Should I Have Worked in Tech?

Shruti Chawla, Intercalating

No, this isn’t a cry for help. 

Recently, I was recommended “The Hard Thing About Hard Things” by Ben Horowitz – a big guy in tech (Wikipedia is your best friend here).

After reading an interesting anecdote on pg 58 in which a consultant let a 35-year-old with heart disease walk out of his clinic, proclaiming him a “dead man”, then reading Horowitz compare this to selling his platform, I had a slight revelation. 

Parallels can be drawn between being a CEO and being a medic. 

Let’s start with page 20 – a section titled “euphoria and terror”, really set the mood for the rest of the book. It gave me flashbacks to the first block of placement on Kidney and Liver Transplant. The confluence of these emotions covered those six weeks of my life, euphoric when I closed a laparotomy , yet terrified when my consultant asked me what the inguinal triangle was. Euphoric when I got to assist during a HOBS crash call, yet terrified when a man screamed at me during my first cannulation. 

On a more thoughtful note, Horowitz describes sacrificing his personal life on page 27. His lack of presence within his family life during crunch situations is a feeling a medic knows all too well. I think we all come into this career with our eyes wide open, yet missing birthdays, knowing that one of us will get the Christmas Day rota and having to cancel plans at very short notice is something that none of us will be doing with a smile on our face. I mean, even having a reading week during my intercalation felt like the biggest reward. I digress, there is no need for this unpleasant reminder. 

 A bit of a structural rant here….

Page 35 – “Needs always trump wants in mergers and acquisitions” – the same can be said for clinical commissioning. 

Clinical commissioning is the process of deciding what service provisions an area gets. It’s a multifaceted process in which certain things are considered: the needs of the population (e.g the chronic condition management, population characteristics and key areas of health promotion). This means depending on your area, you may not be eligible for certain types of treatment. Adopting a more altruistic mindset, the needs of the population outweigh the wants of the certain individuals. If we discuss any ethical theory here, we may find ourselves thinking about healthcare as a negative right; there is no obligation of service provision to an individual. The recent merger of NHS Health Education and NHS Digital into NHS England was a visionary (!) change, aimed to “reduce duplication” and use national data more effectively for processes such as commissioning. This structural reshuffle is nothing but a stark reminder that our holistic approach is prevalent at a micro-level, but is reduced to numbers from a governing perspective. 

Jumping to page 65 – Horowitz described a “fair” way to lay employees off. That’s a task I never want to be endowed with. Continuing with the tenuous links – there is a major comment to be made about fair treatment for employees within medicine. The word “fair” is loaded, and there’s a lot to unpack here. A major issue to highlight is the need for pay restoration for Junior Doctors. Since 2008, Jr Drs have had a 26% pay cut, yet the department of health and social care refuse to engage in this conversation, leading to the 72 hr walkout on March 13^th. The 77% turnout and 98% support for the walkout comes with the aim to reform review processes so that pay can be recommended independently and fairly to safeguard both the recruitment and retention of junior doctors. The GMC estimates 4% (approximately 5000) doctors permanently leave the NHS every year – be that for private organisations – where there’s the promise of free coffee or to a completely different country. Is it the lack of flexible working, staying on call until later stages of employment or the lack of mentoring that has caused this? Food for thought. 

To be transparent, I’ve only got halfway through the book, yet the excitement to write the chaotic thoughts that it brought out of me was too much not to submit and article this month. 

Perhaps there’s a part two in the works?

I think if anything, this highlights that every work sector deals with the same fundamental issues, however, it seems the barriers in a government owned organisation shackle us tighter than in other fields. It’s time to look elsewhere for the answers to our problems… widen the horizons from the medic mindset and explore different models of work, whether this be from the tech sector or the trading floor.