Esohe Omoregie: What’s wrong with public health?

Esohe OmoregieThe other day, I had my first weekend on-call as an SHO. My consultant asked me the inevitable question about my career plans. I resisted the urge to stay in line with her specialty of choice, geriatrics. This has often been a tack of mine and many other trainees to facilitate smooth passage through any placement. So one case of acute confusional state, an anaphylaxis, and three stroke patients later, I decided to be honest. “Public health,” I want to keep the public healthy.

Perhaps it wasn’t the most appropriate setting after seeing five medical emergencies. But even though I didn’t quite see what was wrong with public health, my consultant certainly did. “Well it just sounds like you don’t know what you want to do.” The words stung, but I’ve had worse; “You’re not a real doctor if you’re in public health,” or “Well I suppose you’re lucky because that isn’t very competitive,” or even “Are there doctors in public health?” The comedy duo Amateur Transplants have even dedicated an entire song to the mysteries of public health. To say that public health is stigmatised in the medical arena would be an understatement.

There is support in my corner. For the London Deanery, competition ratios for “public holiday” make it one of the more competitive specialties to get into at specialty level. That’s at least one plus. So I’m not the only one who’s clocked onto this supposedly crazy idea. Call me old fashioned but I don’t see what’s wrong with being able to help a lot of people at once. I certainly don’t feel like a sell out, but my colleagues have other ideas. I wonder if it matters what other people think, as long as you’re happy. A recent study into medical student opinions about career choices ranks public health highly for lifestyle friendliness, but low for prestige in relation to other medical specialties. There seems to be a general feeling of distaste, and that gently empathetic frown I get when I disclose my intentions sums it up quite well.

What’s more disconcerting is that even some public health supporters have tried to rain on my parade, “Well have you really looked into it properly? Most people are very senior in other training before they decide to go into public health. Take me for example; I’ve already got my MRCP…”

That’s great, but I’m not most people. And what’s wrong with being decisive?

Okay, I’m not the most decisive of people. I’ve gone through multiple medical career transitions, but I think this one’s a keeper. Training should allow us to decide early if we’re ready and spend time browsing if we aren’t, as suggest the results of a recent prospective cohort study. I’ve done my homework, and in all honesty, if I hadn’t really got stuck in with many different career choices, I wouldn’t have been sure that public health is the one for me.

You need only listen to the news for five minutes before you hear about a public health issue; most recently the BP oil spill, floods in Pakistan, and the ongoing conflict in Iraq. And even on our doorstep, who of us hasn’t seen someone with COPD, or a stroke, or an MI. Those are all potentially preventable diseases, but make up a large proportion of our clinical caseload. I’ve seen a number of my colleagues and seniors complain about the lack of clinical insight that non medically minded managers and NHS workers have into the trials and tribulations of being a doctor. I’ve also seen the same people moan about how busy (or un-busy) their rotas are, and battle with the EWTD for training opportunities. I would’ve thought it would be a good thing for a medic to infiltrate the managerial camp, but apparently not.

“So… doesn’t that mean you won’t see any patients?” people ask. This is one of the unfortunate downsides of public health. The majority of time of medical school was spent getting my clinical knowledge up to scratch, and true, the clinical aspect is what most medics want out of their careers. I can understand how this would be a deal-breaker for some, and I respect that. Some would argue that real action only comes from cutting someone’s abdomen open, or putting out a crash call on someone who’s ECG shows ventricular fibrillation. Yes, these are shocking situations, but what’s more shocking is the power that we as doctors have to change the structure in which we provide care and subsequently the health of the population as a whole. And let’s not forget opportunities to work all over the world for different NGOs. Public health is multispecialist, so you’re likely to find something that piques your interest.

A career in public health could give me a career that will develop in ways I can’t even begin to imagine. I think my predilection for multiple projects and seemingly unrelated but deeply connected interests might finally find a home. Isn’t it normal to try something a bit different and like it? Life seems too short not to.

Esohe Omoregie is a foundation year 2 doctor in public health at East Kent University Hospitals.