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Reflecting on my first ten years as a doctor

Ten years ago today (eleven by the time this is published), I learned that I had passed my medical school finals and became a doctor. It doesn’t feel like it was a decade ago.

At work, I recently happened to have a meeting with someone I worked with as an F1 doctor but haven’t seen since. It felt like we worked together a month ago rather than a decade. I still occasionally say “hi” in the street to the porter who used to comment on my “Bird’s Custard” colour tie as an F1. And yes, somehow my F1 year was long enough ago that ties weren’t yet banned in hospitals.


I think the Simon of ten years ago would be amazed to find that I’m now working in public health. I didn’t enjoy the occasional public health bits at medical school, and I wasn’t even really aware that it was it’s own specialty until I came to pick a career path. Public health always struck me as worthy, dull, and far removed from anything that actually had any measurable impact on patients.

It was only after a serendipitous run of F1 hospital rotations that I started to see the point. My first job was in upper gastrointestinal surgery, a subspecialty involving seriously brutal surgical interventions to treat cancers with very poor prognoses. My second job was in stroke medicine. My third was in gastrointestinal medicine, a speciality in which a large proportion of the patients had end-stage liver disease as a result of alcoholism.

I think it’s impossible to go through that sequence and not feel slightly despairing: hospital medicine comes too late for most of these patients. Their lives very often cannot be pieced back together: as one particularly insensitive consultant used to regularly say, for those patients “the party’s over”.

The most effective treatment for these patients would be to rewind time and tackle their problems before they were ill. This initially pushed me towards General Practice, until I realised (late) that this was the point of Public Health. My realisation of this came so late that I didn’t really know what public health doctors did all day, but stuck in an application to the specialty anyway… as well as general practice.


After long essay-style application forms, written exams and half-day intensive interviews known as “selection centres”, it somehow came to pass that I was offered places on both the GP and public health training schemes. I had 48 hours to decide between a familiar career path and one which sounded fascinating but that I barely understood. In truth, I hedged: I went with public health because general practice always under-recruits, and I was pretty confident that a re-application to GP would be successful in 12 month’s time if public health turned out to be awful.

I was also put off by the obsession with portfolios in General Practice. My experience of clinical portfolios was that doctors were judged too much on their ability to write and present evidence rather than on their practice of medicine. I was, even if I say so myself, great at presenting portfolios of glowing assessments as a Foundation Doctor, but this felt a bit flat. It seemed to me that people in public health were known by results and reputation, and I liked that idea. I’m not so sure that was an accurate assessment of either speciality, but it certainly played a part in my decision-making at the time.

Leaping into public health felt brave at the time, even if it seems like hedging in retrospect: no end of people were telling me that I’d be “wasted” in public health and that my skills with patients meant that I’d be a fantastic GP. Some of this was subfusc whispers in my ear, some was formal written feedback, some was mildly paternalistic advice. Only a minority were enthusiastic. Luckily, once I set my mind on something, I’m pretty strong-willed.


Public health wasn’t awful. I mean, it had its moments: within weeks of me accepting a place, the coalition Government announced an intention to move public health outside of the NHS. This may have been the right decision, but it was terrifying for me as an NHS doctor to know that my NHS career path had been cut off just as it was beginning.

As I progressed through my training, I came to really enjoy health protection, the part of public health which deals with outbreaks and other biological, chemical and radiological threats to the population. I liked the combination of clinical-style short-term pressure, thoughtful balancing of risks, and the close association with clinical colleagues (and occasionally patients). I wrangled the system to spend almost half of my training in health protection placements, and since 2016 I’ve been a consultant in health protection. It is—by far—the most enjoyable and rewarding job I’ve ever done, in which I’m surrounded by a brilliant team who never give anything less than their best.


So, in career terms, I could not be further from where I thought I’d be ten years ago. But I also couldn’t be happier with the choices I’ve made. I don’t really know that there’s a lesson in that.

Someone once told me that the most important thing in career planning is to do what you enjoy and collect certificates along the way. Delayed gratification is rarely worth it in career terms: the gratification might never come. But its hard to ever regret doing something you enjoy, and collecting certificates provides tools to make a “leap” to something else when the first thing stops being fun.

I don’t know whether that’s good advice or not, but it roughly correlates with my experience over the last ten years. Let’s hope that I’m still enjoying things as much ten years hence – whatever I’m doing then!


The picture at the top is obviously my own. It was from my graduation which was, of course, a little later than the day I found out I’d passed.

This post was filed under: Health, Posts delayed by 12 months, , , , .

Photo-a-day 128: Nine cakes

Hold up!

See that little date above?

This post was published years ago.

My opinions have changed over time: I think it's quite fun to keep old posts online so that you can see how that has happened. The downside is that there are posts on this site that express views that I now find offensive, or use language in ways I'd never dream of using it today.

I don't believe in airbrushing history, but I do believe that it's important to acknowledge the obvious: some of what I've written in the past has been crap. Some of it was offensive. Some of it was offensively bad. And there's may be some brass among the muck (you can make up your own mind on that).

Some of what I've presented as my own views has been me—wittingly or unwittingly—posturing without having considered all the facts. In a few years, I'll probably think the same about what I'm writing today, and I'm fine with that. Things change. People grow. Society moves forward.

The internet moves on too, which means there might be broken links or embedded content that fails to load. If you're unlucky, that might mean that this post makes no sense at all.

So please consider yourself duly warned: this post is an historical artefact. It's not an exposition of my current views nor a piece of 'content' than necessarily 'works'.

You may now read on... and in most cases, the post you're about to read is considerably shorter than this warning box, so brace for disappointment.

20120507-194642.jpg

I wanted to reflect my nine years of blogging in today’s photo-a-day, so had the idea of nine fairy cakes assembled in the shape of a 9… I’m not entirely sure I pulled it off to the extent that you’d realise it was a 9 without being told…

I wrote a bit more about my nine years of blogging earlier today, if you’re interested!

This post was filed under: Photo-a-day 2012, .

Nine years of blogging, and the permanence of it all

Hold up!

See that little date above?

This post was published years ago.

My opinions have changed over time: I think it's quite fun to keep old posts online so that you can see how that has happened. The downside is that there are posts on this site that express views that I now find offensive, or use language in ways I'd never dream of using it today.

I don't believe in airbrushing history, but I do believe that it's important to acknowledge the obvious: some of what I've written in the past has been crap. Some of it was offensive. Some of it was offensively bad. And there's may be some brass among the muck (you can make up your own mind on that).

Some of what I've presented as my own views has been me—wittingly or unwittingly—posturing without having considered all the facts. In a few years, I'll probably think the same about what I'm writing today, and I'm fine with that. Things change. People grow. Society moves forward.

The internet moves on too, which means there might be broken links or embedded content that fails to load. If you're unlucky, that might mean that this post makes no sense at all.

So please consider yourself duly warned: this post is an historical artefact. It's not an exposition of my current views nor a piece of 'content' than necessarily 'works'.

You may now read on... and in most cases, the post you're about to read is considerably shorter than this warning box, so brace for disappointment.

Today marks nine years since I started blogging. Nine years. Increasingly, people are becoming concerned about the permanence of stuff posted the internet. Rick Santorum’s presidential campaign was hampered by the web, and the fact that for almost everything he said, he’d previously given an equal and opposite quote to some other source at some point in the past. And, of course, there’s many other less prominent examples of people’s online history coming back to haunt them.

Anyone with a blog, like me, can essentially make a choice. I could delete a load of old stuff. It wouldn’t make it completely unavailable online, as content from this site is cached all over the place; I guess it might make it slightly more difficult to find. But I’ve chosen not to do that. I’ve chosen to keep the complete sjhoward.co.uk blog intact. And I’m sure many people wonder why.

Firstly, let me say that it’s not because I think everything on here is great. It’s not. There’s some terrible stuff. There’s stuff that’s just plain dross. I’ve written things that I’m a ashamed of, like using “gay” almost as a punchline, or referring to the entire French population as “crazy frogs”. There’s positions I’ve asserted that, at best, are altogether blunter than I’d ever express now, like saying “I’m very anti-smoking”. And that’s before we even open the can of worms labelled “unnecessarily base humour”.

So why, you might ask, do I keep this stuff online, with my name written at the top of the page in a massive font size?

This is something I’ve thought a lot about. In the end, my reasoning was fairly simple. What I wrote in 2003 might have been unprofessional, but I wasn’t a professional then. It might have been immature, but so was I. The date is clearly and prominently shown on all the posts I’ve written. Of course I don’t hold all the same opinions I did when I was 18 – does anybody? We grow, we develop, our viewpoints and opinions change.

One of the more remarkable things about this little site is that you can how it happened. You can see the softening of my opinion on Tony Blair, from barely concealed hatred, to grudging admiration, to actual respect. My changing interests are reflected, from the 2005 election, during which I published daily “swing updates” based on a complex formula weighting different polls, to the 2012 local elections which were only mentioned in passing beneath a pretty picture of a bus stop.

All of this history, and all of these changing opinions, set out the path to where my politics and opinions lie today. And, of course, both will continue to shift over time.

In the end, I guess I came to the conclusion that if someone chooses to judge me on a personal opinion I held a decade ago, then so be it. Though I’d suggest that a far more interesting and intelligent approach is to ask questions: “You once said you thought x: do you still believe that?” or “Your position used to be y, now it’s z. What changed your mind?”

I don’t know exactly when the meaning of the term “flip-flopping” in political discourse changed from being about presenting different views to suit different audiences to being about actually changing your mind on a given issue, but I don’t think it’s a helpful change. I’m vaguely suspicious of people who claim to have “always believed” something – it has a slight whiff of valuing dogma above thoughtful and reiterative consideration of the issues. I can only speculate that the increasingly tribal nature of politics has led to increasing institutional derision of free thought: we must all toe the party line.

If you ask me, the sooner we lose the vogue notion that a change of opinion or reconsideration of position represents a weakness, the better off we all will be.

This post was filed under: Blogging, Politics, Site Updates, Technology, .




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