9 Aug, 13 | by BMJ Group
Nothing much sprung to mind. A friend had just asked me an odd question, paraphrasing the mystical scholar Andrew Harvey, “what breaks your heart the most?” Was this an early showing of the carapace of cynicism to come? A day later it came back to me: the thought of my father’s final walk around the house and garden he couldn’t bear to leave. The thought of his hands – devastated by rheumatoid arthritis – tying a knot in the rope to hang himself from the old oak tree. Nearly a year ago and a few weeks into my first job as a doctor, my father took his own life.
I took seven days of compassionate leave. Then I returned to work. But it was only after several months that the daily sense of devastation gave way to a more tolerable sadness, a forever hardening scar. A week was arguably not nearly enough time to properly grieve, whatever that might be. But much more time off and I would have had to drop out. Such would have been the blow to a growing but fragile confidence, let alone the failure to comply with the relentless demands of the tick-box medical training machine.
A year on, I can see that several things helped me survive the year. From prior experience, I knew of the potential value of psychotherapy. Given the episodic intrusion of suicidal thoughts, perhaps a death-pull to join my father, it was possibly life-saving. The support I sought and received from loved ones and a few colleagues in-the-know was undoubtedly crucial. And a couple of longstanding healthy coping mechanisms, such as a daily meditation practice, provided a buffer to the lure of less wholesome forms of solace and thinking patterns.
More disturbing is the degree to which a narcissistic sense of machismo got me through. This might be a tendency within me, but it is arguably endemic to the culture of working at the clinical coalface in much of the NHS. Apart from the motivation to not lose a year of training before I’d even started, I was already responding to a sense of opportunity to prove my resilience; to myself and colleagues. With hindsight I can see that circumstances had conspired in such a way that within weeks of becoming a doctor, I was already running the gauntlet of medicine’s occupational hazards - burnout, substance abuse, and suicide.
Whilst evading the latter two, I suspect my difficulty in connecting to my own heartbreak betrays more than a few fumes of burnout still today.
This question of burnout was flagged up at a recent BMA conference and rightly reported in the national press given the dire consequences for patient care, let alone the loss of UK doctors, both to better working conditions abroad and worse. Two trainees at the conference commented:
“There are safeguards in place for pilots and lorry drivers to prevent them causing loss of life with large, dangerous machines. But how much more dangerous do you want to get than a scalpel or prescription pad?
“Stress and burnout in doctors can be catastrophic, putting our patients at risk while ruining the careers of our students and doctors at all levels.
“Burnout is causing doctors to leave the profession or seek work abroad. It is linked to alcoholism and tragically suicide.”
The clichéd truism ‘prevention is better than cure’ is surely applicable to the problem. Some life before medical training was my preventative tonic - I very much doubt the lip service paid by my medical school to teaching healthy coping mechanisms would have been equal to the task had I gone straight to the sausage factory from school. On a practical level, any initiatives, and the earlier the better, to teach students and trainees how to better look after themselves, might help save not just the quality of care and lives of patients, but those entrusted to deliver this. More generally, fostering a stronger culture of compassion for ourselves, which could start with greater openness around our own vulnerability, might even allow for a stronger culture of compassion for patients.
“Putting patients first’ is a punchy soundbite for the much-needed cultural change within the NHS, but I wonder to what degree this will ever happen so long as we dare to ignore an altogether more biblical maxim- “Physician, heal thyself.”
Jonny Martell is an FY2 doctor in Edinburgh