UK Psychiatrist Battles Demons Within and Without

Nicholas Genes, MD, PhD

Disclosures

December 18, 2007

Amid all the debate about whether national healthcare is good for patients, one aspect that is often overlooked is the potential effect on doctors. In the United Kingdom, where national healthcare was enacted nearly 60 years ago, many doctors were profoundly affected this past year by a new online job assignment program. The Medical Training Application Service (MTAS) had a particularly disruptive effect on a junior psychiatrist who writes under the pen name "Shiny Happy Person." On her blog, Trick-Cycling for Beginners, she has chronicled this tumultuous year and her frustrations with the system. Writing with great skill, she also describes her own battle with bipolar disease and the struggles she witnesses in her patients.

Dr. Genes: How did you discover blogging? You seemed to have several well-developed themes from the outset; were you active in other literary or journalistic media first?

Dr. SHP: I always thought blogging was entirely the remit of "angst-y" teenagers and pointless dullards laboring under the misapprehension that other people could possibly be interested in the minutiae of their dreary lives. And I think it is, primarily. I mean, have you seen how many blogs there are out there?

But a couple of years ago, a handful of seriously well-written blogs began to attract enough recognition that they were actually being published as books, and the media began to take an interest. I think the first one I became aware of in this context was Belle de Jour. Then there was a spate of articles in the major newspapers about professionals' blogs, notably some of the medical ones. And I read some of them and they were good -- really good.

Whilst I didn't kid myself that I could write as well as them, I realized that there was a way of getting my (very strong) opinions out there without having to (a) be a particularly good writer, (b) get past an editor, or (c) write about something someone else wanted me to. A lot of the posts were already fully formed in my head -- this is all stuff I've been saying for years, but I've never written before.

Shiny Happy Person hosts Grand Rounds
December 18, 2007

Dr. Genes: I wonder whether your pen name, Shiny Happy Person -- like the R.E.M song it's based on -- is sarcastic or genuine. Are you trying to be positive?

Dr. SHP: It's largely sarcastic. As is reflected in my blog, I am cynical, ranty, and angry a lot of the time. Blind optimism is not a quality I possess. I guess the name is partly a nod towards mania; during these times I could certainly be described as Shiny Happy Person. However, I could also be Shouty Screamy Person, Smashy Bangy Person, Slutty Spendy Person, Scary Talky Person, amongst others. But R.E.M didn't write songs about any of them, and I love R.E.M. more than life itself, so there you go. I honestly can't pretend that there's a great deal of thought or meaning attached to my name. It was chosen on impulse, and I didn't think anyone would read my blog anyway. When they did, I rather wished I'd thought about it a bit more carefully.

Dr. Genes: Do your colleagues know about your blog?

Dr. SHP: My colleagues, as far as I'm aware, don't know about the blog. Only a select handful of people I know are aware of it, and I think I'd be far more inhibited about what I wrote if I knew people I worked with were reading.

Dr. Genes: What are some posts that really captured what you were trying to convey? What struck a chord with readers, generating discussion?

Dr. SHP: I think the most well-received post (and most linked to) was The Curse of Mental Illness. The line, "mental illness robs you of your right to be a weirdo," was flatteringly widely quoted. I was proud of this one; it was one of those posts which was particularly liked by people who had been in the position of being judged by their illness; though, like a lot of my posts, my aim was to make a point to other medical professionals. It is my aim in life to make nonpsychiatric medical types examine their attitude towards mental illness and psychiatry as a discipline.

Still Ticking was one of the most personal posts I've ever written, and I was quite pleased with the reaction to my description of what it feels like to be depressed. I know I'm not a great writer, and the experience of madness is not something that's easy to put into words by anyone's standards. But I think I did okay with this one.

A Piano Lesson is possibly my favorite post. I was terribly worried that it would be too cryptic, and people wouldn't get the metaphor, but they did.

And finally, Denigrating Churchill is an old one which few people commented on, but which I liked. Mental illness as a fashion accessory and celebrities claiming to have whichever is the latest trend is one of my biggest bugbears. I detest the media skew on lunacy: If you're a celebrity it adds a touch of mystique; if you're a commoner you're dangerous and deserving of ridicule.

Dr. Genes: Your writing about being bipolar or about the upheaval of MTAS -- is this therapeutic to you? Or do you view these posts as something simply necessary and worthwhile to communicate?

Dr. SHP: Most of my writing is a little therapeutic, but I think I would single out the bipolar posts as the ones that aren't. I don't enjoy writing about my illness. Most of the time I want to pretend it doesn't exist. I don't wear it like a badge as some bloggers seem to; I'm not proud and I don't feel the need to spill my guts. I hate my illness. I hate it and I resent it. But I made a conscious decision when I started the blog that it would be part of my writing, because that is my unique angle on my career. There are some things I will always understand better than my colleagues, and I can empathize with some of my patients in ways that not everyone can. I wouldn't have felt I was being honest if I'd kept that away from my writing, though ironically very few of my colleagues know I am a manic-depressive.

Dr. Genes: The MTAS debacle got limited press in the United States, and I'm just not sure where British junior docs stand now. Are you okay? Was your life uprooted? If you knew then what you know now, would you have gone through with the process of becoming a doctor?

Dr. SHP: British junior docs aren't sure where British junior docs stand now! We all have jobs, either the ones we wanted (I personally was extremely lucky, gaining a place on the training rotation I was already on) or ones we were forced to take. A number of temporary emergency posts were created in order to fulfill the government's promise to find all of us employment. I just don't understand why nobody did the math before all of this happened.

Even now we're in training posts and theoretically allowed to continue to consultant level, but nobody's figured out how we're going to be selected into subspecialties in a couple of years. All of us with training places are supposedly guaranteed a place in higher specialist training where before we wouldn't have been -- which means that some of us are going to end up being forced to train in a subspecialty we didn't want.

If I end up being given a training place in child, forensic, or old-age psychiatry (when what I want is general adult/liaison), I'll have to ask myself whether I am prepared to spend the rest of my life in a career I don't want and can't imagine enjoying. The answer is probably not. I could see myself skipping the country at that point. Plenty of doctors already have. A friend of mine who is a final-year medical student now tells me that a lot of students are sitting American board exams already, in preparation for leaving as soon as they're qualified. A medical degree is no longer a guarantee of employment, but rather a license to be treated like crap.

MTAS was one of the most unpleasant experiences of my whole life, and it makes me feel sick to remember those horrible months of uncertainty and stress. If I'd known then what I know now, would I have gone into medicine? Difficult to say. I certainly wouldn't recommend medicine in the UK as a career anymore. But I can hardly pretend I don't love my job. I hate so much that is associated with it, but the bare bones of being a doctor -- I live it and breathe it. It's more important to me than anything else.

I got so tired of hearing myself ranting about MTAS. But it left its scars, and I think this is reflected in the disappearance of a number of British junior docs' blogs over the past year. I feel it myself -- not quite beaten, but subdued, and so very tired. For a while my job was just a job. I stopped caring: went in, did the minimum I needed to, went home, didn't think about it. I feel I'm beginning to thaw now.

Dr. Genes: Shiny Happy Person's reemergence continues this week when she hosts Grand Rounds on December 18, 2007. Grand Rounds features the best in online medical writing from doctors, nurses, students, and healthcare professionals, organized and arranged by a different blogger each week. Check it out, and learn from SHP's compelling medical perspective.

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