My Interesting Job: Oncoplastic Breast Surgeon

My Interesting Job: Oncoplastic Breast Surgeon

Izzy Dash has been training to become an Oncoplastic Breast Surgeon since 2005, and has just returned to her position as a newly appointed consultant after taking time out to have her son. Here, we speak to the 37-year-old about her new position and having what it takes to do such a stressful job…

What did you want to be when you were young?

I think I wanted to be a doctor around the age of 15, but before then I didn’t really know - like most people I thought being a film star would be quite cool. But I didn’t really have any real idea about what I wanted to be until the age of 15.

What made you think you wanted to go into that field at 15?

I quite liked science and I quite liked people - I wanted a job that involved working around people. I did some work experience with a GP and found that fascinating, it was really interesting to see all the different sorts of conditions people had, and how she met so many different people in a day, so ​being a doctor combined the two really.

Where did you go to university and what did you study?

I studied Medicine at Southampton University.

How long do you study for?

That’s a very interesting question, because I actually had no idea I’d still be doing exams till my mid-to-late thirties! Basically, ​most people do five years at medical school, ​in some ​universities you do six.

Does that depend on what you’re studying or what part of medicine you’re going into?

Well, everyone will study a basic degree of Medicine. There are some graduate entry ones, which are normally a year shorter if you’ve done a previous graduate degree, and in some universities or some medical ​schools you can do an extra degree in the middle of it - a scientific degree - so that makes it six years. Then after that you ​do a generic two-year placement after you’ve come out of medical school, and you start deciding what field of medicine you want to do - that’s when you start doing all your postgraduate exams. And how many exams you do and when you do them depends on what speciality you want to go into.

So how long did it take for you to become fully qualified as a surgeon?

I became a consultant in 2017 and that was because I took two years to go out and work abroad at different times throughout my training. I qualified in 2005, so that's 12 years. 

What's the difference between being a surgeon and a consultant?

Basically, the title ‘Consultant’ means you can be a consultant of any type of medicine, and surgery is just the type of medicine. So, I’m a consultant surgeon, but someone else might be a consultant Obstetrics and Gynaecology doctor, or a consultant psychiatrist. The ‘consultant’ term is just the level that you are at, so it's the most senior level that you can be. 

...Everyone’s crucial to the care of the patients, so you've got to be able to work well with people.

How did you decide on your speciality?

I was quite unsure as to what sort of medicine I wanted to do when I left medical school. I went and spent two years working in Winchester and got experience with lots of different ​specialities. I found surgery quite interesting - it's quite an immediate speciality; people come in who are unwell, and you can often do something to them to make them better fairly quickly. I think that appealed to my personality.  I also worked with some breast surgeons. ​who were just very kind people, and I quite like the fact that with breast surgery, it's an emotive job, so you have to be able to communicate ​well with your patients. So, I did a few placements in breast surgery, and that confirmed that I enjoyed it - so, I went down that path.

What do you think is the hardest part about being a consultant?

I've only been a consultant for a year really, and I’ve had some maternity leave, so it's going to be interesting to see how it works now that I've got a little one when I can't stay at work as long as I ​want to. A lot of my friends and colleagues say that it's the non-clinical ​aspect that is the hardest ​part of being a consultant, the management side of things. But there's always challenging situations and cases that get to you, especially in my line of work. We see a lot of sad situations, that often we can't really improve, so that’s always challenging.

Would you always have your surgeries planned, rather than running from one to the other in an emergency situation?

I’m trained as a general surgeon, and ​it is only now as a consultant I can do ​solely breast surgery. Throughout my training I did all sorts of different types of surg​ical specialities, and that involved lots of emergency work - night shifts, weekend shifts, dealing with patients coming in with emergencies, running them up to theatre, things like that. But breast surgery is a lot more planned, it's a slower pace​d surgical speciality than a lot of the emergency ones. 

Does your work involve mastectomies, reconstruction, cosmetic, all those kinds of things?

I don’t do any cosmetic work at the moment. Most of our work is cancer, or patients who have breast symptoms. They will come and see us if they have breast pain, or they’re worried about a lump. Most of the time the lump turns out to be something not worrying, from a cancer point of view. But most of our operations are cancer-related, and performing reconstruction​s on cancer patients.

Why did you choose the NHS over private?

A variety of people work for the majority of the time in the NHS with private work on the side. Because I haven't been a consultant for very long, I haven't had the opportunity to establish myself ​in the private sector. But also, personally I think now that I've got a baby, I won’t have that much free time ​to do private work. But different people want different things - some people are interested in the fact that they've got more control over their private work, other people are happy to just work in the NHS. But either way, both work very well together, I think. 

What do you think are the core skills you need to become a surgeon?

I think you need to have good communication skills, because all of your work is involved around talking to patients and talking to other members of staff. You need to be a good team player, and a good leader - you’re not the only one there, you have to work within a team, and whether you're a consultant or a junior doctor, everyone’s crucial to the care of the patients, so you've got to be able to work well with people. At the same time, you've got to be able to lead a team, especially in theatre situations. I think being organised really helps, and with surgery you have to do a lot of extra-curricular activities in order to get the job that you want. So being able to manage your time efficiently has certainly helped me as well. 

Do you ever worry about certain surgeries?

I think all of us worry. I think we wouldn't be human if we didn't constantly think about what we're doing and whether we're doing the right thing for our patients. Especially in our speciality we have a multidisciplinary team meeting where we as a team discuss all our patients and help plan what's going to be the best sort of treatment. But still, like myself and some of my female colleagues, we often still have a little bit more self-doubt compared to some of our male colleagues. But I think that's just the nature of job, you just have to learn to get on with it and realise that you will always have self-doubt sometimes. Ultimately, the patient is the one that's going to have to live with what we do to them, so it ​is important to talk to them. We have to involve them and make sure that they're completely understanding and happy to go ahead with what we suggest. 

Have you ever made a mistake that you feel like you’ve really learned from?

I think there have been situations where you've been running around and you've realised that you haven't written something up that you should have done, or you aren't prescribed something, and you've gone back and done it. I think that's a difficulty, sometimes when you're really busy you can forget to do something. I don't think there’s been anything that I haven't realised soon after, but certainly there have been times where you've had to stop and think 'no actually I really need to go and get a drink of water or something because I’m not performing at my best,' on night shifts and things like that.

When was the first time in your career that you'd really felt like you'd made a difference?

I worked in Australia for a year doing a fellowship and I had a lot more independence there. We had quite a few patients where English wasn’t their first language, so it was quite tricky trying to communicate with them whilst conveying the empathy and things like that., ​using an interpreter. And I got some really positive feedback from some of the patients in Australia, that made me feel, “Yes, I've definitely done the right thing, ​chosen the right speciality”. 

Have you ever had a mentor?

Not officially. I’ve worked with some really fantastic people who’ve given me advice and encouraged me, and I've been able to pick their brains about many things. 

Do you think that's something you'd like to do now that you're a consultant?

Definitely, I’ve been on a mentor training programme, and have been a mentor for a junior doctor. I definitely want to broaden that as well. 

What motivates you and gets you up in the morning?

I really enjoy my job and I find it really rewarding. I think how we interact with our patients can really make a difference. All our patients are terrified, some having never been in a hospital or a clinic before, and I think that's something we need to always b​ear in mind. If I can reassure the majority of my patients, and make them less worried about their symptoms while also trying to improve their health in the long term, then it makes me feel like I’ve done a worthy thing. I'm also really lucky that I have a very supportive husband.

What's your proudest moment?

Apart from having my baby, probably the proudest work-related moment was doing my postgraduate Masters in Oncoplastic Breast Surgery and finding out I’d got a distinction.

Who inspires you and why?

There’s not one particular person - I’ve worked with so many fantastic consultants, especially so many inspirational female surgeons. I've also got friends who are really inspirational.

Being a female surgeon, do you feel like there's been a time in your job where you've faced prejudice as a woman?

I've been very lucky in that I haven't experienced any blatant sexism or rudeness, but there are often situations where people presume, you're not a doctor because you're female. There have been some comments from the older school surgeons: “Are you sure you really want to do surgery, it's quite a hard speciality?” And you know actually, there's quite a lot of successful female surgeons out there. Plus, there are both men and women who choose to go part-time or full-time. So, I don't think gender has a role to play anymore. I think the generation above me who are female had a tougher time, but especially in the region where I work there are many successful female surgeons. 

There are often situations where people presume you're not a doctor because you're female or people presume you're not a surgeon because you're female.

Do you think your job can take a toll on your mental health?

I'm sure it could do. There's so much responsibility with the job, I think you could get very stressed. There's a lot of people discussing ‘doctor’s burnout’, especially within our profession, among breast surgeons. And I think everyone needs to be mindful of each other, and help and support each other. To make sure people don't take on too much, make sure that we’re there to look out for each other when difficult situations arise, or when we have a difficult consultation with a patient where we can share the stress out a bit. I’m sure it’ll happen at one point during my profession where I get a particularly stressful period, but I hope with colleagues, friends, and families support it won't have too much of an effect.  

Do you get any mental health help through work? 

You don't per se, but when you're a trainee in a region, if you're struggling as a trainee there are options for you to access counselling, to get help and support. Certainly not everyone needs it but if you do need it, it is there. I don't think people always know that it's there, unfortunately. There are options, we just need to be better at letting people know about them.

What does a day look like for you at work - do you do shift work?

Doing breast surgery, we’re quite fortunate there's no shift work involved. Throughout training there was, but now I’m a consultant there isn't. It's a mix of clinics - new patient and ​follow up clinics. Every week there's at least one multidisciplinary team meeting where we go through all the patients’ imaging and what's going to be the best sort of treatment for them, and then I’ll normally have a full day of operating as well. 

You went on mat leave when you had your son – are you allocated substantial time off with the NHS or do you have to come back a bit earlier?

I was working as a locum consultant ​before going on maternity leave in Wales and I had no issues getting maternity leave. I know some people do because they haven't worked in their job long enough in the NHS. Some of my GP friends didn't always get maternity leave, but I was fine. I didn't actually have a job to go back to but fortunately I had an interview in March and got a permanent consultant job.

How do you switch off from a day at work?

I like running; I used to do yoga. I used to sing in a choir as well. I haven’t worked out how I’m going to fit that in now that I’ve returned to work as a mother. Fortunately, at the moment, I can either run or cycle to work, so that really helps, it's a little bit of a de-stress. 

And how many hours a day roughly do you think you work?

Probably about 10.

When you were in training did you get much time off, or were you always ‘on call’?

It depends what job you're doing. Everyone’s entitled to annual leave, but the rotas are very different according to which hospital you are working in and which s​peciality you’re doing. With some of them there are a lot more people on the rota, so the ratio of emergency is less frequent than other places. At a smaller hospital where there's less people on the rota, you might be doing night shifts and weekend shifts more frequently. At a lot of hospitals, you’ll be on an ‘on-call shift’, working a 12-hour shift that'll often go onto 13, 14 ​plus hours depending on what's happening. When you’re a registrar, which is the level just below me, if you’re in the middle of an operation and your shift has just ended, you can't stop the operation - you carry on until the end of the operation. It means sometimes you'll be leaving the hospital at midnight and have to be at 7.30am the next day. It's variable, but it's not as bad as it used to be 15, 20 years ago. 

Do you feel like you have a good work-life balance?

I think especially now that I’m a consultant and a breast surgeon, definitely; as a trainee it's often quite hard, the work-life balance was a lot more difficult, especially when you're rotating through lots of different hospitals, it sometimes means your commuting long distances in a day.

And finally, if you had one piece of advice for women who wanted to do what you do, what would it be?

You don't need to change your personality in order to become a surgeon - ​nice people can be surgeons too. I was once told that I was too nice to be surgeon, which is a bit ridiculous considering in my line of work - you can't be a nasty person. And keep persevering, if you want to do it, you can do it.

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