Dr Cole is a consultant general adult psychiatrist, now Lead Clinician, NHS Practitioner Health. She is one of 25 women to be highlighted as part of a special project that celebrates the stories of 25 amazing women psychiatrists.
Dr Cole's story
My initial ambition was to train toward a career in General Practice. After my first post-qualification year in house jobs, I spent six months doing A&E, followed by a six-month post in psychiatry at the Whittington Hospital. I really enjoyed the collaborative working and psychodynamic approach encouraged in the day hospital, and even the acute and out-of-hours work. Being able to spend time to get to know and understand an individual appealed to my natural curiosity. I had found my niche, but for unclear reasons had not yet considered the option of joining the psychiatry rotation aligned to the post. That is, until my supervising consultant and a professor suggested I should apply; and so, I applied.
Any stigma experienced towards the profession, came mostly from outside of medicine; I remember being told on several occasions, whatever you do, don’t do psychiatry. Prior life experience did not influence my decision to enter psychiatry, but influenced the approach to how I worked.
The plan was always to train in General Adult Psychiatry and work within an inner-city community setting – to be a first-rate clinician and provide sound clinical leadership. At no point did I veer from this. Following my appointment as a consultant psychiatrist, I later became more interested in medical management, where I could use my clinical insights and research experience to influence how mental health services were delivered. I took a broader view of mental illness; I considered that understanding an individual’s personal and social circumstances were central to how care could be delivered. This led to collaborating with the third sector and volunteers, developing local services that responded to local need.
On reflection, a lot of the positions I found myself in had their origins because of conversations held which opened up opportunities, alongside my being genuinely keen and enthusiastic – and credible. I offered to volunteer to assist with other projects, which meant working beyond my original remit, but doing so in areas of interest to me. This led to undertaking research, securing funding for service innovations and becoming a member of a funding body.
I did not have the challenge of being located far from the networks that sustain me. I knew I wanted to live and work in London, where I have lived for most of my life. My schooling, medical undergraduate education and psychiatric training all took place in London. As a Black British female in those days, I wanted to work and live in a geographical location where I felt comfortable and had good ties. Knowing this, I increased my prospects of a consultant post in London after MRCPsych by undertaking a lead researcher post for a First Episode Psychosis Study in North London. The study explored the over-representation of incidence of psychosis in minority ethnic groups with negative care pathways, which remains topical today. Interviews with patients, carers and staff realised valuable insights, such as the importance of the quality of engagement, especially in the early stages of illness and contact with services.
General Adult Psychiatry is well known for having no boundaries in terms of the workload. I was able to maintain a good work-life balance when I only had the responsibility of providing clinical leadership to a team. This I did by having more of a supervisory role with my team clinicians rather than a heavy personal caseload, working collaboratively with my team leaders in each post, and “bonding” experiences with the team such as going to the pub, other team building activities and shared learning. Most teams I have worked in had facilitated staff support groups. Relationships, having a few personal rituals that mattered, and music lessons, all brought pleasure, freeing my mind from the day-to-day work. I also had paid help in the home.
Occupying medical management and leadership positions was more challenging with respect to work-life balance. There was the additional responsibility and accountability for a wider service and line management of consultant colleagues. Things worked well when I had clarity about what the priorities were for me in my specific role. They worked less well when I found myself being all things to all people. Delegation and saying no was necessary, but was easier said than done! I had confidantes to whom I could speak and offload, both within and outside the Trust. With hindsight, if I were to take on a medical management position now, I would reduce my clinical work to release more time for management activities. I was probably thinking I needed to retain as much clinical work as I did in order to maintain clinical credibility among my consultant colleagues. There is much more to being a good medical manager beyond being a sound clinician. These days more attention is given to development as a medical manager through coaching and other development activities. I did benefit from some coaching sessions provided by my Trust.
My husband and I both worked in the same Trust and clinical directorate. An advantage was that it made it easier to agree where to live. I am confident that we got our jobs done despite being a couple. Maintaining integrity and the confidence of staff was essential, and we did not spend time cooing all day. The real challenge was how this was perceived by others. As I was clinical director for the same department he worked in, responsibility for his line management was instead delegated to the Medical and Service Director. The majority of our colleagues were positive towards us. We made it work, and any difficulty was far outweighed by the advantages of working in the same Trust.
It can be difficult to admit to having a hard time. I never lost the ability to be empathic, creative and to derive pleasure from my work. However, at a point some seven years into being a consultant, I knew I needed some time out, and took a six-month career break with half-pay, doing non-clinical audit work. The audit formed the basis of an innovative assertive outreach service that better served the local population. You realise that it does not have to be a sprint. Your life outside of work needs as much attention as your life within work. Some of these lessons have been conveyed to trainees that have either worked with me directly, or connected with me in my former role of holding responsibility for flexible trainees. There are better opportunities now to do less than-full time work.
I am proudest of the fact that I was able to remain a general adult psychiatrist despite the activity and emotional demands of the job. I was able to deliver and develop innovative, quality, mental health services to an inner-city diverse population at consultant level for 20 years (1996 to 2016). I subscribed to the role of consultant as clinician, manager and leader, and worked collaboratively within my Trust and other agencies. I found new solutions to ensuring sustainable services – developing an assertive outreach team with new cadres of staff, a Befriending service for individuals of African and Caribbean descent and a Clinical Decision Unit to support our crisis care pathway, among other initiatives. I was able to support numerous medical and non-medical staff in furthering their careers.
I am currently one of several Lead Clinicians in an award-winning mental health service that supports doctors and dentists (NHS Practitioner Health). I would like to think, for most patients, I have been part of making a difference in their lives, reducing their emotional distress, and supporting their ability to remain in, or return to, work. This has indeed been a privilege.
My career in psychiatry has given me much more than I expected, but there is still space to apply my experience and skills further, and I continue to explore.
Finally, I would like to thank the psychiatrist who nominated me as one of the 25 Women and wish them the very best for their own future career.