Dr Rupal Davé has recently completed her higher training to become a Consultant in the Psychiatry of Intellectual Disability. She is based in East London and is one of 25 women to be highlighted as part of a special project that celebrates the stories of 25 amazing women psychiatrists.
Dr Davé's story: The Every(wo)man – Just a good Doctor
“It’s my birthday in a week…I can’t believe I’m so old, I haven’t achieved anything!” she said with a laugh, as she stood at the platform. The silvery voice came from a young lady a few metres away, talking to a friend beside her. “How old are you going to be?”, her friend asked. “29! That’s nearly 30 and I have nothing to show for it!”. I smiled to myself, thinking how lucky she was to be in her twenties, with time to grow and to ‘achieve something’.
So here I find myself asked to write about my career, thinking, “I haven’t achieved anything unique or ground-breaking…I haven’t produced significant research, or been a director or a manager: why would anyone want to read this, when my experiences could be those of any and every ‘ordinary’ woman in medicine?”. In this respect, I hope that other women, particularly students and trainees, might relate to the challenges I describe, and feel able to share their own difficulties with their peers or supervisors.
At 21, during the first week of my psychiatry rotation at medical school, I remember hesitantly approaching the first patient to ask if she would mind talking to me about the patient journey. Nearly two hours later, our discussion was still going; this was in equal parts due to my feeling that I was somehow being useful just by listening, my interest in learning about mental illness by hearing someone’s experience, and my inability to interrupt a patient with hypomania.
The biology of all that was known about the brain, and the mystery of all that was still unknown about the mind, was fascinating. Sensitively exploring the complex interplay of biological, psychological and social factors, and their influence on an individual person’s presentation, is incredibly important, especially when working with patients and carers in the psychiatry of intellectual disability, a field where the challenges of both physical and mental illness are fully explored to understand symptoms and treatment.
Having sat on many an interview panel for medical school admissions, I know I’m certainly not the only person drawn to studying medicine at 18 due to ‘a love of science as well as an interest in people’. Ultimately, my love of the latter - hearing peoples’ stories, connecting, wanting to do what I can to help - exceeds the former, and so psychiatry was a natural fit. Some years later, at my Membership ceremony1, a quote summed up the specialty better than I ever could: “Psychiatry is the most scientific of the Humanities, and the most humanistic of the Sciences”. The trust that patients place in us, sharing their story and what may be the most difficult moments in their life, is a great privilege. Without a doubt, for me the interactions with patients and carers are the highlight of this job.
When I have had challenging points in my working life, I’ve tried to remember this simplicity of what I most love about psychiatry. The last few years felt a little tricky getting here. I applied for an Out of Programme Career break (OOPc) due to burnout halfway through higher training, at a time when requesting an OOPc was uncommon unless taking parental leave or pursuing other opportunities, such as research. It felt like a big step opening up and making the request; I didn’t want colleagues to feel I was no longer committed to my role or focused on my patients. I was grateful for the support of my Training Programme Directors and excited about the idea of a year to recharge. Unfortunately, early in the year out, parental illness meant that the OOPc year was very different from the one I had planned. I began supporting with carer duties, and on return to work after the OOPc, I commenced less-than-full-time (LTFT) training for the first time, initially working at 50% so as to fit around my new role as part-time carer. This was an eye-opener to the many challenges faced by part-time trainees, many of whom are women.
I struggled with work-life balance, including the organisational challenges of living in two places. It made me increasingly aware of the impact of my chaotic brain. My head, exactly like my laptop, has multiple tabs open in multiple browsers. A jumble of information means that ultimately the computer is slower, despite working twice as hard. Summarising information quickly is an ongoing difficulty that I had previously sought help with at university; combined with the perfectionist traits which seem to be especially common amongst female medics, this has always made administrative work a lengthy process.
After eight years as a doctor, I finally shared this with the workplace, though there were some delays in achieving the reasonable adjustments I needed. This combination of factors made me increasingly anxious and low. This was a difficult time, yet I was incredibly lucky to have the support of many positive role models - family, friends and colleagues. It was the support of other women, from all walks of life, that lead to me redeveloping my confidence, continuing to progress, and help with ADHD. Discussing it with the Practitioner Health Service, it was a relief to realise how common these types of difficulties are in female doctors.
Having read countless tips on new ways of organising tasks, ordering schedules and such, I’ve ultimately found that being open about challenges has made the greatest difference. When I have felt able to talk to colleagues, it has been really helpful to explain that I care a great deal about a task, and am thinking about it repeatedly, even though this may not be obvious from a tardy email. I’ve also found that working on projects with a ‘co-lead’ reduces my distractibility on any piece of quality improvement work, audit or conference planning task, with the added bonus of making the experience more enjoyable.
Across all medical specialties, it’s all too easy for trainees to compare themselves to one another and feel like competitors in a race. Given the small numbers of trainees in my specialty, all working in different services, it’s common that each trainee leads on a project within their own service. I feel lucky that my higher training scheme led to me connecting with trainees and multidisciplinary team colleagues who became firm friends. In recent years as an LTFT trainee, my most successful projects and roles have been those where each of us participating in a project contribute our own strengths. I hesitate to attribute key aspects of my personality to neurodiversity, but I tend to be able to engage with people and convey my excitability about a project quite well: what I lack in organisational prowess, I make up for in enthusiasm!
I think it is common in medicine that we define and value ‘achievement’ in terms of academic publications, presentations and prizes. In doing so, we undervalue the development of other skills that are a key part of being a good doctor. Every day, so many junior doctors go to work and give 110% of ourselves to doing the best for our patients. We encourage our trainees and colleagues. We teach, we audit, we work evenings, nights and weekends. We rotate every six months or one year, picking up and restarting anew. We are adults, yet we are juniors all the same. In psychiatry, we do it with a smile on our face, asking others ‘How do you feel?’ even when what we ourselves are feeling is so complex, and when there may be many things going on behind the smile. There is no space on an application form - for foundation, core or higher training - that would give us points for this because this everyday work of being ‘a good doctor’ is seen as a minimum baseline standard of competence. I used to worry about the fact I have only a single printed publication, a handful of presentations, and zero prizes. I am ‘just a good doctor’. But now I’m most proud of the moments that haven’t been published - interactions with juniors, colleagues and patients, and how I have maintained these relationships and the best standard of care I could provide, even when things were difficult.
As well as reminding ourselves of our personal strengths, it may be helpful to remind ourselves of our professional strengths, and take pride in them. In medicine, we sometimes forget just how valuable good communication skills - patience, tone, and body language - are, and how these seemingly basic skills are highly developed. As a foundation doctor, when I told seniors about my career choice, some joked I would be ‘wasted in psychiatry’. This was meant to be a compliment to my skills as a medic; in reality, I think I would have been an average gastroenterologist but a good psychiatrist. My cannulae skills were never exceptional and I never really figured out how to gauge the Jugular Venous Pulse, but as psychiatrists we can measure silence, interpret subtle shifts in gaze, and pick up on emotions that are unspoken.
In the last couple of years, connecting with peers and being open in sharing the challenges of training has made a significant difference to my working life. I’ve tried to build a culture of wellbeing in the workplace by contributing to a Trainee Wellbeing Programme at Barnet, Enfield and Haringey NHS Trust, lead by Dr Laura Korb, a peer who is herself an inspiring woman. I find yoga helps quieten down my noisy mind, and I share free yoga and breathwork exercises with psychiatry trainees and with patients. Supporting inpatients in a Forensic Service with accessible yoga practice, and adapting the practice to individual physical and mental health needs, neurodiversity and intellectual disability was a considerable challenge; it was also the most rewarding form of treatment I’ve ever prescribed. The majority of participants had never tried yoga before and yet eventually joined the weekly ‘Football and Yoga’ session. I found sharing a regular practical activity was really powerful. I recently completed higher training on a…high! Despite the natural fatigue of working on an inpatient ward during a pandemic, I was energised by the group work with patients and the support of a brilliant multidisciplinary team.
Having completed a Postgraduate Certificate in Medical Education, I’m currently undertaking the Postgraduate Diploma. I enjoy regularly teaching students & junior doctors and I’m considering how I could deliver teaching to a wider audience using an online platform; though I first need to get past my impostor syndrome! I’m especially interested in pastoral care and wellbeing support for trainees. If a trainee is struggling, it’s important to consider how much they may be juggling. In every extra ball they juggle, supervisors may begin to judge the ‘wobbly’ performance. In all likelihood, the juggler is finding the task overwhelming at times but still putting all their efforts into both the task itself, as well as their appearance as an effortless juggler.
Medicine is a field of many exceptional, high-achieving, inspirational women who seem to be ‘managing it all’. However, just keeping all the balls in the air does not come naturally to everyone, and the juggling itself is an achievement. Many doctors are struggling with physical or mental health difficulties, the challenges of neurodiversity, difficulties in our personal life or commitments outside of our career. Being ‘just a good doctor’ is harder than it looks.
I think we’ve made great progress in reducing stigma around burnout, mental illness, flexible working and neurodiversity in the general population. In the current climate, it has been brilliant to see widespread public health campaigns assuring us, ‘It’s okay not to be okay’, and encouraging people to talk. Royal Colleges and NHS Trusts are also increasingly talking about doctors’ wellbeing; even in psychiatry, however, a profession specialising in emotions, we are a long way from doctors talking about burnout with the same ease they report symptoms of flu. Perhaps what’s needed is a cultural shift, where doctors acknowledging difficulties and asking for support is seen as the norm rather than resulting in a definition of ‘a doctor in difficulty’. It’s a little scary baring one’s challenges to an audience, but if it offers any kind of hope or empowers even one person to seek support, it will have been worth it.
- Psychiatrists are awarded Membership of the RCPsych when they complete a series of specialist exams; they can then apply to enter a higher training scheme.