Training shouldn’t be purgatory: the consultant cardiologist

“I dabbled with lots of other complicated things, but always came back to cardiology,” says Rob Edgell. “I was worried that something I enjoyed and found straightforward might get boring. But if you enjoy it, you do it with vigour and energy, and you’re fulfilled by it.”

That he made this choice is clearly a relief to the consultant cardiologist at East Cheshire NHS Trust in Macclesfield—he has loved caring for cardiac patients ever since. It also prompts him to recommend to resident doctors that they choose a specialty they enjoy.

“Even when you’re focused on the end game of becoming a consultant or a GP, training is a long process and you can’t really go through it as a sort of period of purgatory,” he advises. “You have to enjoy what you’re doing or life feels miserable, and you’re going to disengage and put yourself at risk of burnout.”

After training in Brighton and London, a desire to keep caring for a broad range of heart patients led Egdell to seek a consultant post in a district general hospital.

The hyperfocus on a small clinical area that can happen in larger teaching hospitals didn’t appeal, and he took his first—and current—consultant post in Macclesfield in 2001.

“I like being able to look after all aspects of the heart, and I would feel bereft of that if I worked in a teaching hospital and didn’t see, for example, electrical problems of the heart because they went to my electrical specialist colleagues.”

One of the aspects of clinical work that he enjoys most is picking up a rare and unexpected condition hidden among the more familiar problems. “Once in a blue moon, something unusual, masquerading as a common thing, comes along and spotting that, picking out the signs that there’s something different about this case, and making that diagnosis is very fulfilling.”

He has ensured that the unit has been involved in multicentre clinical trials continuously over the time he has been there, and he has been principal investigator on a dozen such trials.

Egdell’s other favourite part of work is training, mentoring, and developing resident doctors and medical students, part of which comes under his role as training programme director for internal medical training stage one across north west England.

“If I’m seeing a patient and I make a good decision, I’ve hopefully positively influenced one person’s life,’ he says. “But if I manage to teach something important to a student or trainee, that might touch dozens, hundreds, or even thousands of lives in the future because I’ve improved them as a doctor—I find that very satisfying.”

Egdell particularly enjoys talking to resident doctors’ one-on-one, helping them to navigate obstacles and identify gaps in their knowledge and giving advice.

But he feels there are drawbacks to the current system for resident doctors that he didn’t have to navigate in the 1990s. When he was a junior registrar “you felt far more part of the firm, part of the hospital structure, integral to what the department was trying to achieve, than I think our resident doctors feel now.”

Residents are rarely valued and respected by trusts in the way they should be, he says. “They’re almost seen as an itinerant workforce that pass through and you get what service you can out of them. I don’t think we have ownership of supporting and bringing on our resident doctors. We get to know them less well, and it’s a much less cohesive process.”

When considering the lessons he has learnt from being a consultant for more than two decades, Egdell says the value of a good team cannot be underestimated. “As a senior doctor, you gather around you the really good people and do what you can to keep them,” he says. “Be nice to them. You are absolutely dependent on them. None of us works in isolation, and if we think we can, it’s not going to work.”

He also says that being polite to younger and less experienced team members will reap benefits later on, when they reappear as colleagues. “Medicine is a small world—so be nice to more junior staff as you may need to borrow their stapler when they have the desk next to you later on,” he says.