicine) involving a research project. Once training is complete the candidate is awarded the Certificate of Specialist Training (CST) and is now fully accredited. Applications for a consultant post may now proceed.
Are there other areas of medicine in which a background of obs and gynae is useful or appropriate?
The Diploma of the Royal College of Obstetricians and Gynaecologists (DRCOG) is suited to those in general practice. There are opportunities for doctors in areas such as family planning and genito-urinary medicine at sub-consultant level. Consultant posts in community gynaecology are being developed.
It sounds like a very arduous training programme. Is there any hope of life outside obs and gynae?
Traditionally hospital medicine and normal family life have not mixed. Job insecurity during the training years combined with strenuous on-call duties take up around ten years of your life, mid-twenties to mid-thirties.
Do you think any differences exist between men and women wanting to progress in this field?
Some doctors elect to stay single until the future looks more assured. For men this may not be a problem, but for women it is. Does she marry young, have children and then get on with her career? Or does she find herself well on with the career but alone towards her late thirties with the biological clock ticking away?
It used to be said that a woman needed to be that bit better than the men to get the jobs and succeed. That is less true today. All the Colleges are making efforts to recruit women into their respective specialties. There are now opportunities for part-time training and part-time consultant posts.
Apart from part-time commitments as an option, is there any room for flexibility whilst training? For example, doing sabbaticals or going abroad?
The hospital career structure is moderately inflexible. It is probably best to take a break abroad either before the serious training or after. A year or two in a developing country could enhance the CV. The elective year required for MRCOG may be spent abroad, provided the unit has recognition by the College. Once specialist training is complete the doctor has more to offer by way of ability to train others. Again time could be taken out before settling into a consultant post in the UK or seeking a more permanent overseas position.
Can you tell us about your Christian calling into obs and gynae?
My calling into obstetrics and gynaecology was step by step through various jobs rather than a dramatic event. My early calling at medical school was as a missionary. I had an overwhelming interest in South America, which then focused down to Peru.
Originally it was a long term commitment though I saw the possibility of returning to the UK later. After qualification (in Cardiff), various housejobs and a short GP locum, I realised that I preferred hospital medicine; and surgery rather than medicine. Before I went abroad I spent a year at Bible College and also passed the Primary FRCS (Fellowship of the Royal College of Surgeons). When I came back from Peru two and a half years later I was in a good position to complete the FRCS.
There were few female surgical role models in those days and as I looked around I decided I did not want to stay in general surgery. My interest in gynaecology grew as I recognised it as a surgical specialty and one where more women were needed.
What has been the most difficult aspect of your career?
I did not set out to be a ‘career woman’ and if marriage had come earlier I would have been quite happy with a sub-consultant grade. The most difficult hurdle was getting a senior registrar post - not only was I female, but I did not do abortions! However, by then I was aware that God did indeed want me in this speciality and in this country.