A break from medicine can offer greater perspective

by Michelle Hatch

Working in other professions can give doctors more empathy with patients but returning is a challenge 

Location: Wales
Published: Friday 9 December 2022
Michelle Hatch

When asked why I chose to become a specialty doctor, my response is that it chose me

I provide medical support to ITU in Glan Clwyd Hospital, working six clinical sessions a week. I’ve been on a journey to get where I am today, including taking an 18-year break from medicine!

I trained in Edinburgh in the late 1980s and was unsure what I wanted to do long-term. Looking back, I think I would have liked to do acute medicine, but there was no specialty in that at the time.

I bounced around various senior house officer jobs and then got married. My husband settled as a GP, and I didn't want to move around the country with training posts or work full-time. We also wanted to start a family.

Options were very limited, and, in the end, I became a bit disillusioned. I gave up medicine to raise my children – unsure if I would ever come back – and even tried other things: teacher training and interior design.

I stayed on the GMC register and when I was called for revalidation, my husband suggested I go back. I enquired through people I knew at the local hospital where I had previously worked. I'm not sure I would have managed it otherwise. Even then, it was an uphill struggle. Nobody seemed to know what to do with me or where I fitted.

They initially started me in emergency department with no induction or support and I felt very vulnerable. Eventually, I ended up the acute medicine unit and within three months, was asked to cover as medical registrar.

I worked in the medical ACU (ambulatory care unit) for several years on a fixed-term contract and helped develop their ambulatory care processes. When they reconfigured the unit, they told me they wanted a consultant-led service, and I was suddenly unemployed. I felt undervalued.

The medical director suggested I get a ‘proper job'. I applied for a clinical fellow job in ITU and it was the best thing I ever did. They value my medical expertise. They’ve tasked me with developing their rehab planning and delivery and I’m involved in improving delirium management. I feel a valued and supported member of the team.

A typical day for me starts at 8.30am with ITU handover. I then review patients on the ITU, make management plans and attend the ward round. I run the multidisciplinary team / rehab ward rounds twice a week with the allied healthcare professionals and am involved with the assessment of acutely unwell patients in the rest of the hospital, who need ITU support. I’m also involved in various audit and QI projects and monitor the unit hospital acquired infections on a weekly basis.

I enjoy going to work. There’s a real sense of teamwork and my opinions are listened to and often acted on. There are challenges every day and I can honestly say I’m never bored. 

I feel my medical background is an asset, as most of our consultants and junior staff are anaesthetic trained. I bring a different perspective and feel I focus more on the medical issues rather than the ITU and ventilator support aspects of care. I feel my time out of medicine gives me a unique take on what matters to the patients and their families.

I am a strong advocate of getting people out of hospital as soon as possible and have managed to safely discharge patients home from ITU, rather than see them linger on step-down wards.

ITU medicine gives you the opportunity and time to thoroughly investigate and treat a patient. It can be emotionally draining, but very rewarding. And, for those patients we can't save, managing a 'good death' with dignity and empathy is a privilege.

In terms of progressing in my career as a specialist, associate specialist and specialty doctor, I think things are changing but the SAS role is still poorly understood and poorly supported in a lot of places. I looked at doing a certificate of eligibility for specialist registration in acute medicine but had no support in the medical department and gave up. 

While I’m unlikely to progress now to a specialist role, I am content with where I have ended up and want to see change for others. 

I have taken on the role of SAS tutor in my health board and have joined the BMA Welsh SAS committee of the BMA. I feel I can make a difference to the next generation of SAS doctors coming through.

Being an SAS doctor is becoming an increasingly attractive and popular proposition, and this will help to push change in terms of career progression in the role.


Michelle Hatch is a specialty doctor working north Wales