16th June 2017

I Can Be… a GP

I Can Be meets Dr Nupur Yogarajah, a GP in New Eltham, South London.

Have you always wanted to be a doctor?

I think so. My dad’s a doctor, so medicine was always very prevalent in our house. Interestingly, I didn’t get much encouragement. My dad always thought it would be hard for me and said I should think about doing something else. At some points I thought being a pilot or an astronaut would be cool, but in the end I was pretty determined to be a doctor. I used to go to my dad’s surgery with him and I used to look around and think, I want to do this.

Why did your dad not encourage you?

I think it was because it can be quite competitive. The training is tough too and the working hours are long. You have to work nights and weekends, so practically it’s tough. You also don’t have much say over where you live at the beginning.

Being a girl was part of it too. I remember, and I’m not sure if it was my dad or my mum who said this to me, but I remember them saying, “You are a girl. You have to think about your future family life.” I think that made me more determined to do it. I grew up with two older brothers and I thought, “I can do anything that they do.”

Now that you have a family, is it problematic in any way?

When I look at my friends who have different types of careers, it makes me think that anything that you’re passionate about and committed to takes an awful lot of time.  That’s just the way things are, but I think I’ve found a balance. I have two quite small children and my husband and I work in harmony. When I work late, he comes home a bit earlier so he can look after the children and I can get on with the evening surgery. I think any job can be difficult when you have children but it shouldn’t limit you. There is always a way of figuring things out and I think my children benefit from the fact that I go out and work every day.

Why did you want to be a GP, as opposed to a different kind of doctor?

In hospital you do some really interesting things, but the patients get discharged and you never see them again. In general practice, there’s continuity. I know all of the generations of some families, from the grandparents to the babies. There’s also a lot of variety in my job. I think I would struggle to do something very niche. In general practice, I don’t know what’s going to walk through my door. I have 18 patients booked in a morning and I could see things as diverse as a pregnant woman who’s come back from a holiday and is worried about Zika virus to coughs and colds, or an elderly person who has had chest pain overnight and might be having a heart attack. There’s so much breadth, so I never get bored.

Has being a woman affected your career?

Honestly, I don’t think it has and I think in that way, General Practice is different to some other jobs. There are opportunities to train and work flexibly. Lots of doctors take maternity leave and then come back to work flexibly. We’re accommodated a lot better than lots of other jobs. Before I had children, I asked to work flexibly so that I could spend two days a week teaching medical students. The NHS tries to support all opportunities, not just when you need time off with children.

I don’t feel that the fact that I’m not at work five or six days a week limits my prospects in any way, but sadly I think that is the case for a lot of women. From talking to my friends who have jobs in finance or in the City, I think there’s a lot of pressure. Even when they work four days a week, they spend the fifth day working at home, despite being paid for part-time hours.

I’ve heard some awful stories of my friends experiencing discrimination because of that and not advancing in their career as they should do. They aren’t considered as ‘serious’ candidates any more, which is really sad because they might have more experience than their male counterparts. I’ve only realised that recently from talking to other mums at my son’s school. It doesn’t limit me at all as a doctor, because there’s a very set training structure and once you reach various stages you are a GP, or a consultant, regardless of whether you do it one day a week or every day. I hope it can change in other sectors.

What advice would you give a girl who was considering medicine as a career?

I’d want her to know that you need to be passionate about medicine to pursue it as a career. There are lots of times when you are at work until late at night. If people are ill, you stay. You don’t just clock off. That takes dedication and you have to be passionate about what you are doing. But, it’s very satisfying. If you want to do it, then definitely do. Just prepare yourself for the fact that it’s not a typical nine to five and the hours can be all over the place. If it’s what you really want to do though, then I think those things don’t really matter so much.

How do you get to work?

I drive to work. I live in Bromley and drive to New Eltham, which is 15-20 minutes away.

What’s the best thing about being a doctor?

The best thing is the knowledge that you’ve made a change for the better to someone’s life. That can be something really small, or it could seem very small to you but might be a big thing for someone else. It might be someone in persistent pain because they have chronic arthritis and you finally find the right combination of medicine that means they don’t have to live in pain. It might seem trivial but for someone who hasn’t left the house for months that changes the quality of their life dramatically.

Obviously there’s the glamorous stuff too. It can be a bit like ER [a television programme about doctors in an A&E ward in America] when you’re running down the corridor and your beeper is going off. There’s nothing more satisfying than being involved in things like that when they go well. So it can be small things or big things, but achieving any positive change is amazing.

What do you have for lunch?

I usually bring something in from home. I’ll bring apples, yoghurts, things to keep myself going during the morning surgery. Sometimes I have two surgeries, in the morning and the evening, and I’ll go and grab something in between.

What’s been the highlight of your career so far?

There have been a couple of highlights. One was having the opportunity to get involved with teaching medical students. You’re seeing students as they evolve along the path towards becoming a doctor. It’s amazing to be able to go in and teach them things that you do day to day, as well as showing them real patients for the first time.  It’s lovely to watch them and influence them at that early stage.

The other highlight was more unusual. Someone stumbled into our practice very unwell and had a cardiac arrest. We have defibrillators at the surgery and we managed to revive them. That was four or five years ago and they are fine to this day. Most things like that happen in hospitals or the patients arrive by ambulance, so it was really uncommon. I suppose the truly amazing thing was that this person managed to get themselves to the surgery and then they collapsed in the building. If they had collapsed at home or in the supermarket, it’s very unlikely they would have survived. It’s such a credit to their resilience that they managed to get themselves to us. It’s also surprising that they decided they didn’t want to bother the doctors in A&E, so came to their GP. I think some people are like that, they’re scared of wasting doctors’ time even when they’re clearly very ill. You see diversity. On the other hand I’ve seen people who arrive at A&E at three in the morning because their knee has been hurting for a month and they’ve decided to get it sorted now.

Is there anything that has been challenging?

One of the nice things about working as a GP is that you know the people who come to your practice. It’s sad, but I think that’s changing now. With all of the pressure on funding, surgeries are amalgamating and it means you might not know the people who walk through your doors as well. I think that’s sad because patients like the continuity and we can give a better service if we know people better. That’s the biggest challenge at the moment, working in a public service that could do with an injection of funding for resources and staff.

If you weren’t a doctor, what would you have been?

When I was eight, the first British female astronaut, Helen Sharman, came to my primary school. I was so excited about it. She’s actually a scientist and I think she said that someone sent a memo around the scientific community asking if anyone would be interested in going to space. She saw it and thought, “Why not!” After she came back, she toured primary schools and told children about her experiences. I thought she was amazing, especially because she was the first British woman in space. I thought it was so cool.

Later I thought about becoming a pilot. Interestingly, I remember talking to my dad about that and him having the same concerns about how I would raise a family if I were a pilot. It always came back to the same thing for him. I like to think that I could have done it though.

What are your aspirations for the future?

There are always lots of opportunities for growth as a GP. At the moment, I do medicines management work alongside my usual role. If a new medicine is coming out, I’ll give my opinion as a GP on how we should prescribe the drug and what the best pathways are to follow for the Greenwich Clinical Commissioning Group.

I’m also starting to develop an interest in health policy now as well; I think that’s from being a doctor for several years. At some point in the future I’d like to go into that and use my experience to learn more about policy and how I might be able to contribute to that. I think it’s important to have people who have worked at the coalface helping to make those decisions. I am also interested in writing health based articles and have written some pieces for a women’s health website and some blog articles.