Greta McLachlan: Please put your oxygen mask on first before helping others

If we don’t look after ourselves then we will be no good at looking after our patients, says
Greta McLachlan

Alcoholics Anonymous is probably the most well known support group around the world. One of its main principles for recovery is that before you can start to heal, you must first admit you have a problem. Well, healthcare professionals, we have a problem.

This was made painfully clear at Wounded Healer, the 10th annual conference of the Practitioner Health Programme. The Practitioner Health Programmeis a free and confidential NHS service for doctors and dentists with issues relating to a mental or physical health concern or addiction problem, in particular where these might affect their work. Since its inception this has been for the support of doctors and dentists in London. GPs, including trainees, in England have been supported by the GP Health Service since 2017. However, at the conference, the chief executive of the NHS, Simon Stevens, announced that there would be funding to roll out this programme across England. And it couldn’t come at a better time.

Burnout among doctors has been shown to be as high as 50%, and it appears to be getting worse. Burnout is not simply the idea that you are tired and need some sleep: it “is a syndrome of emotional exhaustion, cynicism, and decreased efficacy at work.” Morale among British junior doctors is reportedly at an all time low and I have no doubt that burnout is a factor in this.  

Dr Dike Drummond is an expert on burnout, having treated over 20 000 doctors in 63 countries. He describes hearing from doctors who wished to be hit by cars just so they didn’t have to go to work—a red flag of burnout. Yet, alarmingly, he states that this is a very common thought among those he has treated. Burnout can present by eroding a physician’s compassion, professionalism, and sense of calling, which translates to worse performance at work and poor patient care. In some cases it can even manifest in excessive drinking, drug taking, or even suicide.

Suicide is sadly not unusual among doctors. Dr Michael Myers, a professor of clinical psychiatry at SUNY Downstate Medical Center and author on the topic of physician suicide, quoted some worrying statistics. By going to medical school, your risk of suicide doubles in comparison to the general population. Of 324 doctors who killed themselves over a 14 year period, 74% of those were in their first two years after qualifying and 10-15% of doctors who kill themselves have never seen a psychiatrist. Very few people who die from cancer have never seen an oncologist, yet doctors, our colleagues, are dying from preventable suicides having never seen a psychiatrist. Is this due to the stigma attached to mental health illness, or simply a belief among doctors that they can’t show weakness?

Medicine, while very rewarding, can be a hard life sometimes. Patients die. Mistakes happen. Colleagues can be unkind. This can be difficult to deal with, and for some people may be the straw that breaks their back.

So how can we help? Perhaps we are talking about a sea change in the culture of medicine. The idea that it is okay to put yourself first for five minutes can be unsettling to some. One initiative that aims to do just this is Schwartz rounds. These are multidisciplinary forums, where the emotional strain of caring for patients can be discussed confidentially and in safety. Anyone who works in that institute can attend, and first names are used to diffuse any sense of hierarchy. It allows carers to put themselves first for a short period of time, and to connect with other care givers.

As of July 2015, 116 public health organisations had adopted Schwartz rounds. Professor Jill Maben, a professor of health services research and nursing at University of Surrey, is a strong advocate for the benefits of Schwartz rounds. She reported that Schwartz rounds not only improve patient care, but also improve self reported wellbeing among those who attend them in comparison to groups of care givers who did not attend.

It was World Mental Health Day on 10 October, a day that reminds us of how openness can remove any enduring stigma still attached to mental health illness. We as physicians should be taking a leaf out of this campaign. We need to look out for each other, and as seniors in teams look out for our juniors. The simple validation of “I did it in my day” doesn’t make for good training or pastoral care and we should no longer tolerate this line of thinking.

If you are worried about a colleague there are good organisations out there that they can speak to: PHP, Sick Doctors Trust, and the Doctors’ Support Network—all of whom offer support without prejudice or shame. If we don’t look after ourselves then we will be no good at looking after our patients. We must remember to put on our own oxygen masks first.

Greta McLachlan is a general surgical trainee currently working at The BMJ as the editorial registrar.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: I attended the Wounded Healer conference with a press pass and therefore did not pay for a ticket to the event.

Editor’s note: The second paragraph of this article was amended on 26 October 2018 to clarify the remit of the Practitioner Health Programme and GP Health Service.