In this edition, Angela Thomas, OBE, PhD, talks about defying expectations and mixing politics and medicine. Dr. Thomas is vice chair of the U.K.’s Commission on Human Medicines. She is a fellow of the Royal College of Physicians of Edinburgh, where she also is the director of heritage and honorary librarian. Dr. Thomas recently retired as a consultant pediatric hematologist at the Royal Hospital for Sick Children in Edinburgh, Scotland, and is a former president of the British Society for Haematology.
When did you first realize that you wanted to be a doctor?
When I was younger, my mum had a subscription to Woman’s Own magazine. At the back of each issue, there always was a column in which people would pose medical questions and ask for health advice. That was my favorite part of the magazine to read each week. I can recall, very clearly, reading one of the articles and thinking, “If something like that ever happens, I really, really want to know what to do.” Becoming a doctor would mean I would have the answers.
It was around that time, when I was 12 or 13 years old, that I started thinking I could have a career as a doctor.
However, I attended a relatively conservative girls’ school and becoming a doctor wasn’t the sort of career suggested to many of us. I can think of only one or two other girls who had gone on to become doctors, so it wasn’t a natural path to follow.
One teacher – who I didn’t particularly like – encouraged me to study history or music instead, so I adamantly told her I wanted to be a neurosurgeon. Of course, I didn’t actually think I wanted to be a brain surgeon, but, as a 14-year-old student set on becoming a doctor, I told her the type of doctor I thought would shock her most.
If you had followed her advice and pursued another career, what do you think you would have chosen?
Most of my family were lawyers or barristers, so, I suppose becoming a barrister would have been quite interesting. As a junior doctor, I participated in quite a lot of medical politics and I might have liked to become a politician, as well.
What appealed to you about politics? And, how did medicine and politics intersect?
During my training at London’s St. Bartholomew’s Hospital Medical College, there was great anxiety about the number of hours junior doctors were working; people realized the long hours were not good for us or for patients. Politicians started paying more attention to this issue and recognized that to understand these issues and create policies to address them, they had to listen to the junior doctors around the country about what they were experiencing. We were the ones who could communicate the importance of these problems to politicians at the senior level, who would eventually be able to effect change.
When I was on the British Medical Association’s Junior Doctors Committee, we interacted with several officials, including Kenneth Clarke, who was the secretary of state for health at the time. From those experiences, I saw that as a physician you can make changes in the lives of your patients directly, but to make a step change in how doctors work, we needed to work with politicians. I was proud to play a part in that.
I don’t think politics would ultimately have been a good fit for me, and this is confirmed every year when the U.K.’s long-running “Veracity Index” is released. Each year, a research company asks people about the trustworthiness of various professions and doctors are routinely among the most-trusted professions, while politicians always fall somewhere at the bottom of the list.
I love organizing parties, too, so perhaps that would have been a fun career.
“Chart your own career map; don’t do what somebody else says because they think it would be good for you. If you want to do something, then go for it.”
What other career accomplishments are you proud of?
I am happy to have worked in a small subspecialty within hematology and to have launched quite a few careers in this field. Pediatric hematology is a particularly difficult area to practice in because treating children with hematologic conditions can be demanding and distressing. When trainees start their rotation in pediatric hematology, they tend to be very anxious. But, by the end of their six-month rotation, many admit that they enjoyed it and some of them choose to convert to specializing in pediatric hematology.
That’s been heartening to see, because I feel that we have managed to instill in them the importance, the excitement, and the reward of practicing pediatric hematology. I take pride in knowing that young doctors are going into this specialty because of their training experiences with us.
On the other side of the spectrum, have you had any major disappointments? If so, how have you handled them?
Early in my career, there was one experience that I thought of as a major setback, though it did eventually lead me to where I am now. When I was a secondyear house officer, I hadn’t given a thought to what my next post would be. It seemed like, somehow, everybody had applied for jobs and secured a post – except for me. It was a frantic time: The post-graduate advisor did not realize I hadn’t applied, I was getting married that year, and so I did everything in a bit of a rush. I ended up accepting a post at a small satellite hospital in London that, if I had researched it properly, I never, ever would have accepted.
It wasn’t the job that I thought it was. Most patients who I treated there had chronic chest problems, tuberculosis, and even cases of syphilis, and many were homeless, so it was a difficult bunch of patients to work with. They didn’t trust doctors at all. When I’d advise them to stop smoking or drinking, they would go on rants about not interfering with things; that was the first time I realized that not everybody liked doctors! I wasn’t the savior of the human race that I thought I was going to be! It was quite a surprise.
I was on-call every other night during my time there and one night, I was snowed-in and stuck at the hospital, and I remember thinking to myself, “What am I doing here?” That’s when I made the choice to move on and started the post that eventually brought me to hematology.
Looking back from where I am now in my career, I don’t think it did me any harm in the long run. I was anxious for a time that it was the wrong job and that I’d not be able to move on, but it taught me to appreciate where patients are coming from. You can’t just go into a ward and say, “Look, I’m a doctor. I know what I’m doing, so listen when I tell you, ‘Do this.’” You have to appreciate patients’ positions and what their real needs are.
After that challenging nine-month post, I was fortunate to start a rotation in oncology with Andrew Lister, MD, at St. Bartholomew’s Hospital. I wasn’t intending to pursue hematology, but Dr. Lister was on the interview panel for the position and, after my experience with that first post where I didn’t have a great idea about the job, I went to ask Dr. Lister about the job. He said, “Now, have you come to see me because you like oncology, or because I’m on the interview panel?” I said, “Oh, because I like oncology!” When I got the job, he went ahead and said, “Well, Angela likes oncology, so she can work with me.”
That was the first time I was properly exposed to oncology. And, the more time I spent in the lab, the more my interest in hematology grew.
“You can’t just go into a ward and say, ‘Look, I’m a doctor. I know what I’m doing.’ … You have to appreciate patients’ positions and what their real needs are.”
What lessons has your work life taught you that you would like to pass on to our readers?
When that position at St. Bartholomew’s ended, I again faced the question of what I would do in my career. One of the other consultants I was working with asked me, rather patronizingly, “What do you want to do as a doctor when you grow up?” I answered, “I think I’d like to be a hematologist.” And he shot back, “Oh, no, no, no. That’s very competitive. Cytology’s far better for a woman.”
It reminded me of the teacher who wanted me to be a historian. I thought, Well, I’m ignoring him. I will become a hematologist. That’s something I share with trainees over the years: Chart your own career map; don’t do what somebody else says because they think it would be good for you. If you want to do something, then go for it. You may not always end up quite where you imagined yourself, but – for goodness’ sake – don’t back down from climbing your career ladder because someone told you they think you should climb a different one.
What is your biggest pet peeve?
In practicing medicine, my biggest pet peeve is treatment algorithms that go on for about three pages. I remember one specific algorithm that went on and on like a tangled telephone wire! In my opinion, algorithms need to be pretty simple. When they start getting complicated, there should be a line that says, “Now, ask somebody who knows.” Rather than trying to think of every single little possible exception to a rule, eventually, people should ask advice and make a decision.
Who is your dream dinner party guest? What would you ask him or her?
As a hematologist, I feel a connection with William Harvey, who was the physician who first described the circulation of the blood. We share a connection because we both worked at St. Bartholomew’s Hospital, and I’m sure many hematologists feel a kinship with him, but there have been coincidences where artifacts of Dr. Harvey’s life and career have shown up in my own.
For instance, when my husband and I were on holiday in Vienna after our honeymoon, friends of ours suggested we go to the medical students’ museum. While walking down the corridor, a picture of William Harvey greeted me on the wall; he, too, had been on holiday to Vienna.
When I came up to the University of Edinburgh, I was accepted as the second female member of the Harveian Society, a medical society founded in 1782 that is still active. For more than 200 years, it was an exclusively men’s society. Each year, we hold a dinner and the Harveian Oration to celebrate Dr. Harvey’s life and achievements. Now, I am the first female “Medical Secretary” of the society and am tasked with organizing the yearly dinners – luckily, I like throwing parties. (My counterpart, the Surgical Secretary, only has to choose the wine, so it’s a much easier job for him!)
I have heard many Harveian Orations over the years and have learned so much about his life and the circulation of blood – which is obviously central to my life as a hematologist. When he described the circulation and published his work, there were many dissenting voices, so I would ask him how he managed to win everybody over, especially when they were all saying, “This really is not how it works – this is not circulation. This is not what happens to the blood.” I’m curious about how he persuaded people and what arguments and evidence he used.
Of course, for it to be a true dinner party, we’d need more than one guest, so I would also like to talk with Coco Chanel. She was a trailblazing woman I greatly admire and many successors are still following the trail she blazed. She started her fashion house by adapting men’s clothes for women to wear, designing very simple but iconic clothing. I’d like to ask her where she got that idea, what drove her to start her own original shop, and how she managed to develop such a strong brand.