A&E fellow, and part time expedition doctor.

Nathan Hudson-Peacock is what most people might call ”Headboy material”.

At Cambridge University, while most of us seemed to hazily rotate between the library and the college bar in a sleep-deprived daze, he was invariably either in sports kit going to Lacrosse, in a choir gown off to chapel or off to his morning medical lectures.

Often high achievers like Nathan tend to follow a conventional path: social acceptability comes easily to them as it’s a hard thing to turn down. So it was a surprise to hear that following his 6 year medical degree he’d taken a different route. Eschewing the tempting, well-trodden path of specialising in one medical discipline, he had instead chosen to begin his career differently.

He currently has a part time role in A&E, in one of the few London hospitals receiving trauma victims with stab wounds, and he spends the rest of his time doing work as an events doctor, an expedition doctor, singing in two choirs and doing adventure photography.

He tells me that these side projects help him reduce burnout, improve his mental well-being and ultimately make him a much better doctor.

What made you question the traditional route?

“‘What do you want to specialise in?’ For me, that was like someone essentially asking ‘What do you want to do the for the rest of your life, until you retire?’ I’m 26. I have no idea what I want to do until then! But that’s just the dialogue that everyone has in medicine.

“A lot of people do this thing where they apply to several specialty training programmes to see what they get. That way, you are committing the next 6 years of your life to a full time training programme, and then the rest of your life to specialising in that one niche area. So to just apply and see which one you get? That didn’t sit well with me at all.”

How did you start to think about doing it differently?

“It all happened by accident a little bit... Basically, I really like skiing”.

“I couldn’t get enough annual leave to take a skiing holiday for the 2nd year in a row, so I tried to find a conference in a ski resort that I could use some study leave for. I found a course in Chamonix, and it happened to be on expedition medicine. Doing that conference made me realise there were so many other options.”

“The doctor talking on the first day was just the most inspiring person. She works part time as a GP, part time A&E, part time on the air ambulance. She works on global health projects in Kenya and she does expeditions. She’s been all over the world. She did Planet Earth, she did Blue Planet, she does all the Attenborough programmes as a medic. It blew my mind that this sort of opportunity existed within medicine”.

“At that point, I was like ‘forget specialising for now - I’m going to take a few years to explore what else is out there’”

You got back from the course on Sunday, and were meant to be interviewing for specialty training on Tuesday but cancelled it. How come?

“I realised I just wasn’t ready to do it. There were so many other things I wanted to do. I’m sure eventually I’ll specialise, but there are so many other things I want to do first”.

Was that scary?

“It was very scary. My whole life I had been on the treadmill. “You go straight from school, to university, to medical school, through your foundation training and suddenly you’re in your mid twenties and you’ve never had more than a couple of weeks to step off the treadmill and say ‘what am i doing with my life? Where is this going?’ And, understandably, a lot of people are scared to get off that treadmill.

“When I faced the upcoming unemployment, it was the very first time there would be... nothingness. I found it quite stressful initially, but once I thought about why I’m doing it, I knew it was the right decision. There was still that void. But then things fell into place.”

How did the event medicine get started?

“I started doing event medicine, starting with Tough Mudder and the European Championships, on the side. I was then offered a job to go up Mt Kilimanjaro as an expedition doctor. This led to further jobs as an expedition doctor, and I’ve now been to the Sahara Desert, Mt Toubkal, Everest Base Camp and the Indian Himalayas, and soon I’m off to K2 base camp in Pakistan, with Raja Ampat in Indonesia, early next year.”

Has doing other projects made you any better at your job?

“Doing all this has made me 10 times more passionate about being a doctor. When you’re working as an expedition medic, you take on more risk. You don’t have the safety net of the hospital environment, you don’t have the other nurses and doctors to help support your decisions, you don’t have access to investigations, you can’t just do a blood test or an X-ray. You have to rely on you, your clinical skills and your ability to risk stratify.

“You feel valued, and a lot of the time you’ll be the only doctor. It gives me a lot more confidence and independence when I’m working in A&E.

“The other thing I’ve noticed a big difference in is my shared decision making with patients. Previously in A&E I was doing a lot of discussing options with senior colleagues, but not enough of discussing options with the patients themselves. However, on expedition it’s a constant process, it’s always a dialogue between you and the patient. The whole time you’re sharing the decision making. As a result, I find myself doing that a lot more in A&E. I guess I’m more used to it - it seems weird not to involve patients now.

Doing expedition medicine gives you a different mindset, and you definitely bring that back to your day job in A&E.”

Do you think it helps get through any of the bad parts of being a doctor?

“Well, the other big thing for me is that if you spend your entire life working full time on one thing, in particular something like A&E, you can start to resent it; you start to get burn out and you start to get frustrated that your whole life is spent on that one thing.

“Whereas now if I’ve been away for a month I’m almost looking forward to going back… it doesn’t feel like my whole life is just A&E and I enjoy it more as a result.

“I feel enthusiastic, I’m a lot more energetic and happy. I am choosing to be here - I’m not here because I have to be.

“In medicine there’s been so much media coverage lately with the junior doctor contract, burnout, people leaving... This is largely because their life is tied to one job.”

“I have managed to find the ability to take a step back, and it means I am so happy. It’s something that a lot of other doctors should consider doing.”

What advice would you give other people interested in doing something new?

“My advice would be: just be brave, step off the treadmill and do something different. No-one is going to penalise you, and you’re just going to end up a better doctor as a result.”

“There may well be hurdles you need to jump through, whether that’s financial or otherwise. But there are ways of doing it. You can locum for a while to raise funds and you can explain to your programme director how it will improve your career. It might be that you’re on the verge of burning out, maybe taking a year out might energise you.”

“Doing the expedition medicine course, meeting other medics who’ve taken this alternative path, they all said it’s the best thing they’ve done. No one had any regrets.”