Episode 5: International Women's Day

Oli Lewington                   

This week marks International Women's Day 2024, which focuses on the theme of inclusion. It's clear that there is still a lot of work to be done before we see women gain parity with men, both in health outcomes and in terms of working conditions and pay. Just last week, Global Advances in Integrative Medicine and Health published a study on how women working in health care endure significantly more stress and burnout compared to their male coworkers, primarily due to gender inequality and a lack of workplace autonomy. Later in this episode, I speak to doctor Dr Sonia Babu-Narayan about the health inequalities women face and the barriers that exist in cardiology specifically. But first, we wanted to take the male voice out of this episode. So, I took a step back from the interviewer role to bring you an open and honest conversation between 2 incredible women working at the Royal Brompton. They talk about the issues and challenges they've faced and the successes they've enjoyed throughout their careers. 

JINGLE 

Oli Lewington 

We start this episode with the conversation between doctors Naqvi and Ridge. Dr Nitha Naqvi is a paediatric consultant in cardiology, and the director of the Paediatric Cardiac Network at the Royal Brompton. Her story has been featured in the NHS Migrant Museum, which led to her winning the Asian Women of Achievement Chairman's Award in 2019, and subsequently being named as an inspiring leader by several national media outlets. She even shared a spot with the queen on the famous Piccadilly Circus billboard. Dr Carole Ridge is a consultant radiologist at the Brompton, an honorary senior clinical research fellow at Imperial College London. She leads the lung tumour ablation service, which won the health care outcomes award at the LangBuisson 2022. And in early 2024, she received an individual award for her role in interventional radiology services at the National Clinical Impact Awards.  

Her extensive research has been cited over 1700 times and includes contributing to 105 publications. Dr Naqvi led the conversation and started by reflecting on both Carole's and her own journey into medicine. 

Dr Nitha Naqvi                 

Hello, everyone. My name's Nitha Naqvi. I'm really lucky because I absolutely love my job, and I've got so many fantastic colleagues that I work with who were all inspiring and I'm here with a fabulous woman, Carole Ridge, who's one of our brilliant Radiology Consultants. And so, we're going to start off talking about how we got to where we are. So, Carole, tell me, when did you decide to become a doctor?

Dr Carole Ridge                                            

Well, it was pretty easy one for me. I was the daughter of a psychiatrist, and she was the daughter of a general practitioner who was the, again, the son of a doctor. But their family had come from farming. And, my great grandfather had decided that it was really important that education was going to be their way out of, a relatively basic, farming background. So he decided that all of his family was going to become doctors, and they all went off to university. There were 3 girls and 3 boys and they all did pre-med. 

Dr Nitha Naqvi                                              

And that's so inspirational that he supported the girls as well as the boys. And had equal ambition for them. 

Dr Carole Ridge                              

No. There was no question about it. Now not everyone ended up becoming a doctor, but they all did premed. And, ultimately, my mum was the only girl who decides to go into medicine. So she became a psychiatrist. She, at the same time, had a family quite early, and I do believe I was present for one of her first job interviews, in her belly. And unfortunately, and this is topical, I suppose, she was told at the time that in the interview that she was not going to be successful in the job because they could see she was pregnant. 

And she worked the whole way through my childhood and was a fantastic psychiatrist. So she inspired me to go into medicine, and there was never, I think, in my mind, any question about what I would go on and do. I think it was a little unusual that I went on to become a radiologist. That was not, in my mother's era, considered to be a very glamorous job. It is now. Technology moved on so much, that, it was a really exciting time for me to join radiology when I became a registrar in 2006. 

Dr Nitha Naqvi                 

I guess initially, though, you didn't know you wanted to be a radiologist. You just wanted to be a doctor. Yeah? 

Dr Carole Ridge                                                           

So funny story. I was a medical student, and as Irish people tend to do, I was traveling the world, during my university holidays, and I met an interventional radiologist in America. And he said, come and work in my hospital for a month. And interventional radiology, at that time, it was probably 2000 or thereabouts, was an emerging specialty. And I spent a month with him. His name was Jerry O'Sullivan, and I was in a hospital called Rush Presbyterian in Chicago. And I saw things that I never even dreamed were possible, and he let me partake in procedures even though I was just a medical student, and I was hooked from that point. 

Dr Nitha Naqvi                                              

That doctor, Jerry O'Sullivan, he probably changed the course of your life. Do you think you've had lots of other men in your career who've helped you like that? 

Dr Carole Ridge                                            

Absolutely, actually. Because not so many women had senior positions in the roles that I pursued. I relied on the people that I came across, whether they be male or female, to support me. And just by virtue of the fact that more men were in senior positions, yeah, men certainly have supported me along the way. In fact, when I then went on to become an intervention radiology fellow and I was working in a wonderful hospital called Memorial Sloan Kettering in New York. The fellowship, director who was called Ray Thornton, was extremely supportive of me. And I found myself at that time, expecting twins and in the middle of an interventional radiology fellowship where I was done doing a 1 in 3 call.                                                  

So he was really helpful, made sure that I did everything I needed to be doing to be learning, but at the same time stayed safe and that I felt comfortable that I was, you know, definitely looking after my pregnancy as well as looking after my career and my learning. 

Dr Nitha Naqvi                                              

That's really fantastic. And that's so important that we do acknowledge that although as women we often have challenges, men have different challenges and behind all of us, I'm sure there's supportive women, but there's also been supportive men who've helped us to get where we are. So my story is, similarly to you, I come from a family of doctors. My mum and dad are both doctors and they came initially from Pakistan, and they worked as junior doctors when it really was tough. And they were doing a 100 hour week and working 1 in 2. So particularly difficult would be Friday. You'd start 8 o'clock in the morning, work Friday, Friday night, Saturday, Saturday night, Sunday, Sunday night, and then you'd finish at Monday at 5 o'clock. 

So you'd think that it must have been quite tough with me growing up with parents working those kind of hours, but, actually, I had the most fantastic childhood. We always lived in the hospital and I lived in hospitals. I lived in so many different hospitals, I think 9 different hospitals, until I was 9 years old, and I thought that was normal. I thought everybody lived in the hospital. And it was really great because there was lots of other families there who had children. So I felt like I was at a Butlins camp all the time. And, basically every day I'd be eating in the hospital canteen. 

So I love hospital food. I think that's the best food in the world. And I've always felt completely at home in the hospital. So I think it was inevitable in that way that I was going to become a doctor. And my parents love their jobs. My dad's a cardiologist. 

He's got an OBE. My mum's an obstetrician and gynaecologist. So I was always in the medical environment and most people I met were medical. And my dad, when I was about 6 years old, he was working in London at St Thomas's Hospital, and he took me there when I was 6 years old and he showed me this big St Thomas's Hospital, he said, oh, this is the brilliant hospital and I want you to go and work there. So then when I went to university I did actually go to medical school there, and then when I was a junior doctor I met my husband in the lift there. He's also a doctor. So I've very much been connected with hospitals. 

My life has been with hospitals, and now I'm really happy that my daughter is at medical school in Aberdeen. So between us, we've got a 150 years of service to the NHS. And so that's how I became a doctor, but then my speciality is obviously paediatric cardiology, and I look after children with heart problems from the day they're born till when they're about 16, 17. And the reason I became a paediatric cardiologist, I suspect, is because I was probably brainwashed by my dad because he loves being a cardiologist and he always said the heart is the best thing. And then one day my childminder rang my dad and she was crying and she told him that I'd died and I was about 1. And obviously I hadn't died, I'm here, but I'd had a febrile convulsion. So I'd had one of those little fits that babies sometimes get when they're hot. 

And so he ran from the hospital and got me and took me to the hospital and then by that point I was screaming and my mum was there because obviously they're all working in the same hospital. And I was crying and I must have been very hot and a paediatrician came, a paediatric consultant, and then just took me from my parents and picked me up and gave me a hug and I stopped crying. And then I think my dad had a light bulb moment. Oh, these paediatricians are amazing. And then that's how then he started telling me, I think you should become a paediatric cardiologist. And I'm lucky that he chose that because it is a fantastic speciality. I think I'm got a real luxury in that I go to work with fantastic colleagues at the Royal Brompton Hospital. 

Every single day is really interesting. And being a paediatric cardiologist, I get to see children from when they're born, and then I look after them and see them regularly. So I feel I've got several 1,000 children. 

Dr Carole Ridge                              

So you went into medical school, very much inspired about becoming a doctor and feeling that you belonged in medicine. Was there any point along that course, particularly when we all as women try to achieve both personal and professional goals. Was there any point along that course where you found that there were challenges? 

Dr Nitha Naqvi 

Certainly. I had two times in my career where things were quite tough. The first was when I was a registrar, really loving my job. My son unfortunately became quite unwell and he was unwell for a prolonged period. And often when my bleep would go off, instead of it being a hospital emergency, it would be my own emergency that my child was in another A&E. And that that was really difficult. It was difficult to carry on with work and also be looking after him as well as I could.

And that would be challenging for anybody if your child is sick. I think the good thing about it though was that I went to many hospitals with him and I learned what it's like being a parent and having your child in hospital. And from that I think that's made me a better doctor. I'm a paediatrician, and I understand how difficult it can be having a sick child. The other thing I learned from that is how to be with colleagues when they're having their own difficult situation. Because some of my colleagues were very supportive and some of my colleagues who were the opposite. I've had times when my son was really sick in hospital and I was called to work and then I was told well, your child's in hospital anyway, so what are you going to be able to do about it? Nothing. The nurses are looking after your child, so why don't you just come to work? 

And actually, on some occasions I did, if he wasn't too sick, but he was very small. He was under 2, so mainly I tried to stay with him, but it was tricky. So that was the first challenge I had, but fortunately he's completely fine now and he's a man, and is doing very well. My second time I found difficult was with my next child, When I was pregnant with my daughter, I was just moving jobs as we do. I was on a rotation. I had a 5 year job, and every few years, I moved to another hospital. And, I was at one of the hospital's induction day, and I attended the whole day, and I was very excited to be there. 

And then at the end of the day, some people from HR came and said we have to escort you off the premises. We're basically sacking you. And I realised straight away it was because they'd noticed that I was pregnant and clearly they realised that maternity pay would have to be paid. And at that stage, in my specialty, there was very few women, if any at all, and maternity leave and that type of thing was very new. And it was clear that initially it was members of staff who were senior, who were men, who didn't want to pay from their budget, my maternity leave. And but the thing that hurt me the most actually was that the very senior person in the hospital who wrote me a lot of very hurtful, quite aggressive letters was a lady. And unfortunately, we do sometimes come across women who don't support other women. 

And probably you've had that situation as well. But that just made me stronger to think, oh, I must always support other women. So I ended up with no job for a few months and obviously no pay. And it was a bit tricky because I was buying a house and I lost that house because I didn't have any payslips. But while I was sitting at home, I thought, well, I'm going to what am I going to do? I've got all this free time. And I knew that I'd always wanted to help doctors who came from overseas because I remembered what a difficult time my mum and dad had had and all their colleagues. 

Although I had a fun childhood, I think it was very tough for all the doctors working a 100 hours, especially from overseas. So I decided to set up a training course for doctors from overseas And doctors who were coming particularly from India and Pakistan and Bangladesh and Africa had to do an exam called the PLAB exam, run by the General Medical Council. So I got a bank loan and I bought lots of mannequins which were quite new then. Now of course we train on dolls all the time but I bought them from China and then I set up a course in a local scout hall. And sadly nobody came, but at least I'd done it. And in the same time I was going through the legal channels to get my job, which obviously I eventually got back. And then eventually more and more people came to my course and that then eventually became a big thing and I got the BMA to sponsor it. 

And in the end, I taught more than 3,000 doctors over many many years. And it was a wonderful experience. I got to meet so many interesting men and women for all over the world and I had a virtually a 100% pass rate because if they were struggling, I would just stay up all night teaching them. And now, eventually, most of them became GPs. So that's 3,000 doctors. So overall, I think that they probably look after about 5% of the UK population. So I had a big impact with that. 

And I really felt that then I was trying to give something back. So even though I had the very difficult thing of losing my job, I had resilience and found something else to do. And that's what I always say to people. If you're struggling, just keep going, and something else will turn up.

Dr Carole Ridge                              

That's amazing. That's an incredible story. And it's lovely that you're able to turn something so difficult into a success story as well. It's funny. There's a V&A exhibition of moment, with Gabrielle Chanel, and there's a quote she's asked when she's at the age of 70. And after World War 2, she had ceased a lot of her activity but she decided to go back into business at the age of 70 and she was asked why did you do that and she said because Christian Dior said at a dinner party that no woman could ever be a great couturier. So even at 70, she decided I'm going to prove him wrong. 

And she went on to have some of her most successful decades of work. So, yeah, that is a fantastic similar story. 

Dr Nitha Naqvi                               

Well, one of the interesting things that happened to me while I was running that business, I set up a website, and that was when websites were very new. Even the hospitals didn't have websites at that time. But I was doing it to try and get people to come because otherwise how would these doctors from all over the world find me? And there was only one other competitor at that time. And on my website all I'd written was my name, Dr Naqvi, and I didn't have any photos of myself. So interestingly, the competitor just assumed I was a man. And then what he did was he wrote loads of obscene things about me on the internet assuming I was a man and I realised that was because as a man he didn't dream that a woman would be going out and setting up their own course and trying to teach people from all over the world and having their own website. 

But I just kept going. I kept going and eventually people realised I was a lady and people kept coming to my course. 

Dr Carole Ridge 

That's fantastic news. 

Dr Nitha Naqvi

So, I’ve talked a bit about challenges that I've had. Can you tell me about the challenges you've had? Because I know all women have challenges getting to the top. 

Dr Carole Ridge                                                           

Well certainly I feel as though when I was coming through, going between registrar training and then trying to move on into consultancy, you're left with the question of, well, I also want to have a family, and where does that fit in? And how am I going to do both, while, always seeing trying to be on top, of what I'm doing and doing it in a professional way despite having all of these other things, all of these things other things to juggle. And I can remember back to when I, had my 2 children. I have twins, and this is 10 years ago, I really felt as though I was going to prove that I could do it all, and felt like there was a pressure, that I would have to achieve, all the time.

Dr Nitha Naqvi                 

Do you think that was a pressure you put on yourself, or do you think it was actually extra pressure because you were a woman trying to succeed in medicine? 

Dr Carole Ridge 

I thought I had something to prove. I thought that it was important to show that I can still move on to consultancy at the same rate as a man can. I can still achieve the same things that a man can, despite also having to take maternity leave, look after children. To the extent that and actually, I must say I had hugely supportive colleagues during my pregnancy. But when I wanted to figure out whether having a pregnancy as an interventional radiologist was a safe thing to do, whether I should continue my work, exposing myself to ionizing radiation every day. I found that there was absolutely no information available, in the published literature. 

Dr Nitha Naqvi 

And was that because there were so few women who'd actually reached that high level in radiology and had been pregnant? 

Dr Carole Ridge                              

It was probably a subspecialty within radiology that was less populated with women. Yeah. It was probably more male particularly in Ireland where I trained and in England at that time than it was female. I was trying to establish whether it was safe for me to continue to work and I had absolutely no data. 

Dr Nitha Naqvi 

That must have been quite frightening actually? 

Dr Carole Ridge 

It is and I think a lot of people when they when they do get pregnant and they're working in interventional radiology, they probably do take a step back because they just don't know what the future holds. I, however, went into it headlong, and wore rather than just wearing lead while pregnant with twins, I wore 2 sets of lead. 

Dr Nitha Naqvi 

How heavy is that?!

Dr Carole Ridge 

Well, twice as heavy as regular lead. And I had I had a little Geiger counter underneath my lead to make sure that I wasn't getting any dose. So, I was trying to do everything I could, to work safely to protect my children and myself, but also achieve all of the milestones that I felt I should. So I got to, you know, 6 months into my pregnancy. Everything had been going fine, and I started to develop some symptoms that were a little bit concerning. And I can remember waking up at 3 o'clock in the morning thinking to myself, things aren't going quite right here. I probably should go to hospital, but I have a lung biopsy at 9 AM. So, I'll just put on my work clothes, and I popped on a dress, high heels... 

Dr Nitha Naqvi 

You wore high heels to work as well? Wow. 

Dr Carole Ridge 

...Brought a little suitcase along with me, stepped out onto the road, hailed a taxi, and said, can you bring me to the maternity hospital? I just need to get checked out before I go to work. And I arrived into the maternity hospital at 4 AM in the morning and the doctor said you're not going to be doing that lung biopsy today. We think that you're going to have your babies sooner than anticipated. And she was right. So I didn't get to do the lung biopsy. 1 of my male colleagues stepped in and did the biopsy instead and my children were delivered at 28 weeks. 

They were looked after extremely well in the Rotunda Hospital in Dublin. I'm extremely lucky but it was a difficult time definitely. I managed to write I think 2 book chapters while I was in the ICU. 

Dr Nitha Naqvi 

There we go. Multitasking all the time! 

Dr Carole Ridge 

You know what? I'm not sure it was the wisest thing to do but it kept me busy and a lot of people who do have infants who are born prematurely they do find those early weeks strange because you're trying to figure out well what do I do? Premature infants don't do a whole lot. And you can't really contribute a whole lot other than maybe expressing milk, but they're not well enough to feed themselves. So I suppose that was my way of keeping myself busy. But looking back on it, maybe I should have gone a bit easy on myself. 

Dr Nitha Naqvi 

That's very impressive. One of the things when I speak to colleagues who are now at my stage of their career, who are women and who have children who are now older and maybe have left home and gone to university, One of the things we reflect on, which we wish had been different, is that in order for us to progress with our careers, we had to not just do the work and the hours that you put in, but it's all the extra things we have to do to get to that stage of being a consultant or a senior GP or wherever you are in your career involve lots and lots of extra time out of the normal hours that you're working. So, for example, writing research papers, writing talks, studying, and all of that inevitably takes time and something has to give. And certainly in my case and many of my peers, the thing that had to give was time with your children that you can never get back. So moving forward, one of the things that, as women, I think we are aware of and we would like to do for the women coming through in their careers and also the men, because now everything's much more different in sharing childcare, is to see how we can change things so that people still can pursue their careers and still get all the ambitions that they want complete and still be fabulous doctors, but still have more time with their children. And it may be that all the things we have to achieve can be done at slightly different times. Also fortunately now we have more hybrid working, which I think could be done a lot more. 

I still think that there's many things that doctors come to work for that they could actually maybe do at home so that they could then maybe be able to pick up their kids from school. That was a big thing for me. I always wanted to pick up my kids from school, and I used to try and do it once a term. I remember just as a kid myself always wanting my mum to pick me from school so it was a similar thing carrying on. But I think, especially as women, we should try and think of ways always to try and help the younger women who are coming through. 

Dr Carole Ridge 

Yeah. Yeah. No. I definitely understand that sense of wanting to be everything to everyone, and to try and achieve everything all at the same time. I now, try to have the mantra of doing one thing at a time. So over maybe a 3 month period, I decide what are the things I really want to focus on right now. And sometimes if things are not a huge priority, they do have to take a back seat at that time. 

I say this as though I'm a perfectionist and I I can manage to juggle everything in a perfect way but I think the reality is that none of us are doing this absolutely perfectly. What my mom often says is it's not perfect, but it's good enough. And I think she's absolutely right. She did a very good job of raising 4 children, and was able to accept where things are going to be good enough. We need to be treating our colleagues in the same way as well. 

Dr Nitha Naqvi 

She was obviously an amazing role model. So, do you have other role models? 

Dr Carole Ridge 

Absolutely. My my mother certainly is a very relaxed individual, and the perfect counterpoint to that is my father, who is a very frenetic man. He is the biggest proponent of women, having careers that I've ever come across. And he has always wanted me to achieve and to be happy at the same time. So he's been a huge role model for me. He did not work in medicine, and he worked in the food industry in Ireland and has built several businesses, over his career. But he never made me feel like I was going to achieve any less, than any of my male counterparts, and I thank him for that. 

Dr Nitha Naqvi 

That's very important, isn't it? I have the same with my dad. He always has said whatever you want to do, you you're definitely gonna be able to do it. And it's never been ever an issue that I'm a girl and that anything would be impossible. 

Dr Carole Ridge 

I think that's the key, isn't it? That you give both males and females equal ambition and equal expectations of their future. 

Dr Nitha Naqvi 

So inevitably, our jobs are very stressful in terms of hours, in terms of just actually what we do because people's lives are at stake. So how do you manage stress in your life when you've also got the demands of your twins as well? 

Dr Carole Ridge                                            

Well, I'm not very good at relaxing, so I've always found that exercise, has been a great release for me. So in the past, I've run marathons. At the moment, I'm weight training. And I would not uncommonly, at the end of a day's work, go and do 30, 40 minutes of weight training. And then I feel at the end of the day so much more relaxed, because I've exerted myself in my head and and exerted myself physically as well, and I feel much stronger as a result. So exercise has been a huge thing for me, and I find, my husband is being really supportive of that. He's very much into marathons and weight training as well at the moment. So he's brought me along in that respect. 

Dr Nitha Naqvi                                              

One of the interesting things I know about you is that you also commute to work. So tell us a bit about that. How you manage because that sounds very stressful to me. So what's the distance between your home and your work, Carole? 

Dr Carole Ridge                                            

Well, I'm very unusual, and I have to say no one should ever try and design their life the way my life is at the moment. To explain a little bit, I, moved into the UK. 

I moved to work in the NHS in 2017. So, I've been working in England now for 6 years. And I moved over with my husband who came here for a job opportunity. We brought our 2 kids over with us, and we were extremely happy in London. And it just so turned out as it happens when you have families where there are 2 careers, that an opportunity came up for my husband to move back to Dublin over a year ago. And we decided our kids were probably at a good age that they might move back to Dublin with him. So I spend my, time commuting between London, where I work, and Dublin, where I live. 

And it is door to door, probably 5 hours. Don't ask me exactly what the distance is, it's a couple of 100 miles but I have found that I absolutely love my job in the Royal Brompton. And when it came to decision time about whether I wanted to leave that job, I felt that I had lots left to achieve. I had a huge sense of satisfaction from my job, building up an interventional radiology service, building up the lung tumour ablation service, I simply had too much left to do. And my husband, Adam, was really supportive in me continuing to do that. So, yes, the 5 hour commute is stressful, particularly for someone who historically has hated flying, but I figured out a few tips along the way. And turbulence does not bother me anymore. 

What I tend to do is I just get myself onto the plane and concentrate on the day ahead, concentrate on any mini organisation that I have to do, making sure the kids have everything arranged for the week ahead, while I'm on the plane. And then I look up, and I'm in London again. So, yeah, it's it sounds stressful. I certainly wouldn't recommend it to anyone else, but I've made it work because I really want to make it work. 

Dr Nitha Naqvi                                                            

So, what are your tips to be a working doctor and a mum? Have you got any tips for people? 

Dr Carole Ridge                                            

I don't know. I mean, I think having tips suggests that I've absolutely nailed it, and I'm not sure I have. I think the first tip I'd give is, you know, don't pretend that you're going to do this absolutely perfectly. You've got to realise that you have to give yourself a break as well. It's hugely important to have supportive people around you. You cannot do it on your own, and you've got to ask for help. And I have a lot of help.                                                                     

My husband and my family have an extended family in Dublin who are absolutely amazing to us as well. So first of all, be kind to yourself. Realise that you're not going to do everything perfectly. Second of all, accept help. My third tip, and this is something that I repeatedly have to say to myself because I'm terrible at following this tip, is do one thing at a time. I am a usually a terrible multitasker, but you really need to try and focus on one priority at a time. And that is something that I continue to have to work out. My husband will laugh now if he hears me saying this. 

Dr Nitha Naqvi 

And I think I would also say that is quite common with women because we always want to say yes And we always want to please. So we're more likely to take on so much stuff that then the thing that gives is obviously the time we have to look after ourselves. From winning that Asian woman of the year, one of the things I learned a lot about was the importance of networking and supporting other women in their careers. And this is something that seems to happen automatically for men and is newer for us, I think, as women, particularly in medicine. And I've really taken that on board and tried to support women coming up in their careers, and I've been supported by different women as well, at my level or at senior levels. And there's now more and more networking organizations to support women, and I definitely think that's really fantastic. 

Thank you so much, Carole. I very much enjoyed speaking to you today. Likewise. Thank you very much. 

Oli Lewington                                               

There's so much to take away from that conversation that I wouldn't know where to start. But Carole's reflection on the lack of research for pregnant women working in radiology and the associated risks is really striking in the light of our next conversation, which highlights how that lack of research is causing dramatic health inequalities for women. Dr Sonia Babu-Narayan is a consultant cardiologist at the Brompton and an associate medical director at the British Heart Foundation. She's been vocal about health inequalities when it comes to women and the perceived risks of heart attacks, including commenting widely on a BHF funded study with the University of Leeds that provided hard data to back up established fact. Dr Babu-Narayan also coauthored an editorial in the BMJ referencing the lack of representation of women working in cardiology. I spoke to her about the specific issues women are facing in the field, what steps need to be taken to improve things, and what hope she has for the future. But I started by asking Sonia how she got into medicine, which includes a poignant personal story that speaks to everything we're discussing today. 

Sonia, what was it specifically? I ask this of quite a few people we have on this podcast, but what was it specifically that got you interested in cardiology specifically, but also just generally wanting to go into medicine as a field? 

Dr Sonia Babu-Narayan                              

I don't remember really a time I didn't want to be a doctor. I'm one of those people who always wanted to be a doctor. It wasn't that I was good at science at school and someone said you should do medicine. I had a father who was a doctor. He was a surgeon for a long period and then a general practitioner, and I and I definitely went into it with my eyes wide open about how much work it was. All the cliches he told me were true. It's a way of life.                                                 

You will learn forever. It's hard work and I've loved every minute of being a doctor. The decision to choose cardiology, in a way, was more difficult. I knew very early I'd want to be a physician, but a life event happened to me that made that decision harder and easier in equal measure. As I was leaving school. In fact, I was on a year out, my mother had a heart attack. Heart attacks kill and as we've been talking about today, heart attacks kill women too. My mum was just 42 years old when she presented with her pain. It was totally unexpected. I was at my fourth medical school interview and by the time I came back to London, I had a very interesting experience of being a relative and a daughter and seeing healthcare in action. That itself hugely motivates me around the subject we have today. Not in our hospital, but I was told by medics, oh, she's not on she she's already on pain relief as my mother wept with the pain she was feeling in her chest. I was told Indian women always complain of pain. I wish I could tell you that doesn't happen anywhere anymore, but I believe and here that it does. I know my mum, in retrospect, from years to come was having a heart attack even in those moments but was dismissed even though she was complaining of symptoms.

So, you will never hear someone more motivated to want to see change in how we treat people as individuals, women and men. Listen to them, take their story seriously and give them the best possible care and communicate in the best possible way we can with their family. I know all of us can do that well and do that less well on a given day, but all of us can always 100% of the time make an effort to make that contact really important.

Oli Lewington

Thank you for being willing to share that with us today. I know it's not easy to talk about these kind of things and I think it's important and I think it takes us nicely on to the question of health inequalities, particularly in cardiology and how significantly they have and are impacting women. What do you think is that lies behind those inequalities and what's your reaction when you see these sorts of stories?

Dr Sonia Babu-Narayan

As a cardiologist and as a woman, of course, is the last thing you want to see that women aren't getting the same good outcomes as men when it comes to cardiovascular health. And the reason women aren't getting the same outcomes or aren't having good outcomes is a mixture of things that affect them at every stage of a patient's journey.

They're under aware, they're underdiagnosed or even misdiagnosed. They are undertreated, under supported after heart disease has been diagnosed and underrepresented in research studies. So, we're living in a world where the inequalities in their access and their treatment from the cardiovascular point of view is costing lives. So, heart attacks are actually more common in men than women, and women are more likely to get their heart attack ten years or so later than men.

But unfortunately, the fact that women less commonly get heart attacks doesn't mean heart attacks are uncommon. And that's a big difference. Ischemic heart disease is the world's biggest killer of women. Coronary heart disease kills twice as many women in the UK as breast cancer, and more women die prematurely, so before their 75th birthday. So, it's really, really important that we bust the myth that it's something that only happens to men and only looks like a Hollywood heart attack. But to end those injustices at each stage of the pathway is going to take quite a bit of change and perhaps to live in a world where health care professionals, who are part of society to dismiss us when we're women telling them the same story with the same symptoms or perhaps assume that we're being emotional rather than having a heart attack because all of these things really do happen. We see stories like that all the time where someone has presented perhaps with what you and I might call the classic or textbook symptoms of what a heart attack looks like. So, they're not presenting with something different. And yet, shockingly, even though they have textbook symptoms, their symptoms are more likely to be misdiagnosed or dismissed as not being a heart attack.

Some women have even told me that the doctor said, oh, you can't be having a heart attack, you're too young or you look too fit. And time matters, time is critical when it comes to the potential for damaging your heart muscle. The more time that passes, the more chance of irreversible heart failure and living with more symptoms that could be disabling when you survive your heart attack.

Oli Lewington

And I also want to pick up on the point that you made about textbook symptoms being dismissed by doctors when women present with them, because that's something that we frequently we hear about in lots of different contexts. It's not uncommon to hear of women who are diagnosed late with things that have been dismissed and frequently, as you say, dismissed as emotional as opposed to anything else.

But this is really the core of the point that you're making, isn't it, that these inequalities in the health care treatment of women are costing us thousands of lives every year?

Dr Sonia Babu-Narayan

I think they do cost lives. There's research out there that shows that if women were treated the same way as men for the same condition, there might be thousands of lives saved a year in the UK. And this is just staying within cardiovascular disease. Everybody has been hearing more and more about women's health in general and there are many other examples of women just not seeming to get the same access to care as men in the same timely fashion.

Now, some of it is awareness. Ourselves as women, we live in a society where there were health care professionals, nurses, paramedics, doctors or not, where traditionally heart attacks, for example, have been presented as a male thing. You see a middle-aged man on the television bending double clutching his chest. And so, we tend not to associate having a heart attack with being a woman. And that's also for the person themselves. If I was if I thought I might be having a heart attack, I might myself more likely think, oh, well, it can't be. I'll do something else first or I'll leave it.

Oli Lewington

One of the things that you've focused on, particularly in recent years, is around kind of highlighting the lack of inclusion for women in cardiology specifically. Do you think that has an impact on cardiac care for women as well?

Dr Sonia Babu-Narayan

The lack of inclusion of women in senior leadership or even at consultant level in cardiology definitely has an impact for patients and for healthcare and also for research and innovation. There are excellent data that tell us that diverse teams produce better results. We produce better innovation, better research. with better research and innovation, we have better care. We have better outcomes when we deliver that health care for patients.

 And so, it's a bit of a no brainer that we need to address better equality, diversity, and inclusion in our workforce. But not only at the junior level, at the senior level. We know that around just under 30% of trainees, so specialist trainees, in cardiology are women. Yet less than 20% of cardiology consultants are women. And that's despite that for over a quarter of a century, we've had more female graduates than male graduates from medical school. And it doesn't get explained simply by experience or less than full time, it would seem. So, there's clearly a dial that needs to be shifted to make both the research and clinical cardiovascular care workforce representative of our population, including at senior leadership level.

Oli Lewington

So, what is happening at the moment to try to combat that and redress the balance, as it were, and what needs to be happening to make that happen?

Dr Sonia Babu-Narayan

If we want to improve the representation of women in the cardiovascular, clinical and research workforce, there isn't going to be one simple single fix. I believe it's going to take multiple levers over time to redress this imbalance, an imbalance that's been entrenched for decades so isn't going to be a quick fix. We need to start early. We need to ensure that the widest pool of talent feels that they could go to medical school if that's what they want, if they want to be a doctor. We need to know that the medical students of today have a great exposure to cardiology and could choose cardiology if they found it as fun and brilliant a specialty as I have found it.

We need to make sure it's a level playing field so that everybody with talent can rise and be retained. What is it that women describe as some of the barriers? They describe culture and the word bravado is often used. They describe, sadly, sexism, but also sexual harassment. They describe work life balance. As do some of the men coming through the system who also want to be able to have a quality of life that's sustainable for decades in a career. And women, whether it's an actual barrier or a perceived barrier or a bit of both, describe a lack of access to support and sponsorship, mentorship and coaching and so on. So, all of these things are things we need to address, but there are also some crunchy topics we need to be transparent about the gender pay gap. We know in the cardiovascular workforce that that is occurring, or we have enough sight to believe it's not immune. And there is also an ethnicity pay gap and we know there's intersection in disparity if you have more than one personal characteristic that you're underrepresented with. When it comes to academic, cardiology and academic medicine, things are tough. There hasn't been a growth in academic medicine for some time. And if you look at academic cardiology, where are the university funded professors of clinical cardiology that are women? There are very few. Where are our clinical leads that are lead consultants, that are women? They are drastically underrepresented. And so, we need to shift that dial too so that there are enough role models to know for junior people that it's possible.

Oli Lewington

How much hope do you hold that some of these issues can move forward significantly in the next few years?

Dr Sonia Babu-Narayan

I do hold hope. If we turn our eyes or ears to business and finance, for example, they work towards having 30% of women in their representation. And that has really started to produce change. I'm not pretending I'm an expert in their world. I'm not. But I look to it to learn. And I can see that once you get to a certain critical mass, it's not so unusual to be a woman.

You're not so alone. You're not like the only one. You're not the credit to all womankind or the tar to all womankind. If you do well or less well. And I think we really, really need to get to that sort of number to then make this conversation, a conversation of the past.

Oli Lewington

Do you think we will get to a point where this conversation should become something in the past? 

Dr Sonia Babu-Narayan

No. If we make no effort. Yes. If we do tangible, actionable things.

Oli Lewington

Fantastic. That was amazing. Thank you so much.

Dr Sonia Babu-Narayan

Thank you, Oli.

Oli Lewington

I want to thank all three of the women who took part in this episode and who were so willing to share some very personal and difficult stories to help highlight how much more work there is to be done. Stories like these need to be heard, but more importantly, they need to be acted on too. I hope you enjoyed this episode and feel as inspired by Carole, Nitha and Sonya as I do. 

And I would also like to thank both the South East London NHS Women's Leadership Network and the NHS Confederation's Health and Care Women Leaders Network for providing member feedback to ensure that this episode was as inclusive, as representative, and as relevant as it could possibly be. Thank you so much for listening and we'll see you next time.