Always Be Closing

Nobody tells you how expensive it is to become a surgeon.

The fees are only the beginning. There is medical school, then the postgraduate examinations, the courses, the conferences, the revision materials and the professional subscriptions. There is the cost of moving around the country in pursuit of training. There is the course everyone tells you is essential for your career, delivered by people who show remarkably little interest in how you are supposed to pay for it.

Then there is the cost that never appears on a receipt. The weekends spent working. The evenings not spent with friends. The holidays that never happened. The relationships that thinned out because you were always studying, on call, or trying to find another way to make money.

And somewhere in the middle of all of that, you are expected to become an excellent doctor. Preferably without complaint.

Medicine likes to describe itself as a meritocracy. Hard work, dedication and talent, we are told, will carry us where we need to go. Perhaps they will. But it helps considerably if somebody else is paying the bills while they do.

For those of us without that kind of safety net, the journey asks for something else.

Creativity. And, more often than anyone admits, a side hustle.

The jobs that never made the CV

During medical school I worked as a hotel receptionist. I worked as a healthcare assistant in hospitals and nursing homes.

None of it was glamorous. Nobody was going to congratulate me for answering a hotel telephone or helping an elderly resident with their personal care. There were no certificates, no portfolio points, no fellowships. Just work.

But I have come to wonder whether those jobs taught me more about the people I would one day treat than much of my formal teaching did.

Working as a healthcare assistant put me in a different place in the hierarchy. As a medical student, I was being prepared to make decisions. As a healthcare assistant, I saw what happened between them. I saw who actually kept the ward running. I saw the nurse who knew a patient was deteriorating long before the observations caught up. I saw the colleague who noticed an elderly patient had not eaten. I saw the difference between doctors who acknowledged the people around them and doctors who moved through the ward as if everyone else were part of the furniture.

I saw how patients behaved once the consultant had left the room.

And I learnt that dignity is not something doctors bestow on patients. It is maintained, usually quietly, by people whose names never appear on the discharge summary.

Hotel reception taught me something different. Customer service.

Some doctors find that phrase offensive when it is applied to healthcare. Patients are not customers, they say, and they are right. A hospital is not a hotel. But patients are people with expectations, anxieties and frustrations, and an entirely reasonable wish to be treated with respect. Calming an unhappy guest without making things worse is not so far removed from calming an unhappy patient. Both require listening. Both require understanding that the person in front of you may be reacting to something that happened long before they met you.

And both require knowing when to stop talking. It remains one of the most underrated skills in medicine.

The summers I learnt to sell

Between my first degree and medical school, I spent my second summer selling door to door. By then I was no longer only an independent sales consultant. I was also a student sales manager.

Actual door-to-door sales. Knocking on strangers' doors and trying to persuade them to buy something they had not woken up that morning intending to buy.

I appreciate this is not the usual origin story of an orthopaedic surgeon. But I would argue it was one of the most important educational experiences of my life. Not because I became an extraordinary salesman. Because it exposed me to human behaviour in a volume and variety no university course could have replicated.

Every door was different. Every household had its own dynamics. Every person brought their own motivations, fears and priorities to the threshold.

Some people were welcoming. Some were suspicious. Some were curious, and some were rude.

And some threatened to shoot me.

Yes, really.

Nothing sharpens your attention to non-verbal communication quite like the possibility that the person on the other side of the door is armed. You learn to read a face in the second before it decides what it thinks of you. You learn to listen to the tone of a voice before you hear the words.

At the time, I thought I was learning how to sell.

It took me years to understand what I was actually learning on those doorsteps.