Women at Work – Dr. Harwood, London 2021

I’m Catherine Harwood.
I am a medical doctor and a consultant dermatologist, that’s a skin specialist. I’m employed by Barts Health, which is an NHS Trust, and I’m also employed by the Queen Mary University of London, the medical school, and I do both clinical work and research work, most of which is around skin cancer.
My first job – do you want my first ever job ever? At age 16, I was a sales assistant at British Home Stores, which is now long gone, they became
bankrupt. So that was my first step. When I was at school, I’d work there on a Saturday for a little bit of extra money. And then my first proper job would have been when I qualified as a doctor and that would be a house job, so house physician and surgeon, and yeah, so that was my first professional job. I went to medical school, straight after my A-levels. So I did A-levels then I went straight to medical school. I went to Cambridge for three years to do my
preclinical. That’s the kind of theory side of medicine. And then I came to St. Thomas’s Hospital in London to do my three years of clinical training.
And then I qualified and then I did a year of house jobs. Then various medical training posts mainly in and around London and the Southeast and passed initial medical professional exams, and then decided to specialise in dermatology. Then had another three or four years of basic training and then I did a PhD. I took me three years to do a research Ph.D. around skin cancer.
So I became a clinical and academic doctor, followed by a senior lecturer role and then a professor, about 10 years ago.
Mentoring and being mentored it’s usually a succession of clinicians who will become your official kind of mentor and, but also on the kind of research side as well. So I’ve had people who have mentored me on the research side, and now you know, the whole process is repeated. So I look after some of our trainees and supervise them so you have a clinical supervisor, educational supervisor, and also on the research side, I have Ph.D. students, for example, and sometimes
clinicians who are doing like I did a Ph.D. and sometimes it’s scientists who do a Ph.D.
The NHS pension scheme, which I have been part of since I’ve started working, is a very good pension scheme. I only work in the NHS, I don’t do any private work at all, lots of people do private work when they become consultants and they would often sort out, maybe some of their pension for that
separately, but I am just in the NHS pension scheme, which is a good scheme.
I still think the whole time it’s such a huge privilege to do what I do.
People put their trust in you to help them with their problems and it might be a queue problem – when I was a junior doctor doing queue medicine sorting out very sick people on the wards and in dermatology, not so much in queue medicine you still get sick in-patients, but a lot of people I look after with chronic
conditions, and a bit in the same way like the GP you’d get to know them. I’ve got patients I’ve looked after for years and years helping them live with chronic skin conditions, things like skin cancer go on and on and on, that’s hugely rewarding. It’s looking after people, they trust you to do that, and that’s a huge privilege. Also, working as a part of a team is hugely rewarding.
Medicine is completely about working in a team, so a doctor is just one part of the whole jigsaw of nurses, occupational therapists, physiotherapists, and all the different types of medical allied, healthcare professionals, secretarial staff, receptionists, the porters. It’s a huge community and nothing is independent of any other aspects of it and most of the time it’s really amazing to work in a team like that, you are working towards a common good, which is always very patiet
centred, making what you do is provide the best possible care you can, sometimes under very difficult circumstances. So that aspect of it is amazing, looking after people and working as part of a team. And on the research side as well, you are helping to looking into problems that you identify as a clinical
doctor is really incredibly rewarding and working with people who are amazing scientists for example and biometricians and so on, to get a completely different take on diseases, if you like, both in the lab type basic research, about what causes skin diseases or skin cancer – this is what I investigate – and also doing clinical trials, being part of the clinical trials to try and find better treatments for patients. So, the two things go together very well: on the clinical side, I’m identifying where the problems are, and then on the research side doing my bit to try and help answer them, not just with other clinical staff but with scientists. It’s too much, there are too many things that are rewarding! I still think it’s just amazing that I get paid to do it.
You are always learning, and you never finish learning, so there is never a point where you can say: ”OK, I know it all now, so I’m just gonna do the same job”, every single day is different, every single patient is different and a lot of it is actually problem-solving and in all aspects of looking after patients is not
just medical problems and diagnosis, how you are gonna sort out their treatment when they’ve got maybe lots of other things going on, family problems, social problems, financial problems. And then on the research side, how can you tackle answering a particular question.
So, lots of problem-solving, but it’s always different, I’m always seeing something I’ve never ever seen before, despite I’ve been doing it for a very long time.
That really is exciting.
Talking about the balance work/life, it kind of changes throughout your career, your circumstances change, so, you know, as a medical student, obviously, I didn’t have anyone, depending too much on me. I just had to study and do whatever I wanted, you know, in my spare time. When you start working, particularly as a junior doctor, you are committed to doing on course in most specialties. So you know, there will be weekends and nights during the week when you’re based in the hospital.
And so obviously, that doesn’t interrupt your outside life to some extent. It was a bit less well sorted out in the past when I did it. It’s a little bit better sorted out, but there are different pressures for people. That can be a real pressure. And also moving around the country. So particularly nowadays, you can end up moving all over the show to do various jobs. So you might have to, you can’t necessarily be certain if you want to stay in London, that you’re going to be able to stay in London.
You may end up at some other end of the country. So you know that when you’re training, that can be really challenging for people’s personal lives. I was
lucky enough that it was slightly different way back, and you basically applied for jobs where it was a totally different system.
So I kind of kept in the area I wanted to be in. And then, of course, when you start, if you have a family, there are different pressures again. So I’ve had three children, three boys, and it is a bit of a balance, you know, working doing research, I was doing my Ph.D. between. I started after the first one, finished just before, I had the second one during my Ph.D. and then submitted my Ph.D. just before the third one. So doing that and the clinical work and being on call and so on.
The good thing is I live very close to the hospital, so that makes a big difference for cycling if I’m needed.

There’s all of that juggling looking after them, doing what they need to do.
And you know, I worked full time.
But dermatology is one specialty that the on-calls tend to be less pressurised and some specialties, you know, like certain surgical specialties. And that’s part of the reason you kind of go down that career path. But then there are different pressures and then, you know, as they get older, you have different pressures. In career-wise, you might have management, I’ve been involved in management.
Some of the kind of academic side pressures and then during COVID, everything went completely upside down.
So in all our junior staff, poor things, were all redeployed to the wards, so they more or less all left and they were on the wards. So we were trying to, consultants were running a service, obviously very scaled down. But also, quite a few of us helped out on the wards as well in weekends and things like that, because it got, particularly January, February, this last year really, really busy here. And then it changed the way we work. So lots of telephone consultations, which it can be really difficult, particularly with elderly patients or patients who can’t send in photos. So there’s a lot of sending in photos to show what they had and try and work it out and trying to obviously avoid anyone coming up to hospital who didn’t need to come up to the hospital. And then catching up with all the stuff that hasn’t been done is going to take a bit of time, but that’s a very specific thing.
Covid pandemic has changed the way we work quite a lot. Some of it for the better, for the future. But you know, that meant we had to be flexible about what we were doing in a way that, before the pandemic, things were fairly predictable, if you like, you know, clinics, research, etcetera. And then this kind of was like, throwed a grenade into the middle of all of that and just changed things enormously. Some of it for the better. But yeah….
Under the first wave of the Covid19 pandemic, everyone was stressed, but there was a feeling of, I don’t know, that kind of trying to pull together, I think, and tackle the various problems that arose. And I’m not somebody who gets too anxious about things generally, fortunately. So I just kind of, I suppose, got on with it. I know it sounds ridiculous, but you just, you know, things, you just have to get on. What do you do? You either just have to do whatever needs to be done, I suppose. And I think it was much harder at that time, my youngest child was just starting his sixth form.

Nobody taught me to be confident in myself.
I went to a school where the expectation was not very high.
And they mainly concerned about turning out my skills, it was a kind of typical kind of convent school. And my family haven’t been to university, they were
supportive and they never questioned anything I did. But you know, it doesn’t give you lots of self-confidence. I see people have come out of other families or schools, and they’ve just kind of got natural stuff. So I think I underestimated what I could do. I just wasn’t confident in myself, and I think that’s a very typical female thing. Totally. And you know, you worry about things that often other colleagues would just, you know, just “so I can do anything”, you know, like – really? But that’s partly to do with upbringing and expectation, and things have changed a lot now; I’ve seen it transformed from girls doing OK O-levels (Ordinary Level), but not A-levels and boys doing much better at university. And that’s a far more men, you know, women were outnumbered by about three to one, but now it’s all completely changed. The expectation for women is totally different, and I think that just puts different pressures on you, doesn’t it? But yeah, so I think that’s probably to have been a bit more confident if somebody had told me, I wish I had my head on me now at the age of twenty one. But that’s life, isn’t it? That’s the thing you expect. That’s how, same kind of experience, isn’t it? Yeah, it’s easy to know what you would do decades later, but you know that part of it is learning all that.
This is an important piece of advice: be confident, don’t underestimate yourself. If you want to do something, just do it. I think that’s for life in general, as I said, I think this is an issue and it was in the past. There are more women going into
dermatology now than men. It’s the men who are kind of endangered species.
Is that not correct, in dermatology? And enjoy it.
I mean, the work of patient-centred, unless you’ve got the patient at the forefront of everything you do, it’s pointless in a sense. I think I would say just be confident about what you do and don’t underestimate yourself. I wish somebody had told me that. What’s the phrase? Impostor syndrome! That’s it! impostor syndrome. I have it all the time still! Totally! I think that’s the female thing. “How have I got to this position? I really don’t know what I’m doing here” And I think that’s it and still, that’s the one thing I can’t shake off. I don’t know whether that’s a female thing or not, I’m not quite sure. I think that’s the whole. It’s linked to what I was saying about confidence. I think actually what I mean is don’t feel like you don’t deserve to be somewhere if you’ve got there. You know, there’s a lot of luck in a lot of life. I mean, totally a lot of luck. I see patients who, you know, some tiny thing has happened in childhood like dads walked out or mums are drug addicts or something. And their whole life just kind of, you know, spirals out of control through something that was totally outside their power to do anything, yeah, everything that’s happened in their life is a consequence of that. And so there’s a lot of luck involved in a lot of life. But you know, certain things, you shouldn’t constantly have impostor syndrome, which I think probably not a small number of women probably do feel imperfect. I don’t know in everyday life, but certainly, in a lot of professions. And I don’t think that’s an exaggeration.
I might had gone off being a cardiothoracic surgeon. You just didn’t even enter my head at the time because it was so male-dominated, for example, you just wouldn’t dream of going down that route.
And things have changed now there are lots of female surgeons.
I think it genuinely is more equal now, so the numbers going into medical school, there are more females than males going into medical school now, just, the balance was switched quite a few years ago that slightly more women than men. But I think what’s important now is not so much becoming a doctor. It’s making sure that you get women further up, if you like, the career ladder of
different diverse specialties, so that what would often happen is that they’d go into certain specialties like general practice and they might not. They should then necessarily get to the top of that general practice/medical/surgical career ladder. They stop at a certain level.
Representation at the higher career levels didn’t reflect the number of women going into medicine. And that I think it is slowly changing. But it’s slow and the same is true in research to some extent as well, I do many kinds of clinical research, but looking at the scientific research as well, there are far fewer women that go up the research academic career as well. It’s not so much encouraging women to go into medicine because they they have no qualms that they’re just as entitled to go into medicine as men nowadays.
I think it’s more about making sure that we get representation right up across the specialties, right up the career ladder, both on the clinical and the research side of things. That’s what will change in the next 10 years, hopefully.
There are ageist assumptions and that kind of things. But I don’t view it as specific problems related to the age I am, I don’t think so. I’ve never really thought about it. I don’t really know. I think it’s really hard for me to know somebody who’s in a different profession or in a different country, you know, and it will vary enormously across the world. So if I was in Afghanistan right now, I think, it would be completely different pressures, just the pressure of having being independent and doing what I wanted would be. Whereas I have that, you know, so I think it’s very difficult to generalise. I honestly don’t know.
There’s a balancing of home life and career and aiming higher, you know, as high as you should be going. Perhaps, I think probably women of my age still have that slight hangover that of the expectation that we had when we were at school and going to university. Yeah, I think that’s a hard one to answer. You know, things change throughout your lifetime, as a 58 year old. If you were in Hollywood or somewhere, it would be very different at 58, there’d be
presumably far fewer parts for you to play and all that kind of ageist type of thing. And I don’t think certainly there’s not in my professional life, it’s not. That’s not such a prominent problem. I mean, in life in general, as you get older, obviously.
Women supporting women? I think, and it’s changed as I got older, actually.
So when I was younger, I didn’t think about it at all.
You know, I had probably more male friends and female friends simply
because of the university was very male-dominated. Medicine back then was very male-dominated. So a lot of my friends were men rather than women.
But actually, as I’ve got older, far more of my friends are women.
You know, you gravitate toward women who have had similar experiences. And I found it really important to have relationships, you know, to have that relationship with lots of women.
They’ve been, on the whole, far more supportive as I’ve got older and you go through different things in your life. My closest friends now are women rather than men, actually, so it’s kind of all changed. And I think it’s very important for women to support each other. And certainly, in the UK, I can only speak for being in the UK, in London especially, having enough money to do the kinds of things you want.

It’s very important that you do support each other actually in the kind of things you’re wanting to do or with your families or problems.
It really has been in various things I’ve gone through over the last 10 years, really important to have women friends supporting me and I, in return,
have supported them emotionally in all kinds of other ways.
So it’s really interesting how my view of female friendship.
And supporting other women has changed as I’ve got older actually, really has, strikingly.