“Working Here Is Like Being on a Train That You Can’t Get Off”
Humans of Medicine #28
A General Practitioner (GP) in England talks about her experience as a Malaysian doctor in the UK.
Working as a foreign doctor in the UK comes with unique challenges. When I applied for specialty training, there was an unspoken pressure to apply immediately after completing housemanship without a career break. If not, you would only be eligible to apply for jobs left over from the first round. Things have changed substantially since October 2019, as foreign doctors are now considered on equal footing with UK nationals when applying for specialty training. However, we still have to meet a minimum salary requirement in order to secure a visa. Assuming you manage to end up in the system, it’s difficult to go part time or take time out of your training. If you do, Health Education England may not be able to continue sponsoring your visa for you to continue with your specialty training. Many of my British colleagues take time out of their careers as junior doctors to travel or work overseas as they have the flexibility to return, apply for specialty training and compete in the first round at any time. Foreign doctors like me don’t have that luxury. We are pressured to finish our specialist training in one long, unbroken stretch in order to gain career security, with the exception of maternity leave or acquisition of UK citizenship along the way. Thankfully, I managed to complete my specialist training here and am now a qualified General Practitioner.
Then again, being a doctor here is not all smooth sailing. The National Health Service of the UK (NHS) is structured so that patients can only see the GP that they are registered with. Hence, GP clinics that serve areas with high levels of deprivation have a greater workload. Additionally, patients must see a GP if they want to be referred to a specialist, placing us as gatekeepers between primary and secondary care. We often find ourselves stuck in situations where if we don’t give patients a referral, they may be unhappy, yet if we refer too many patients (not necessarily out of clinical need, but instead to avoid the risk of litigation) the consultants are unhappy with “rubbish referrals”. Some patients demand unnecessary interventions which are simply not available through public healthcare. It can be a challenge to manage their expectations when we’re bound by what and when we can offer to them, even if they think that they are entitled to it under the NHS. For example, I once had a patient who insisted on a cervical smear test even though the national screening program put her down as ineligible. Even though I had already explained the circumstances to her, she still put in a complaint to which I had to write a response.
Here in the UK, the culture favours extroverts, so quiet people may be misunderstood or thought of as “weird”. I was once in a surgical job where our consultants weren’t often on the ward. One of my colleagues didn’t do much work on the ward but was talkative and good at relaying the goings-on of the ward to the consultants, while another colleague and I slaved away on the ward. My consultant-supervisor in that job reported concern for my communication skills and relationship with patients because in his words, “that’s my feeling about you”. This was in contrast to previous supervisors who had all been very pleased with this aspect of my work, even when it involved a lot of breaking-bad-news conversations! This bothered me for quite some time until another supervisor in a later job told me it was all because of my quiet nature!
As with every other Malaysian, I miss food back home! We often fail to appreciate the variety of food we have back home and how easy it is to eat out - something that we don’t have here in the UK. Most of all, I miss my family. My parents and grandmother have been persuading me to move back to Sarawak, something I have seriously considered. However, transitioning to the Malaysian healthcare system (and the hot and humid weather) is daunting.
Ultimately, medicine is an unforgiving career regardless of where you work. It may be a little better in the UK in terms of support for doctors, especially if you have some form of disability or impairment, but you also face more problems with litigation and complaints from patients who think they know better. Every healthcare system has its challenges, so it is important to stay connected to people who you can open up to if you are to endure it. Find happiness in your misery and be grateful for what you have instead of looking for what you don’t - that’s the attitude that will help you survive a career in medicine.
About the author
Interviewed and written by Jerry Tan. Jerry is an intercalating medical student at Newcastle University with a keen interest in mental health and medical research. When he’s not out running or taking pictures, he can often be found curled up on the sofa with a good book and a fresh cup of coffee.
Consent has been obtained from the interviewee for the purpose of this publication. The author has rewritten the article with permission from the interviewee.
Humans of Medicine is a new initiative under MMI. We tell inspiring stories behind portrait shots of our everyday unsung heroes. Curated by Malaysian medical students from home and abroad.
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