Dr Nagore Penades

Dr Penades is a consultant general adult psychiatrist at NHS Greater Glasgow and Clyde, as well as a Partnership Research Fellow and Mental health e-health lead.

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 Penades' story

I completed my medical training in the Basque Country, and thanks to the support of my consultant supervisor during my psychiatric placement, I decided to come to the UK and gain access to structured broad-based training.

As a non-native English speaker with no experience of living abroad, no contacts in the country and not much postgraduate experience, the challenges were many. A nine-month period in London was enough for me to realise that I needed access to the countryside and water to maintain my sanity. There were, of course, romantic notions that go with beautiful Caledonia that drove me to apply for posts in Scotland.

I started my rotation in NHS Forth Valley at the turn of the century, February 2000. There were many challenges both at work and in life, but I had so much help along the way that I cannot say that I did not enjoy it. I will never forget Laura, an HR assistant whom I never actually met in person, but who helped me find accommodation, transport and even gave me night out recommendations in and around Stirling. I mean…there is no price for that, is there?

This more-than-excellent welcome was supported by a postgraduate tutor who was himself an international graduate and understood first-hand the challenges that were involved. I really could not have had a better start to my career and cannot thank those whom I worked with in my early days enough. From consultants to domestic staff, everyone made me very welcome and part of the team, and I was never made to feel an outsider. I can honestly say that being a woman never, that I was aware of, added any extra challenges or barriers to this incredibly formative part of my life and career.

While I had originally considered coming off the training ladder to look for a specialty grade position to prioritise my work-life balance, it was my second postgraduate tutor who encouraged me to apply for a higher training post. She was a great example of a strong overseas graduate woman who had a brilliant career and good work-life balance. This encouragement was supported by many others within the wider Forth Valley Mental Health family. I am still really grateful to all of those who rallied round to be part of the mock interview panels. That was nerve-racking and hilarious in equal parts!

When I started my higher training rotation within the West of Scotland Deanery, I was excited but very apprehensive. I was now a small fish in a very big and deep pond. But….once again I could not have felt any more supported. My impostor syndrome started to leave me slowly but surely, and within a few months I felt very much part of the new team and rotation. I would like to clarify at this point that the impostor syndrome did not have anything to do with my gender.

However, a few months later when I decided to start a family, I did worry about what people would think about my commitment to training. If they had any issues, they hid them very well because I could not have felt any more supported. This went on until well into my consultant post and the arrival of my second baby. I can very openly say that my gender or choice of starting a family never made me feel disadvantaged or judged in any way at this stage.

Fast forward a few years, to when I started work in clinical research and became a partnership researcher with protected weekly sessions. It really struck me how little female presence there was in senior positions. From my perspective, once again, I did not feel disadvantaged or unsupported, but was aware of at times being the only female Principal Investigator or expert advisor on advisory panels. It was first during an investigators’ meeting that I had this, should we say not the most pleasant realisation, that the senior medics in the room were male, the nurses and research assistants were all female, and then there was me! At the next meeting I dared to turn up with a male research nurse. Funnily enough that made people notice.

As time went on, I started to realise that this could easily be due to longstanding biases that occur much earlier in people’s careers. For example, at the PhD stage. Who is more likely to have a PhD in a couple where both are graduates and they have a family? I do not have literature review or randomised controlled trial level evidence to support this, but I would say that the male in the family is more likely. Sadly, I think this might have become acceptable as “the way things are”. There are implicit biases that we don’t even notice anymore, but they are the start of inequalities evident at later stages - and that is the worry, isn’t it, the acceptance of this as the status quo?

I think I speak for many of my colleagues, of all genders, when I say that when asked to picture a Professor of Medicine, the majority would picture a male of certain vintage. The only way of changing this will be to ensure that we make it very clear to our younger colleagues, from medical school stage, that their gender should not be the determining factor when choosing career options. When I was growing up as a female in a working-class family, it was always emphasised to me that it was important to keep working hard to succeed when I came across obstacles. I am proud to be achieving success in a male-dominated field, and I hope my visible presence will encourage others to keep all career options open to them and to follow their passions.

As somebody who has started to get involved in e-health and digital medicine in recent years, I have been struck by how similar my experience has been to that of the academic field. I have been involved in the development of medical mobile applications and health data systems for over six years now, and the female medical representation is not representative of the wider workforce at all. Any female medical e-health leads out there?

I have recently been appointed as the Mental Health e-Health Lead on my health board. I hope to bring digital health to our everyday delivery of care, as well as supporting digital literacy of staff and patients. This is a new field, so please let’s make sure from the beginning that we do not work with the same hidden biases. We need to destigmatise part-time PhDs and postgraduate further education, as well as supporting our female colleagues who show an interest in academia and digital mental health, at every stage of their career.