MR: “I don’t have thick enough skin for this job” said Maria, explaining why she was switching from paediatrics to a lab-based specialty. She was the third colleague to decide to quit paediatrics that week, with others admitting to crying, and running to the toilet to hide. Doctors across all specialities are reporting higher levels of stress, depression and anxiety. Recently, I myself had found a set of night shifts particularly difficult knowing that a baby who I had spent a lot of time with in intensive care had died.
NM: No doctor finds it easy to lose a patient, but learning to cope, putting aside your distress, providing solace, and yes, carrying on, is part of what it is to be a doctor. Looked at dispassionately things have never been better for junior medics. Your working hours are regulated, part-time working is accepted, you are taught and trained well, and not asked to practice above your competences. So why are junior medics today in such straits? Why the unhappiness? Is this a ‘lack of resilience’ or does the problem lie deeper?
Professor Neena Modi
Photo credit: Layton Thompson/Imperial College London
MR: Medicine impinges upon life outside work with lots of ‘homework’, long hours, self-funding for exams, choosing between long commutes or regularly moving home, and a substantial burden of assessments and regulation. Bullying and intimidation in the workplace persist, and we aren’t always as good at working together between different specialties as we could be. Busy on-calls are often spent with colleagues who don’t know you very well, and so don’t know when you are finding the shift stressful. Many units are working to capacity and there is little time within the shift to bond with colleagues or complete other work such as GP letters.
NM: It seems that one problem is the loss of camaraderie. The excessively long hours of yesteryear also meant living in hospital, and benefiting from the support of working in a very close-knit team. No one would advocate a return to the days of one in two rotas, rank misogyny, a see-one (if you were lucky), do-one, teach-one, approach to training, having to find a new job every 6-12 months, and a very stern authoritarianism. It was like that for all of my generation, but it’s worthy of note that not one of my contemporaries dropped out; and we’ve mostly all had fulfilled, rewarding careers. My point is that tough jobs can build resilience, and do not necessarily mean stress and unhappiness.
MR: I feel the problem is not a lack of resilience, but chronic underfunding of the health service and the workforce feeling undervalued. We want to do our best for our patients, yet we are continually told we must do more with less. There are many political or management targets that clinicians do not feel are compatible with good patient care, which is further demoralising.
Photo credit: The BMA
NM: I think you’ve put your finger on part of the problem. You mention “homework”, assessment, regulation, bullying; these are the words of the schoolroom. Have the attempts to improve the terrible working hours and poor training of yesteryear led to the pendulum swinging too far? It’s worth considering whether occasionally, what is perceived as bullying reflects difficulty in accepting criticism. It seems there’s also a need to repair the damage done to over recent years through doctors becoming simply the providers of a service. Perhaps using the term junior doctor – not trainee – would be a good start; you are not children, you are doctors entrusted with your patient’s wellbeing, and all of us, throughout our careers, are continually learning. Junior doctors showed great maturity, commitment, and team spirit when they united over the contract dispute and took on responsibility for trying to solve a problem. Perhaps there’s something to learn from that.
MR and NM: We suggest that high morale and job satisfaction come from working together for a common cause. There was a lot that was not right in the past, but also a lot that was good. Let’s take the best of past and present, and create a new future. Professionalism is a two-way issue; for employers it’s about valuing doctors and doing their part to ensure a positive and supportive work environment; for doctors it’s about our behaviour, not just our knowledge, and our ability to create supportive team-working. Use available mechanisms for change but if necessary, develop new ones. If shift-working isn’t right, suggest alternatives and take responsibility for finding a model that works. Suggest ways to bring back firms and a team structure. Get to know your patients as people, not just as names on a handover list. And if the politics of the day aren’t serving patients or the profession well, get involved in bringing about change. Discuss possible solutions with both peers and senior colleagues; you are likely to find they value this. Leadership is about leading and shaping the world around us. And remember, patients die, bad things happen, and real life is tough, so yes, resilience is important, and so too is supporting each other.
Neena Modi is Professor of Neonatal Medicine at Imperial College London, a Consultant at Chelsea & Westminster Hospital, and the President of the UK Royal College of Paediatrics and Child Health.
Melody Redman is an NIHR Academic Clinical Fellow on the Paediatrics training programme (year 1) in Yorkshire.