Work experience with the ‘surgeon who lived round the corner’ led to falling in love with surgery and Dame Clare Marx grew up to become the First Woman President of the British Orthopaedic Association and the First Woman President of The Royal College of Surgeons. Now chair of the General Medical Council and a retired orthopaedic surgeon, Dame Clare speaks to First Women about what she has learnt since her first encounter with ‘blood and guts,’ aged 16.
What I have learnt about…Independence
I was seven years of age when my parents chose to move me from the local primary school to a junior school in Warwick, which was miles away. My sister and I walked three quarters of a mile to the bus stop morning and evening, for a bus to travel the 10 miles to school. That daily journey instilled quite a lot of independence. Aged 10, I was sent to a school in Switzerland for two terms near to my grandfather. I headed off – speaking no French or German – and had an absolutely fantastic time climbing mountains and learning to speak French and of course, occasionally seeing my grandfather. At 14, my parents sent me to Cheltenham Ladies College for my O- and A-level years. I remember being struck by how much more independent my years of travelling miles had made me as compared with my fellow pupils
What I have learnt about…Stability
At Cheltenham Ladies, I was noticeably amongst the less well-off girls. My father would come and collect me and my sister any moment we could get out. He would drive us home, we would have a day there and then he would drive us back. This was a huge commitment from him. He was always on time, always good to his word. So from a young age I had this unshakable feeling that my parents valued me and I could depend on them. That provided a phenomenal stability and bedrock of confidence which has stood me in good stead all my life.
What I have learnt about…Values
I understood that life was tough for my parents. My father had been made redundant and so my mother went back to work. She seemed to keep so many balls in the air. She was a magistrate and very funny, yet firm about law-making, with incredibly sound principles. She taught me about the importance of understanding people’s circumstances – but that there was also a line over which you shouldn’t step. I remember in the early days of race relations, she used to welcome people who were arriving from abroad and find them places to stay. Once, a local hotel wouldn’t let a guest in because of the colour of their skin and so my mother reported the hotel to the local race relations board. Consequently, our house was daubed with shocking slogans like, ‘N***** lover,’ yet in the face of this, my mother was totally solid. She just got on with things and stuck to her values. She deeply inspired me.
My father was very proud of my mother. He always supported her in following her passion and I suppose that landed a sense of equality in me. Partnerships work best when the people in them respect the successes of the other.
What I have learnt about…Finding My Vocation
Before I went to medical school, my mother (rather than going to the local GPs’ office and asking if they would give me some work experience,) went round the corner where she knew a surgeon lived and asked him instead. That’s what inspired me to study surgery in particular. I remember when I told my parents of my choice they looked quizzical – not because they didn’t want me to do it but because on the whole, women didn’t become surgeons at that time. Nevertheless, they said, ‘fine, if that’s what you want to do we will support you.’ But I do also recall going home once and talking about blood and guts and my mother saying, ‘I don’t know why you can’t do something that I can talk about at my coffee mornings!’
What I have learnt about…Honesty
That first surgeon became my mentor. I knew of other people mentored by him in different spheres – it didn’t have to be surgery. For him, the joy was in seeing others achieve their full potential and I took that lesson with me; a good mentor gets their pleasure in seeing people flower.
He also really hammered home to me the importance of being honest with people. I’m not talking about being blunt and unfeeling, but rather, speaking up when things are not working. Don’t be nice and then going behind someones back and undermine them. He taught me to be ‘constructively upfront.’
What I have learnt about…Conflict
You cannot do things on your own. You need people who will give you their honest option, people who will act as flankers and flag up some of the things you may be blind to. I have also learned to cultivate a really strong sense of purpose and the understanding that you cannot please all of the people all of the time.
I think I have probably handled more conflict in recent years than in my formative years and what I have gained from that is the understanding that rather than go into opposition directly, its better to go out to meet your opposers and try to listen and understand. If someone seems to be perpetually resisting you, ask yourself; what’s underneath their resistance? Fear? Insecurity? Once you can tap into that, you can meet them where they are and make sure they feel understood. This can help move the seemingly immoveable.
I am also a great optimist – and a great pragmatist – so it seems to me that when challenges are served up, you can either lie down and beat yourself up or you can say, ‘how can I make the best of things?’ In doing that, you often find opportunities for change. A door opens because it has to.
What I have learnt about…Changing the Status Quo
Once you have made a change – it is just as important to bed it in. Dedicate time to helping people understand the benefits of what you have done. Then they have a vested interest in maintaining the new way and not falling back into old way; which can very often feel as if it is much less hassle for them. One must invest in stabilising and socialising the changes to make those new ways sustainable for the future.
I learnt not to get too caught up in constantly making changes, but rather to consolidate the changes one has already made. I now think of some of the changes that I fought really hard for, which were later lost precisely because they were not bedded in. For example, 13 years ago, I became the first woman President of the British Orthopaedic Association…but they have not had another woman president since. And last year there were no women on their council at all. I felt a failure as regards trying to socialise the thought that diversity was a really, really important part of the whole governance process. So, I learnt that lesson from the BOA, and in 2014 when I got to be president of the Royal College of Surgeons, one of the things I started was the Emerging Women Leaders Group. This time I wanted to be sure that I was going to leave behind something that would grow women to move through the system. Now I always try and ensure that as I go along. People who are new and in the minority will not willingly step into group of other people who are confident of their place. A network that ameliorates that sense of outsider-ness is very, very important.
What I have learnt about…Responsibility
Sometimes it is a heavy burden. Learn from mistakes and perceived failures but try hard not to be personally destroyed by them. I hear people say, ‘I couldn’t get it done so I resigned’ and I think that is very destructive. Women tend to say, ‘it’s all my fault’, but nothing is ever one person’s fault; what is important is to be reflective and take the learning with you so you don’t keep coming up against the same problems.
It is also important to have solid friendships and mentors and sounding boards and people who value you, so that when the world out there is thrashing what you have done, you can make sense of what’s happening – maybe an idea wasn’t that great or maybe it wasn’t the right time or maybe you didn’t do it in the right way, but actually there is nothing wrong with you fundamentally as a person. Rather than be utterly crushed, it is worth taking some time to lick your wounds and then getting out there and trying it again.
Oh, and the world isn’t fair and you have to just understand that!
What I have learnt about…Imposter Syndrome
Like all women I have a fair degree of the ‘Imposter Syndrome’ so my brain goes; ‘hmm that went well, it can’t have been down to me. It was something that went right or luck or whatever.’
I think it is important to celebrate success with good friends and recognise when you get things right. And usually, when you get things really right, it wasn’t you working alone but a group of people that you have managed to corral and direct. So when you do celebrate, you truly can because there is a group of people to celebrate with you. You don’t walk out of an operating theatre and say, ‘hey folks, I have just saved someone’s life’ because it was not you. You were part of a team that you were leading.
What I have learnt about…The Inner Critic
Yes, it is challenging to receive negative and difficult feedback. But the hardest thing for me is my own inner critic. The most difficult thing to deal with is when you know you didn’t do something well enough – particularly if you know why too. I think about some of the days when operations didn’t go as well as I would have liked and dealing with my own reflections on that. That really can get you down. It’s finding the balance between not being overly self-critical but reaching a place of deep honesty with yourself about what has happened and your responsibility.
To help with this if I felt I made a mistake, I tried to pass that learning on to students by being honest about what I did and make sure they don’t fall into the same trap. So I might be teaching surgery and I would ask a trainee; ‘what are going to do now?’ And they suggest something, I would say, ‘I remember doing that once and this is what happened. Do you want a rethink?’ Afterwards I ask why they think I shared my story and the enlightened ones say: ‘because you wanted me to learn from your mistakes.’
What I have learnt about…Diversity
I think all societies are richer for diversity. Over 50% of our medical school graduates over the last 10 years have been women. We still face the problem that that not enough of them are reaching the very senior levels right across the board. Diversity of voice brings diversity of understanding and appreciation and value. For me, it is a question of trying to maximise natural benefits. Making people feel confident to show both their male and female aspects – whether they be man or woman – is really important. It is what makes them rounded people. Too often I think women try to show their male sides when they are in the dominant position and women tend to hide ways of being that they think don’t ‘fit’. I have enjoyed saying, ‘that’s not the way I want to communicate’. Just being yourself is the happiest way to be.
Interview by Deborah Willimott