When Medicine Meets Reality

Role: Junior Doctor, NHS Scotland

Scope: Emergency & Acute Care | Urban Deprivation Context

An early clinical experience that reshaped how I understood health, responsibility, and systems.

Much of my day was spent on administrative tasks, rather than speaking to patients

Context

As a junior doctor working in a hospital serving the east end of Glasgow - covering some of the most socioeconomically deprived neighbourhoods in Scotland - I regularly treated patients whose medical needs were inseparable from social and structural realities.

One encounter has stayed with me. A man in his forties was brought into A&E after collapsing on hospital grounds following substance use. When he regained consciousness, he told me his story: childhood abuse, early exposure to alcohol, heroin by his teens, and decades of addiction. He was not simply a reflection of “poor choices.”; he was living with the long-term consequences of trauma, environment, and societal failure.

That moment crystallised something for me. Poor health outcomes are rarely the result of isolated individual behaviour. They are shaped by early life experience, access to support, and the systems that surround us.

At the same time, I experienced daily friction within the NHS’s digital infrastructure. Accessing a single patient’s full record required navigating multiple disconnected systems - laboratory results, imaging, prescribing, discharge summaries - none of which communicated seamlessly. Much of my day was spent moving between platforms rather than speaking with patients.

I began to question information asymmetry. If I, as a clinician within the system, struggled to assemble a coherent picture of a patient’s history, what chance did patients have of understanding or accessing their own information? It became clear that digital infrastructure is not just an operational issue; it shapes transparency, autonomy, and agency.

What This Taught Me

Health is deeply structural. Where we are born, what we are exposed to, and the systems we inhabit shape outcomes long before a doctor intervenes.

These experiences led me to step back from front-line clinical medicine and study public health at the Karolinska Institute. I wanted to better understand how policy, infrastructure, and system design influence population health; and what it would take to shape those systems more intentionally.