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In the nick of time – the increasing importance of portfolio careers

The Doctor 
Issue 18
home hero 
February 2020
MASUD: Consultant and police officer

There was a police officer, a soldier and a consultant... and they were all called Syed Masud. But doctors with such a mix of skills are not always given the chance to use them to best effect. Neil Hallows reports

Syed Masud’s dad was a doctor. He was from a traditional Asian family for whom education was everything. As a boy, he knew what he wanted to be.

And it wasn’t a doctor. His dressing-up costumes of choice were military fatigues and police uniforms, rather than a plastic stethoscope. Not so unusual, perhaps, for someone to weigh up other careers before finally succumbing to medicine. But where Dr Masud is possibly unique is that he has also done the alternatives.

He has been an Army officer. He remains a police officer. And as well as being an emergency medicine consultant, he has worked for three air ambulance services, is a police force medical director, and been the chief medical officer at Wembley National Stadium.

Dr Masud appears to be the ultimate poster boy for a portfolio career. Diversifying careers is increasingly popular, and those who have several medical roles at once say – perhaps paradoxically – it can make it easier to control workload, and the variety helps prevent burnout.

 

Multi-skilled

What Dr Masud is also keen to tell us is how the NHS, and other big organisations, succeed or fail in harnessing the skills of doctors who, literally, wear a number of hats.

The first thing that strikes you about Dr Masud is the degree of intense focus. Not so much seize the day, as seize it, triage it and have it medevaced in seven minutes.

He has served in war zones, Gaza and some dark streets in east London but when he says his main fear is that of under-achievement, it’s plausible.

His toughness, however, is as much a product of what the ‘system’ has put him through. As a student, he had to argue for his future as a doctor and an Army officer when he was found to have dyslexia in his final year.

‘The medical school said I could have written down the wrong drug and killed somebody.’

A professor and a brigadier spoke up for him, and it gave him a lifelong commitment to help ‘gutsy’ juniors and students who turn to him for help.

 

Struck down

In the Army he sought deployments with the same high level of commitment he gave to avoiding parades and posh dinners.

He served with specialist units and seemed to have perfectly balanced his childhood dream with the medical career his mother, in particular, was infinitely keener for him to pursue.

Then, disaster struck. Not an injury, despite serving in places such as Bosnia, Kosovo and Northern Ireland but the entirely unexpected onset of diabetes.

He could have continued in the Army, but realising it was going to limit him from some of the edgier activities, chose what was a very viable alternative, the Great North Air Ambulance.

Still quite junior, he was then persuaded to go to the Royal London to pursue emergency medicine specialty training.

Technically, that was three careers before the end of his 20s, but, with hindsight at least, one led clearly to the next.

 

Draw of the Met

The fourth, however, was anything but inevitable. Seeing an advert on the tube, he applied to the Metropolitan Police as a special constable.

‘I couldn’t quite get the policing thing out of my head.’

His deanery had a ‘wobbly attack’.

‘They said we can’t have a specialist registrar on the streets of London. They asked, what would you do if there is a stabbing and you can’t do a thoracotomy?

‘I said the police say that saving life comes first and the GMC says the same. If I don’t have the kit, there’s not much I can do about it, but if I can help the public and my colleagues by blending my skills, I don’t think there’s a problem.’

It gives an insight into how the NHS values skills and experiences outside medicine. On the one hand, application forms seem to expect junior doctors will find time to be Olympians and concert pianists in their spare time, but when a doctor wants to pursue an outside interest, of direct relevance to their specialty, it can be awkward and inflexible.

This is particularly the case when trainees want to pursue out-of-programme activities for reasons such as a career break, training, research or clinical experience.

 

Keeping talent

BMA junior doctors committee chair Sarah Hallett (pictured below) says access ‘remains far too rigid and inflexible at present’.

She says: ‘Stories like those of Dr Masud show how the ability to combine a medical career with other interests can retain talented doctors in the profession, and allow them to develop complimentary skills.

‘The BMA has been working with education bodies such as Health Education England to improve flexibility, on projects including the LTFT [less-than full-time] category 3 pilot in emergency medicine, paediatrics and obstetrics and gynaecology, which allows junior doctors to work LTFT without needing to provide a reason. Much more remains to be done, however.’

Fortunately, in Dr Masud’s case, Gareth Davies, an emergency medicine consultant at the Royal London and at the time medical director of the London Air Ambulance, took a more flexible view.

‘He said, “Syed, if we don’t have people like you who can put on other hats, we’ll never know how we can transfer skills, knowledge and culture to medicine to improve, integrate and collaborate. Go and fill your boots”.’

 

Secret mission

While he did his share of padding the streets, Dr Masud saw a chance in the Met to apply his medical skills more directly.

He set up a panel to improve the force’s clinical governance, addressing equipment and training needs and pressing for greater consistency.

‘There was some great stuff of police officers saving lives, but there was no documentation. There was also not such good stuff going on, with minimal governance and multiple opinions and thoughts, bringing that together was the real start of clinical governance in this area.’

He also did some training with CO19, the Met’s Specialist Firearms Command, not as an armed officer but in sharing expertise. And then there was the day when an inspector turned up at his hospital – by now the John Radcliffe in Oxford, where he had moved after the Royal London.

‘He said this is a highly secretive mission, it’s very dangerous, actually. We are asking you to be the medical component of the team to take Tony Blair into Gaza.’

 

Held back

He is not bragging when he says it wasn’t frightening.

‘I was wired differently. I feel complete when I’m doing it. I’m not a sitting-there-talking-to-people type. I’m not good as a surgeon who can take someone’s heart and repair it. I’m quite base. I can do this, I can keep people alive and I seem to be OK at it.’

The disappointment was that he could not do more of it, and there is no formal role for doctors in hazardous police operations.

‘In America, in France, many other countries, there are doctors who are part of police forces on the front line, part of SWAT teams. If you look at Paris after the attacks, there were very specialist doctors wearing black kit in the front, going in the door.’

Military special forces have officers serving with them, he says, because ‘they realise that in pre-hospital care we can save more people with advanced stuff if we get to them quickly enough’.

 

'Medical vacuum'

With road accidents, there are well-established systems for getting an advanced critical care doctor to the scene.

With police operations, meanwhile, the ambulance service needs to determine whether it is safe before any medical teams can go in. There is what he describes as a ‘medical vacuum’ in such incidents, which could make the difference between life and death.

‘I can’t save someone who has been shot, with a penetrating injury, an hour down the line,’ he says.

Clearly, staff need to be protected, but that’s where the highly trained specialist doctors, able and willing to cope with the risks, come in.

Dr Masud also makes clear that doctors from any specialty could benefit the police force in other capacities.

He would ‘love to see a psychiatrist’ in the force, given their expertise in many areas including detention practice.

 

Mutual benefits

For Dr Masud, the benefits work both ways and are felt every day. Plenty of emergency care work has a policing aspect to it.

‘There may be a prisoner who comes in, there may be a rape or assault case, or drugs case, or domestic violence.’

Dr Masud had two years away from his consultant job in Oxford to train and work full-time as a police officer, and is now force medical director of Thames Valley and Hampshire police forces on a voluntary basis, as a special constable.

He stresses, however, that if a bag of cocaine were to drop out of a patient’s pocket, it’s not his job to arrest him.

Confidentiality is not an absolute obligation for doctors, but disclosures are limited to circumstances when the doctor or others are at risk of serious harm.

 

Elite forces

As for the ‘doctors in black’, the elite but still hypothetical unit, Dr Masud continues to work on a force-by-force basis to convince senior officers of the need.

He has dedicated more than a decade to changing systems and potentially convincing people of the role of special pre-hospital emergency medicine doctors on the front line of specialist police operations.

He says it took three or four decades from the first developments in roadside critical care and the use of helicopters to achieve the status of a recognised sub-specialty.

‘Hopefully there will be junior doctors who carry on the fight. Who knows – in five or 10 years’ time, somebody might say, why haven’t we done this before?’

If this happens, and if he is still up to it, Dr Masud will no doubt be the first to join.

Find out more about flexible careers

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