Charlotte Elder: A call for a bit of honesty

charlotte_elderBefore a career move to paediatrics I was a GP trainee. Whilst brainstorming what topics we were going to cover in our VTS half day release, I suggested that we develop our skills as reflective practitioners and discuss our imperfections as doctors. It would be a chance to talk about ourselves as fallible humans who do occasionally allow our personal life to get in the way of our work, and do have days when the line we gave at our medical student interview, “I just want to help people,” seems a little hollow. I gave the theoretical example of an over running evening surgery at the end of a fraught day. You have tickets for the theatre, so are keen to make a timely exit. The last patient has the dreaded long list of things to discuss. You make a decent stab at addressing the first few concerns and then perform a blood pressure as a parting gesture, whilst asking them to book another appointment so you can discuss some of the other list items. The blood pressure, to your surprise, is elevated—not so high that it requires immediate treatment, but enough to need to be taken seriously……but another time. The thought of yet another domestic when you miss the start of the play and have to be shown to your seat by torchlight, with your fellow theatre-goers having to stand up, and the glare of your partner as you sit down, flashes through your mind. You look up, “well, we’ll check it again when I next see you” and you somehow forget to enter the value in his computerised notes. The VTS course organisers looked at me with astonished disgust that I had said such a thing and it was dismissed as an inappropriate topic.

So there it is I will put my hand up and say—“I sometimes do things that wouldn’t make my mother proud and certainly don’t make me proud.” Sometimes I am just not the doctor that I can and strive to be. Sometimes I put my needs before the patients. Sometimes I am not the supportive colleague I should be. Sometimes I am human.

Perhaps it is easier to accept that we fall below the gold standard as partners, friends, and parents, but it seems we’re not prepared to admit this as professionals. Perhaps this has something to do with being members of a caring profession where the stakes are high, as are the expectations of us by society and ourselves. We work under a veneer of perfection, burnished by the elevated status held by doctors (but which is reducing thanks to American-like litigation, negative press coverage, and governments threatened by our public standing). I believe in being a reflective practitioner—learning from our mistakes by a process of reflection, both personally and with others. I don’t, however, just reflect on critical incident like events. Significant events e.g. drug errors may only occur every once in a while, and whilst it is very important to reflect on them when they do occur, the more subtle ways life impacts on my ability to be the best doctor I can, is a battle I fight more regularly, and may not be picked up by any of the clinical governance systems in place.

I’m sure many of us do this type of reflection both in our personal and professional lives, but others may not. I believe until we start being honest with ourselves, and each other, opening up to our darker sides, we prevent ourselves becoming the best doctors, partners, friends, or parents we can be. It also helps to soften the “I’m a rubbish doctor” stick many of us beat ourselves with on a regular basis and helps us be more understanding of the fallibilities in our colleagues (we are not a terribly forgiving profession). This is not about making excuses for poor practice, but about acknowledging that life is stressful and forever changing and those stresses impact on our work. I love clinical medicine and, like most doctors, am prepared to go the extra mile and often put my job above all else. I like to think that I try my best and that the majority of the time patients, families, and colleagues get me as good as I can be, but like everyone I have bad days and so I’m just championing honesty and compassion for ourselves and each other so that we can strive to be our best more of the time.

Charlotte Elder is a clinical lecturer in Paediatrics at the University of Sheffield whilst on an OOPR (out of programme research) from training in paediatric endocrinology and diabetes. She qualified in 1999, started off training in general practice, but changed to paediatrics in 2002.