Medicine often runs in the family. Many doctors have relatives in the profession, and obituaries in The BMJ show how common it is for doctors to have siblings and children who are also doctors. Surveys indicate that around a fifth of doctors have parents who were both doctors and that many junior doctors and medical students ask their medical family or friends for career advice. Nonetheless, debate continues about whether having doctors in the family influences career decisions and makes life easier for those who follow relatives into the profession. Stephen Allen, a consultant paediatrician, was the first person in his family to become a doctor. He says that certain aspects of studying medicine seem easier for students who have a medical family, something he was aware of when he was a student. “I think the territory is more familiar [to students from medical families]—the vocabulary, the thought processes, the complexities of managing patients, working with colleagues, etc,” he says. “It’s easier for medical students to adapt to the NHS as a working environment if they are already familiar with the territory. I think I appreciated at the time that it was possibly more difficult for me.” Allen says that being the only doctor in his family may also have affected his specialty choice. “As a student, I found that paediatrics was a very down to earth and supportive place to be and work. Whereas, at that time, I found specialties like adult medicine and surgery more challenging. I suspect that if I was more familiar with medical practice through my background that might have been less so.” Differences Abeyna Jones, an occupational medicine registrar, is also the first person in her family to be a doctor. She says that, until recently, she wasn’t aware of being at any disadvantage for not coming from a medical family. But since she began reflecting on her own career while researching barriers to career progression, she noticed some differences between herself and her contemporaries from medical families. “My peers with medics in the family tend to express directed career ambitions at an earlier stage; either a similar specialty to their relatives, or something completely different as they’ve seen the negative aspects of their career pathways,” she says. “From a general practice perspective, I know of many colleagues who have trained with the intention of taking up a partnership at their relatives’ surgery. I also believe that some have progressed in their career simply because of nepotism—usually their medical relatives know people who know people, etc—which is always difficult to prove.” Recently, there have been discussions within the profession around reducing nepotism and eliminating a system where doctors help out their own or their friends’ children to gain access to medical school. And calls have been made by organisations, including the General Medical Council, to widen participation into medicine after research found that only one in 20 doctors in training grew up in the most deprived areas of the United Kingdom. Stories and reality Andrew Rowland, a consultant in paediatric emergency medicine, was also the first doctor in his family, but he did gain some understanding of the medical profession from relatives. As a child his grandmother, who had been a nurse during the second world war, talked to him about her experiences. “The stories that she used to tell are nothing like things are now but I grew up with those stories,” he says. “Before I went to medical school I’d only had one bit of work experience and I didn’t really know whether her stories would match the reality. “For example, in the clinic my grandmother worked in, you couldn’t speak to the consultant directly if you were a nurse, you had to speak to the sister and the sister would speak to the consultant. My grandmother said they were absolutely terrified of the consultant as enrolled nurses and all of the communication went through the sister. And they wouldn’t call a sister by their first name at all; they were always referred to as ‘sister.’” For doctors who do come from a medical family, whether they believe that their background has influenced their career choice or not, one of the benefits of having medical relatives can be that it brings an understanding of what a medical career is really like. Two of consultant psychiatrist Nicola Byrne’s grandparents were doctors, as was an aunt, and a niece of hers is a medical student. She says that coming from a medical family can make it easier for young people to realise that becoming a doctor is a possibility for them. “You’re always aware of it as an opportunity, as something that you could do,” she says. “Sometimes people don’t have that if they come from a family where no one is a doctor or where no one has been to university. I think it’s difficult to envisage yourself doing medicine if that is your background but if there are doctors in your family you are always aware, from an early age, that it’s a real opportunity for you.” The father and uncle of Clare Gerada, a general practitioner partner, were both GPs and she grew up watching her father at work. “I loved watching him work,” she says. “Our front room was the practice for many years. When it moved into the back of the house, out of the front room, he used to take me on home visits. It was part of my life; it wasn’t a separate issue—I knew my dad was a GP.” Gerada says witnessing her father at work and being immersed in medicine from a young age influenced her own decision to become a GP. “I don’t think I was ever going to do anything else,” she says. “There was nothing else on the cards except once I saw a picture of a high court judge who was a woman, which was the only careers poster in our school.” She adds, “Before [my medical] training our conversations used to be all about medicine and we used to talk about the human body. I remember my father telling me about how they had found the cure for schizophrenia when they found anti-psychotics. He used to have medical text books around the place, MIMs magazine and The BMJ was always around, so I was immersed in it.” Gerada says she was lucky to have a doctor in her family because it helped her to understand the job. But she believes that other young people are not so lucky and therefore can require extra support if they embark on a medical career. “Medicine is tough, really tough, and if you don’t come from a medical background where do you offload all of the stuff that’s going on?” she says. “It is hard work dealing with death, despair, and dying. We need to make sure we provide medical students and young doctors with the support they need, through young practitioners groups. Not so that we restrict medicine to just medical families but so we replace what medical families automatically have with something else for people who don’t have medical families. I think they [people from medical families] have an inbuilt support and I think we need to try and replicate that for those who don’t,” she says. Great expectations Despite benefiting from having a doctor in her family, Gerada also experienced first hand the disadvantages that being related to another doctor can bring. “It was helpful [having a medical parent] and not helpful because actually he wanted me to take over his practice and I didn’t want to at all, and I didn’t know how to tell him.” She adds, “I think there was a time when he really did think I would just go and take over and put my plaque up there. It was the expectation that I would be the third ‘Dr Gerada.’” As the 14th doctor in his family Krishna Kasaraneni, a GP, says that having medical parents proved useful at medical school. “My mum is a GP and my dad is a surgeon so when I wanted to discuss something or pick their brains it was easy for me to just give them a ring and ask,” he says. “That has helped. I can’t say it hasn’t.” Kasaraneni initially wanted to read history at university. After deciding to study medicine quite late on in the application process, he didn’t have much time to submit his medical school application. He says that having medical parents who had connections to other doctors made finding last minute medical work experience relatively easy. But having doctors in the family also “adds certain pressures and expectations,” he says. “I used to get home and my Dad would say, ‘How are studies going?’ and ask me a question about something. My parents would know the answer already, and I had no way of bluffing my way out of it. But overall it certainly has helped a great deal through medical school and making career choices.” Navjoyt Ladher, clinical editor at The BMJ and a GP, faced a different kind of pressure when she chose to become a doctor. “My mum always wanted to be a doctor,” she says. “She wanted to convert her degree in political sciences into a medical degree but she got married and moved to the UK from India instead.” Ladher says a pivotal moment came when she was picking her A levels. “I wanted to do English, history, and French but my mum said, ‘I don’t think they are going to be very good, you need to do something more vocational that will give you more options.’ I was good at sciences so I thought, ‘I’ll do those then.’ So my mum strongly encouraged me to do medicine. If it was all down to me I would have done totally different A levels. But in hindsight I love what I do and I’m really glad that I do it.” Daghni Rajasingam, a consultant obstetrician, has six aunts and uncles, and a brother, who are all doctors. Despite this background, Rajasingam says it was her school rather than her family that influenced her decision to become a doctor. “Acceptable choice for girls” As part of her work with medical students, Rajasingam, who is a spokeswoman for the Royal College of Obstetricians and Gynaecologists, says that she has seen doctors from medical families going into medicine as a result of family pressure rather than personal aspirations. “I also see it from the non-medical families who have very high traditional aspirations for their children, and because their children are performing highly at school, academically, and with the systems we have at the moment they are guided to a medical career,” she says. She says that families of South Asian and South East Asian origin are especially likely to encourage their children into medicine. “But as entry into medical school has become more and more competitive I see more of it across cultural boundaries.” Rajasingam says schools also have a part to play in encouraging students into medicine when they may not be completely suited to the career, something that can especially affect girls. She believes schools are not appropriately advising their students who succeed academically in science about all the possible careers open to them. “There is not an insignificant number of medical students who probably wouldn’t have chosen medicine as their first career but who have been guided or pushed into it because they are doing so well and it’s seen as a plus point for the school. [Going into medicine] is generally viewed as a really good thing, it shows how hard you’ve worked and how bright you are,” she says. Rajasingam adds, “I’m not sure that that translates into making doctors who, at the end of it, are fit for the jobs that we need them to do. The number of girls who are told they ought to go off and do mathematics, or physics, or astrophysics is next to none. We see medicine as an acceptable choice for girls who are superb at the sciences because the other careers are not seen as traditional female professions.” When Mair Parry, a consultant paediatrician, was young she had two brothers at medical school, although neither of her parents was a doctor. Her decision to become a doctor “was probably more to do with the school I went to than the family I was in,” she says. “I went to the local comprehensive but if you were good at sciences and if you ever developed an interest in medicine then that’s what they wanted you to do,” she says. “I don’t remember getting any careers advice on the matter, ever. I don’t remember anybody saying, ‘Have you thought about it?’” Cath McDermot, head of education at The BMJ, also says that her school, rather than her paediatrician mother, influenced her decision to go to medical school. “I was aware of what those roles were, I knew how to work hard, and I knew what a job with long hours looked like. If something is in your world, you’re more likely to be a bit more familiar with what it involves but I don’t think that it was my motivation,” she says. “At my school, we were almost coached in what you needed to do to get into medical school. At our school if you did artsy things and you did well it felt like you were encouraged to think about law and if you did well in science you were encouraged to think about medicine.” Your experience Did medical relatives influence your decision to become a doctor? Do you regret being persuaded to enter the profession by relatives, or are you glad to have been given a push towards a career in medicine? Have you persuaded younger relatives to pursue a career as a doctor? Add your experiences as a rapid response to this article. Box 1: Views from Twitter: “Would you recommend medicine as a career?” On Twitter Abi Rimmer (@Abi_Rimmer) asked, “I’m writing a piece on medical families. Would you recommend medicine as a career to younger family members?” Readers of BMJ Careers (@bmjcareers) responded: Dermot O’Riordan, surgeon, @dermotor: “Definitely. Been a privilege although my daughter had three generations of doctors on both sides and never contemplated it.” Umesh Prabhu, medical director, @DrUmeshPrabhu: “I would to anyone, any time. Had an amazing 30 years in NHS. Most wonderful and noble profession. Proud of it.” Rose M, foundation year 2 doctor, @DrRoseM: “Absolutely! As long as you are aware of the realities of the job day to day! I wouldn’t change my job even on a bad day!” Chris Tiplady, haematologist, @christiplady: “Yes I would, making it clear that it is a difficult, stressful but rewarding job. And it’s not like the telly.” Melanie Jones, director of Medical Career Support, @medicsupport: “Children should be supported to make their own career choices. Becoming a doctor to please your parents will not end well.” Shanaz Husain, GP, @ShanazHusain: “Only if it’s a calling. It takes over your life and if they’re not prepared for that level of sacrifice it is not for them.” Toby Hillman, doctor, @tobyhillman: “Hmm really, really depends. If they still want to after surviving as kid of medics—good luck to them!” Box 2: Doctors at The BMJ The doctors working alongside Navjoyt Ladher and Cath McDermot in the editorial offices ofThe BMJ come from both within and outside medical families. Fiona Godlee, editor in chief ofThe BMJ, has doctors in both her immediate and extended family. Her father is a retired consultant radiotherapist and her two brothers and her sister are GPs. “My father comes from a historically medical family,” she says. “His great, great grandmother was the sister of Joseph Lister [a British surgeon and a pioneer of antiseptic surgery],” she says. “Her son was Rickman Godlee, a surgeon and a president of the Royal College of Surgeons. Then there were the Hodgkins and the Fothergills—Quaker doctors in my father’s past.” Godlee says that her experience of growing up as the daughter of a doctor partly influenced her own career choice. “As the child of a doctor people ask you what your father does. You say, ‘He’s a doctor,’ and their almost universal response is, ‘Gosh! How marvellous! Isn’t that lovely? How great!’ So early on you get the sense that it’s a good thing to do.” She adds, “There was a driver of feeling that one would be doing something that was a good thing to do. Not good in status terms but good in terms of wanting to make the world a better place, which sounds a bit trite, but there is a feeling of goodness about the career.” Godlee says that having a medical family can help with understanding what a career in medicine is like. More practically, it can also help with interviews and job applications, she adds. “No doubt it also helped in all sorts of hidden ways, when you were applying for jobs or applying for university,” she says. “In those days, perhaps more than now, it probably did mean something. People did think that it meant that you knew what you were letting yourself in for and you would have the support of the family to keep you going through.” Trish Groves, head of research at The BMJ and editor in chief of BMJ Open, also comes from a medical family. “My father was a general surgeon, then a GP surgeon, and then a GP,” she says. “He was happiest in the 1960s when he was the main surgeon for a large market town and also a GP, and was able to mend people he’d known since their births.” But Groves says that her father’s profession did influence her own career choices, to some extent. “My parents never directly suggested that I do medicine and my father was pretty disillusioned with general practice by the time he retired in the 1970s.” Deborah Cohen, investigations editor at The BMJ, was the first person in her family to become a doctor and was inspired to train in medicine after a trip to Africa. There, she witnessed first hand the effect of diseases such as malaria and HIV and also met a group of doctors. “I had had no contact with doctors in my family,” she says. “I was never exposed to the medical profession. My mum was a social worker and that’s about as close as I got. But I went to Africa and that was really when I thought I wanted to become a doctor.” When she attended medical school Cohen says that one advantage that students from medical families may have had was that they knew better what to expect. “I didn’t have a clue what to expect or what the demands of medicine would be, in terms of medical school and your working life,” she says. “I was hopelessly naive about it really.” Emma Parish, editorial registrar at The BMJ and a paediatric trainee, is also the first person in her family to become a doctor and the first person in her immediate family to go to university. She says that her mum’s role as an educational assistant inspired her own career. “I can remember going with her to help at events for adults and children with learning difficulties,” she says. “Probably being around that caring profession for a long time is what inspired me to do medicine.” Although Parish felt at no disadvantage at medical school for not coming from a medical family, she saw the advantages that having medical parents could bring when applying. “I had to get my work experience to apply for medical school through a friend whose parents were doctors because I didn’t really have the contacts to arrange an in-hospital experience,” she says. “So I was really fortunate that the parents of one my best friends were a GP and a dermatologist and they kindly allowed me to do some shadowing with them.” She adds, “But I think I had enough experience through family illness of hospital and hospice environments. That had probably shaped my decision to choose a medical career, and I could talk about it on my application.” The only disadvantage she now sees to not having a medical family is trying to explain her working patterns to family members. “No one in my family has really worked in the environment that I have worked in so that can be quite hard,” Parish says. “When you miss weddings or birthdays or Christmas, you sometimes worry that they don’t understand. A lot of my family work shift work, so they understand that; it’s just a different kind of pressure.” But coming from a non-medical family also has advantages. “There was no pressure on what I chose to do at university,” she says. “There was no pressure to go to university at all, although my parents were very happy that that’s what I chose to do,” she says. “Actually having experience of people who don’t work in medicine is nice because you have a much more rounded view of what other jobs are like and what other people’s priorities might be.” Box 3: Eight generations of doctors Mark Batt, a consultant in sport and exercise medicine, has eight generations of doctors in his family. “I’m the eighth successive doctor in my family. It started with Augustine Batt, born in 1717,” he says. “If you go to the church in Witney, Oxfordshire, there is a marble plaque that celebrates five generations of Batt doctors: 1713-1926. They are the first five and then my grandfather, father and I follow.” Batt says he hopes to one day chronicle his family’s medical past. “It should tell a fascinating story of what was going on in each of these generations in terms of history, society, and medicine,” he says. “Augustine Batt was almost certainly an apothecary and then his son Edward received a certificate in surgery from St George’s in London in 1765 and he was a surgeon practising in Witney. Within our family archive we have a set of ledgers which are currently in the Wellcome Trust library. They start in 1774 and list in Latin the patients that were treated, the cost and type of treatment. There are also letters in the ledger from Charles Darwin about the breeding of rats and from Florence Nightingale about convalescent and village hospitals.” Box 4: Medicine as “the family business” Coming from a family of doctors, I have been surrounded by medicine my entire life. My mum is a Roald Dahl sapphire children’s epilepsy nurse specialist, my dad is a GP, and four of his siblings and a niece of his are all doctors. My parents never encouraged me or my siblings to become doctors, but my younger sister is now in the fifth year of a medical degree. One of the main drivers behind my dad and his siblings becoming doctors was my grandmother Beryl. She was the daughter of a GP and studied biology at Liverpool University. Her own ambitions to become a doctor were thwarted by her father’s ailing health and the second world war. But of her 16 siblings and step-siblings, five became doctors. Beryl’s husband Bernard, my grandfather, was a vet, whose practice was based in the family home for a number of years. Of Beryl and Bernard’s seven children, five became doctors. My uncle David Rimmer, a retired consultant histopathologist, says his mum strongly encouraged her children to become doctors. “Beryl was brought up in the household of a busy GP, and had older step-brothers and sisters studying medicine,” he says. “She clearly felt that medicine was a worthwhile career. I don’t think that she regarded medicine as ‘the family business’ as such. After all, her large family of siblings included lawyers and accountants too. But her regard for her father and disappointment in not being able to follow in his professional footsteps herself were probably factors that led her to strongly encourage her own children to consider medicine as a career. “My father, Anthony Rimmer, a GP and the sixth of the seven siblings, says that medicine probably was the Rimmers’ family business. In our case dad, being a vet and having his surgery in the house where we grew up, was almost identical to a GP of the time,” he says. “He was on-call to his ‘patients’ 24 hours a day, seven days a week and we all lived ‘above the shop’ as it were. Family talk was veterinary or medical in nature and as several of mum’s siblings and father were medics, there was a natural ‘normality’ to all things medical and a career in medicine seemed a normal pathway to take.” Anthony’s sister Ruth Bryant, a retired GP, agrees that medicine was like the family business, “but with some degree of reluctance by some of us.” As a child, she wanted to study humanities but was “persuaded by the age of 12 that medicine would be a good career,” she says. “As soon as we were tall enough to see over the operating table in the middle of the room, we were drafted in to help with dad’s work in the evening. We did things like holding broken legs out straight on cats and dogs while he plastered them, or holding retractors at the edge of the wound while he did operations. That might have as much to do with our doing medicine as anything else, and I certainly found recognising paediatric illnesses easier having seen most common ones at home in my siblings.” Anthony and Ruth’s brother Martin Rimmer, a consultant radiologist, says that his mother spoke a lot about her childhood living in a busy GP household. “There was an unstated expectation that we would do well at school, particularly following siblings that had done,” he says. “I was following two brothers who had gone to Oxford, and two sisters that had gone to Bristol to do medicine.” But Martin says he never felt that medicine was the family business. “Perhaps it was so ingrained in the family culture that I did not recognise it.” Competing interests: I have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare. Source
