A controversial career

Authors: Cath Janes 

Publication date:  06 Aug 2009


Cath Janes speaks to doctors whose chosen career is not always welcomed by the wider world

If you’re reading this article, you’re no stranger to heated debates about the ethics of medicine. Would you perform euthanasia? Offer in vitro fertilisation to a 60 year old? Refuse to treat the obese? Yet how would you feel if it was your career that was being hotly debated? Imagine colleagues shunning you because of your views or the public raging about your achievements. Some people don’t have to imagine that at all.

“People think they’re liberal but they really are not”

“People have been very rude to me about what I do,” explains Fran Travers, a consultant gynaecologist who does an average of 16 abortions a week as well as running a local abortion service in the north of England.

“Social workers, specialists, fellow gynaecologists, patients . . . I’ve had it from them all. I once called social services about an unrelated issue and I could hear one of them saying that they didn’t want to speak to me because I am an abortion doctor. I also had a miscarriage patient who made it clear that she wasn’t like ‘those other women’ and that she expected to be treated differently because she felt superior to them. I made it clear that she could find herself another surgeon. People think they’re liberal but they really are not.”

Rarely a week passes without the announcement of a medical breakthrough. On the surface we appear to be progressive, innovative, and constantly pushing the boundaries. Yet for all of our outward insouciance, there are plenty of careers that most of us wouldn’t touch with a bargepole. Not only are they an affront to our sense of ethics and social conscience, but they’re jobs for people who are lacking a moral compass . . . aren’t they?

“It’s easy to sit on a pink cloud and judge everyone else, but every aspect of my work is about doing what is best for individual women,” argues Travers. “What’s the alternative? To make women have their babies because they’ve been bad girls and need to be taught a lesson? I do this job because I understand the backgrounds that these women often come from, the social problems, the domestic violence, and the joblessness. They make mistakes and I give them a second chance and I’m not going to roast in hell because of it.”

If Travers sounds touchy, can you blame her? When poised at the start of a career in medicine it is hard to imagine your work garnering such conscience pricking reactions. Every time you go to a party, bump into an old friend, or even fill in a form you reveal what you do to wide eyes, a sharp gasp, and yet another moral debate. It’s about more than doing a job that others find controversial; it’s about being a walking litmus test for the morals of wider society too.

But how do you live with this constant debate? Travers admits that when her children were younger she concealed her work because she didn’t want them to suffer others’ reactions. When they were older they were picked on after telling the class about their mum’s work. Travers knows doctors who have been driven from doing abortions because they can’t cope with the pressure.

“Not a real doctor”

None of this is news to Malcolm Vandenburg, a specialist in general and pharmaceutical medicine. He admits that his career choices have angered his contemporaries, and it’s obvious that he is no stranger to controversy.

“If you stick your head above the parapet you get a few arrows,” he says philosophically, “whereas if you are on an accepted path and you do the job adequately no one is going to fire bullets at you. Although it was upsetting and difficult when colleagues started to say that I’m not a real doctor, especially because everything I’ve done has been in pursuit of being a good doctor.”

Vandenburg first experienced what he describes as “people turning up their noses” when he started and funded a hypertension clinic with soft money in the 1970s. During the course of his career he became a research director at drug company Merck Sharpe & Dohme; founded his own research consultancy to register and research drugs; and founded a pathology company and a management training company, each of which he sold. He also founded a private sexual health clinic and works as a medicolegal expert.

“Things have changed a lot since I worked in pharmaceuticals,” he says, “but back then this wasn’t an accepted career. I thought of myself as a trailblazer and was proud of what I was doing and saw that the pharmaceutical industry had a lot to give. I was shocked by the reaction of my colleagues though. Parties were funded by pharmaceutical companies and none of them had a problem with that, yet they thought I had sold out because they also funded my work.

“If there is one thing I have learnt it is that you should never be afraid of what people think. Make your own life rules instead. I’d much rather have my career path than that of those who graduated with me.”

“The headlines are all about mix-ups and bad news”

Sarah Wentworth, who is the medical director of a fertility clinic, is also used to endless debates and controversy. She says: “It is an uphill battle to get people to see that this is a branch of medicine and I am amazed at how many of my colleagues regard fertility medicine as an optional extra. I find myself having to defend people who want to have babies, even when there is a pathological reason for their infertility.”

Wentworth also believes that the media are part of the problem. National debates about the cutting edge fertility treatments her clinic offers do little to progress intelligent discussion, and she is now used to battling the nation’s outrage.

She explains: “Colleagues of mine in other countries are often amazed at how the UK media portray fertility treatment. The headlines are all about mix-ups and salaries and bad news while in other countries fertility treatment is celebrated. I recall travelling to a conference when a controversial story broke about egg freezing. I had so many calls from the media that I never made it to the conference. It all adds to the misperceptions of what I do and, in turn, fuels the debate.”

Wentworth admits that she even chooses when to tell people what she does for a living. “No one should ever admit to being a gynaecologist at a party,” she says. “It’s a conversation stopper and you end up with a queue of women asking you about hot flushes and heavy bleeding. I enjoy, though, telling people what I do at pompous academic dinners when faced with the patronising question, ‘And what do you do, dear?’”

All this makes you wonder whether the people who are attracted to these “controversial” careers are looking for a fight. After all, if you like the quiet life, are you really going to pursue a discipline that provides the Daily Mail with a year’s worth of screaming headlines? For some people, though, they have no idea that their career will be a controversial one until they’ve already embarked on it.

“You have the same arguments time and time again”

David Haroldson specialises in microvascular reconstruction of birth defects in children, as well as doing cosmetic surgery in adults. He had no idea that his work would result in continual moral debate when he embarked on his discipline.

“And that debate is wearing,” he says. “You have the same arguments time and time again and it takes a lot of patience to deal with it. The complexity of what I do is deep but when the media get hold of the issues surrounding cosmetic surgery it only thinks in headlines. The intellectual issues get ignored. The result is that I try to not tell people about what I do.”

As Haroldson’s workload is split, he gets a unique glimpse of what people believe is morally acceptable, another issue that causes him concern.

“If I tell people I work with children they say ‘aww!’ but when I tell them that I do cosmetic surgery they say ‘really?’ Yet I am tired of hearing that only my work with children is worthwhile because this suggests that [my work with] people who need cosmetic surgery is not. There is an image that it is all about pop stars and page three models when really it is about normal people who have issues that need to be addressed because of anything from self harming through to congenital conditions and tumours.”

For Haroldson what lies at the heart of any debate about controversial jobs is the question of health care. He believes that we need to look hard at what health care actually means. Perhaps then the boundaries of what is or is not acceptable will become less blurred. After all, even if you’d never dream of doing a breast augmentation or an abortion, would you really want to live in a society where these practices were outlawed?

Conviction

One emotion that seems to be common among medical professionals who do stick their necks out is passion. It’s an indication of how strong you need to be to enter certain disciplines. In fact, perhaps the likes of Travers and Vandenburg are to be respected. After all, they are doing jobs that help a healthy society function even though they are also jobs that many people would shrink from. We may not all agree with them but can we really be so unforgiving about the rare personal conviction that helps them do it?

“Luckily for me I love my work,” says Haroldson. “It is so diverse and challenging and microsurgery is a Zen-like experience. I’d go mad if I treated gall bladder after gall bladder instead. And I really don’t care whether people think this is proper medicine or not. I could not have had a more interesting career than this and, controversy or not, I know I’ll be sticking with it.”

Competing interests: None declared.

Some of the names in this article have been changed.

Cath Janes freelance journalist Pontypridd

 cath.janes@gmail.com

Cite this as BMJ Careers ; doi: