Mark's story - Part 2

Dr Mark Davies is featured in Spark the Difference's Humans of Healthcare art exhibition and is interviewed here by Sam Meikle, founder of Spark the Difference.

Mark's interview is published in two parts. You can listen Part 1 of Mark's interview here. The recording and transcript of Part 2 is below. You'll also find links to Mark's two interview warm-ups: (1) Getting to know Mark in 10 questions and (2) Mark's drawing challenge.

Mark: So the reason I got upset, is ‘cause I haven’t thought about her for years and years and years and years, I hadn’t really reflected on that.

And when you - when I started talking about it - I remember she was teaching me, teaching me as I was doing it. She was lovely. And her husband was a management consultant working in the health service. When she died, he left the house and never went back.

Sam: Too hard?

Mark: Yeah. I got a letter about 10 years later, just a really nice letter, saying he was having a nice life, met someone else and all that kind of stuff.

Sam: Did you reply?

Mark: No.

Sam: Why?

Mark: Quite often people broadcast to clinicians. They’re not expecting something back – they’re putting something out. I thought he was broadcasting, not want to exchange. Might have been wrong, but you make a judgment.

Sam: Why do you think they broadcast?

Mark: I think it’s cathartic, I was a personification of his wife’s passing. I had been there at the point of her dying. For him, I was a part of that death; a part of - those moments that he lost the woman that he loved.

Saying he was doing all right and was moving on - to me, I felt was him saying that to himself.

Sam: If you feel comfortable to do so - and that is the clause here - if you feel comfortable to do so, please tell me about the scariest, darkest or most challenging moment of your career?

Mark: One of the hardest points in my career, was around the death of a child.

The parents who brought the child in to see me, on the night before. The child had a temperature but didn't have any other signs that I thought indicated a significant illness. I had explained to them what they should do if the child got worse and various other things.

I came into work the following morning to receive a message that the child had subsequently died later on that day, in an intensive care unit.

That was very difficult and there was a lot of self-doubt, on my part around my own clinical skills and had I done anything wrong.

I have to say my colleagues were amazing during that time and enormously supportive – both my colleagues in hospital and in general practice; and in fact, the family were very supportive as well.

But no, I think that was the darkest period I had to go through.

If you start to doubt your own skills, then what right have you got to be there, caring for people? So that's a difficult thing when you start to feel that you are not sure the skills that you have trained and honed and practiced and improved over time are all up to scratch. It's a terrible responsibility.

Sam: Can you tell me about the most emotionally challenging period? So it may be an individual moment or over a longer period of time.

Mark: A difficult time for me is when I stopped being a doctor. I spent 25 years being a GP.

I done it so long it became who I was, it was part of my identity. Even now when I don’t practice, people say what do you do; I often say I am a general practitioner. Just – if I don’t know them very well, it’s an easy thing to say.

And letting that go and taking what I thought was a brave step of doing something different - that was, a bit of a stretch, that was a bit of a difficult thing. It was described to a friend of mine as me letting my safety blanket down, which I thought was a good way of describing it. So yes, that was a challenging time for me.

Sam: And it's only been a relatively recent period hasn't it?

Mark: A couple years ago, yeah.

Sam: What have you learned from that?

Mark: I think that is a really good question. I think what I have learnt is that there are lots of different ways of touching people's lives. Although medicine is incredibly intense and tangible, there are other ways of touching people's lives that are less visible, but can be more profound and larger scale. Seeing that and experiencing that has been very reassuring.

Sam: What has working in healthcare taught you about people?

Mark: It's exposed me to the most miraculous variation in our species. My goodness we're a varied bunch. People's reactions to adversity are constantly surprising and amazing and it brings out sometimes the very worst in people - and sometimes the very, very, very best in people.

Seeing that is both inspiring and challenging and exciting.

Sam: Thinking about the people you’ve worked with and for over the year, and all of the people who've helped you along the way - who has had the greatest impact on?

Mark: I remember working with a consultant surgeon, when I worked up in Manchester, who - I was amazed by the level of personal commitment that he gave his patients.

So he would come into the hospital every day - Saturday and Sunday - to see all patients who are under his care. He knew their histories and what was going on with them far better than I did as I was what was called then the House Officer.

And I was amazed at his ability to hold in his head all the facts and figures and results that were going on for his patients in a way that I struggled to. So that was very impressive. But the thing that was really inspiring about him was his drive for professional excellence.

He studied and worked and honed his technique and was on this constant, aggressive drive of self-improvement. And seeing that drive to technical and knowledge improvement in the context of a deep humanity and a deep interest in people – being able to combine those two things - for me, he epitomised a lot of what was good about clinicians and certainly he's been someone that I've aspired to.

Sam: What kind of surgeon was he?

Mark: Well, he was what was then referred to as a general surgeon – they don’t even exist anymore. It seems amazing to say it now, but he did all sort of things. A lot of thyroid surgery, breast surgery, bowel surgery - people don't do that anymore.

Sam: They don’t make them like they used to.

Mark: They don’t make them like that anymore.

It was very funny actually because he had an essential tremor so his hand shook, which used to…

Sam: Is that funny?

Mark: Well it used to make the patients quite nervous as well when they saw him trying to write on their notes just before the operation. But he was a very good surgeon.

Sam: If there is anything you regret about your career or that you could go back and change, what would it be?

Mark: You know it sounds trite to say it, but I don’t regret anything.

So the things that I've done which have led me to good things, have been great - but the things I've done that have superficially seemed like the wrong decision, [there] have been all sorts of interesting consequences and lessons and positive things that have come out of it.

So the person I am now is a combination of all those good things and the things that weren’t so good. So, I wouldn't change a thing. I would be a different person with a different set of perceptions and a different understanding of the world if I hadn't been on the journey that I've been. That journey is really important to me. That was my life.

Sam: Looking back across your career to date, what do you hope that people you’ve worked with, remember you for?

Mark: I’d like to be considered a good doctor. Someone who's been kind and respectful to my patients and someone who's been a supportive and thoughtful colleague.

Sam: Mark, it’s been an absolute pleasure to speak with you and hear about your life and work.

Mark: It’s been great, thank you very much.

Sam: Thank you and thank you for listening.

Mark's story - Part 1

Mark Davies is featured in Spark the Difference's Humans of Healthcare art exhibition and is interviewed here by Sam Meikle, founder of Spark the Difference.

You'll also find links to Mark's two interview warm-ups: (1) Getting to know Mark in 10 questions and (2) Mark's drawing challenge.

Sam: Mark, thanks very much for joining us.

Mark: No problem.

Sam: Where’s is your accent from?

Mark: I guess I grew up in the south, so I’ve got a sort of, I guess a non-descriptive southern accent but I’m one of those people who’s a bit of a chameleon. So when I talk to people with strong regional accents, I acquire them over time, which is slightly embarrassing because people think you’re taking the mickey. I guess I’m just jealous of other people’s accent maybe.

Sam: Where have you spent most of your working life?

Mark: Most of my working life has been spent as a General Practitioner in West Yorkshire, a place called Hebden Bridge, which is where I live. But I’ve spent a large amount of time also in London, doing various government jobs around health and the NHS.

Sam: What made you decide to start working in health care?

Mark: I think I had always been interested in biology. As a young man I was particularly interested in doing zoology actually, marine zoology. I wanted to be Jacque Cousteau I remember.

But when it came to actually applying for the course, a very good friend of mine - my best friend - decided he was going to be a doctor and I thought, 'well if he’s going to be a doctor, then I’m going to be a doctor as well'. It wasn’t one of those vocational things, it was more kind of keeping up with him, to be absolutely honest.

Sam: What made you want to become a GP, all of those years – not, all of those years ago - some of those years ago.

Mark: Do you know what - it was all of those years ago.

The thing that drew me to general practice was about the longitudinal relationship that you have with patients and indeed, with families.

I remember saying someone to me once - ‘cause I started off in hospital medicine – that actually in hospital medicine, the diseases stay the same and the patients change. And in general practice, it’s the patients that stay the same and the diseases change. And as I was more interested in the patients than the diseases, it seemed like a more logical place for me to be.

Sam: What made you stay working in healthcare?

Mark: I found that I loved it. And I was really worried when I started as a medical student, I didn’t find the undergraduate subject really interesting. I wasn’t really into the anatomy, physiology and a whole bunch of chemicals. And for a time, I kind of really worried that this wasn’t was for me.

I remember the first time I went to a ward and they introduced me to a woman who was a patient on that ward and asked me to get her story. They had to come and drag me away.

I just suddenly realised what an amazing privilege it was, that people let you into their lives in a way that you could affect the outcomes that they got and that you would affect their wellbeing and their level of confidence they had in the care that they were receiving. And that seemed like an incredible privilege. I couldn’t believe that I was in that position.

So I kind of got hooked on it then and I’ve been hooked on that ever since.

Sam: Do you remember her story now?

Mark: I do, yeah, very clearly.

Sam: Could you share it with us?

Mark: She was a young woman in her late 20s, who had had Crohn’s disease from a very young age – about 10.

Crohn’s disease is an inflammatory condition of the bowel, that in those days was often treated by having the area of Crohn’s disease removed surgically. And this had led to her having a shorter and shorter bowel. In her late 20s, she was quite severely ill and didn’t really have enough bowel to give her body sufficient nutrition, which meant she was extremely weak and in and out of hospital a lot.

On a lot of tablets and steroids, which had puffed her up and made her quite puffed up and round. One of the things I remember is her saying that she refused to be defined by her illness and there’s so much more of her than people see because of her big puffy face because of the steroids and all the bags, drips and all the paraphernalia of her treatment.

She was really concerned that she was disappearing behind her disease and was just desperate to be seen as a human being with a real story to tell.

Because she had been ill for so long and she’d spent so much time in hospital, actually she'd a lot of really interesting stories to tell. I guess she’d seen more than she should have done as a child and had a really interesting perspective of life’s journey.

It had quite a profound effect on me and I came away with a mixture of – well, actually frankly – being quite impressed by her and being incredibly grateful for my own health, that I hadn’t been through that and really touched by the humility that she showed in just sharing her story so generously.

So it wasn’t really very much about Crohn’s disease, which is what I was really supposed to finding out about as a medical student, but I knew a lot about her.

Sam: I’m reading a book at the moment ‘Do no harm’ by an author whose name I cannot remember. He’s a neurosurgeon and he talks about how you bring the humanity back to medicine and to clinical practice and sometimes those bits are the most challenging, over and above the procedure itself.

Mark: And actually, you know what - if you block the humanity out of the practice of medicine, it's quite a lot easier.

Sam: In what way?

Mark: There’s something called the collusion of anonymity, where patients pretend you are not a doctor and the doctor pretends the patients isn’t a real human being. And it makes the difficult encounter, around medicine, which sometimes can be really difficult - telling someone they are dying, or telling someone their child is going to die, or telling someone they’ve got a serious diagnosis.

If you can keep that humanity of the other person at a distant and make it just a technical transaction – emotionally, it’s much easier for the doctor.

And there’s an element of that, that you have to do in order to keep doing the job and not become emotionally exhausted, but actually if you do it too much, you miss the whole point.

And at its very heart - clinical practice, medicine, nursing - is about the encounter between two human beings. There is a whole bunch of stuff around the treatment of diseases, science, interventions and operations, but at its heart it’s that interaction is where the richness is. And we lose, that we lose everything.

Sam: What one piece of advice would you give to a young professional just starting out in their career about how to retain their values or to stay human in an increasingly stressed environment?

Mark: Oh my goodness, what a great question. It’s a very poignant question, as you know, ‘cause as my daughter is a medical student and I have had this conversation with her. I am left feeling that I wouldn’t be so presumptuous to tell her what the answer will be in her career, because I suspect her career would be very different from the career that I had. And the pressures that I’ve had to deal with during my professional life as a doctor are likely to be very different from the pressures that she gets exposed to.

I think there’s a real danger with the pressure of work and just the sheer volume of work that you are expected to get through, as a doctor. There’s a real danger that the people and individuals get crowded out from that. And it becomes much more become a technical exercise. It sounds naff to say it, but I think the greatest protection that you have against that happening is to put yourself in their shoes.

So if you were on the receiving end of medical care, what would you want and what would you be worried about? You know what would you be expecting to happen and what would you hope for? And that’s true obviously, if that was your mother, or your brother, or your child, or indeed you, yourself.

And if we can hold onto that ability to project our own experiences through our patients and see it through their eyes, then that's probably the most valuable tool we've got, in holding onto the humanity of medicine.

Sam: Knowing what you know now, if you could - what one piece of advice would you give yourself if you were starting out on your healthcare career?

Mark: The most important lesson that I have learned professionally is the power of mature reflection. The ability to be able to look at successes and failures; complaints and the everyday job itself - to take step back and think about it critically and think about it in a balanced way that allows you to see perspective, not over-personalise things and derive what learning you can from the experiences.

The power of reflective practice ,which is something that I suppose I came to realise quite late in my career, I think is enormously, enormously powerful. I guess in another setting you might call it mindfulness, but the ability to come up reflect in a mature manner around learning I think it's really important.

The reason I say that is I've seen people’s careers go down. You know I've been involved in a few personal tragedies, which I have found personally very difficult. The well-honed skill of being to step back and reflect on those things; either with someone or with a trusted colleague, in retrospect would have really helped me get through those difficult times. It also would have helped some of the clinicians I know who – actually, one of them that I’m thinking about, actually ended up leaving the profession - which is a tragedy for everybody.

Sam: Do you think that is up to the individual - or leading question here - can the service for teams and organisations support that reflective learning?

Mark: Actually genuinely, because I was a General Practitioner, I think the appraisal process that has been introduced into a postgraduate training for General Practitioners and appraisal has been a really major step forward in terms of encouraging reflective practice. That's why said I come to late was because of the introduction of appraisals that really made me go through them.

The first few years I did it, I went through it in a fairly tick box way, without really driving much benefit from it. Then the more I did it, the more I actually started to do it properly and actually started to get a lot more from it.

So - it’s both, it’s a willingness on the part of clinicians, particularly doctors, to stop pretending to be such heroes and acquire the humility to be able to question what’s going on around them. But, equally a system that allows and encourages a framework for that to be happening in a supportive way.

The million-dollar question is, how do you create space for that to happen in such a busy and pressured environment?

But I would say it’s a bit like the man and the saw that he’s not sharpened. You that story don’t you? The guy who’s sawing a tree down with a blunt saw and someone comes along and says ‘why don’t you sharpen your saw?

And he says, ‘well, I’m too busy cutting this tree down. I haven’t got time.

I think there’s a lesson in there, around professionals looking after themselves and making sure that their tools are optimised for the difficult jobs that they’ve got to do - that their saw really is as sharp as it might be.

Sam: What was the best or worst advice you've ever received?

Mark: The best advice I ever had, was from a patient who - I was having a really difficult conversation with, because I was needing to tell her that she was dying.

Well, I wasn’t actually, she knew she was dying. We were going through the motions where I came to the realisation that she realised that she was dying - and I was, in my own clumsy way trying to get there. I was quite a young GP at that time - [pause] and she helped me do that.

Sam: How did she help you do that?

Mark: She was a teacher. And she taught. She just couldn't resist teaching.

So, I was starting off, exploring her ideas - and what the books teach you to do around breaking bad news.

And she was saying, ‘you’re doing this really well.’

When I finished, she said – she said to me, that she was pleased that I was the one who told her that. She was grateful that I had told her and it was a very special gift.

She was only young. She was in her early 60s, she’d just retired. She was looking forward to a happy retirement in Scotland with a husband.

That was being taken from her. She was a very impressive woman. She left a big impact on me.

-- End of Part 1 --