Alumni profile - Dr Simon Fleming
I was a medical student during the 7/7 bombings and I was at the Royal London when the major incident was declared and all of the patients started coming in. That day confirmed that I wanted to be an orthopaedic surgeon; I saw the way the ‘pods that day were cool, calm and collected whilst fixing people and making decisions... I also lead the internationally renowned anti-bullying, undermining and harassment campaign known as #HammerItOut.
Why did you choose to study both Medicine and MSc Surgical Skills and Sciences at Barts and The London? As a prospective medical student I did the same as everybody else: I went on all the forums, I attended open days and I spoke to people that I knew had trained in medicine around the country. For me, Barts and The London was the first place where I felt at home. I could see myself studying there and the more I spoke to the students about the course, they also mentioned the two sited attitude of Barts – the really urban, trauma based, experience of living and studying in Whitechapel versus the super specialist, edgy stuff going on at Barts. I loved this balance, as well as the equilibrium between clinical and academic (lectures) on the medical course. This really appealed to me seeing as I learn through discussion, talking and existing within a community. Barts and The London truly is a medical school where the students know the faculty and the faculty know the students. This mattered to me then and, to be fair, matters to me now.
I’ve worked all over the world but the East End of London has always felt like home to me, which is why I chose to study my masters at Barts too. I finished my Core Surgical Training and I wanted to be a teaching fellow; at the time teaching fellows were very rare but Barts, in a really forward thinking and progressive way, had a clinical teaching job going for anatomy demonstrating and clinical skills tutoring. I took this role as I wanted to give back to the medical school and be part of it from the other side of the curtain. I had an afternoon off a week and I’d heard about the Surgical Skills and Sciences masters which allowed you to do a dissertation on anything you wanted (within reason); I was a medical student during the 7/7 bombings and I was at the Royal London when the major incident was declared and all of the patients started coming in. That day confirmed that I wanted to be an orthopaedic surgeon; I saw the way the ‘pods that day were cool, calm and collected whilst fixing people and making decisions. I was able to do my dissertation around the 7/7 bombings – something that I cared about and was interested in; I had a supervisor who had a load of data on it and I permission to use it. It’s a very… Barts’ thing to support and empower people in what they want to do and how they want to do it, and it is one of the reasons why you often find people who graduated from the medical school in positions of leadership or advocacy. For me the Masters itself was exemplar of that, and my experience now influences how I mentor and sponsor my students.
What sparked your desire to study medicine in the first place? The answer everyone gives to this question is that they like science and they like helping people – which is mostly true for me, but it’s more nuanced! My Dad was a doctor, but both my Mum and Dad actively tried to put me off a career in medicine, as did my school, stating that my ‘skills lay elsewhere’. I now recognise that the reason why I got into medicine was because I like identifying problems and fixing things, alone or in a team. As I’ve progressed through my career this has become more apparent.
What is your specialism and what brought you to this? I’m in the final years of training to be an orthopaedic surgeon. My ultimate goal is to be a hand surgeon; I’ve done courses, trips and I’ve been planning some fellowships too. There is a real drive in medicine to always better yourself and to make sure that you have the most up to date knowledge. Because medicine is such a broad field it means that there is always something new to learn. Ironically, most of the things that you learn at medical school are out of date by the time you graduate. This is due to the pace at which medicine advances; I love this aspect of medicine but it can stress other people out.
You wear many hats, what are these and what do you enjoy the most? I’ve got loads of roles, as I’m that guy who always puts his hand up! I have been quite involved with the British Orthopaedic Trainee Association which is the organisation that represents current and aspirational orthopaedic trainees in the UK. During my 18 months as President of this organisation, we saw the organisation grow and evolve as well as the birth of the now internationally renowned anti-bullying, undermining and harassment campaign known as the #HammerItOut campaign. My work with this campaign has acted as a stepping stone onto other projects too. I do a lot of work now around culture change in healthcare; I have just returned from the Middle East where I talked about culture change in healthcare – I even won the Advocacy Award, which was humbling, if a total shock! I also do talks around being a leader, when you are a medical student or trainee, as well as a lot of work around equity, gender and the wider culture of undermining and harassment. My other main interest is education. I am currently doing a PhD at Barts and the London on medical education and I work in the UK and with the Royal College in Canada. My work ultimately boils down to me trying to make things better and the way we train and the way we treat trainees, better. If I had to pick a favourite role, it would have to be the work I do with #HammerItOut; I love meeting people from all over the world and talking to them about the world and the culture they live in. I was at Moorfields recently talking to the trainees and managers around bullying, undermining and harassment. The chief exec was there and I got to hear about and be part of so many great discussions during the session. This is the stuff that gets me out of bed in the morning.
Congratulations on being awarded a leadership award by the Royal College of Physicians and Surgeons of Canada. I understand that you received this award for your work on the #HammerItOut campaign. What is this initiative for anyone who isn’t familiar with it and what motivated you to be so actively involved with the campaign? I’ve always hated bullies and, when I was part of BOTA, we did a piece of work that was led by the then President, called the BOTA census, where we gathered data around orthopaedic trainees – what they wanted and what they felt was going on. A few of the things I pushed for and later led on, were questions around bullying, undermining and harassment, because there was data in the GMC survey, the NHS staff survey and from all over the world that it was happening – but not ortho specific. However, in the UK we didn’t seem to be talking about it; it seemed to be very much an accepted part of what it was to be a surgeon, a doctor and to work in the NHS. Through this census we found the really very upsetting data that showed that these behaviours were prevalent both in terms of people experiencing them and in terms of people witnessing and perceiving them, which in turn has implications for recruitment and retention, role modelling and how you build a culture and set a tone, as well as patient care. These behaviours lead to burnout, effect job satisfaction and cognition as you’re basically doing your job less well, which means you’re making more mistakes and harming more people. Last year, bullying cost the NHS 2.3 billion pounds. All of this testifies as to why change needs to happen.
I took #HammerItOut on as a little passion project, but since its birth it has resonated globally to the point that I am still doing it 6 years later. There is something about healthcare which means we think we’re special in a way that excuses certain attitudes or behaviours, but it has protected us from changing certain aspects of our culture which are no good for us or for our patients. I am very aware that I have, let’s not kid ourselves, white male privilege as a Caucasian, straight, rugby playing private school educated man. But, with great power comes great responsibility and the responsibility and privilege I have means that I can help start a move towards change, as an advocate and an ally. My message isn’t particularly complicated; it is to be kind, thoughtful, civil, to think before you speak, to try not to use your power in a way that is toxic and to make people feel valued. These things improve patient care, save the NHS money and make everyone happier at work.
When I spoke earlier about fixing things, at first I wanted to fix sick people, then I wanted to fix people who had broken bones and now I talk (in a broad sense) about wanting to fix the NHS, because this culture is pervasive and we can do better.
How does it feel to be made the first male honorary member of the Medical Women’s Federation? This came as a huge surprise. The Federation has been around for over 100 years, they’re an absolutely amazing organisation and their leadership really wanted to make the MWF a more inclusive and equitable organisation. I think, now, you can’t bring around change unless you have allies, which, I think, harks back to the privilege and power I have in society as a whole, and is, in and of itself something that needs addressing! They decided this year for the first time in their 102 year history to have honorary male members; they opened it up to nominations and this year they had three of us: myself, Tim Mitchel and Simon Wessely. It was extremely humbling and a massive honour to basically have the women of the NHS say thank you because, a) you don’t do it for thanks or recognition and b) because I’ve been doing all my other projects for years (equity & #HammerItOut) and this was one of the first big “thank you’s” I’ve received. So both of the awards you mentioned happened in quite quick succession and it’s the first time in 6 years that large organisations have publicly said: we see all the good that you’re doing. It was really touching, and I’m still sort of reeling.
What do you think you will bring to the federation as a man? As an honorary male for three years, I honestly think I will continue the work that I am doing now and be an advocate for the things people can’t/won’t say/do, promote equality and equity and be an ally working alongside the federation to support them through the networks I have built over the years. I want to help however I can. Sometimes it just comes down to role modelling; I won’t be part of a manel – an all-male panel – for example. I will send communications to organisations where it is clear that their committee or their organisation is lacking diversity. I have to recognise that although it is not about me at all, with society being the way that it is, I do have a small part to play in supporting people, speaking out about stuff that I think is wrong and being a champion for people in whatever ways I can. I was recently the only male author on a paper, led by an inspirational group of women, in the Medical Journal of Australia around whether there was gender equity in healthcare and I felt that my place there was both to show that there are men as part of the process and also that you can be male and want to see true equity and true equality too. These can be hard concepts for men to get their head around; I’ve never been mistaken for a nurse, so I don’t know what that feels like for female doctors. I’ve also never worried that I won’t get paid for doing the same job as my colleagues. It was only when things like the gender pay gap were brought to my attention, years ago now, that I realised how wrong and how prevalent it was. Once you know about these things, you can’t turn a blind eye. To start, little changes, such as buying a junior doctor a coffee, wearing the NHS Rainbow badge, or supporting work toward pay equity can make a world of difference to our culture.
I understand that you deliver inspirational and motivational public talks both nationally and internationally, what is it about public speaking that appeals to you so much? What do you try to achieve when you talk to an audience? I’m a weirdo in that I love public speaking; when I was at Barts, I was part of the Drama society, I loved performing and being on stage. I have always enjoyed using humour to diffuse difficult discussions. I think this approach makes my talks less preachy – like a very one sided conversation in a pub instead, or even a stand-up routine instead! When I leave, I want to have made a connection. From a wider, selfish, take home, I just want to change people’s minds or if I can’t change their minds, to at least get them thinking about or talking about, what I have said. I do it because I meet people now, who say ‘I heard you speak a couple of years ago and I’ve changed the way I… I now introduce myself to patients in this way… I behave around medical students in this way’ – that’s a win for me.
Why did you choose to study at Queen Mary (Barts and the London) and what was so special about your time at Queen Mary? Barts was the first place where I felt like I could be myself. Did I make mistakes? Yes. I look back at medical student me and am aware some of my behaviours were just…not ok and reflecting on those mistakes and that culture is a big part of my journey that brings me to where I am today. However, I felt like I could explore the things I was passionate about and the things that I was good at. At Barts, I could play rugby, whereas at school I was told I was too fat and didn’t fit in with the “sporty” clique. I was able to write, direct, perform and sing as well as multiple other roles within the Students Association; that’s why I still have a lot of friends that I made at Barts and why I still have a lot of links with the medical school. There was something very special about it in terms of that feeling of community and family and when I meet more senior alumni, they talk about Barts and the London in the same way. During the Rites of Passage ceremony, where any colours you have from your time at university are read out, I remember hearing this ear shattering applause when it was my turn. This was a very powerful moment for me, having my parents see who I had grown into, with my new adopted medic family.
Is there any advice you would give to current students or recent graduates considering their career options? Find mentors and be a mentor or sponsor. When I was a younger doctor, mentoring was explained to me like dating. Both people need to go into it knowing what they want to get out of it, sometimes you want a short fling, like being supported in your first year as a doctor, sometimes you want something even shorter like support writing your first paper. You might even want something more long term – I have those as a mentee/mentor – someone you can speak to, pass things by, sense check with and be vulnerable with, obviously so long as it’s appropriate! Social media has made it so that your mentor does not have to work in your hospital, your city or even your country, for them to be a powerful influence on you and how you work and the life that you live. It’s okay to ask for help, it’s okay to want and need help. If you pick the right mentors, they will role model to you in a way that will subtly shape the person that you grow into. But also if you actively mentor people you need to recognise that you are shaping the future of the health service. Being a mentor is a real honour. The fact that we can all be a very small part of a very big change is a very powerful message in healthcare.
Do you have any role models that you look up to, both inside and outside of your field? I have loads of role models, and they are a bit like mentors, in the sense that I have different role models for different things. When I look at medical politics, I look at some of the medical leaders who I think have instigated real change. There are also loads of doctors and physicians that I admire, who I have worked with and worked for, who have shown me what it is to be a good person, as well as a good trainer and a good doctor; half of them don’t know that I think of them in that way and I kind of don’t want them to know either, I wouldn’t want to embarrass them. The world is full of people who inspire me every day to keep doing what I am doing.