You still do clinical?

I’ve been agonising over how to describe the ‘clinician’ bit of my role (who knew there is so much decision making involved in writing a blog?!). I do want to cover the ‘clinician’ as well as the ‘academic’ as the purpose of this blog is to open up all aspects of being a clinician academic. But the ‘clinician’ bit is… well, it’s complicated [you know, complicated, like it can be complicated to talk about any multifaceted relationship….].

I think it’ll take me a few posts of tight rope’ing to explain the ‘clinician’ part. So treat this just as post #1 of many (I plan to alternate between clinician and academic).

According to Council of Deans, a clinician academic is a healthcare professional who is concurrently engaged in both clinical and academic activities.

I do various clinical activities. All of them are quite complicated to explain due to a further set of complicated reasons. Things like, I don’t have a job description for my clinical activities, and different people can have quite different interests in terms of what they’d like me to do – or not do. [It doesn’t need to be like this – I have been in a post where all this was clearly agreed, and there are KSF profiles plenty. In my experience, how things are set up varies between organisations depending on people in charge.]

The easiest aspect of my clinician role is my clinical morning or a day. I will focus on that in this post.

In my speak, doing a clinical morning/day means I’m in the NHS, providing direct clinical care, or otherwise directly contributing to the frontline service delivery. For me, this is working in a children’s community or outpatient occupational therapy service. This is because children’s community/outpatient (i) services and (ii) interventions are my two key areas of expertise both clinically and academically.

My clinical caseload and role reflect my clinical and academic expertise. I have always had a mixed caseload of children – not limited to any specific diagnosis – and this is also how my research studies are set up. Having a mixed caseload is pretty typical in community services so it makes sense to reflect this in our research. If we want the research results to translate to practice they need to involve the populations we actually see clinically.

Currently the children on my caseload are around age 7-11 years – but more typically my caseload would be anything from about age 2 years up to about 16 years. The age has never been an active choice for me but more of a reflection of the ages when children tend to be referred to us.

Most of my clinical work at the moment focuses on working with families (parents and the child) to identify what they want the child to do that s/he isn’t doing at the moment. I try to keep it very family led and hear from them about specific things that matter to them. And just to be clear – I don’t “just sit them down and interrogate goals out of them”!!! I usually play and do assessment tasks with the child, and in the course of that they usually bring up things they want to take forward. All this matches really closely with my academic work on family-centred services and goal-setting.

Once we know what the family wants then my role usually involves discussions with school (for school based changes) and/or work with the child and parents at home. I’d be keen to look for more ways to help the children to participate in community activities too – but this almost never comes up anymore (it used to in my old job). I wonder if it’s socioeconomic. Perhaps I should explore it.

Most families tend to want similar things: for the children to be doing the everyday life things, to be learning and developing, to be confident, and to have some friends. The reasons why the children struggle in these things differ. My job is to work with those around the child to identify the pathways to positive outcomes. Again, this aligns very closely with my research into clinical (OT and PT) interventions.

I have done clinical work for most of the time I’ve been in research. The exeptions have related to competing priority events in my working life: the year I undertook a full-time MSc, the final year of my PhD, and when I was on a Visiting Fellowship in Canada.

I think most of my colleagues don’t know I do clinical work. When it comes up in conversation, my academic colleagues appear endearingly indifferent to it (I think they just accept it as part of me). However, my medical academic colleagues and AHP clinical colleagues outside my “home team” usually seem very surprised. The way they express their surprise tends to fall into one of three categories. Some people say “[long pause] …good for you…!” in a way that leaves me feeling they are impressed for some reason – but I can’t figure out what this reason is (I have asked, and no one has given a reason). Others say “So you still do clinical work…!” leaving me feeling I’ve just passed an implicit credibility test. I used to feel quite pleased for passing this test, but I increasingly question the meaningfulness of this. It seems to imply that if I no longer did clinical work I would somehow be a lesser of a person… and I find this idea disagreeable as I know very impressive non-clinicians. Finally, some people quizz me for details “Do you actually see patients…?”. What do they think – that I just sit at the clinic and pretend?

My leading hypothesis for why people are surprised relates to an aspect of the ‘clinician’ role that I find one of the hardest. I come across quite a bit of the view that being a good academic excludes me from being a good clinician. I fairly regularly come across people who either explicitly express, or through their actions indicate, that they think I’m clinically permanently stuck at my pre-research level. I will return to this in more detail in a later post, but for anyone out there harboring this view….

I quote colleagues from the NMAHP RU, Stirling University, who some years ago were doing research on what is expertise and how it develops. They told me: one does not become an expert clinician by serving time – by doing the same thing over and over again.

I totally see it now. Becoming an expert takes constant learning and discovering of the new. And that is basically what research is.