I was pretty sure I was going to do adult medicine, I just didn’t know what flavour. I had enjoyed paediatrics as a medical student, but the 8 week rotation made up barely 2.5% of my entire medical school training, and frankly, it never entered my thinking. I did a couple of adult SHO posts after house jobs, and decided to do an emergency medicine job to expand my experience. I had two revelations during my time in St James’s Hospital A&E in Leeds. The first was that I wasn’t really cut out for adult acute medicine – while many others thrive on the relentless and pressured environment while remaining empathetic and true to their values, the job made me less patient and narrowed my focus, and changed me into someone I didn’t really like. The second was that I loved treating children. My fellow SHOs would recoil in horror whenever the paediatric ED shifts were being doled out, while I would find myself volunteering to do more and more, which suited everybody all round. It was at the end of that job that I was sure paediatrics was the career for me.
I have never once regretted that decision. Paediatrics offers the same variety of specialisms that adult medicine does, but in community and general paediatrics in particular it also offers greater opportunities for those who enjoy the breadth and richness of generalism.
As befits someone who is “a bit distractible” (ref: Dr J Hickson (1997), Undergraduate Tutor Report for R Cheung), I have taken every opportunity to explore other areas of interest alongside my clinical training initially, and, since 2014, my general paediatric consultant post at the Evelina London Children’s Hospital. I currently work as a clinical advisor to Public Health England’s Child and Maternal Health Intelligence Network, working with the team of analysts to create and disseminate meaningful child health data and tools to practitioners and commissioners. I am also clinical lead for Healthy London Partnership’s programme to improve the way Child Death Overview Panels in London work together to reduce variation and share learning.
It is this variety that keeps me motivated and energised, but more importantly, doing one part of my job makes me better at the others, and vice versa. Clinical practice, system improvement and health data intelligence all inform each other, and has made me think differently about how to make healthcare better for children and young people at both population and individual levels.
Paediatric trainees are increasingly enlighted to the possibilities and the opportunities that population health and system improvement can provide to improve care for children and young people, and we should be rightly proud of that. Many trainees ask me how I got started in this area, and how I have been able to carve out a mixed role like this. And the truth is that I never planned it this way. In fact, I didn’t really know what I was interested in until I started doing it – I just knew that, as much as I loved clinical work and would never give it up, it would not be enough to sustain me in the long term. So really it was good fortune, and being brave – and thick-skinned – enough to seek out interesting opportunities, that allowed me to channel my existential ennui into something I discovered I had a passion for. Simply saying yes to one interesting thing after another has led me to work in the Department of Health for a year on an OOPE, be seconded to the Cabinet Office as a health policy advisor, lead national programmes to identify clinical variation in child health care, work on various reports and research projects with the RCPCH and the Nuffield Trust, and lead clinical improvement programmes as part of an NHS England 5 Year Forward View Vanguard. I have done some of these things better than others, but have enjoyed and learned from every single one.
And of course, you soon realise that the more you say yes, the more (and more interesting) opportunities seem to come to you.
I am aware that I am very lucky to have this balance, in a stretched system where there is an ever-increasing pressure to deliver more direct clinical care. It can be a challenge making the case that you might give more value by working smarter (or helping the system work smarter) rather than harder. But it is also vital to remember that that applies to how we look after ourselves too. We are all under increasing pressure to deliver more and more in our working lives, and for me the variety of what I do keeps me engaged and energised.
We are very fortunate in paediatrics to work in a system which recognises the importance of family life and other pursuits in shaping well-rounded and resilient clinicians.
I was able to work part-time during some of my registrar training in order to spend more time with my young children. My non-paediatric medic friends were both shocked and envious – it had never occurred to them that it was an option for a male trainee to take time out, or work less than full time, for family reasons, and indeed I had female friends in other specialties who felt pressurised into working full-time despite their reservations. Yet here I was, telling them that my specialty was not only accepting but incredibly supportive, and that I knew of at least 3 other male trainees just in London who were doing the same, with no doubt many more across the country. Finding a way to keep you career, family and relationships in balance is easier said than done, but I really believe that paediatrics gives you the chance to do that better than most.
I often think back to those days in St James’ A&E, and wonder where I might be now had the paediatrics spark not ignited. I am sure I would still be doing adult medicine, and I would probably have been happy enough. As Donald Rumsfeldt famously said, “there are things we don’t know we don’t know” – I was never miserable in my days as a medical SHO, and I suspect I would have enjoyed adult medicine well enough. But it sends a shiver down my spine to think that I might never have known how fulfilling a career paediatrics would be, and or be part of an incredibly supportive and inspiring paediatric family.
Dr Ronny Cheung