My last GP trainer conference as Associate Dean - Diff'rent Strokes

This was the final conference I organised in my role as Associate Dean for GP Education. 
The conference was held on the 14th/15th November at the Hilton Warwick. 150 GP trainers attended both days. We were fortunate to have a plethora of aupicious speakers who addressed issues of differential attainment and celebrating difference. My conference introductory speech is below. 

Welcome to the annual Birmingham and Solihull GP education conference. It is a real pleasure to see you this morning. We have two days of a packed programme filled with new insights and a tremendous line up of wonderful, wise speaker. I know, as with much education, that the experience is not just what is taught, it is also what it caught, through networking and peer learning.  That is the meta-cognitive stuff. 

I've always felt that is extremely important. 

That brings me onto rolemodels. 

This sari belonged to my paternal aunt - Aunty Zamruth. She was a consultant obstetrician and gynaecologist who built and lived in an Obs & Gynea nursing home in Krishnagiri, near Bangalore, South India. As I child (on vacation) I would stay in this nursing home, because it was where the family lived. I would see how hard she worked day and night. I would see how loving she was towards her own family - Three kids and me, (she was also kind and respectful to her servants/staff workers). She would not charge poor people who needed her medical care.

She always wore a Sari to work. She was one of my first rolemodels  - female, professional, skilled, knowledgeable, loving and graceful. Seeing her in action was powerful. It raised my hopes and my aspirations. It made me believe 'I could'. 

I am proud of this Sari, she gifted it to me, (I asked her for it, one day when she was wearing it).

Some of you know that this is my last conference as AD. Six years as AD. My last day with HEE is in 3 weeks. I have enjoy my 13 years of postgraduate Med Ed. I am excited about the new challenges ahead,  leading on Medical Professionalism at Birmingham University Medical School. As a result of my leaving some trainers and trainees have conveyed some lovely farewell feedback. 

Among these (are people from mainly Asian backgrounds) saying that 'I made them believe they too can succeed'. This was unexpected feedback. I realised that I was more than just an AD job description that had the required competencies. I was something more to some people. I am touched by this. You too have this 'power'. Power to inspire and power to give hope....just by being, unapologetically, you. 

I was sat in a GP school board meeting last month. The Lead employer presented data on West Midlands trainee sickness absence. The group that have taken the most sick leave are female, Asian, usually Muslim trainees with childcare responsibilities....

People

Like 

Me. 

Maybe when they feel overwhelmed by training and curriculum requirements and feel the odds are stacked against them what really gets them through is hope brought on by knowing someone "like them" has got through and done just fine. 

Don't underestimate the power of that. 

I feel some trainees feel ashamed of their cultural identity, they live two lives (their professional persona is an act).....This is not helped by the 'current climate'. (I am not allowed to talk about this because I am 'in election purdah'). How ironic and amusing that a Muslim women who choses to cover,  has a 'purdah' enforced ....as a HEE employee (essentially a civil servant) who is contractually required to NOT get political in the run up to an election. 

There is an important term you need to know about, that is 'Intersectional'. It refers to categories of discrimination. Some people fall in the Venn diagram intersection where they have many categories - being female, being Muslim, being Asian...if I was LGBTQ I'd have a full house.  

You know, you can check you intersectionality score online. Apparently mine is 55 and it tells me that 81% of people are more privileged than me. Personally, I refuse to believe that. I am incredibly privileged & blessed in many innumerable ways .... 

I feel these intersectional labels along with research evidence that associates them with low achievement, paralyses individual progress and sadly sometimes becomes a self fulfilling prophecy. Is it counterproductive? Yet it is really important to capture and prove inequality if it is happening.

What do we do? How do we navigate through these sensitivities?  I am hoping these next two days will give us the current evidence and postulate how we may address the issue. We have many trainees (over 50%) who fall in intersectional categories. We have performance data that shows stark differential attainment....what CAN we do? What SHOULD we do? 

Here's some interesting data on Ambition and Gender 

Dr Sarb Clare AMU Consultant, Deputy Medical Director swbnhst.

Take a minute to look and reflect on the HEE research on supervisor microaggression comments left on your tables. Have you heard these things during your career? I have. 

Interesting stuff and it can undermine a person's flourishing. 

I believe representation matters. There is evidence suggesting diverse boards make better decisions. 

I sat on a foundation training board meeting two weeks ago. There were 17 people around the table. I was the only BAME person. In was speaking to 22 Deans from US Medical Schools on Monday. I was the only person of colour in that room.  

Although I am looking forward to my new job I felt sad the representation would be even worse when leave.  We also need to think and reflect whether positive discrimination/affirmative action (when it comes to recruitment) is equally 'unfair'? 

The most diverse undergraduate medical training is in Manchester, Imperial and Birmingham medical schools. This is subsequently reflected in foundation training and speciality training. John Hopkins University research has shown 

Studies show that students trained at diverse schools are more comfortable treating patients from a wide range of ethnic background.

It is important to develop cultural competencies in care providers to help them respect patients' values and habits, and to bridge gaps in understanding their concerns. ... 

One big plus point is that as BSOL GP trainers you ARE a representative group, representative of trainees. A very gross tally (because there is no formal HEE data of this type) showed: 

We have approx. 237 trainers in BSOL. 101 with English sounding surnames & 136 non English sounding surnames.

We have approx. 220 trainees currently working in BSOL. 67 with English sounding names  &  153  with non-English sounding names.

When I started as a TPD in 2006 there were only two Asian TPDs (out of about 70 across the west Midlands) : Myself and Amjad Khan. (Amjad has gone onto magnificent things and is now the Director of GP Education Scotland.) Recently Steve informed me that 

16 new TPDs have been appointed over last 5 years (since 2014). 12 (80%) are BAME; 11 (69%) are female; 7 (44%) are both; 100% are either. All were appointed on merit. 

So, there is hope. It trickles through like sunshine on snowy white peaks. (Snowy white peaks is actually a rather tongue-in-cheek term that speaks of senior leadership in organisation including the NHS). It is basically dominated by white men. No offence Steve. You have been an incredible line manager. I have no complaints about Steve at all. He has been really empowering and encouraging to me.

I just wanted to conclude by saying that this conference is not JUST about looking at Differential Attainment and potential disadvantages from intersectional issues; it has another fundamentally important function ; That is to celebrate difference. To embrace your identity (and encourage trainees to embrace theirs), and to know that the best doctor is when the WHOLE of the doctor engages with the WHOLE of the patient.

To both feel whole and to both flourish. 

It has been a pleasure and honour to serve as you AD for six year. I have met so many wonderful people and YOU inspire me everyday.  

I will still be a GP trainer (if the new AD thinks I am competent enough). I look forward to being here next year, quietly sitting in the audience. 

Keep going BSOL because you are awesome.

Thank you for taking a chance on me, for giving me a voice..... I feel I belong. The ovation was mind blowing! What overwhelming love I felt in that moment.

(Written on a plane flying over Greenland on 9/11/19....Literally on top of the world)

https://www.jubileecentre.ac.uk/media/news/article/6646/Affiliate-PhD-Student-Presents-to-Medical-Professionals-in-Arizona

Philanthropic Medicine - Reflections on a visit to Bangladesh

Philanthropic Medicine – Bangladesh visit July 2017

I married 19 year ago. I am Indian origin, my husband is Bangladeshi origin. We met at Nottingham University where he studied Economics and I studied Medicine. We are both born and educated in England. Our mother tongues are different.

This is my fourth visit to Bangladesh. I wanted it to be different to my previous visits. I am not a fan of sitting in relatives homes being over fed as a result of their enthusiastic hospitality.

On one previous visit I remember a relative saying, “Why didn’t you bring your BP machine?”
He had a point. Being a doctor means we are gifted with privileged expertise and knowledge. Here I am, planning a trip to one of the poorest countries in the world…and I have something to offer. Besides, it is a vocation, something that will help me feel a bit more useful on the adventure that always results from visiting Bangladesh.

“The purpose of life is to discover your gift. The meaning of life is to give your gift away.” 

David Viscott

On thinking of this I composed a Whatsapp message with an inventory. I contacted a few GP colleagues to see if they would donate unwanted, working, second hand items for a “pop up GP clinic”. The response was great and within a few days I had a suitcase full of stuff to take including BP machines, BM machines, testing sticks, lancets, sharps box, auroscope, opthalmoscope, simple medications, MIMS etc …I felt ready to see what this half hatched plan would become. I cannot tell you how lifted my spirits became when this plan was coming to fruition. I felt an enthusiasm for the trip I had not felt before. I had developed a strong sense of purpose.

My husband’s ancestral home is a village 7 hours drive from Dhaka. It is in the province of Sylhet 5km from the Indian border. The neighbouring states are Assam and Tripura in India. The state of Sylhet is lush green. I can only describe it as a vast allotment, with well demarcated plots of edible vegetation from rice, pineapples, okra and spinach. Green is almost the only colour you can see, apart from the grey water pools which are home to a wide variety of fish. One conversation amused me. I mentioned (with a hint of a moan) the prolonged power cuts in the village. I was reminded to take the optimistic approach; village life is without power, so a bit of electricity, when it comes, is a big bonus!

We arrived in the Bari (ancestral home) on Saturday 22^nd July. We had spent the previous few days in Bangkok exploring the temples and waterways.

My father in law spends stretches of months in the Bari. He is a well-respected man in the village. My husband and his father have the surname Choudhury. This technically means “landlord”. The villagers do seem to still come to my father in law for counsel, advice and assistance. In exchange, they help him and attend to his care needs. He has moderate dementia and is unsteady on his feet, he needs the help, but he is doing well for an 83-year-old though! One villager named Monu has known my father in Law since he was born. Monu must be about 25 years younger than my father in law. Monu is like a bondsman to him. I find this concept hard to understand, and these days it is not a bond of slavery but of commitment and service. Monu’s family were also very attentive and caring towards us during our visit, even washing my children’s feet after muddy barefoot walks, (my 7-year-old describes the mud walk as a high point, along with catching fireflies).  It was monsoon season in Bangladesh so mud was plentiful!

As I endeavour to treat others as I would like to be treated so I find it hard to accept the concept of servants cleaning up after me. We are equals, so it is hard to accept this in my head, yet I console myself by thinking this is how they make a living, I should let them do this. I am still grappling with it. Anyway, I felt my payback would be to do my best to consult the villagers, sitting side by side, to hold their hands and to examine them with kindness and tenderness. This is my way of showing that I can serve them. One of my husband’s older cousins said after one of my veranda surgeries, “make sure you wash your hands well”. Another of his cousins (who runs a small NGO) told me “Some people here don’t like the poor”. This reverberated in my head, I could not come to terms with it because “the poor” are not a group, they are people, human beings like me. Their predicament is unlikely to be of their doing and how arrogant it is to “not like them”, like they are vermin or something. This pained me immensely.

I did three consecutive morning clinics. Village hearsay spread the message that Mr Choudhury’s daughter in law is a doctor and will see you (free consultation and meds) if you come to the Tongi veranda (bungalow). It wasn’t long before queues of people waited to see me. I understand Sylheti but I don’t speak it very fluently. My father in law helped me with some interpretation. In total, I saw about 50 patients from babies to the elderly. Common complaints included dyspepsia/heartburn, polyarthralgia, poor dental health, cataracts and fungal skin infections. I would assess the condition then go to the pharmacy in the town about 5 miles away and buy medication from the pharmacy (yes, they sell ALL medication over the counter!) Most villagers will drink water from a tube well. This water has been reported to contain mercury and heavy metals. Whilst cleaning my teeth I noted how strongly it tasted of iron. My son said it was like tasting blood! I wonder if this contributes to the high prevalence of gastric problems? Both my mother-in- law (62) and her 60-year-old brother died from gastric cancers recently. Their childhood was spent here.

One man in his late 20’s is usually fit and strong according to my father in law. He slowly walked to the tongi, labouring to reach the veranda and using a stick as a staff. He looked weak and clammy.

I heard how he has been feeling awful for the past three days, no localising symptoms or incidents. His BP was 78/40 and his temp was 39. I felt it could be septicaemia. I told him he needed to go to the community hospital. He could not afford to go. He asked us to call his wife from the village. His wife came and my father in law gave him some money to get to the community hospital. 

I also saw a lovely smiley 3-year-old girl. Her father was anxious as she could not stand unsupported nor speak. It was clear she had developmental delay and maybe an underlying condition like cerebral palsy. She needed a CT scan. My findings were later confirmed by a letter from a paediatrician, that also suggested a CT scan was needed. The big problem is the scan would cost £250, the father only earns the equivalent of about £10-20 a month. So, a barrage of questions ran through my mind, even if she had the scan what would that lead too? More expensive treatments and physio? I am not sure how well the medical infrastructure deals with learning disability and developmental delay. What kind of a future does she have? I hope she will not be abused or treated badly because of her disability, maybe her family see her as a burden?... I hope she maintains her lovely smile.

After some compulsory visits to family members homes (and attempts at over-feeding us) we managed to arrange some visits with a large Bangladeshi based NGO. BRAC is in fact the largest NGO in the world (revenue US$684 million/year) and works across many countries. They are famous for introducing microfinance initiatives to help the poor get out of the poverty trap.

http://www.brac.net/

I had been in email correspondence with a programme visit manager in Bangladesh. I told him I am interested in visiting educational or healthcare related programmes in Sylhet. I had to complete a formal programme visitor form and sent my CV. I was then informed that two programmes could accommodate our visit.

We first visited a non-formal education programme for young children of tea garden workers. The tea estates are often too far from main stream schools. BRAC in association with UNICEF has set up some classrooms within the tea gardens. We visited two classrooms. The children saluted us on entering, they then sang and danced a performance for us. We felt very honoured and were welcomed like royalty. I enjoyed the beautiful scenery in the tea gardens too. I donated to the project after the visit and the educational and management team were thrilled.

Again, with BRAC we followed the tea garden visit with a healthcare programme which is essentially a visiting antenatal care clinic that comes to remote villages every month. I spoke with the ladies in the clinic and the health visitor. Most health education is verbal and pictorial as literacy rates are quite low. Any potential antenatal complications must go to the local community hospital about 40 mins away, many women feel this is too far. Postnatally women are given sanitary pads and iron tablets. Contraception pills can be purchased at cost price and condoms are distributed too. I was interested to note the COC contains ferrous sulphate! The women were given opportunity to ask me anything, I was asked a few questions about menorrhagia and its management.

Our final formal visit was to drop of all the kindly donated medical equipment (in my “pop up GP suitcase”) to the community hospital. It was located about 30 mins drive from Bari. It is run by the UK run charity Muslim Aid (revenue £34 million/year). My husband and I have known Jehangir Malik (the CEO) since well before he was famous!

https://www.muslimaid.org/

It was sobering to see the extensive and comprehensive work the hospital performs BUT under difficult conditions in a building that is run down and damp. You can see from the photographs the damp is in the main stairwell and the operating theatre. They have daily walk in clinics and specialist clinics. The hospital has 30 in-patient beds and performs operations like hernia ops, cholecystectomies and caesarean sections. I met patients on the wards who had these procedures. The treatments are not free, they are heavily subsidised though. Any donated medical goods will not be part of the charge to patients. Apart from the surgeon and specialist clinics the hospital is run by newly qualified doctors straight out of medical school. They earn about £300 a month. I had chance to see the “autoclave” sterilisation room, pathology room and theatres. This hospital provides invaluable, essential treatments. The waiting room was full on the morning we visited.

I tweeted and Facebooked details of their good work in the hope that people would consider donating to this worthy cause. Today I received and email from them and I have informally had a message from the CEO too.

Dear Mr. Sultan Chowdhury and Dr. Sabena Jameel,

Assalamu Alaikum Wa Rahmatullah.

We thank you very much for your recent generous visit and valuable contribution to Muslim Aid Community Hospital, Brahman Bazar, Kulaura on 29 July 2017. Your willingness to support Muslim Aid Community Hospital is inspiring and we do appreciate your endeavours.

Muslim Aid UK Bangladesh Field Office is always available to welcome philanthropists /individuals and institutional donors in serving humanity towards Healthcare, Education, Skills Based Livelihood, Microfinance, WASH, Child Sponsorship and Food Security & Wellbeing Livelihood programmes.

We will keep in touch and look forward to making future collaboration.

Sincerely,

Mahfuz

M. Mahfuzur Rahman

Country Director

Muslim Aid Bangladesh and Indonesia Field Office

Charity Registration No. 295224

I guess on the scale of NGO’s I got to speak to my husband’s cousin Jamil Ahmed Chowdury, who runs a very small NGO (Revenue £15 000/year).

http://www.nssbd.org/

He provides worthy interventions in the form of building latrines (toilets) in school and villages, he provides mid-day meals in village schools on occasions (no meals provided normally) and he funds a few medical camps where he employs doctors for the day (opthalmologists and family medicine practitioners) to go the villages and provide free consultations and medicines. He has also established a few bursaries for children in schools, so they can buy more books for further studies. I also left a modest donation with him and he said he would use it to provide a mid-day meal in a school near Bari.

All in all, I felt it was a fruitful trip and I learnt a lot. I felt I had a purpose and a gift to give. I now want to produce a presentation (maybe for VTS trainees) on the charitable dimension of being a doctor. I hope to explore altruism and exploring going “above and beyond”.

I also learnt one important lesson (especially because I got my fair share of bites);

“If you think you are too small to make a difference, try sleeping with a mosquito!”

3/8/17 for my NHS appraisal portfolio. Dr Sabena Jameel 

Competence-Capability-Phronesis: An ancient idea inspiring innovative enhancement to medical education?

Apologies for neglecting this blog site. Good news though, I wrote a blog for the "Good Doctors" website on request by the GMC. I am honoured they are interested in my PhD work on Phronesis ( Practical Wisdom) and its application to Medical Education. Here is the blog, originally published on https://gooddoctors.org.uk on 24/6/16. Enjoy, feedback welcomed:

Wednesday evening, and I am sitting on the side-lines of the dojo watching ‘the Master’ sow seeds of wisdom to my six year old son. The Tae-kwondo teacher is speaking about the belts he has to progress through in order to attain mastery.

“These mark your wisdom” he says, “treat them with respect”.

Fast forward to my other world (GP Education) and I saw a connection; Competence, Capability and Phronesis are like belts. Completing speciality training is not the end of learning journey, in fact it is probably just the beginning.

To me, the ultimate CPD is to seek what it means to be a wise doctor. To do the right thing, at the right time for the right person, whilst keeping societal flourishing in mind and attending to one’s own well-being (Eudaimonia). This concept is described as Phronesis (Practical Wisdom) by Aristotle. Yes, that’s right Aristotle, the son of a physician from 2500 years ago!

Phronesis is an intellectual virtue that adjudicates moral virtues. It has an executive function when moral virtues conflict e.g. honesty versus compassion. It lends itself to situations which are unpredictable and ambiguous. Phronesis seems particularly suited to the work of the General Practitioner, where uncertainty prevails. The dominant positivist approach to the practice of medicine operates on a level of predictive probability guiding the clinician’s knowledge. We know that the rules don’t always fit and the guidelines are often step removed from the real world. General Practice defines itself in terms of relationships, where knowledge is co-constructed and is specific to the circumstances at hand. Alasdair MacIntyre developed these ideas further in his work “After Virtue”, he speaks of Phronesis as a broader concept in holistic professional development.

Phronesis is rooted in Virtue Ethics, an undervalued moral framework in Healthcare education. The moral frameworks that dominate medical education and healthcare are rules-based code ethics (Deontology, Consequentialism and more recently Libertarianism). The code-rules based ethics have no doubt revolutionised medicine (EBM, Quality standards etc.) but I believe it can only get you so far, and we end up with reductionist targets and hidden curriculums as unintended outcomes, sometimes with deleterious consequences.

Phronesis captures not only the essential, well-emphasised cognitive aspects of professional practice, but it highlights the importance of the agent’s affective (character) and reflective abilities. These three elements have been repeatedly emphasised in more general literature on wisdom development and attainment.

“There are three ways in which we learn wisdom, the first is by reflection which is the noblest, the second is by imitation which is the easiest, and the third is by experience which is the bitterest”   Confucius

So, the cynics will now be thinking “character education?”, “Professional virtues?” How is it possible to educate for this with so much moral pluralism in society? Agreed, but we are talking professional virtues and we already have set standards in good medical practice. I think the key here is to nurture a growth mind-set (Dweck) in learners, moving away from the fixed mind-set that plagues competitive courses and careers. We need to talk about professional virtues, benchmarking against each other in supportive environments.

How do we know what a Phronimos looks like? Rodger Neighbour suggests, “We will know it when we see it” (The Inner Physician). Aristotle defines them as attaining the golden mean, which is a path of moderation between two extremes (e.g. Sentimentality…..COMPASSION…..Detachment).

We face huge challenges, but not insurmountable. We know how important it is to be a reflective practitioner, but the wielding axe of legalism comes in, and doctors are scared to reflect candidly in their learning portfolios in fear of being sued. We are time-starved, with stress levels hitting an all-time high for many. To me these are indicators that we need to do something, we need a paradigm shift.

The bottom line is that there are so many unanswered questions, and the only way we will come closer to understanding and maybe even achieving a ‘Phronesis belt in Medical Practice’, is if we take the concept seriously and study it. That is why my PhD aims to look at enacted Phronesis in General Practitioners.

“The best doctor is also a philosopher” Galen.

About Dr Sabena Jameel

Dr Sabena Jameel BMBS, BMedSci, M.MedEd, FRCGP is a General Practitioner in Aston, Birmingham and Associate Dean for GP Education (Health Education England West Midlands). She is also a GP Appraiser for NHS England. She is a third year PhD Candidate at the Jubilee Centre for Character and Virtues, part of Birmingham University School of Education. She is committed to highlighting the importance of the meta-cognitive aspects of learning and developing empirical research that enables professional virtues and values to be developed in Medical Education.

Related links

Online module on Character in Medicine:

http://jubileecentre.ac.uk/1649/character-in-the-professions-medicine

US Undergraduate Phronesis project:

https://news.virginia.edu/content/teaching-wisdom-phronesis-project-brings-practical-wisdom-medical-school

Compassion is a connection

Redeploy your senses

The God of small things

“Health is the soul that animates all enjoyments of life, which fade and are tasteless, if not dead, without it”. 

Sir William Temple. Nectar in a Nutshell 1945.

Some of you may be familiar with Arundhati's Roy's debut Booker prize winning novel "The God of small things" (1997). It is one of my favourite books, for many reasons. I chose her title for my blog because it is a description about how small things in life affect people's behaviour, and their lives.
In this blog I wanted to reflect on the experience of suffering a "minor" illness. In fact, so minor that some doctors would scoff at how such an insignificant diagnosis would violate their already busy day. I am a GP and until recently, I may too, have been lacking in empathy due to poor understanding of the implications, contaminations and ramifications. 
With a retro-specto-scope  I can look back and recall the fear and loss. I can also reflect triumphantly on the lessons learnt. My ailment only lasted 3 weeks and I am back to normal, or am I? I am clinically and physically back to normal...but psychologically I have grown... matured, with a renewed admiration for people with chronic and terminal illness, the tremendous resilience required just to live.

So what do you see? Any medics out there want to diagnose the "minor" illness? The illness that caused pain that seared through my eyes in Christmas week, that rendered me unable to function as a mum, wife and daughter and doctor. That felt like fire burning in my eyelids as I attempted to sleep; no rest when asleep, no peace when awake. A condition that led to blinding intolerance of any light? It required a 30 minute morning ritual of  eyelash exudate dissection. A condition that made me become a patient, submitting powerlessly to the perceived inefficiencies and delays of the NHS. It gave me a couple of panic attacks.......an overwhelming fear I had never experience before. My body was fine, but it was lifeless without vision. A large proportion of my recreational pleasures in life comes from seeing; reading, observing, watching.
The photographs were taken over about 1 week period in Dec 2013. They illustrate a conjunctivitis. Not a normal "common" bacterial conjunctivitis that requires antibiotic eye-drops (and often bizarre nursery policies).
http://johncosgrovegp.blogspot.co.uk/2014/01/conjunctivitis-nurseries.html

This was an Adenoviral Kerato-conjunctivitis.

I bought chloramphenicol antibiotic eye drops over the counter, as initially I thought it was just a bacterial conjunctivitis (from daughter, with love). I didn't improve. I don't like seeing the doctor. As the weekend progressed my appearance and condition deteriorated. I was about two months too late for winning a Halloween costume prize. I missed the surgery Christmas party too. Apart from maternity leave (x3), I had never really had more than a few days off work with illness. I felt I had let my patients down. Checking Deanery emails on my i-pad made me feel normal, at least in my actions..but the reality was I could not tolerate the light from the screen.
For Christmas week I hid in a small dark room, with my three year old son who was also affected. Toddlers are so resilient, they moan, then play!
My family tried to help, but they also feared contracting the illness. My husband even made a roast dinner for 10 people!
I had been to the Midlands Eye Centre A&E about five times over a two week period, mainly because my symptoms were not improving. I was informed of the extreme infectiousness of the virus. I had very good NHS care. The staff listened to me and were kind. I complied with their treatments....and also became one of the 10% of the population who have an allergic reaction to the preservatives in eye drops. Iatrogenic intensification of symptoms?  Oh dear.
Worst of all was the feeling of suffocation I experienced when putting Lacri-lube ointment in my eyes. I felt like I was being buried alive. How disgusting that medication is...I will prescribe with cautious warnings in the future! I spent around £50 on prescription charges, some of the medications became obsolete after one use due to allergy.
I went on to develop a complication from the infection ; pseudo-membranes and corneal precipitates (like cataracts). When the doctor told me the precipitates could last weeks or months I felt devastated. MONTHS????? How can I function if I can't drive for months? Three kids in three different schools, shopping, working in two different places? How? How? Oh no........ I had to submit to this fate. I learnt to be a patient patient. Thankfully the precipitates improved within a week.
It made me realise the importance of the doctor conveying HOPE to patients.

My descriptions may lead you to believe I have a low pain threshold, or I am easily made fretful. Both of these are untrue. This was confirmed by a wise medical educator colleague, a retired GP, who informed me having kerato-conjunctivitis was the most painful thing he has ever had. My yogic breathing thwarted the rising panic....but it made me truly empathise with the patients who come to me with panic disorder. It is an overwhelming wilderness of intense feelings that erupt uncontrollably.

I am certainly not wishing illness on anyone, but I have learnt so many valuable, enduring lessons about life. Not least true self acceptance. I hope this blog will help at least one person with their reflections, with their interactions, with their considerations.

I thought I was just a service provider
My personal NHS Appraisal portfolio entry 10/2/14
I just wanted to reflect on something that has honoured and pleased me. It has also come as a bit of a surprise. Over the Xmas period I was unwell with a serious eye condition. It was the first time I required time off from work for longer than a couple of days (3 weeks). On my return to surgery I have been touched by the genuine kindness and concern from patients about my well being. In fact I have been taken a back, in that it is not just from my regular female patients who are friendly faces, but also from patients I did not even recall - like an elderly Rastafarian gentleman.
I am very honoured to be able to feel their genuine concern. I hope I will always help patients to feel my genuine concern for them. If I ever failed you I am sorry.

Maybe it is just Karma?

I woke up one morning in January and I could open my eyes unassisted. What an amazing experience...to be able to see on waking in the morning. Cherish the small things...as they are in fact the most important things.

Moseley sunrise 12/1/14 - from my bedroom  (smart phone pic, no filter)

My Birmingham and Solihull GP trainers conference speech 2013 - Virtues and Values

You know that vulnerable feeling you have when you want to tell someone you love them, but you know it could all go horribly wrong and that is the end of that?Alternatively, the love could be reciprocated and you could be the happiest person in the world ( at least for a while)? Well, that is how I felt before delivering my debut speech. It is a "debut" in that I have only been the Area Director for GP Education for Birmingham and Solihull for 6 months now. Many of the trainers and Training Programme Directors do not really know how passionate I am about Med Ed and what drives me. I wanted to tell them and I felt the trainers conference would be the ideal opportunity. I have not really delivered a speech on a topic so close to my heart, especially to a large group of respected GP colleagues (who are renowned for not being backward in challenging ideas they disagree with). 
Thankfully, I have had fantastic feedback verbally, by email and on social media. This has been hugely encouraging and has given me a little more confidence to speak out a bit louder about "my purpose". I delivered the speech at the opening of the conference. I had been up since 1 am ruminating about the themes in my head!

"I saw this slide a few months ago, it really appealed to me. I could not really comprehend why, but I saved it anyway. Walter Benjamin the early 20th century German philosopher once said 'speech commands thought and writing conquers it'. On looking for inspiration for this speech that is what happened. In focussing on the words above it became clear what the vision and the process really were to me.

Let me speak about

The vision (short term and longer term)

Aims of conference

I am hoping you re-engage with why you chose to be a trainer, to revisit the warm glow you get from seeing trainees develop.To enjoy company of colleagues with a similar outlook.

To get away from some of the stresses of running your practices, with constantly moving goalposts.

To learn loads, (I am unapologetic for the noticeable increase in intensity in the content of the conference compared to previous years).

We are so fortunate to have such expertise in our patch.. even a Health Service Journal award winner and docs on the Pulse power 50 GP list! Along one of the founders of "Grassroots GP" .....all will become clear at the end of the conference (clue : social media).

Thank you to all the workshop speakers, in advance! We are most grateful for you putting your head above the parapet and offering workshops.

Long term vision

Well, I could speak about GMCs  "The shape of training" or to their document "The state of Med Ed and practice in The UK 2013" or the revised "HEE mandate".. But, I am going to be selfish and tell you briefly about MY vision. To which you may conclude I require some lithium or something..but here goes. 

I am embarking on a six year part time PhD, not for any pretentious title reasons,or for a particular career pathway, but because I truly believe in the cause, I am essentially self funding. I am studying at Birmingham University School of Education, within the Jubilee Centre which looks at Character Education and Values.

My cause is "Eudaimonia" - state of human flourishing ( as described by Aristotle, 3500 years ago) ..Sarby first heard this and thought it was an STI! 

I believe it is potentially possible to achieve Eudaimonia  if we shift the focus of education to character and values. The focus of my research is practical wisdom (phronesis): being wise, in the broad but very practical sense. Wisdom not just as a cognitive process but as a virtue.

It is inherent to our jobs along with other professions such as Law and Banking. I recommend an inspiring readable holiday book by  Barry Schwartz "Practical Wisdom - The right way to do the right thing". 

I will read you a short extract from the book:

We are happiest when our work is meaningful and gives us the discretion to use our judgement. The discretion allows us to develop the wisdom to exercise the judgement we need to do our job well

I ideologically challenge that tick box curriculums, traffic light management of trainees, in fact the very tenant that medical school is based on - the biomedical model, has the wrong emphasis.

(I came up with this quote during a school run incident!) It conveys the value (consideration) being restricted by the societal acceptance of rules defining behaviours.

When I think about what I remember from my GP training, it wasn't the content of the Wolverhampton training grid, it wasn't the content of summative assessment....it was inspirational people/trainers, their dedication, commitment, kindness and work ethic.

There is an error in this slide, but I love it. These are some of the professional role models in my life. It is not supposed to say "saving" across the top, as that was a process of the "app", but for some reason it does. I think as a result it really illustrates what Professor Billett refers to when he speaks of "Appropriation - setting it (behaviours) apart and using it for my own use".

Prof Billett from Griffiths University, Australia  (guru in learning in practice) closed a Med Ed research conference last week suggesting "appropriate Appropriation trumps Mastery".

I suspect we are getting dis-illusioned and frustrated because tasks are onerous and do not seem to serve their purpose in creating the best doctors, and may even prevent us from being good doctors.

Thus, potential solutions which shift the focus to character and values , such as a current movement for positive education - e.g PERMA (Seligman)........So I am hoping you can see my purpose.

For the cynics and critics amongst you ( and there will be some) the educational endowment foundation looked at a cost/impact analysis of a few educational methods. They found that attending to metacognition ( that is essentially what we are talking about here) has a high impact at low cost. 

The process

"Rely less on processes and more on values and culture"  NHS lay advisor Leon Pollock speaking at a Health Education West Midlands conference last week. I seem to be surrounded by confirmatory bias.

About some recent difficulties along with an apology:

-Administration , still no dedicated administrator for Birmingham & Solihull (BSOL). Flux in the administrators who do support BSOL, thus things slipping through the net. We have a patch was big as Oxford Deanery. I have lobbied, Debra (team leader) has lobbied, Martin has escalated. Still no support...but we ( Debra's team and myself) are doing our best under the circumstances. It obviously boils down to ...cost savings, but in the mean time I am aware of problems with .....just about everything that requires good administration.

I am hoping you are thinking, "How can we help?", well being patient with us in the first instance, (* summer ARCP feedback is on tiny strips of paper, as the thought of emailing 180 trainers was demoralising for me) and secondly ....well, maybe ask Martin what can be done?

-Portfolio frustrations...can we field some of the questions for Ryan and Sian's expertise in the workshop tomorrow as they probably have better answers to hand?

- Tightened education and training budgets in a climate of growing training demands in primary care (déjà vu situation) ..inevitable in the current NHS climate..so some advance apologies if the ramifications affect you.

So, for me the "process" is actually less about the operational aspects of the Deanery (but as patch AD I will still strive to ensure we meet the performance targets, quality standards and curriculum aims), but the PROCESS is more about LEARNING, about INFLUENCE and the BELIEF that things WILL BE better, even GOOD, and WE (me and you) can make and influence that GOOD, even with the constraints and limitations.

So, PROCESS to me, is more about an ATTITUDE.

Thus, if you are open to the concept, I am hoping to unashamedly infect you with the concept of Eudaimonia . We have NOTHING to lose.

So ........after 6 months in my new patch AD role my new mantra:

Just a few final housekeeping things:

We have a twitter wall at this conference so please use the hashtag and tweet learning points, feedback and interesting things!

I am still the Associate Dean for Foundation Training in GP. I have not included any foundation workshops in this conference but I have updated the training guide and it is on the Deanery website as highlighted. 

And finally….

I wanted to say thank you…not just for the explicit things you do as a trainer, but for the tacit things too. I prepared this slide for you - I took the photo in Iceland.

Dr Sabena Jameel

28th Nov 2013

Hinkley Island Hotel

Leicestershire