Dr Duncan is a Specialty Registrar in adult liaison psychiatry at NHS Greater Glasgow and Clyde. 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 Duncan's story
I am a higher trainee in psychiatry in the final year of my training. I am 49 years old. These are two sentences I never thought I would write.
My plan at medical school was to become a GP. I had no exposure to any other medical specialty – I don’t come from a long line of doctors – and I had worked in the local GP surgery whilst at school. The things that made it interesting for me were the patients, the relationships with the other staff, the families and the community.
So, I suppose looking back, it probably isn’t surprising that I have ended up in psychiatry.
Sadly, my first year of work in house officer jobs felt like a form of torture, with very long hours and a lack of support and mentoring. I was totally unprepared for the realities of the work. I applied for psychiatry following house jobs in the hope of more connection with patients and a more supportive work environment. Again, I was probably too young and unprepared for the distress of the patients and the day-to-day realities of the work. Added to that, I was in an unhappy relationship, and my career in medicine almost came to an end.
In a way, it was the end of that relationship that spurred me on. I returned to my home city and took a locum post with a fabulous team in a local adult Community Mental Health Team (CMHT). I had a renewed sense of purpose and a plan to complete exams and training. This time I knew what I wanted to do.
I became a trainee psychiatrist within the north of Glasgow, and outside of work got married to a lovely man. Then I was pregnant. I applied to the flexible training scheme, even then a competitive process. My plan was still in place. What I hadn’t reckoned on was the amazing, overwhelming love I felt on the birth of my daughter. Suddenly, going back to work, doing on-calls and being away from her overnight didn’t hold any appeal. That combined with the huge changes a baby brings to life, not to mention a little bit of post-natal depression, meant I took a part-time staff grade job. The staff grade post was one way of being able to continue in a career in psychiatry without the longer hours and on-call commitment of a training post.
I was able to see patients in the community and build up longer-term relationships with both them and the team in which I worked. In a way, this was an insight into what life might be like as a general adult psychiatrist. Over the years I was in this post, I gained confidence and worked with high levels of autonomy and responsibility for patient care and management. From the perspective of work-life balance, it also meant having regular hours of work and being located in one place, something that isn’t always possible in a training post. Despite all the benefits of the post, I did still plan to return to training in psychiatry once my daughter was old enough.
Then I had another baby, a boy this time. Nothing in my plans changed until he fell ill. He was only four when one morning he woke up with involuntary movements; writhing and repetitive movements of his arms which just didn’t stop. He wasn’t especially upset, but I clearly recall phoning our GP in tears asking for an appointment that morning.
It turned out he had an unusual form of Sydenham’s chorea. Sydenham’s chorea is a neuropsychiatric disorder where the person can have obsessional symptoms, anxiety, poor concentration and sometimes mood disorders. These symptoms are less immediately obvious to others than the movement problems but can be the most difficult issues for the child and the family to manage. This is certainly my family’s experience.
For the next five years we saw a variety of specialists in the local children’s hospital. I continued to work in psychiatry, but at this stage with the pressures at home, I had no thoughts about exams or career progression. I have never experienced anxiety like I felt when he was being investigated. I kept working, but the deadline for the validity of my Part 1 of the College membership exams came and went; without this set of exams fully completed, I would be unable to move back in training to become a consultant. I wasn’t even too upset by that at the time, as my focus needed to be on my son’s health. At times it felt as if I was doing neither job in the way I would have liked. Sometimes going to work felt as if I was being torn away from giving all I could to my son, and sometimes it felt like a welcome relief from the stresses at home. Taking time away from work during his inpatient stays and for clinic appointments was hard. While the immediate team I worked with was very supportive, staff more external to the situation were not always so understanding. Support from family, friends and also from other families locally was invaluable in bolstering my ability to keep going both at work and at home.
Later on, we were referred to the local paediatric liaison psychiatry team. The very lovely consultant in the team had a special interest in Sydenham’s chorea and was doing work with a group of affected families locally. There appeared to have been a spike in prevalence of a Group A beta-haemolytic Streptococcus that was causing a large number of cases of Sydenham’s chorea. My son was one of the youngest patients.
It was this consultant and his team that changed my mind about my career. They were simply inspirational in what they could do and how they helped my son. I wanted to be able to do something similar. Once he had begun to recover, a light switched on in my brain. I realised it would be very hard to become a paediatric liaison psychiatrist with my background at work being in adult mental health, but I could instead become an adult liaison psychiatrist and try to do a little of the type of work they did with my son.
This meant applying and studying for exams in my forties. This is not as easy as it sounds. My colleagues in the CMHT where I was working were incredibly supportive. I was able to take time to attend courses, see a patient under supervision from a local psychotherapist, and to complete the necessary training to provide evidence that I had the same competencies as the core trainees who would be applying for a place in higher specialty training alongside me. One of the consultants has remained an informal mentor even during my higher training. All of this was done despite them knowing that were I to be successful in my application to return to a training post, they would lose a long term member of the team; I had worked there for 14 years. I sat and passed one part of the membership exam per year for three years, and when I passed the CASC1 in 2016 it was amazing to me. Twenty-two years after graduating from university, I had done it!
I started back in a training post in 2017 on a part-time basis. During this period of time, an immediate family member was diagnosed with vascular dementia and sadly deteriorated quite rapidly in his abilities. For the first two years of training, I had the additional stress of travelling several times a week to share caring responsibilities for him. This was part of my reason for choosing less-than-full-time training. It was very challenging to once again have to balance this new role in my home life, whilst also participating fully in all the opportunities training brings. Covid has meant that I am one of many across the UK who cannot see their loved one in a care home in person, which is a sad and difficult situation.
My experiences of the last 20 years have led me to want to help and support my fellow trainees as much as possible. I am a Psychiatric Trainees’ Committee representative for local trainees in the West of Scotland and now the RCPsych’s Scottish Division trainee mentoring representative. I care deeply about the experience my colleagues have in training. I know that combining training in any medical specialty with 'life' isn’t easy. During the Covid pandemic, I have been especially keen to provide support, both practical and emotional, to other trainees locally. Exams, long hours of work, challenging clinical situations combined with a global pandemic mean that more than ever trainees need this support. Making sure there was an on-call bed and a box of snacks and drinks for the on-call room, and being able to do online CASC practice with pre-membership trainees are some of the practical ways I hope I have helped in the last year.
My wish is to continue to use my experience of a long road through training to help and support trainees through the rest of my higher training and beyond. During the move back into training, I have received much support and encouragement but I am aware that this is not always the case. When I first took on a staff grade doctor job, there was a sense from some colleagues that I had failed in some way, and perhaps an unspoken sense of not being “up to the mark” when it came to combining career and family life. I think there was also a degree of self-stigma along similar lines. Moving back into training was not an easy route to obtaining a CCT (Certificate of Completion of Training), and might have been a reaction to that stigma at some level, if not the main driving force behind my decision.
With the right support and encouragement, I think that non-training posts in psychiatry have many benefits to both the doctor and to patients. During my time as a staff grade, I was able to use almost all of my working hours in direct clinical care without as many of the managerial and outside responsibilities that a consultant post would involve. This made my working relationships with the team even stronger as their first point of contact when crises arose and advice was needed urgently. This was very valuable experience to have gained before returning to training. However, after 14 years in that role it felt like it was time for a new challenge.
I am proud of my persistence and being in the final stages of reaching a goal I have had for many years. Most of all I am proud of my family for their support in getting to this point. I have shown my children an example of what a woman can do in life, even when she doesn’t follow a traditional career path, and that age really is no barrier to pursuing your goals.
- Clinical Assessment of Skills and Competencies exam, which is the final exam of the series and allows doctors to enter further specialist training towards becoming a consultant in a branch of psychiatry.
Why Dr Duncan was nominated
We also include some of Dr Duncan’s nomination from her colleagues, Dr Gareth McGuigan and Dr Honor Lenaghan, both year 3 core trainees:
In the pandemic, Fiona found herself not only returning to training, but returning to being the first contact for the acute health needs of inpatients – prescribing insulin, reviewing fevers and potentially partaking in resuscitation for the first time in years.
But, instead of complaining, Fiona took the lead in identifying unmet training needs, organising refresher sessions, and advocating for the wellbeing of trainees at every level. I’m pretty sure she was single-handedly responsible for ensuring that all trainees had adequate rest facilities – and, on a personal note, was quick and ready to check in on colleagues and friends whenever she could.
Advocating for the welfare of colleagues can often go unappreciated; it is a difficult job that sometimes puts you at odds with decision makers. And, whilst undoubtedly appreciated by her colleagues, future trainees will never know her contribution to their continued wellbeing.
Despite the emotionally draining impact of family ill health, when at work, Fiona remains focused and devoted to her patients. Fiona is the sort of psychiatrist whom you would choose to have as a doctor, colleague and friend. She is an inspirational woman and an even more inspirational woman psychiatrist.