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See Pete's Hidden Curriculum Part 1 here


Interviewer: “Mr Murphy, what attracts you to the leisure industry?”
Spud: “In a word: pleasure. It’s like pleasure in other people’s leisure.”
Interviewer: “Do you see yourself as having any weaknesses?”
Spud: Shakes head, then: “Oh, yes, cos like, I’m a bit of a perfectionist actually, yes I am, see for me it’s got to be the best or it’s nothing at all, like, if things get a bit dodgy I just cannot be bothered, but hey, I’m getting good vibes about this interview thing today, man.”


In this memorable scene from Trainspotting (1996), Spud successfully fails to get a job at the leisure centre, which he had been obliged to attend by the Department of Employment, by messing up his job interview whilst high on speed. In a similar fashion, although not high on drugs, I half-heartedly interviewed for a senior house officer (SHO) post in neurosurgery on the south coast of England, as I really could not face that particular job in order to tread water for another six months before getting into my chosen career of ophthalmology.


Corrour Railway Station, Trainspotting Fresh Air scene recreation.


The following day, with a spring in my step following my successful rejection by neurosurgery, I travelled the length of the country for an ophthalmology SHO interview in Glasgow [1]. However, this time I put my heart and soul into it, and thankfully managed to persuade them, like Spencer for his barman interview in Phoenix Nights, that “I’m your man!”.

Before I took up my ophthalmology post in Glasgow, I had to fulfil an obligation to a locum agency, which was a two-week accident and emergency (A&E) SHO locum and also in Glasgow. What I hadn’t realised until I turned up was that the locum agency had craftily employed me as an SHO 3, essentially the most senior SHO in charge of supervising all the other SHOs in the department. “One of your roles is to greet the major trauma helicopter when it lands on the helipad outside,” the consultant explained to me on my first day as the colour drained from my face, “and assess whether the patient can be managed initially by your team in the A&E department or can be transferred to the neurosurgical unit.” Thankfully during my two-week stint, the major trauma Batphone in the department didn’t ring and an opportunity to make this assessment out on the helipad didn’t arise, as I would have set the bar extremely low for any transfer over to neurosurgery.

“Is that me then?” the middle-aged, slightly inebriated man asked me in a broad Glaswegian accent, having examined, and treated his sprained ankle during my two-week A&E locum. I pondered for a moment this, what I believed to be, philosophical question. “I’m sorry?” I replied. “Is that me then?” he insisted. I looked quizzically at the nurse hovering by the end of the bed. “Is that him then?” she helpfully added. My puzzled look continued until she finally elucidated for me: “Can he go home now?”

Difficulties acquiring the new colloquialisms were not confined to the workplace. On an evening out with some new friends, a few weeks after my arrival in Glasgow, we eventually pitched up at the famous Sub Club nightclub. In my haste leaving the bar a few minutes earlier I had put my jacket on, but unbeknownst to me the collar was tucked in on itself. At the front of the queue the bouncer looked me up and down and asked: “Are ye’ steamin’?”. Now, when learning any new language sometimes you have to guess the translation and I thought “steamin’” meant “up for a good time”. However, “steamin’” in fact means drunk and the bouncer was assessing the appropriateness of my entry into the nightclub. “Yes,” I replied in a chipper fashion “I’m up for a great party tonight!”. My forlorn Glaswegian friends then frantically explained to the bouncer with heads in their hands: “Don’t listen to him, he’s English!”

In my opinion, there are three main modifiable factors to get right in order to achieve happiness in life. Your career (and of course, subspecialty), your partner, and where you live.

I was also not completely prepared for the vagaries of the weather in Scotland. One afternoon off in late June during my locum, I joined some friends at a beer garden in the West End of Glasgow. The sun was shining, and the temperature had reached the dizzying heights of around 20°C, so I wore jeans and a t-shirt. Later at around 6:30pm the sun dipped behind the tenement flats and suddenly the temperature plummeted, and I was left shivering with cold. I believe that day in June counted as the Scottish summer for that year. In Scotland, I have learnt that at any time of year the weather can quickly default to cold and / or wet [2].

Whilst my initial difficulties experienced in Glasgow learning the regional colloquialisms and struggling with the weather did not represent any significant hurdles and merely serve as anecdotes, they do aid as an introduction to Pete’s Hidden Curriculum Part 2.

It is not explained in medical school that in order to determinedly pursue one’s chosen career in medicine, it will often necessitate several relocations both within a country and sometimes between countries over one’s lifetime. Most of my friends from medical school have dispersed throughout the UK, and some overseas, with only a handful remaining in London. Many are in locations which I consider to be more glamorous and desirable places to live than my own.

This leads me on to my next piece of advice for the medical students, which is as follows: in my opinion, there are three main modifiable factors to get right in order to achieve happiness in life. Your career (and of course, subspecialty), your partner, and where you live. If you get these three things right then you should achieve some degree of happiness, which is easier said than done. I have covered careers in a previous instalment, partners I will touch on in a future instalment in a totally unqualified way, but in this one I will cover location and in particular climate, and explore the question: “Does the climate really have any effect on happiness?”

The climate in Scotland, for the majority of the year, is cold and wet. My definition of an optimist is now someone who buys garden furniture in Scotland. Scotland also does not do so well in terms of happiness. The UK currently lies 18th in the Happiness World Rankings, but Scotland is officially the most unhappy nation in the UK. However, the top three happiest countries in the world in this league table in order are Finland, Iceland, and Denmark. These three countries have relatively cold climates, similar to Scotland, although admittedly much lower rainfalls. Therefore, does this increased rainfall and a consequent lack of sunlight lead to the lower happiness score in Scotland?

Weather as an influence on happiness has been investigated in many studies, the largest of which to date is a paper by Lucas and Lawless [3]. Reassuringly, in their study examining the association between daily weather conditions and life satisfaction in a sample of over a million Americans from all 50 US States, they showed that weather does not reliably affect judgements of life satisfaction.

There is also another reason why a move to a place with what may be considered to have a more favourable climate will not lead to a long-lasting change in happiness. This is the concept of adaptation. The theory is that when something changes in life, such as a new car, house, or partner, everything is wonderful initially. Then, after a while, the novelty wears off, and the pleasure from the new experience diminishes due to adaptation. Brickman et al. studied this adaptation effect by examining happiness levels in groups of lottery winners and paralysed accident victims. As time passed both groups returned to former levels of happiness through adaptation [4].

In summary, location is important for happiness, but the climate does not appear to be. At least that’s what I’ll keep telling myself as I scrape the ice off my car for the umpteenth time in winter whilst my former registrar colleague drives to work listening to Surfin’ USA by the Beach Boys with shades on and sunroof open, in La Jolla, California. I will ensure to maintain a positive attitude like William Wallace (Mel Gibson) in the movie Braveheart (1995) when he says, in a dodgy Scottish accent, to a local: “It’s good Scottish weather we’re having madam. The rain is falling straight down, slightly to the side.”



1. Fortunately, I never had to work in neurosurgery. However, as part of my ophthalmology SHO rotation, I did have to do six months of neurology. In the “neuro” building, we shared the on-call lodgings with the neurosurgeons and neuro-anaesthetists. In the six months, I don’t think I ever saw the other teams in the on-call TV room as they were so busy, which led to a rather solitary existence, but on the plus side I always got to choose which TV programme to watch.
2. When Fran Healy, lead singer in the Glaswegian band Travis laments, “Why does it always rain on me?”, he ponders if it is “because I lied when I was seventeen”. Like many song lyrics, I have a problem with the thought processes involved here. However, Fran can stop hypothesising as I can reassure him it is simply because he lives in Glasgow.
3. Lucas R, Lawless N. Does life seem better on a sunny day? Examining the association between daily weather conditions and life satisfaction judgment. J Pers Soc Psychol 2013;104(5):872-84. [This paper reminds us that it is probably true that we make our own sunshine in life.]
4. Brickman P, Coates D, Janoff-Bulman R. Lottery winners and accident victims: is happiness relative? J Pers Soc Psychol 1978;36(8):917‑27. [This is a reassuring read that winning the lottery will not make you any happier. But I am still buying my ticket just in case.]



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Peter Cackett

MB BS (London), BSc (London), FRCOphth, Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK.

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