As some of you know, I am in Japan for my three-month stint here. I had a week off in Tokyo before joining my colleagues at Fukushima Medical University where I had some time to visit some friends, including a couple of Japanese GP friends. Having not seen them for a year, one of them asked me how being Chair of the JIC has been. I always feel a bit guilty not being able to be gushingly positive about the two years out of three that I have been Chair because it has not been without its challenges but it has also been an amazing experience and, single-handedly, the one thing that has changed my professional and probably personal life.

Two years ago, I put myself forward for the position of Chair. At the time, I was Deputy Chair and had to step up when Sinan stepped down fairly suddenly. The RCGP International hadn’t advertised for this position yet leaving us in limbo and this was also polluted by the fact that the powers that be in the RCGP International at that time also wanted to exclude the JIC completely from the selection process. I remember discussing this at length with Ryuki, my boss in Japan, and his wife whilst on a study trip in Australia and being quite frank about my concerns about working for a new unknown person but also how much work it would be if I serendipitously became Chair myself.

Fast-forward two years and I can see how much I have matured in this time, with the grey hairs that I pluck from my scalp being a testament of this. I look back on how much I have changed both personally and professionally and how many opportunities have sprung forward from this one role. I remember during my blog interview with Vikesh two years ago that he said to me that somehow the right Chair always seemed to come along to take JIC in the direction that they needed to be taken most at that time and he felt the same for me. This was such a kind thing to say during my initial stages of insecurity and uncertainty and I have since hoped that this has been the case (it’s difficult to know when you’re knee-deep in it).

So this week, I thought I would share with you my reflections of being Chair of an awesome invigorating team and having the opportunity to advocate for issues that are really close to my heart – basically, my passion as my job. Read to the end to find out why I’m issuing this blog post now.

Imposter syndrome

My Japanese GP friend, Ai, reminded me of an end-of-year party in Japan in 2016 when we all had to stand up and talk about our reflection of the year. Apparently, I stood up and said that the best part of my year was becoming part of the JIC and the worst part of the year was having to face my imposter syndrome.

The dinner and those feelings seems like such a long time ago. Imposter syndrome is that constant feeling of fear, waiting for the time that someone will expose you as a fraud. The JIC are full of academic GPs and ex-Darzi fellows or they’ve all started some charity or done something extraordinary and its hard not to feel intimidated by their CVs – me included. Over time, I have realised that my role is not to be amazing at everything but to create an environment where the rest of the JIC can flourish. The less it is about me and the more about them, the better and somehow it’s very difficult to hold onto imposter syndrome when you’re letting go of your own ego and your need to be centre-stage in order to do your job well.

To further shed the sense of self, it’s important to recognise that your opinion is just that – your opinion and not your opinion. Mine is based on many experiences of traveling and observing healthcare abroad but also as a trainee, a first5 GP and a user of the RCGP. The RCGP don’t ask for my thoughts and expect anything profound (nothing profound happens between my ears anyway) but they ask me because I’ve experienced the frustrations first hand. But more importantly, to the RCGP, I represent the many experiences of GPs interested in global health and international primary care and it is these experiences that they want to hear. Through this blog and through talking personally to as many GPs who enquire about the JIC, I get a real flavour of other people’s stories. It is these stories that I am seeking to shape RCGP policy.

A final point on feeling like a fraud, this piece of advice came from a friend who once said to me that the first time you do anything will be the first time in your life that you do it. This sounds so simple but yet so true. The first time I tried to ride a bike, I fell off and I certainly didn’t feel like I was going to be exposed  as someone who shouldn’t be on a bike. In the same way, the first time we take on a role or a task or the first time we meet someone important, it’s essential to remember that it is your first time and we shouldn’t be putting pressure on ourselves to make it look like we’ve done it a million times before. For some of us, it’s meeting the practice partner for the first time. For me, it was meeting the Chair of the RCGP for the first time. For others, it’s meeting the Prime Minister for the first time. And every time you do it again, it gets easier.

Micro-managing

I feel that, as doctors, we are natural micro-managers. Think of all the ward rounds we have been on with our task lists set by the consultants and of all the registrars creeping in after their theatre lists to make sure that the juniors have done everything – all in the name of patient safety. I’m not sure we’re any better as GPs but I guess we work more independently of each other.

When I started, I wanted to be copied into everything and I wanted everything to be done my way.  The only thing that happened was that I had no work-life balance, would have mini nervous breakdowns (and Cemal, my Deputy, had to jump in to give me a week off) and I became dangerously close to burnout. Further to this, my team couldn’t spread their wings, do things the way that they felt right and they couldn’t learn from their own mistakes. A really hard thing to do has been to keep my nose out of things and to instead keep my fingers crossed that each project will work out fine – and most do but some don’t and that’s also ok. Instead, I have learnt to give better briefs ahead of time so that they know my expectations and being quite clear with my vision. I’ve still not perfected this but I’m handing entire projects to people rather than tasks and it seems to be working so far. This frees me up to do other things like join RCGP working groups such as the appraisals and revalidation working group (to try to make it easier to navigate for doctors who want to leave the country or come back) and a working group to improve local provision of RCGP services. I wish I could emulate Robin, previous Chair of JIC, who apparently used to inspire the JIC so much that everyone worked hard in order not to disappoint him. However, realistically, I may not do as my leadership style is  very much like a “labrador” where I run full throttle with naive enthusiasm with my tongue hanging out and expect everyone to follow me. Probably less cool than Robin!

Feedback

Coming from an Asian family, feedback usually involved just pointing out the mistake and telling them not to do it again – pretty straightforward. Apparently, this is not the right way to do things in the Western professional world.

I think giving feedback is something that many people struggle with and it’s difficult to tread that balance between conflict avoidance and being too blunt. I’ve learnt to give positives as well as the negatives and learnt to give suggestions for improvement not just a list of mistakes but I still struggle with this area. My team are all alphas so if I give feedback poorly, I know about it because they’re not afraid to push back. This has been an invaluable lesson of getting feedback on feedback. If I’m not sure how I’m coming across, I send Cemal a draft and he usually edits the hell out of it before I send it on. There has been many drafts that didn’t make it off the editor’s table for good reason! (thanks Cemal for all the damage control!)

It does make me think that, again, this is not our forte as doctors and how time and time again we prefer to allow the six-month rotation to finish and move on rather than discussing why a problem is a problem. And don’t get me wrong, it’s sometimes hard to receive negative feedback myself and, annoyingly, as the person at the top, you have to listen (graciously too) and can’t be rude about it even if you want to be. Another advice I received is that giving and receiving feedback is less thorny if you try to contextualise it in terms of the benefits and risks to the group as a whole. Somehow, this shift in perspective allows it to seem less personal and I think everyone in the team appreciate the need to work together for the greater good of the JIC.

A good book is Non-violent communication: a language of life which goes through how to give non-confrontational language when giving feedback. I like the way that they address communication (both positive and negative) by stating the action, the feelings that it elicited and then the needs that were not met. Read the book – it’s good.

Finally, being Chair has taught me to work entirely without expecting positive feedback. It has made me acutely aware that we tend to give positive feedback down the ranks indiscriminately but not in many other directions. It’s made me more determined to give positive feedback to seniors and peers and not to take it for granted when I’m being treated well. I used to crave and hold onto the any positive comment that I might get from my team but now my contentment in myself has had to come from within and learning to benchmark against realistic expectations of myself like: seeing everyone have fun at the Away Day (our annual AGM); seeing our workshops dominate a conference; seeing JIC mentioned at the closing ceremony at the RCGP conference; seeing 12 applications for one advertised JIC vacancy; hearing a delegate at our symposium say that she had finally found her GP community; hearing an F2 say that she wants to apply to become a GP because of the JIC; winning the VdGM forum bid; getting an increase in funding for the team; and being told by random people that they love reading my blog. It’s so cheesy saying that happiness has to come from within but the ability of not being swayed by external positive and negative feedback has been a priceless but challenging lesson to learn. I am still occasionally wracked with doubt but overall I think happy with what I’ve achieved.

Being a people-pleaser

I am so certain that we are all guilty of this. We like to be seen as the team-player and we want to be seen as approachable and nice which leads us taking things personally when someone doesn’t like us. I remember asking Helen Stokes-Lampard about this the first time I met her (I can’t remember how this came up but I’m an over-sharer so it was probably all me) and her response was that some people will dislike you whatever you do just because of the role that you have taken on and there is nothing you can do to please them. She said don’t bother wasting your breath on these people. It’s the people who are on the fence that you should spend time talking to.

I’ve had a couple of occasions where people have made it clear that they dislike me. On one occasion, a delegate at a conference turned their back on me every time I walked near them and I know of some who have said malevolent things about me. I’ve received emails stating that “as the Chair of the JIC”, I am x, y or z and how dare I a, b or c. I know that, when I am socialising and say that I am affiliated with the RCGP, some GPs , especially if they are not aware of the JIC, assume that I am some sort of RCGP poster girl. I can see their faces reflect what’s running through their mind and I used to feel obliged to say something negative about the RCGP in order to fit in with everyone else just for the social event – a total Judas. I felt very torn about how I was being perceived and how I felt. I have no choice but to suck it all up and that’s what I found most difficult at the start. These altercations (as such) were deeply hurtful and I would, at the beginning, spend days to weeks mulling over what had happened to figure out what I had done to deserve this or what I could have done differently. However, now, I feel that a lot of what they are saying or doing has more to do with them and where they are at rather than who I am or what I am doing – which feels less wounding.

Converse to all the negativity, I would also have GPs who would seek me out and are so deferential to me that it is unnerving since, in my head, I am still the same old Sonia. I inevitably find an element of this with the newer members of the JIC but this usually settles after a couple of social events.

Part of this learning process has also included learning to be careful with my words – the talk-first-backtrack-later method has had to be phased out as people are actually listening to each word  I say now. I must not forget that I am now a representative of the JIC and the RCGP. I probably spend more time sitting in silence as my brain is desperately trying to filter out all the unnecessary comments before my thoughts reach my lips. And also, to this note, I’ve realised not to crush anyone’s dreams with my words. GPs early in their career come to me all the time with their ideas and projects and, for some people, they will always remain ideas and dreams that they can romanticise about to get them through the day. Me taking it super-seriously and getting over-practical with it doesn’t always help and, with the heavy duty rubber-stamp of my supposed authority, I have to be careful to be positive and respectful. The art has been to pick out the few that will materialise and to encourage and nurture until fruition which is immensely rewarding.

As mentioned, I have now learnt that being disliked comes as part of the job and am rather resigned to it. Interestingly, this has been a real transferable skill in the consultation room – I really don’t mind when a patient dislikes me and now it doesn’t bother me if a patient calls me names because I can’t meet their unrealistic expectations. On the other hand, I also find obsequiousness slightly weird and am now creeped out by patients who tell me that they really like me (I used to crave this when I was a trainee). Not being pushed and pulled emotionally by my patients brings steadiness to my day and the ability to provide care more objectively. I know that none of my patients can really like or dislike me because we only spend 10 minutes together and therefore what they are alluding to is my persona as a doctor. This has been revolutionary in my daily practice and my levels of resilience.

In the word of the famous Taylor Swift, “haters are going to hate”.

Being reflective

I have probably chewed off a million people’s ears with issues about the JIC. Whenever I felt that I wasn’t doing something well or a conversation hadn’t gone as I had planned, I had a huge source of friends – both medics and non-medics – who I could lean on to ask for advice.

I had some pretty valuable lessons from Sinan (ex-Chair of the JIC) about managing a team cohesively, from Claire Thomas (President of VdGM) on managing challenging behaviour,  from Lucy (my best friend from med school and paediatrician extraordinaire) about leadership and team dynamics, from Klara (I don’t actually know what she does but she’s pretty amazing) about project management, from Sophie and Maham (my lovely GP friends) on human relationships, interactions and self-reflections. The list is endless.

I think we are all forced to be reflective through our GP training but being in charge meant that I really had to explore some core issues about myself in order to evolve for the benefit of the team. I think true reflection is a hugely uncomfortable process. Having thought that I was this great team-player and leader with fantastic communication skills (unconscious incompetence), I realised that actually I wasn’t (conscious incompetence) and that was a bitter pill to swallow. However, I know that I have reflected on many occasions throughout the two years, moved on and am a better person for it (hopefully moving to conscious competence) and I know that this is a constant evolution to finally reach unconscious competence.

What have been the positives?

I bet you’re now thinking that this has been the worst two years of my professional life!! It’s definitely been the most reflective and I’ve had to deal with a few home truths but I feel like, as I’m entering my third year, that I am being spat out on the other side as a better person. It’s definitely also been enjoyable with a million amazing memories and sometimes I wonder if I take the joys for granted. I am privileged  that I rub shoulders with such dynamic people all the time. If you read my previous blogs, you may know that I feel really strongly that all GPs should surround themselves with like-minded people to feel part of a family or a community because we work so individually. For me, this is my international community and I feel like I am recharging every time we meet. For others, it could be Next Gen GP or doctors into lifestyle medicine and nutrition. It is totally up to you.

I also get to meet some pretty amazing people from all over the world and I have made some pretty close friends through this process. Being part of this tribe makes me feel like I am part of a movement and I am so proud to be a family doctor which makes me an optimistic GP in my daily practice (noted by the receptionists and secretary). My closest GP friends have such exciting lives or they have a real can-do attitude. Having such people in my social capital means that I feel like I can achieve anything.

I really think that medical school teaches you that there is only one way to live your life and it’s almost been a personal mission to break out of that. The JIC has taught me that we don’t need to wait for permission to do what we want to do and I think that it is this attitude that has led many alumni to go on to do amazing things. I feel like I’ve matured in these two years and I have a better understanding of my skills, my weaknesses, my interests and my potential. I’ve had so many doors open for me that I know what’s through most of them even if they are not for me. Being Chair has been more about self-discovery than it has been about leadership for me and I always say that, in an ideal world, I would make everyone spend at least a year doing this role for their own benefit. I’m starting to believe that you don’t have to be a born leader and anyone can do it because you can learn on the job if you have a supportive environment (the JIC) and willingness to reflect. And it certainly has made me a better leader, a better person and a better GP over the last two years.

Further to all the lessons on interpersonal relationships, I have learnt how to write business proposals and bids, to think strategically, to give talks, to write opinion pieces in journals, to write blog posts, to use iMovie, to use social media, to set up websites, to run workshops, to write posters and to figure out a budget. I’m sure there’s more skills that I have learnt but underlying all these comes the confidence to give it a go.

And the JIC are just such a fun lot. I will forever take away with me memories of deep and meaningful heart-to-hearts; putting the world to rights with Rakesh and Ula whilst ordering pizza at 3am with an impending workshop in six hours; trying to interpret Aliki’s drunken Whatsapp voice messages with David and Karishma on repeat the morning after the Dutch party (after finally figuring out it was in Spanish); being given too many drinks tokens at said Dutch party; dancing with wild abandon with everyone at several events; smirking away at really stuffy dinners with Stuart; Cemal’s salsa-dancing attracting all the ladies with the surrounding men looking crest-fallen; and running riot at the British Embassies with the team. I have certainly learnt from the best and I would have never had these experiences and personal development without these guys.

Why am I telling you all this?

This year, we are doing something unprecedented in that we will be recruiting for the Chair role a year early so that there is an overlap and a decent handover. The reason why I implemented this is because even with a year as Deputy Chair before becoming Chair, I felt that the transition was too grand and, by having a Chair Elect, we would allow a smoother transition for the JIC and for the RCGP.

In terms of email burden, I spend a couple of hours a week responding to emails and answering calls. This obviously goes up if I have to read reports and attend meetings which can also be done remotely. The four events that are compulsory are the Annual Away Day (all-day AGM), WONCA Europe, the symposium and the RCGP conference and I’m afraid, as Chair, you can’t wriggle out of these things although you can have more of a say on when they will be. I plan the agendas for the Away Day and I chair the day in conjunction with the Deputy; ensure that I have an overview over both conferences; ensure that all team communications are optimised; and respond to enquiries from the RCGP, from GPs early in their career and from third sector parties. This is done outside my clinical role on a voluntary basis but my conference tickets are paid for and there is a subsidy towards travel. I also get invited to give a lot of talks. This year, I have been invited by the GP trainee conference in London, by Imperial VTS, by a Programme Director in Wales for her VTS, by North and West Thames Faculty, by South East Wales Faculty, by one of the GPVTS’ in Oxford, by King’s Medical School GP Society, by the Japan Primary Care Association (JPCA), and by WONCA Asia Pacific. Transport is always covered but my time is often given for free.

I would suggest someone who is a GP who is within five years of qualifying rather than a trainee only because of flexibility but also because there is no down time to do exams or portfolio work which would have to take precedence for training. However, never say never – with a good Deputy Chair this could be fine!

My committee are GPs who have come together for their love of global health and international primary care and none of us have worked for the RCGP before this role. I feel that this is our strength since our loyalties lie with those who are like us but we are eternally grateful for the RCGP International for giving us the platform to push our agenda forward. My wish is for someone to take over the reins who is passionate about global health rather than someone who would just like a leadership role. There’s plenty of time to learn during handover and learning to lead is a lifelong process anyway.

If you want to know more, please email me at Chairjic@rcgp.org.uk. Adverts will be out in due course.