Column
Bad advice
Authors: Caroline Elton
Publication date: 07 Nov 2012
Patently bad advice is dangerous, warns Caroline Elton, but plausible poor advice is worse
The worst careers advice I was given was to become a war reporter in Rwanda, at the heart of the civil war. I had no experience of working in a war zone; in fact, I wasn’t even a journalist. And there was also the slight problem of three small children at home, minimal childcare, and a husband who worked full time. So who was the source of this particular gem of wisdom? A bloke sitting opposite me in a café who saw me editing a chapter of my doctoral dissertation and got it into his head that I was a journalist whose career would be enhanced by a direct flight to Kigali. Unsurprisingly, I didn’t take his advice.
When career suggestions are clearly off the wall, they are actually pretty harmless, because they tend to go in one ear and straight out of the other, without causing much cerebral activity in between. The same can’t always be said for plausible sounding advice from senior colleagues, where the seniority of the person offering the advice can obscure the fact that they may not fully understand the trainee’s career situation or have an up to date grasp of the specialty they are advising them to consider.
One example of plausible but poor advice that trainees repeatedly tell me about is the recommendation by their hospital based supervisors that they would find general practice much less stressful than working in secondary care. On the face of it, this piece of advice seems pretty sensible. But as a general rule of thumb it can rapidly fall apart, because to know whether somebody would find general practice more or less demanding than a particular secondary care option you need to know the specific aspects of work that that person found stressful.
I can understand why hospital based specialists looking at the green grass of primary care could conclude that life as a GP seemed easy: few or no night shifts, no crash calls, and often dealing with the “worried well.” But, from the inside looking out, GP trainees (and even fully qualified GPs) can paint a different picture. In a given surgery you never know what is going to walk through the door; you have to manage your consultations within the allotted time, despite the fact that patients can turn up with complex comorbidities; you don’t have immediate access to the range of diagnostic tests that you have in an inpatient setting; and you are on your own in the consulting room.
On the basis of the discussions I have had with unhappy GPs who have contacted the Careers Unit, I have a hunch that a central issue in job satisfaction for GPs is whether or not they cope well with uncertainty. Of course, uncertainty is part and parcel of all clinical work, but it manifests itself differently across the specialties. Some aspects of general practice can provide a fertile medium for breeding worries. Examples of this include the fact that GPs have to become comfortable with not referring patients for further investigations unless there is a sound clinical reason for doing so, and they also have to have a working knowledge of so many different clinical conditions. Yet over and over again when I explore why these doctors chose general practice, they tell me that they were advised by hospital based clinical or educational supervisors to consider primary care because it was much less stressful than working in secondary care.
I am not for a minute suggesting that senior clinicians should refrain from offering careers advice to their juniors and leave it to the so called careers “professionals.” Quite the opposite, actually, because not only has the research literature repeatedly shown that students and junior doctors want to discuss their careers with clinicians rather than careers advisers, but the medical school and deanery careers services are too small to provide in-depth advice to each and every medical student and junior doctor.
But I am definitely making two other pleas. Firstly, clinicians who provide careers support should focus more on helping the student or trainee to become clearer about the specific aspects of clinical practice that they enjoy and also the specific situations that they find particularly stressful. And, secondly, rather than advising the student or trainee about specialties that they have never experienced themselves (or experienced only briefly, over a decade ago), they should encourage the individual to discuss their career plans with people who currently work in that specialty. In this way, doctors at the beginning of their professional life in medicine are less likely to be on the receiving end of bad advice.
Competing interests: None declared.
Caroline Elton chartered psychologist and head of Careers Unit
London Deanery, London, UK
caroline.elton@londondeanery.ac.uk
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