{"id":28258,"date":"2013-08-09T10:33:18","date_gmt":"2013-08-09T09:33:18","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=28258"},"modified":"2013-08-09T10:33:18","modified_gmt":"2013-08-09T09:33:18","slug":"jonny-martell-surviving-burnout","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2013\/08\/09\/jonny-martell-surviving-burnout\/","title":{"rendered":"Jonny Martell: Surviving burnout"},"content":{"rendered":"

\"Jonny Nothing much sprung to mind.\u00a0 A friend had just asked me an odd question, paraphrasing the mystical scholar Andrew Harvey, \u201cwhat breaks your heart the most?\u201d\u00a0 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\u2019s final walk around the house and garden he couldn\u2019t bear to leave.\u00a0 The thought of his hands – devastated by rheumatoid arthritis – tying a knot in the rope to hang himself from the old oak tree.\u00a0 Nearly a year ago and a few weeks into my first job as a doctor, my father took his own life.\u00a0<\/p>\n

I took seven days of compassionate leave.\u00a0 Then I returned to work.\u00a0 But it was only after several months that the daily sense of devastation gave way to a more tolerable sadness, a forever hardening scar.\u00a0 A week was arguably not nearly enough time to properly grieve, whatever that might be.\u00a0 But much more time off and I would have had to drop out.\u00a0 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.\u00a0<\/p>\n

A year on, I can see that several things helped me survive the year.\u00a0 From prior experience, I knew of the potential value of psychotherapy.\u00a0 Given the episodic intrusion of suicidal thoughts, perhaps a death-pull to join my father, it was possibly life-saving.\u00a0 The support I sought and received from loved ones and a few colleagues in-the-know was undoubtedly crucial.\u00a0 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.\u00a0<\/p>\n

More disturbing is the degree to which a narcissistic sense of machismo got me through.\u00a0 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.\u00a0 Apart from the motivation to not lose a year of training before I\u2019d even started, I was already responding to a sense of opportunity to prove my resilience; to myself and colleagues.\u00a0 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\u2019s occupational hazards –\u00a0 burnout, substance abuse, and suicide.\u00a0<\/p>\n

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.<\/p>\n

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.\u00a0 Two trainees at the conference commented:<\/p>\n

“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?<\/p>\n

“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.<\/p>\n

“Burnout is causing doctors to leave the profession or seek work abroad.\u00a0 It is linked to alcoholism and tragically suicide.”<\/p>\n

The clich\u00e9d\u00a0<\/em>truism \u2018prevention is better than cure\u2019 is surely applicable to the problem.\u00a0\u00a0 Some life before medical training was my preventative tonic –\u00a0 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.\u00a0\u00a0 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.\u00a0 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.\u00a0\u00a0<\/p>\n

“Putting patients first\u2019 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.”<\/p>\n

Jonny Martell<\/strong> is an FY2 doctor in Edinburgh<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Nothing much sprung to mind.\u00a0 A friend had just asked me an odd question, paraphrasing the mystical scholar Andrew Harvey, \u201cwhat breaks your heart the most?\u201d\u00a0 Was this an early […]<\/p>\n

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