• Paul McGovern

Occupational Medicine – is it all it’s cracked up to be?

A year ago, I was about to start a new job as an occupational medicine registrar, and wrote a bit about what I expected from quite a significant career change. Looking back at it, I seemed pretty positive. I used superlatives like ‘amazing,’ ‘exciting,’ ‘very favourable’ and ‘good.’ I thought that, in switching to occupational medicine, I had found a really wonderful new job.

The Crossrail station at Whitechapel under construction. © 2016 Paul McGovern
The Crossrail station at Whitechapel under construction. © 2016 Paul McGovern

On the commute for your first day though, you never really know. You can speak to people, do your research, and yet you still can’t truly predict how a big career change is going to work out. Worrying about whether you’ll mess it up is one thought, but is as nothing to the burrowing beetle in the brain that asks, “will I wish I’d stayed where I was?”

I’ve had a chance to see places I otherwise wouldn’t; a food factory to watch houmous and lasagne be made (the place smells amazing); a Crossrail station while it’s being built (a gigantic subterranean concrete cathedral right in the middle of London), an aircraft repair company to walk around stripped-down military planes; a lab where dangerous organisms are tested; a depot where they rebuild tube trains. I even got to sit in a train cab.

All this stuff is great. It’s what I wanted, and what I expected from the specialty. And these experiences – getting an insight into things I otherwise wouldn’t have – extend to clinical work.

I don’t generally have access to blood tests, or scans, or x-rays, or even clinical notes. What I do have though, is time – something that used to seem impossibly scarce. I previously saw 25 patients in a morning in clinic, and now I get an hour for each person. That means I have much more chance to question and listen, and much more opportunity to think holistically. Because I don’t treat directly, I can focus less on the illness itself and more on the people: what they can do to overcome barriers; who they can contact when they don’t know how to get help; how they can improve things for themselves; how they can prevent problems in the future.

I get more of an insight into people’s lives outside their illness – work is such a big part of who we are and what we do – and it’s a real privilege to understand just a bit more about how people work and what they do to get themselves through.

It’s been fascinating seeing some of those workplaces, and then getting to meet the people who work in them. Seeing tube trains being rebuilt makes me look at my commute differently; speaking to the people who work on those trains gives yet another take on how the world around me works. It’s endlessly fascinating speaking to people and seeing how they fit into their job, how they work with their boss and colleagues, their family, their community and society and it gives me a unique chance to see the world in a different way.

The occupational health consultation presents me with two sides of a story – from the patient and from their manager, and lets me use my training to come up with an independent and balanced assessment and opinion. And it gives me a chance to make a tiny difference to some people’s lives. Like any other doctor, but in a different and sometimes unique way.

Do I wish, then, that I’d stayed where I was?

When I was a student, I spent a year in Manchester studying Ethics and Law. On my first day in this great city, I discovered, amongst other things, the Manchester kebab. Unlike the inferior kebabs of my native South, these were gigantic, served in a Naan bread rather than a pitta, and wonderful. I ate them fervently and frequently, and became moderately and joyfully obese.

I doubt I could eat one now. I don’t think I even want to try one. The memory of those kebabs will always be better than the reality. Thankfully they, and hopefully the obesity, are behind me.

So it is with my former life in orthopaedics. Being in an operating theatre was great, and I loved it, but it’s just another thing to look back on fondly. Without changing career, I wouldn’t have had a chance to visit places that interest me, or speak to people, both patients and managers, that give me a daily insight into how we all fit into society. All the stuff I spoke about a year ago – the variety, the flexibility, the chance to make an impact – all are still there. What’s great to realise is that there was even more to it than I thought.

My slightly overenthusiastic zeal for the job, then, remains. It’s very different to what I was used to, and that’s exactly what I had hoped for.

I can’t imagine wanting to go backwards. Onward, to year two.

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