Choosing a specialty

Apropos my tale of point-scoring off the boss it is worth noting an important maxim which my wife lives by:

If it’s meant to be, it’s meant to be.

I was always going to be a hospital doctor. My parents were both GPs and, OK, things are very different now but it was not the life for me. Hospital medicine is also different; maybe if I was starting out now, when hospital consultants have little say in how they run their hospitals (or even their own departments), I would take a different view. Also trainees find, thanks to the new career structure, that they are on tramlines and cannot easily switch specialties.

When I went for my first SHO post it was at the Hammersmith and you applied for all the medical jobs and were interviewed by all the consultants. At once. I pitched to do gastroenterology. At medical school neurology was my weak spot, so that’s what I got[1]. But six months convinced me it was what I always wanted to do. So I planned my next moves with that in mind; writing off options in medicine of the thorax was not a problem, and I did two years of general medicine in Bath, which was wonderful, and led to aforementioned marriage as well. But by the end of my time there I was not only newly wed, but in need of a job near London, as my father was terminally ill. So I headed back to talk to my old boss at the Hammersmith, Chris Pallis, who had been very supportive of my plans.

However it was clear when we met that something was wrong. I don’t know what, or why, but he seemed quite lukewarm about my future in neurology and when he sent me to Queen Square to talk to the Dean there I got the same bad vibes.

So – what to do? I thought for a while and decided that the least bad option (note this – it’s not the same as the best) was to try rheumatology. I had turned down the offer of a years’ rheumatology research in Bath, and applied to my training hospital.

Things didn’t turn out too badly in the end, although that’s a long story. However quite by accident, while trying to find some stuff for a research patient in a filing cabinet, I discovered my old registrar application in which my last Bath boss had written “He has made a sudden decision to go into rheumatology, and I am not convinced of his long-term commitment to the specialty”. I derived some pleasure, nearly 30 years later, by writing to him to suggest that by being elected President of the British Society for Rheumatology I had perhaps proved him wrong.

The moral of this tale is that, if a door shuts you should push another open but, once committed, stay there. There will always be something special that comes out of it; I certainly would never have thought that going to a small, just-out-of-London district hospital, I would end up as an expert on medicine and surgery of the First World War.

As a rider to my tale of risking the boss’s wrath I should point out that when Chris Pallis had his 70th birthday celebration at the Athaeneum I was the only non-neurologist invited, so standing up to people does perhaps work. But be true to yourself.

[1] In the armed forces it is a common belief that you get allocated at random, or in deliberate contradiction to your suitability. When I was a lad our next-door neighbour was Eric Fenby, the distinguished musician who had been Delius’s amanuensis, and had taken down from dictation much of the composer’s later work after he went blind. When WW2 began he offered his services and was posted to the searchlights. It was only later he discovered that the recruiting officer had noted his occupation not as composer, but compositor. Fenby ever after harboured a deep resentment of the conscientious objector composers whose reputations had flourished in the war.


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