Dr Sarah Leeder discusses the highlights of her career, the challenges of find the right work-life balance, and how she's applied her training to her role on a busy hospital ward.
What made you decide to choose rehabilitation medicine?
I came to rehabilitation medicine (RM) in a rather round about away, I had worked as a general practitioner and as a registrar in an acute older persons unit, before taking on a specialty doctor post and subsequently specialist training in rehabilitation medicine.
I wanted a combination of the things I loved about general practice, in addition to experiencing the aspects of hospital medicine I enjoyed. I wanted to offer my patients continuity of care, I like getting to know patients and their families and this is one of great pleasures of rehabilitation medicine.
Understanding pathology in the context of the person also fascinates me, how their psychosocial background, culture and religion affect the impact of illness and recovery. In both general practice and rehabilitation medicine holistic care is central to successful treatment and I prefer applying pragmatic solutions and problem solving skills to organ-focused acute medicine. Most of all I enjoy the day-to-day team working in RM, I thrive in a social hospital environment.
While RM aptly fits the bill, I had to work in my other roles to really understand myself as doctor before being able to effectively decide what kind of doctor of I wanted to be and the field I wanted to work in.
I was often surprised by what could be achieved and how small changes in function could mean so much to patients and their families
What was your first experience in your specialty like? Did you hit it off immediately?
I completed my medical senior house officer (SHO) training in Bath and as part of the rotation I went to the Royal Hospital for Rheumatic Diseases for 4 months. Two months of the placement were spent on the second floor of this incredibly historic building working in the Brain Injury Unit. It was the first time I dipped my toe into the sea of rehabilitation medicine and I was delighted to find warm and welcoming waters.
I distinctly recall being enlightened by the multidisciplinary focus and the work being undertaken by the therapists, observing what could be achieved in young people who often had the some of the most serious injuries. What really struck me is that the patients and their families and loved ones had been on the most extraordinary and sometimes heart breaking journeys prior to their admission to the Unit.
There was often a history of an accident or other life-changing event resulting in multiple injuries and numerous subsequent interventions combined with a lengthy ITU admission and sometimes near death experiences. There was always a surrounding mist of prognostic uncertainty. The arrival in the unit signified the next stage of the journey, the one of extensive assessment and the long, slow and sometimes difficult process of rehabilitation, with the focus on optimising the patient’s function and minimising the impact of disability. Decisions and therapeutic strategies were undertaken as a team and when possible families and patients were included.
This was the first time in my hospital career that I had experienced such a focus on the intricacies of patient’s social background and pre-morbid function, not only did this guide the assessments and therapy but it was essential for the complex discharge planning that so many of the patients required. The psychological and emotional impact of injuries were not overlooked, instead there were acknowledged and explored, families were counselled and supported.
I was often surprised by what could be achieved and how small changes in function could mean so much to patients and their families. I remember telling my colleagues how much I was enjoying the placement only to be met with baffled or quizzical looks, I think my acute friends found the pace too slow or the levels of disability overwhelmingly removed from acute hospital life
Did you always want to train in rehabilitation medicine?
In the maze of medical careers, I took several turns to find the right exit. I have been lucky and enjoyed fabulous teaching and training, experiencing a wide number of specialties in a pilot foundation programme and a traditional medical rotation.
However, as my medical training was drawing to a close I still had no idea which direction to take. The only striking thing was the warning bells ringing in my mind about acute medical specialties; it was like they had hazards stickers all over them. In hindsight, I guess the answer about my career choice should have been obvious to me after my experience in the rehabilitation unit in Bath, but after completing the MRCP I elected to enter general practice training rather than take up my run through post in medicine.