16 Mar, 15 | by Toby Hillman
The rigours of life as a junior doctor are well described, both in popular modern classics like House of God by Samuel Shem and the television series Scrubs, but also in lesser known works, like A Country Doctor’s Notebook by Mikhail Bulgakov.
There are common themes – imposter syndrome, fear of killing patients, bullying seniors, long hours, mental and physical exhaustion.
There is no doubt that working conditions have improved somewhat from those experienced by Bulgakov in revolutionary Russia, but the first months and years of clinical practice remain a difficult time.
A paper in the current issue of the PMJ looks at a group of junior doctors who face additional challenges, and examines their coping strategies.
Dyslexia is considered to have a global prevalence of around 6% and in the medical profession, the rates of declaration of dyslexia amongst medical students are around 2%, and rising. The paper highlights the difficulties that people with dyslexia face, and the potential impacts these would have on doctors who have just entered into their professional roles.
All of the FY1 grade doctors in Scotland were asked if they would take part in the study, and 9 agreed. This could represent about 40% of the junior doctors in Scotland who have dyslexia, so the study provides quite an insight into their experiences.
One question that interested me was if the subjects had disclosed their dyslexia to colleagues. The report states that only a few had discolsed their dyslexia to colleagues. The reasons for this were varied.
Some felt that to disclose a problem like dyslexia might be considered by others as ‘help-seeking’ or as an excuse for poor performance, that would mark them out as different from the ‘neuro-typical’ house officers, with the attendant problems this might produce. Shame was a factor in some decisions not to disclose, and there was anxiety amongst the subjects about the impact of dyslexia on their future careers – owing to the difficulties with written exams, and subjects were aware that dyslexia could become a reason for bullying.
Only the minority had actually disclosed their dyslexia to others, and had seemed to have benefited – with a wider range of coping strategies available, particularly in troublesome settings like ward rounds, or presenting cases in MDTs. One subject had made use of a ‘buddy’ system for writing on ward rounds.
The issues that this paper highlights around disclosure of dyslexia throw up questions to us all about how we as a profession treat our colleagues – not only those with dyslexia, but anyone in our profession that might be suffering with an illness that is not immediately obvious.
My most recent blog tried to highlight that doctors remain humans, despite their attempts to control physiology, master illness and manipulate tissue. As such, we are at the mercy of the cognitive biases that have been discovered in other professional groups, but we also need to realise that we are at the mercy of our own biology just as much as those patients we try to help. And yet, as a profession we still take pride in being robust, if not indestructible, and the prevailing opinion is generally that admitting to an illness, or struggle is beyond the pale. This is reflected in ubiquitous anecdotes about ‘never having had a day off sick in x years’ or ‘the only reason I got any treatment was because I clerked myself in.’
However, when studied objectively, residents in the US reported the feeling that there would be both empathy for colleagues who missed work through illness, and a concurrent risk of being ostracized from their peer group. This tension reflects the both the caring nature of our profession, but also the seemingly excessive expectations we place on ourselves and our colleagues when it comes to stamina, and resilience.
I would not advocate moving to a world where the slightest hiccough sends us running for the duvet, but equally, if colleagues in one of the most stressful periods of their careers cannot turn to peers and supervisors for help for fear of being ostracised, then the hidden curriculum has swung the wrong way.