Dr Steve Harris
SpR 4, Academic Fellow
At the time of the interview (February 2010) Steve had just returned from Haiti working there as an anesthetist on his third tour with Medecines Sans Frontieres, and is at the start of a PhD programme.
“I don’t think I would have been asked to go to Haiti if I didn’t have the specific skill set of an anesthetist.”
What made you want to become an anesthetist?
I trained to do internal medicine. Initially I wanted to do tropical medicine but there aren’t many opportunities in England. After internal medicine training I went to work with Medecines Sans Frontieres (MSF) for a year and the last training post I did before I went to MSF were in intensive care: normally done through anaesthesia. I decided that I wanted to do intensive care, which is usually subspecialty of anaesthesia (although it is becoming an independent speciality in it’s own right). An advantage to anaesthesia is that you are more of a technician; you don’t have the same long term follow up. For example, I don’t think I would have been asked to go to Haiti if I didn’t have the specific skill set of an anesthetist.
Did MSF appeal to you when you were going through medical school?
You have ideas about what you want to do but you don’t really know. My wife, who was my girlfriend at the time, was a year ahead of me in her training and we had decided on taking a trip to the Congo [Africa] with MSF as a sort of vacation. A lot of it was chance; I was in the right place at the right time. Also, the department I was in at the time was all right with me going away and was willing to accept me back when I returned. Everything fell into place where I could go experience MSF and still have a job when I came back.
Pain or Intensive Care? How do subspecialties in anaesthesia work?
The biggest two subspecialties are pain and intensive care. In general you apply to intensive care through an anaesthesia or internal medicine training program. I am heading towards an intensive care position but I have a few more months of anaesthesia and critical care training. I am a Specialist Registrar 4 (SPR 4).
What is the best part of anaesthesia?
As an anesthetist you are around sick individuals, and I was always drawn to these types of patients. You are the person everyone calls when they can’t handle a situation. I never wanted to be in internal medicine on a critical care unit and have a sick patient that I bring to someone else and say, ‘they’re too sick for me, I need your help.’ I always wanted to be the person they call to ask for help, the anesthetist. The main reason for that is because no one else in the hospital has airway skills. Actually physically sticking a plastic tube into someone’s windpipe (ie intubating) is not difficult, what is difficult is doing it without killing the person.
Another nice thing about anaesthesia is that you never work in isolation; you are always working as part of a team.
Has anaesthesia been what you expected it to be?
When I started I didn’t like it at all. The thing that I disliked the most about anaesthesia is that it is not a caring specialty-you are a technical specialist. That is why I like critical care, but as an anesthetist you are there to provide a technical service and you can do that well and make a difference or do that poorly and make a bad difference, but it’s still not your responsibility to work out what is wrong, try a course of treatment, and adjust that accordingly. The thing that I like about that (critical care) is you either make them better or you don’t, but that’s a really nice interaction and that’s the great thing about medicine: speaking with people, being attentive to them. You can argue that exists in anaesthesia as you have to assess their health before the procedure, but for me I never really enjoyed that. I liked sick people so I became a doctor and if they have a problem and I get my satisfaction out of helping them get better.
I think, to put it in the simplest terms: in medicine there is a problem and whatever that may be, or whoever that patient is, you treat them to the best of your ability and move on.
Academic Medicine
How did you get into an academic medical program?
In order to have any sort of hospital job you can’t just be a clinician, you have to teach or be in management or something. I was always going to get my masters in epidemiology which costs about £10,000 and if you work that out over five years its £2000 a year that’s not such a big deal. I had a few projects on sleeping sickness that ended up getting published with MSF. Then I ended up sitting next to Professor Monty Mythen and Dr Ramani Moonesinghe who were talking about a Masters in Clinical Trials program that was funded by the intensive care society. I applied for that and the academic post at the same time and got lucky on both. Once I got the title of a ‘Research fellow’ I felt a little sheepish because I had this title but wasn’t really doing any research until I found some good supportive people who supported me in this grant. I got lucky and got funded by a group called Wellcome. Now I feel like I have money, but no data. Once I have got some data then I think I will feel like I am actually doing research.
It takes a long time to get the grant money. I got the job at the end of 2006 when I was finishing my SHO training and this program was coming out. 2007-2009 I had two year of further clinical training and a year of research time, which was when I put together a grant proposal and eventually got the grant at the end of 2008. This took a long time to write a project, design it, and convince others that it’s a good idea. It takes 5 months to find out if you get an interview for the grant then another month after you have the interview to find out if you got the grant. July 2009 I found out that I got the grant and with a few more months of clinical to finish I ended up starting in November 2009. Now it is February 2010 and I am getting the Research and Development and Ethics approval.
Do you think the waiting is the worst part of being involved in academic medicine?
It seems that elsewhere (for example the US) there is more of a well-oiled machine where administrators really push a project through quickly whereas here it takes a lot of individuals who are very motivated to get a study up an running. It is changing a bit, now there is a program where doctors, like me, can take time off of clinical practice to do research. Colleague Roman Cregg and I were the first two people in that program. It is called the Academic Clinical Fellow program, which was a government initiative to reestablish academic medicine as a career path. In the past it was even more along the lines of doing only clinical work and in your spare time you were trying to do some research. Now there is money to fund a post where you don’t have clinical commitments and you have time to do research. You do a year as a specialist trainee getting some pilot data and a proposal written, get your grant, take three years out and do a PhD, then come back as a year 4 or 5 specialist trainee. Then you come back and apply for your next level of grants. I think academic medicine is worse than business in the sense that it’s largely about hunting money and convincing people of your ideas. There is a balance because you could be doing full time clinical, where you are a straight technician and are in the routine. Somebody told me when I was a medical student that, “every single job in the world is boring, you just need to find the one with the boring bit you can cope with best.” You find the boring bit you can cope with, like filling out ethics approval forms for research and then you enjoy the other bits.
What do you enjoy about working in academic medicine?
I like the fact that someone pays me to read literature, think about what I am reading, and then do a bit of writing. Once in awhile I even get to test out an idea I have had, which is quite scary. I have a friend who works in film and when he has a great idea for a great film, he will go around and pitch the script. He will get denied a lot, but then someone will tell him that is really is a great script and we are going to give you this much money. Then he will go out and celebrate with champagne and party all night. The next morning he wakes up with a hangover and also the terrible feeling that ‘I have actually got to make the thing.’
It is not just the idea for a research project that I have sold, but I actually have to follow through. They give you money for three years and it isn’t all up to you and a lot of luck to make the project happen. Research doesn’t reward negative answers, which may be why there is so much bias. Hopefully at the end of those three years you will have made it work and your CV will allow you to have another go with a new idea with some more money. Same thing with the film – if it is a good one they will fund you again, if it is a straight to DVD then I wouldn’t expect another try.