The culture of working without breaks is dangerous to doctors’ and patients’ wellbeing, only a cultural shift can change things, argues Heidi Edmundson

“Every now and then go away, have a little relaxation, for when you come back to your work your judgement will be surer,” Leonardo da Vinci. 

Surely we should follow his example. But, as the old adage goes, carers are not good at caring for themselves and doctors have always had an ambivalent relationship with breaks. This is driven by the nature and demands of the job and is tangled up in a complex web of beliefs that stretches beyond individuals and into teams and specialties. As a consultant in emergency medicine I am aware that my own specialty has a chequered history around breaks. In principle we all agree with taking them, but in practice many of us can go a whole shift without visiting the bathroom. Worse still, at times we have been known to flaunt this fact like a badge of honour.

However, it has become impossible to ignore the huge cost of burnout to both individual doctors and the medical workforce. Breaks are no longer being viewed as a luxury, but as an integral part of physician wellbeing, patient safety, and workforce sustainability. Exceptional reporting and the costs associated with recruitment and retention issues mean that they are becoming a financial issue as well. I have always stressed the importance of taking breaks at staff induction, but I was becoming increasingly aware that there is a huge difference between telling people what they should do and what actually happens on a busy shift.

The more I thought about breaks, the more I realised that the solution required more than words—it needed an entire change in culture. So, back in the summer of 2017, I set myself the challenge of trying to run my own departmental “public health” campaign entitled “take a break” to see if I could change this culture. I started by designing 16 posters all of which showed different commonly missed fractures and the slogan “if you don’t take a break you’ll end up broken”.  

I displayed these round the department and, ran a quiz with prizes for the first doctors to correctly identify all 16 fractures. I highlighted the posters’ educational value and the patient safety issues associated with taking breaks. I wanted breaks to sit alongside other important aspects of the job such as education and patient safety. I felt that this worked similarly to content marketing where a product is advertised as part of content which will interest the consumer. I also incorporated the posters into some of my teaching sessions, both formal and informally, during quiet moments on the shop floor. If I delivered any teaching I would make staff repeat the mantra—“What are we aiming for in this department—no missed breaks”. I don’t doubt that at times I may have been incredibly annoying, but I was constantly finding ways to repeat the message.

Having learnt from previous mistakes I recognised that I could not make an impact on my own so I enlisted our ACCS trainees to act as “take a break champions.” It was their role to remind, encourage, and, hopefully, empower their peers to take breaks. I wanted them to have a sense of ownership, recognition, and even some excitement towards the project. In their own words “being able to address the issue of missed breaks and encourage colleagues to prioritise their health and wellbeing in a job that is so demanding spoke volumes.” They appreciated the role which involved reminding colleagues about taking breaks, and enjoyed being part of a departmental project which saw staff undertake various activities that changed their daily behaviour and mood for the better.

We surveyed the first cohort of doctors who experienced the campaign at the end of their rotation with us. We found that  78.6 % [out of 14 junior doctors] took their breaks “often”, while only 42.9% had done so in previous jobs. The trainees also felt that taking breaks was more valued in this job than in previous jobs. The survey also highlighted problem areas. With night-shifts in particular, the length of shifts meant that doctors struggled to take the second of the two breaks that they were entitled to. 

I started this project with a desire to try and change culture and I have come to realize that changing the culture around taking breaks is really just the tip of the iceberg. What we really need is a huge cultural shift in our attitudes and behaviours towards staff wellness. This will require imagination, innovation, and investment at all levels. Changing culture takes time and will only succeed if it speaks to a collective will and is driven by a collective effort. I sometimes say, half-jokingly, to my juniors that they need to take their breaks, not just for themselves but for every doctor who comes after them.

Heidi Edmundson is the Consultant for Emergency Medicine at Whittington Health NHS Trust. 

Twitter: @heidi_ed

Competing Interests: None declared.

 

Take A Break champions were Nabil George, Richard Crowson, and Robbie Huddlestone

 

The BMJ is calling for doctors to be able to take the breaks that they need for their wellbeing and for patient safety. You can follow our work at https://www.bmj.com/wellbeing and take part in the campaign by sharing your examples of where things are changing for the better or where more work needs to be done through social media using #giveusabreak.