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as in a digital innovations in learning.
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A totally all video journal of neurosurgery and neuroscience in association with Glasgow neurosociety, the largest society for young students, residents and young neurosurgeons interested in
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neurosurgery neurology and clinical neuroscience in Glasgow, Scotland, are pleased to present
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another in the series started by SI Digital called Let's Talk. This is the third in the series and it's an intergenerational discussion on this topic of women in neurosurgery. SI
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Digital is now offering this program and all of its programs on podcasts.
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This program was organized for the Glasgow Neuro Society by Mohammad Ashraf and Hassan Ishmael with the help and aid of the new Glasgow Neuro-President or 2025-26, Risa Tamid. And this is part two
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of Women in Neurosurgery discussion series.
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Now this one is 54 minutes
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But on the other hand, you've all probably been in this situation and I'll just tell you the scenario. I mean, I trained with Ranserhoff. He was absolutely an unbelievable technician, et cetera.
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And I remember one instance where he was in the mail changing room, banking. He was going to do this big posterior fossa meningioma. And I was a chief resident and I had my junior resident. And
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basically, it was an intra-tentorial meningioma. We took out the whole thing. So by the time he walked sauntering into the operating room, right?
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You know, and he flipped out, Oh, you're finished. But, and there were other cases like that, especially with Fred Epstein. You know, Fred, by the time I was, you know, done with my six
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months or a year or whatever. I was bringing in a new paper, actually, every weekend. And he said, You know, Epstein, you're a better surgeon than I am. And this is the kind of thing, you
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know, you don't go into the operating room after a while, you know, once you mature and you've got some of the technical skill under your belt, you have to realize that it's your creativity and
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your expertise that's going to add to the field not what your predecessors necessarily have. They've perpetuated or they've imbibed in you, basically what your technical skills happen to be,
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Basically, you've got to fly in your own. I mean, Jim, you used to see this in residency all the time, right? Yeah, I was going to make, I don't want to prolong this 'cause I think we got to
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get to questions, but I think it boils down to it. I've heard all the opinions, I think they're reasonable, but I think the one thing is what I think Nancy's is paying attention to. We've
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traveled all over the world. We've seen people all over the world. There are people in countries right now who are working extremely hard. They're very smart, they're very good They may not have
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all the good things that you have to work with, but they are going to be leaders and they're going to succeed. Your competition is the world Your. competition is yourself. It's not the person next
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door. And it's like we do in the journals. We don't have any criteria by which we accept a paper, except it's fact-based and it's excellence.
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And that's what it is. You've got to work as hard as you can every day, not to be better than your neighbor. but to be the best in the world. And that's very demanding. You are, your competition
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is yourself. And you've got to be the very best person you can be. And you've got to read constantly. You've got to learn constantly. You've got to know what's constantly going on. Then you won't
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feel inferior or insecure. And I don't care what people say. We're both Jewish. We've been through all kinds of bias for our whole lives. And the way you do that is you work twice as hard and
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you'll be twice as good and you're going to get there. And you don't let the turkeys get you down. I'm sorry. No, not at all. It's clear that a
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great deal of drive is required to thrive in this environment. And that leads us really nicely to the question I wanted to pose to you guys next, which is, as a woman in neurosurgery, did the
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specialty make you sacrifice something in order to pursue it? Ms. Whitehouse, we haven't heard from you for a bit. Why don't you start us off? No, I've never really - I've never bear in mind, I
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have never wanted children. And I think that
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we've got to start going onto the topic of talking about how to have a family within neurosurgery. There's no point having a talk about women in neurosurgery about talking about family. So I don't
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have children, I've never wanted children. So I've never had an issue with that. I would second. I agree, I also agree with that. And I'm married
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and actually my husband survived my entire residency, but we never wanted kids either But again, if you're gonna be a woman neurosurgeon and you're gonna have kids go and get somebody else to help
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raise them, because if you choose the mommy track and you choose like a Kaiser Permanente job and you wanna be the nine to five neurosurgeon, don't belly ache about the fact that, you know, your
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male counterparts are gonna get more accolades and better cases, right? Mr. Dude, what do you think at the end? You've mentioned you have a child Yeah, so I think it has made me sacrifice things.
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Um, I don't, I think firstly, um, I agree with, with Kat. I think it's, um, it's about having a child. I'm more so than anything else. I think as a parent in general, uh, there's, uh,
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your surgery makes you compromise. It, it does. You have to, to some extent, think, but as a, as a mother, specifically, it's much more so, uh, would I have it any other way? No, of
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course not I love my child and I love neurosurgery. Um, yes, there are times that the expectations from me, uh, even I have the most amazing supportive husband, I have the most amazing
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supportive family, although none live in the city with us, unfortunately, but, um, the expectation for me generally from people around me are very different. Like my male counterparts when
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they're sometimes, uh, well, I'll, I'll give you an of them wanted to scrub out of a case in the evening and he said, Oh, I need to get home because I'm babysitting. That's his own child. I,
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on the other hand, have had many situations where I've been like, Okay, what do I do?
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I've got a case. I've got a child. I've got a dog waiting at home. How am I going to manage all of this? My husband's very, very supportive and I've actually managed to sort of have a support
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system around me where, for example, when my husband has not been around, I've had friends pick up my child at 613 in the morning. I hand over my child. I have walked my dog before that. They
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then take my child to school and then I go into work. I've had many situations where my friends have had to go and pick up my child because come 6 pm. that's the latest the school keeps them.
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There's no one to do it. And yes, I could,
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I guess, scrub out, and I could say, okay, no, actually, I need to go home. And if I'm honest, my boss is a very supportive of that. But that would change the way that things are for me.
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That would, A, for me personally affect my learning because I would not be able to see a case through. I would not be able to see my patient wake up. I would not feel good about that. And B,
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also, it would be, it would reflect badly on,
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because people around me would think, well, you know, well, you know, the soccer ball going to follow through, or she's going to have to go home because she's got a child. So yes, you have to,
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I think you definitely have to organize yourself a lot better when you're a mom. And you definitely will sacrifice some things. I know already, for example, my daughter's next week on Monday,
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she's got a dance thing just yesterday she said to me with her doughy eyes. Oh mommy are you coming to see my dance? you know it's near Christmas time and I was like oh my god Monday is like my
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theatre day and I there's no way that I can get to that unless I forgo theatre but am I gonna do that no because actually I really would like to be in theatre on that day so I said no sorry yeah I
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will not be coming but I will then try and make up for going to a different thing and yeah so I think definitely having kids makes you sacrifice stuff but then neurosurgery makes you sacrifice a lot
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in life generally you know your your health you know but you know there's no way there's no way you can get through what we get through without I mean I'm sure actually that Americans will disagree
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with me but I don't have the time in a day to be able to look after my mental health my physical health do my job have a good relationship with my husband my child and my dog I just I cannot fit all
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of that into something has to give and for The first thing that usually goes is my physical health. So exercise becomes a problem, followed by mental health. Any time to yourself becomes a problem.
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It's usually when you get home and you sit outside for like 10 minutes and you're like, okay, let me just sort out the chaos in my mind before I walk in and then there's another chaos at home.
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There are things that makes you sacrifice. But then the days when you go to work and you have the best day and it makes up for it But would I sacrifice my home life for that? 100 no, I love my
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child, I love my family.
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And I also love my job. Thank you for being so open. I think that's given us all a great deal to think about because one of the other questions that's come through is, is it possible to have a
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work-life balance in neurosurgery? And I think, Ms. Whitehouse, you might be a good person to come to for this and you can maybe tell us bit more about what the institutional policies are. a
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maternity leave in family life on procedural opportunities
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in the UK? Well luckily I have this in a presentation that was in the background and I was just getting ready for this. So you are entitled to maternity leave, you're entitled to shared parental
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leave, you're entitled to adoption leave if you're adopting. You'll have to check your local processes, I'm not going to go into the nitty gritty of it all right now
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You are you have a right to come back less than full time and bear in mind I'm talking about we say this is women but I would also very highly advocate this is for men as well. Women shouldn't be the
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only people who have to bear the burden of child care as well and I'm quite a strong proponent for allowing my male trainees and male colleagues to go to the things for their children as well and in
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the same way that women should be allowed and have aligns those sorts of things. So. And yeah, you can do less than full-time. Be aware that during your training, of course, if you do take a
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year out, your training will be a year extra. If you are less than full-time, your training will be longer. You may find you have to work a bit around whether
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you get a specific day off and how that works. And therefore, what training opportunities you might be missing out on that day. So there might have to be a bit of wiggle room with that. And I do
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agree with what Nancy said before it is, generally, if you're a person who's gone into neurosurgery, if you're a woman who's gone into neurosurgery, you're usually quite competitive and you expect
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to do the best in everything that you do. It is there are not enough hours in the day to be the best neurosurgeon and to be the best mother. There's just not, it's physically impossible to do it
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unless you've got some sort of time machine. So you have to realise that you don't have to be the best. You have to look after your child. You have to make sure that your child is safe 'cause at
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the end of the day that should be the most important thing really. And you have to make sure that at the end of the day you go to bed thinking, I've done everything I can for my child and these
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people. And that might mean that you have to have good relationships with the people in work as well. Your partner, your social structure around you in terms of your family and stuff like that
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might need to help out Back in the day, you would be able to say, Oh, let's get a nanny or put them in private school and make them bored or whatever, but that's really disproportionate,
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expensive nowadays. Like, it's so expensive to have child care nowadays. It's ridiculous.
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And so it's really hard. So you do have to rely on other people. Something that is happening more and more nowadays as well is it's not a case of, you know, the neurosurgeon marries,
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a nurse and then the nurse can give up work and live off the neurosurgeons' wage anymore, that doesn't happen. Nowadays we're more likely, I feel, that our trainees are married to other doctors
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and often those other doctors' training are quicker and so they become a consultant sooner than the neurosurgeon and so they might actually be earning more and have a more high power job than the
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neurosurgeon and so if that other person is a woman they might say okay neurosurgical male can you do nursery or go less than full-time because you're actually learning less than me and we've got to
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be allowing of that and we've got to understand that happens I'm here I can know the professor of course of course he's going to make a couple comments here Amirah one we've got to have shorter
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answers from everybody but two uh here can you can you briefly tell us you have written neurosurgeon your wife's in neurosurgeon you raised two children right five children, five children, five
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children. tell us what's the secret? How did you sacrifice? What did you do? Well, first of all, let me confess I'm having a cute case of imposter syndrome as a male neurosurgeon.
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So, look, I agree with what some of the speakers have said. Neurosurgery is a demanding profession and certainly in the United States, it's probably a little different. There's no way that my
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wife or I could scrub out and have someone just take over for us and you can't compromise, I think, on the well-being of the patient for family and so you have to be aware of that upfront. I think
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in our case, it was just a matter of functioning as a team. Now, obviously, I mentioned my wife transitioned from being a complex spine surgeon to doing radio surgery, which doesn't have a lot of
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emergencies and is more time manageable. But in general, at least as you know, for us as a team, I mean, we just viewed it as that we had these responsibilities. We had the responsibilities to
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take care of our kids and responsibilities to take care of our patients. And it wasn't as though my career or her career took precedence. So I think it's important that you have a partner in general
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who's going to work, you know, collaboratively that way to make sure that there's no suffering on either side. But it's not easy. I mean, these are the demands And we may have made other
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compromises. I mean, you know, we compromised in other aspects, financially, they visualized these type of thing. But we did set as a goal to prioritize those two aspects, well-being of our
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patients and well-being of our kids. And we had our kids a little bit later in life also, which made it easier. Speaking of having kids later in life, Professor Epps sent a question for you.
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Might be this one that's just come through to us apparently some American residency programs will pay for surgical residents to their eggs for IVF to use post-training, therefore implying that
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children should not be had during residency or should be had later. Have you had any experience with such policies over the course of your career? Actually, no. I mean, I'll just impart to you
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that, you know, I used to go to the national meetings and when I heard them talking about having kids, I said, Look, at least you shouldn't have the kids doing a residency because I just don't
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think it's fair to your fellow residents to do that. But that's just my bias. And again, like Kat, I was never interested in having kids, so this is perhaps not the best question for me. But,
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you know, if you're going to go into neurosurgery, your aim should be, How are you going to be the best neurosurgeon? And if you're so concentrated on the kind of life and lifestyle you're going
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to lead, maybe neurosurgery isn't for you. I remember going to.
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a group of us, a group of different specialty surgeons, we were meeting at NYU and everybody was talking about, well, I went into ENT because it was nine to five, or I went into OBGYN because it
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was eight to four, and actually I went into neurosurgery because it was life, liberty, and the pursuit of disaster and happiness. You have to have a passion for the field and everything else I
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think has got to be somewhat in the background, you know, yes, you're spouse, critical, if you're going to have kids, I think you should owe it to yourself and to your future kids to have them
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after you've done your residency because I think integrating them in the midst of a residency, you're going to have all kinds of resentments, you're going to get lesser degrees of experience and
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you're going to be distracted You know, I. I again stopped going to the women in neurosurgery groups 'cause they were driving me crazy with baby care and stuff like that. I mean, I'm the wrong
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person, as I said, started out to say, this is the wrong question for me because this was just never one of my major concerns. And if it is a major concern, maybe neurosurgery isn't the field,
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that's appropriate to the choice because this is not one that's gonna be forgiving. You wanna be a frontline neurosurgeon. You wanna be one of the best people in your field You wanna do some of the
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reading and writing. How are you going to do that? That should be your major question, I think. But can I just interject there for a moment? Firstly, we're not, we're never asking male
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colleagues, these questions, right? Our male colleagues, the best neurosurgeons in the world have kids. So that's the first thing. Secondly,
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so the onus is not just on the mother, to be there for the child, it's a two-way thing. It's also for the father. So if the male neurosurgeons are managing to have excellent careers and have kids,
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I think the same should be available to female neurosurgeons.
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And how often does that happen though? Well, this is what I'm saying. I think it does. So like I said, I think in my case, I have not had to, I have had to make sacrifices. But like I said,
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if you have a supporter family, if you have support around you and you are extremely organized, and by the way, I'm the most disorganized person in the world, I'm sure Kat can also tell you that,
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but when
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it comes to our home life and how that will run, we have to be extremely organized. We look six months in advance at our rotors. My husband, by the way, is a vascular surgeon, complex aorta, so
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his on-call zone tents, just like neurosurgery, he's finished training, so it's a bit different but it means a lot of organization. it can work. The other thing I wanted to just quickly touch on
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was the fact that you said that do not have it during residency. So what, as someone who was born to my mother, when she was 42 years of age, I am somewhat resentful of the fact that my mother's
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not going to be around to seeing my daughter grow up, to see my daughter get married. She was not where, by the time she had me, she was 42. When I was in my teens, she was already in her late
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50s.
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My parents are old, and that means that there were so many things that I saw my friends doing with their parents, that my parents physically weren't able to do with me. So as someone who had, you
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know, I had my child when I was 34, I was already feeling quite old to be having a child, because actually, When I look at people around me who have children in the late 20s, your energy levels
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are completely different. So actually, having a child much later on in life is actually able, you know, from all the complications of birth and all the genetic stuff that it's not ideal. But
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there's also that element of how much can you be there for your child and your job, the older you get? Because physically, as well as mentally, you get more exhausted with each decade. So leaving
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it, I appreciate residency is difficult. But leaving it to later on in life, in my opinion, may not be the best way. I think we've got to be done with you. Thank you. I think we've got to be
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wary
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here at the difference between the American and the British systems as well. So within the British system, you are relatively well paid as a registrar, and then as a consultant, you are better
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paid. Whereas my understanding of the American system is that as a resident, you are not paid greatly, and then you have a huge leap in your wage when you become attending is that? correct. And
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therefore, when you are in attending, you might be able to pay a lot more for child care, which as a consultant in the UK, where we are paid relatively less, that still is a really, really high
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proportion of your wage, if you were going to get a lot of child care. And it's just not sustainable here. So that does make a big difference. I mean, I just want to say, when it comes to
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childcare, we actually, me and my husband, having both full time and I came back to work after maternity leave, full time surgeons, we actually did have a nanny. So we had an enemy who would get
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here for seven in the morning, so my husband could leave. I would leave properly usually before that, depending on where I was going. When I was traveling to Stoke, I'd leave home at 513 in the
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morning on a bicycle. So
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we had a nanny and she would be here for 7 am. and then our nanny was excellent because she would leave, usually my husband would be home by 7 pm. unless he was on court. Um, if she needed to
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stay later, all it needed was a call to her to say, do you mind staying on? And she was very, very accommodating. Yes, it meant that it was extremely expensive. And as Kat said, it's, it's
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difficult to afford. And probably on my salary, we, we, I know on my side, we wouldn't have managed to do that. But because my husband's a consultant, we managed. It was uncomfortable, shall
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we say, for those years, but we managed to afford that. And that was pretty much the only way we would have survived that time Because as you know, nurseries, again, not an option after a
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certain period of time in the evening.
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So I think even if you can, the issue there arises, not one of you can find someone to look after your child. The issue then arises off, how much do you want that to be the case? And how much are
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you willing to do that? Because at some point, you also have to, what is the point in having a child if you're not spending any time with them? There's also that element of it. And that is where
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mom guilt and dad guilt comes in. And that's where you have to find a balance that works. And you have to find a way to look after your child and be at work. And I mean, I am very proud of the
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fact that my child, you know, if I ask her, even if I call her now, and I say, Nia, what are you gonna do when you go up? You'll be like, I wanna be a brain surgeon like mommy. And then I'll
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be like, not a vascular surgeon like papa. And she's like, no, because women are cleverer So she has grown up in a household of surgeons. And she's not resentful of the fact that I do what I do,
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or that my husband does what he does. She's like, she's very excited by her jobs. Amira, do you want to see if there are questions from the audience? So I think we've seen that there's a lot of
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different answers for this topic depending upon what person's circumstances and so forth. Is there any other questions or missing from the audience here? I have a question. Oh, please go ahead.
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I'll be making sure that more women write papers.
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Okay.
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I'm very glad you asked that 'cause I think it comes back to the debate about women and being at home and it's perhaps a more social-cultural question. How do we create more time? Is that something
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that we can really expect to do in surgery, in the medical profession? Or does that speak to a wider systemic issue about society that should be addressed from a different angle? Ms Whitehouse,
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what do you think? Sorry, I didn't quite understand your question.
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The think not we do, but perpetuates and perpetuates that surgery in women of question
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it might be a cultural or social problem, the fact that there's a lack of child care for her after a certain amount of time? Is it necessarily a question for the medical profession specifically to
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solve? Or does it speak to just a shift in how society functions and a lack of accommodation for that. That's your personal choice. It's not a choice of the government or anybody else. And if you
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make that choice, you have to make some sacrifices. You have to know what to do. We have this problem in this country. We have most of the residents who finish our exorbitant amount of debt. And
26:45
they have families. They have everything else. I don't think they're
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poppers in the street by any means. So it's a life decision. What are your priorities? What do you want to do? And you judge them up, but you can't have - listen to this, OK? You can't have
27:03
everything you want immediately. And I'm telling you that, because that's a sickness in today's society. And that is everybody wants it. And they say, I have somebody auto-afforded. It's the
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rich people. It's the government. It's somebody else. And they can't do it. And so you're asking, this is your own personal decision. And that you have to make it. You have to solve it in your
27:28
own way. Everybody here has done that. And everybody comes from different backgrounds. I think we should ask and see if we're answering the audience's questions, that's what bothers me. I wanna
27:39
know that we've answered that. Indeed, I'm actually glad you brought up the costs and the financial aspect of it, because we've had a question come through here that says, and this is perhaps more,
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perhaps, is there anything to speak about? Because
27:53
they're asking about the private practice opportunities for women being differential. And then NHS, we obviously have relative standardization of opportunities, but what about in the United States?
28:06
I mean, in the US, basically, you go through your training, you go through your residency. I mean, Jim, correct me if I'm wrong, there's tremendous pressure from the universities to basically
28:17
join full-time practices A lot of the universities, let's just take NYU, you know, and New York University on Long Island. They have bought up many, many hospitals, and they've bought up a lot
28:30
of the practices. In neurosurgery, there's still a lot of private practices. They have tried to recruit full-time neurosurgeons to the academic staff. In the past, and Jim, correct me if I'm
28:45
wrong, a lot of the academic neurosurgeons had a lot less experience surgically than the private neurosurgeons And technically, at least my experience, in large part, was that those who were going
28:58
into the university practices were not as technically proficient. And basically, a lot of them never wrote a paper in their life.
29:09
So in the states, I think they're still private practice. It's more and more difficult for neurosurgeons to join a private practice in the state of New York, you have to pay350, 000 in
29:23
a medical malpractice to go into a private practice. If you go into a university practice, usually that's taken care of from that end of things. But it's an interesting phenomenon because the trend
29:36
has been so many in private practice going into university practices and those in university practices finding that they didn't like the lack of freedom and choice and everything else going back into
29:47
private practice. Jim, am I wrong or right or what do you think? No, I think that's your opinion. That's okay. Anybody else?
29:59
I don't practice private practice and in the US it is very different. I think you can go into the UK but there's not a huge
30:09
audience for it within the patients here apart from in some of the largest centers London there's a little bit in Wales, for example, but yeah, you can go into it if you like It's huge. Like all
30:20
these questions, like there's a reason there's a massive ocean between us, right? We're completely different. Health systems are attitudes towards everything. It's going to be completely
30:31
different. The UK is socialist and America's is more sort of a capitalist society. So we're with very different people This is true, but it's still a very evolving field, either side of the pond,
30:32
and that takes us nicely to another question that's just come through the coming thick and fast here. Someone is
30:50
asking, How would you suggest students coming into neurosurgery adapt to the rapid advances in the field? Miss Janoon, would you like to? this one.
31:01
Eric, you want to answer that?
31:05
Oh, I think it was thrown over to Miss Junoon. It's Junoon, yes. Although Junoon is also a nice name and it means passion, I think, in my language, but no.
31:19
So
31:21
I think it's about exposure. Unfortunately, at medical school level, we don't get much exposure to neurosurgery. You have to seek it out. I remember we got half a day of neurosurgical theatres
31:33
and one neurosurgical ward round. That is what was expected that we do during five years of medical school to get signed off for that aspect of stuff and the neurology, you do like five weeks in. I
31:47
think if, especially at the moment, but everything that's happening with robotics, with endoscopic stuff, there's stuff that we ourselves are like learning and bringing to the departments.
32:02
There's less scope for
32:06
allowing medical students to get involved surgically with that sort of stuff. But there's a lot of scope for
32:15
exposure. So there's a lot of, you know, the students coming through now are seeing a completely different kind of neurosurgical experience to what they would have seen maybe 30 years ago. So
32:29
exposure to deep brain stimulation, you know, a lot of functional stuff, robotics and just copy spine completely different. I think probably a lot more difficult for students to get their heads
32:41
around because their anatomy is very different compared to open stuff, which they could probably still, you know, when we talk about going back to talking about looking at stuff 3D and imagining
32:51
how things are. It's one thing doing that when you've got an open spine and quite another doing that, when you're looking down
33:02
a scope for a tubular discectomy, for example, or for a monotomy and all you've got is the facets and you're like, okay, what is that neurosurgeon actually looking at? But I think it's a case of
33:15
exposure. I think the more exposure that students have, if people are interested in neurosurgery, they should be seeking out every opportunity at medical school to get exposed. They should be
33:25
doing, I spent all my summers doing a placement, I've done placement in Malaysia, I went to the US, I worked at a New Mexico one summer. I've been, I went back to Pakistan one summer. I've done
33:41
a placement in Cape Town in neurosurgery. It's about just exposing yourself as much as you can the specialty to actually um, not only just to know, just to get a feel for the advances in the, in
33:56
the specialty, but really about everything that we've talked about this evening, about getting a grasp on, why is it that you're choosing neurosurgery and why is it that neurosurgery would choose
34:06
you? And when you can marry the two, uh, that's when you know, okay, this is the specialty for me. Maybe what, maybe that actually exposure will make you think actually, I, I thought I loved
34:20
it. And I thought I really liked this idea of being the next, what's his name mixed steamy, no, Mick, dreamy, whatever. Uh, but actually that's not it. That's not it. That's not real life.
34:30
And that might be the case. But yeah, I think exposure is the way forward.
34:35
But actually what's interesting is you're talking about new techniques. And what we're seeing again and again and again, is some of these techniques are farming patients. They're be used in the
34:47
wrong circumstance. Surgeons are not realizing when they should a bigger exposure or an open exposure that these gimmicks and gadgets are just not going to solve the problem. I mean in the US we
35:02
have a phrase you know it's like a mental error in baseball in other words did you do their operation from the front where it should have been done from the back or from the back where it should have
35:10
been done from the front why are you doing this endoscopically it's a stenosis case what you need is more room not less room what you need is to avoid that CSF leak and not to have such minimal
35:22
exposure that you're getting in you're getting the leak how many times do we see somebody did a discectomy endoscopically they got the leak what did they do they closed they didn't tell anybody that
35:32
they never took out the disc and then you're taking out the disc you know six eight months ten months later realizing that that surgeon actually never did the operation that they supposedly were going
35:41
to do so techniques and advances are not necessarily always a step forward sometimes they're a step back familiarity with the pros and cons is great but also the ability to convert and understand what
35:54
the open operations offer is critical. Yeah, I think I'm gonna bet in there a bit in a Greek Annanci. You need to know your fundamentals. You need to know your anatomy. You need to know what
36:06
you're doing to start with. So you need to have that basic knowledge really, really down. And then with time, you can start looking at other things and getting involved with other new technologies
36:21
The most important thing to do, and as Dr. Epstein and Dr. Losman said, keep reading, you've got to keep reading, you've got to keep going. I'm writing, writing, look at your own results.
36:33
And you've got to look at your own results 'cause otherwise you could really be screwing people up without knowing, so you've got to keep an eye out on that sort of thing. And you go to conferences,
36:44
you see what everyone else is doing and you keep in contact with the rest of your society about what they're doing a relatively open mind but have some critical analysis 'cause there will always be
36:57
someone who wants to sell the best thing but you've got to be able to critically analyze what's going on as well. And the other thing too is we have to be excellent neuro-radiologists. I mean,
37:09
those are the roadmaps to the pathology that we're interested in correcting. If you can't read these studies yourself, you know, you're then relying on radiologists, neuro-radiologists, many of
37:20
whom are not as good as you are or not as, you know, three-dimensional thinkers like you are. You can use them to supplement. I mean, you know, I've worked with a neuro-radiologist for like 40
37:30
years, and he's brilliant. And he always teaches me something else. And it's always a great idea to go down and in person, try and bounce something else against him or, you know, hey, these
37:40
days we have to do it by computer a lot of the time. But, you know, learn from your colleagues what they can add to your knowledge so that when you go into that operating room, you have as much
37:49
information. as you possibly can to do the right operation and not just, you know, one that's, you know, sort of, you know, rubber stamped.
37:59
Eric, any thoughts about this?
38:02
No, I mean, I agree with what people have said. I, there is a syndrome that I've seen neurosurgery amongst some neurosurgeons where they feel that if they just add more and do new things and do it
38:15
differently, that there'll be a great neurosurgeon. And really, in my personal experience, it's the opposite I mean, many of the best neurosurgeons that I've been privileged to work with
38:27
basically do it fundamentally the same way that they train. Now, there are additions and different aspects to it. But
38:35
the experience I see is there's a situation here in the Twin Cities where to put in a ventricular pair, Neil Shunt, has turned into a 10-hour operation in an intraoperative MRI machine with
38:49
ultrasound. and with endoscopy, and it's getting pretty specific here. But if any ventricular parrot and shunt operation that takes 10 hours is doomed to failure. So you need to know the
39:03
fundamentals. I completely agree. You need to stay abreast of the developments. One thing on a positive note, however, is that what's great about neurosurgery is that there's so much we don't
39:12
know and there's so much left to discover. And there's always exciting new things coming out, but you have to have a great filter so that you don't want to jump on every new trend because within
39:23
neurosurgery, you can hurt patients quite a bit. And there's a reason that the tried and true techniques have become just that. So that's the balance. Thank you, Sarah. Along those lines, it's
39:37
so important for each of us to write up our own series and our own experience. I mean, decades ago, what came out? anti-servical plates, and they were fixed plates with fixed screws. Atlantis
39:50
plate, whichever one you wanted to choose. And I'll be damned, but I was following patients that I had, and these plates were extruding out, superiorly or inferiorly. And the papers that I was
40:02
reading, they were just perfect. So I actually submitted this to one of the journals and they rejected it, and then I kept pursuing in this and that anyway. They got published, but then came the
40:13
plates with a little bit of toggle, 15 degrees, whatever it was. Well, guess what? Well, still extruded and protruded. And then came the dynamic plates. Well, that was like a huge step
40:23
forward. Well, the only reason I figured out that those really worked and those were better is because I did these long prospective studies of my own patients and I measured paints taking me how
40:34
many millimeters above, how many millimeters below did the plate, the screws migrate in the plates, but those did not fracture out and extrude. Well, it took an awful long time for them to start
40:45
taking off the market some of these fixed plates. but they were not telling the truth about the results of those plays, but it just underscores each of us should be taking the responsibility of
40:57
evaluating our own experience in our own patients, because that's the only way you're gonna keep the profession honest as to what works and what doesn't. I mean, I completely agree Nancy. I mean,
41:08
I deal with this, you know, especially with in vascular where I see patients for second opinions and a lot of the surgeons are quoting patients' complication rates based on the literature, not
41:19
based on their own experience. It's meaningless. I mean, it's absolutely meaningless to the patient what results have been published. They're often published by more qualified or skilled
41:30
neurosurgeons who are reporting their series. So I agree with you and I don't discount the importance of people should be reporting and writing. And for younger neurosurgeons, what it's worth.
41:42
It's my opinion that if you can find areas where you can become an expert and know more than other people, and it doesn't have to be a huge area, but it can be an area in which you focus so that you
41:55
do know more than many of your colleagues and other neurosurgeons practicing in your area, it will improve your confidence, but it's also an important tool, I think, for career development And
42:13
speaking off the younger members of our profession, I've had another question come through that I think is a good one for us to share, especially for a women in neurosurgery panel where role models
42:25
are so important. Someone has asked is having a doctor in the family, a privilege and has that helped further your career Actually, I think Ms Whitehouse, why don't you start with this because I
42:36
know your parents didn't come from a medical background. How did you find entering? medicine and indeed neurosurgery, because medicine is obviously the most perishable, I think, of all the
42:45
traditional professions. How is that shaped you as a surgeon?
42:50
Well, I mean, I don't know, again, difference between the US and the UK. So I went to private school. So I had a scholarship and assisted patient to private school. So I managed to get a leg up
43:06
there, which wouldn't have given me opportunities if I went to the standard secondary.
43:10
Medical school was free for me because my parents didn't earn enough to pay for that. So I went to medical school for free. I worked throughout the summer and the weekends to afford rent. So
43:27
I never had any sort of extra help or, you know, if anything, I just have to pay my parents debts and I don't mind the other way around.
43:36
So, yeah, I think from my perspective, meant that I had to work harder to get in. And I think once you start working hard and you get used to doing
43:46
nine, 10 hours a day in medical school and then going and working the weekend and 12 hours shifts and then working your summers and stuff, you don't get as let level of entitlement or privilege and
43:57
then you just get used to grinding. And then if you carry on with that throughout and a lot of what we're talking here is you grind through med school, you grind when you're a doctor, when you're
44:07
in training. And then if you keep going as a consultant, you will get higher and higher. So I think that gave me a good thing to not rely on privilege. I've never been able to rely on my parents
44:19
doing anything for me. Everything I've got is because I've had two. But it does mean that, for example, I couldn't get into a hospital to go and - see things, some of my mates in private school
44:35
there are like weekend, sorry, week-long courses and stuff you can do in summer and stuff like that. I couldn't do that because I was working. And I think it's a pity that it's it is harder and
44:47
that these sorts of things aren't recognized, you know, if you're if you're working throughout your summer, is
44:57
that better or worse than going and, you know, working in a hospital or is it really worse than someone who gets to do a gap year or whatever or for a few months and go and build a hospital in
45:05
Africa, I don't know. And so I think I think that should be appreciated more in what we do. And then the way that we we do our job applications and things like that, because work is working if you
45:20
can work in a shop and if you can put up the general public, then you can put up with your trustworthy to work with money and to say that you're honest and all that sort of thing. Anyway, um, But
45:32
yes, I think it is more difficult because it's not assumed that you're going to go into things. You don't get the opportunities. And I think you do have to work harder.
45:42
But that's how things are. Yeah, most definitely. And Mr. Dune, how have you found it as being the child of medics and choosing surgery? I'm going to let's stop here a minute, where you come to
45:56
an hour and a half. That's what we told them it was going to be And
46:00
unless people want to go on, I think we need to see get some feedback from the audience, which you can do by computer. If you follow this session. We will indeed. I have the link ready. Go ahead,
46:11
thank you. Be sharing that in the chat in a few moments time, I believe. Yeah, we need to know what their opinions are.
46:18
Does everybody wants to finish in about a few minutes, or is there everybody want to go on? Yeah, this is actually our last question What's the last question, okay? it is. Mr. Jin, would you
46:32
like to finish us off and tell us about your experience?
46:36
So, interestingly, I grew up in a family of doctors. So, my mom's a doctor, my dad's a doctor, my three older brothers and sisters who were much older than me, all three of them were at med
46:46
school when I moved from Pakistan. But interestingly, because I moved with my mom and my younger sister, and at the time, my mom was obviously, she'd been practicing in Pakistan for many years.
47:01
When we moved to the UK, she actually initially didn't have a job for over a year. I remember I got to a point that my mom went to ask for a job in a factory because she said, actually, if I'm not
47:10
going to get a job, she was a dermatologist by trade for many, many years. She said, if I'm not going to get a job, I need to find a job. So there's only that much that your your savings can
47:20
last you. So she went to the factory and we came home from school that day, and obviously we weren't in a private school. I didn't, I didn't go to any private school
47:31
I remember I came home and my mom was very upset because she said actually they said I was overqualified so they wouldn't give her a job. So even though I came from a family of doctors, we initially
47:45
in the UK weren't financially in a position
47:50
to go to private school, have the opportunities that the other kids did. And when I speak to my peers now, most of whom around me in neurosurgery have come from a private school education, there's
48:02
a
48:05
difference in how, in the opportunity to have, like Kat said, being able to do courses, being able to work in a hospital for free, get some hospice experience, all this stuff, which if you're
48:16
working at McDonald's, which I did once a summer, and pizza had the following, you're not going to have. The other thing is obviously having a doctor in the family you would expect that they would
48:25
know what is expected, for example, in a personal statement when you're applying. at university, but my family were from Pakistan. So no one had actually been through the system. No one had any
48:35
clue of how to direct us to doing a personal statement, how to improve my CV to get into medicine. And actually, because I went to some of the worst schools in London, because when my mom did end
48:51
up getting a job, we were moving. I think the worst was when in two years I moved five schools So that obviously is not just disruptive to your education, but also disruptive to making rapport,
49:03
finding mentors. So when I did apply for medicine the first time around, I had no clue as to what to expect when I went for an interview. And I remember I went for an interview at Cambridge, and I
49:17
had no clue how to conduct myself or what to say, because no one else around me
49:23
was - no one from my school was applying for medicine, by the way. It was one of the It was in a very poor part of London where most kids were planning to just finish, you know, a lot of them
49:39
didn't even go on to 6th form actually. So even the 6th form people weren't really planning to go to university and the ones that were going to university to do other things. So I must say it didn't
49:53
do much for me at the time, but I do know and I have spoken to my colleagues and friends that yes, having someone who is in the profession can help. It can help you know what's to be expected,
50:07
what your life will be like, but also in some ways help you navigate things like getting work experience at a hospital. If you know someone, if someone in your family can make a call and get you in
50:19
to do work experience, that's much easier than trying to do what I did, which was try and go through this person and not person and so. So yeah, I think it can have its benefits. Also, when
50:33
you're discussing what is expected during medical school, how to conduct yourself professionally. All these things, if you've got someone, a mentor or someone who can be there for you, who can
50:46
just guide you, it's definitely a lot easier. Yeah. Thank you so much for that insight. And thank you all for taking the time to share such personal stories of resilience with us Mira, I'd like
50:58
to stop here and make some closing comments here. It's been, it's 90 minutes. Of course.
51:06
I think we've had a wide ranging discussion. When we started this two, three years ago, I told Muhammad and
51:16
Hassan that they should run it themselves because we needed to find out what young people were saying. And this is an intergenerational talk because that's what we have here interested in all
51:26
opinions. There's not one opinion that's more right than any other. It has to be something that fits your life. We've talked, everybody talked about being competitive. You're in a very
51:36
competitive field. If you don't want to be in that competitive field, you got to find something else. We talked about the imposter syndrome, which is almost slipped by us, but when it came out,
51:47
it was very significant in that it's people feeling inadequate. Well, it can be due
51:56
to a lot of things. It can be due to your personality, it can be due to you're not studying enough to feel adequate. I could tell you if I'm a medical student and I'm trying to learn medicine,
52:04
it's overwhelming. You're never gonna feel adequate because it's an overwork. There's somebody told me, I can always ask you a question you can't answer. And it's true as a resident, you start
52:16
out, and I remember my differential diagnosis was pretty limited. After a period of time, you become more sophisticated. You know, you gotta be patient with yourself also. It takes time, but
52:26
you've got to keep working at it and working at it and learning more all the time. And you mentioned at the beginning about being empathetic and I'm going to talk to you about that now for a minute.
52:36
I've been in the hospital, I've had five operations, I had four cancers and so I've seen it on both sides of the knife and I'm still living. And I can tell you from my point of view what people are
52:48
missing here, which I haven't heard anything in 90 minutes about And that is what does the patient expect when you come into their room? The patient expects that they're going to talk to somebody
53:02
who is educated, who knows what they're talking about, what they're talking about, who keeps up with the literature because I'm putting my life in your hands. Don't forget that. I've been taken
53:13
care of by physicians who I knew more than they did and I had to go research it and tell them. They didn't know that you can get multiple midline cancers from radiation, which I had after a
53:24
testicular seminoma. And nobody knew that, but it was in the literature. That's what Nancy was telling you. These are people who are at the heads of their apartments.
53:34
So you've got to stand up, you've got to learn, you've got to understand what you're doing by yourself. You also have to understand you're living in a world of people who want to follow everybody
53:43
else. And that's true in medicine. And following everybody else is following down the wrong path. You've got to decide what you want for yourself, what you're confident in what you're happy with
53:56
doing and you have to do it. And we have multiple people on the panel who've done that and overcome obstacles like
54:05
had has done. Terrific job. So think about it. You're not going into medicine for yourself. You're going into medicine to make somebody else's life better.
54:17
That's when it is - That's true. Very wise words, very wise words, proph. Patient comes first. And that is what motivates you in life. It motivates you when you go home. It motivates you at
54:28
night when you're trying to sleep. If I'd done the right thing for the patient, it motivates you to study more. So you know, because when you walk into that room, they expect that you know, but
54:39
what's happening in our country, and it's probably happening in your country, because we have socialism just like you do, and it's destructive of medicine, is you know more and you've gotta read
54:52
and your patients are gonna read, they're gonna be on the internet, they should be encouraged to do that, so they ask questions, and in our country you get 15 minutes to be with a patient, and I
55:01
just told the people at the beginning, I'm a cardiologist who was out of the room in 15 minutes, I couldn't find 'em, and he knew who I was. So that's what you're in this for, you're not in it
55:13
for yourself, you're in it, 'cause you're there to help people, and you're gonna help them get better, and there is no limit to what you can do to do the very best you can. Obviously, you've got
55:24
other priorities. You have to fit them into that. But don't walk into my room like I had a person who, it was a two years out of residency and wanted to do a thrombectomy after I had a DVT. And I
55:37
said, what do you know about it? How many have done it? So I've done 3, 000 cases. She didn't do 3, 000 cases. It was impossible. And she had all the information about what was going on. She
55:49
had no idea what the complications were So I had to talk to her. I said, You get me in touch with the head of your group. And he began to understand what I was saying. So don't be so arrogant and
56:01
don't be so self-confident. You don't know, it's always a place to learn. Well, we hope with this that you've learned something. We hope it's invaluable to you. And if you'd like to have this
56:14
some more, let us know. And we appreciate the audience Uh, uh, Okay, you did a, Dr. Biden, she did a terrific job by Meyer, what you're doing. And Amira, thanks for doing all this. Nancy,
56:31
thank you and Eric and I'm sorry, your wife couldn't make it. And Kiva, you've done a terrific job. Given the circumstances you had, understand that terrific job, everybody can do a terrific job.
56:44
You just have to work at it.
56:47
Isn't that right? I guess your results,
56:51
right? Those papers and send them in. Okay, well, we hope you're doing it wrong. We'll tell you if you are. Okay, Mary, you've been closed. That's a few questions. Thank you, Prophet. I
57:03
won't keep anybody for too long, Mo. I think you wanted to say a few words. No, I just, I think Prophet said what I wanted to say. Thank you everyone for your words of wisdom. And I am just
57:12
going through the feedback that we've had submitted. And people are well and truly grateful for you all you've inspired up. large number of medical students and junior doctors and giving them
57:21
ambition and direction. So thank you.
57:25
It's been lovely having you all tonight. Please do fill out the feedback form if you haven't already and I hope you have a lovely rest of your weekend. Nice to meet you all. Yes. Thank you very
57:35
much. Thank you very much. Thanks. Bye. Bye-bye. We hope you enjoyed this presentation
57:45
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