You’re a keen, first-year medical student. Today, you’re practising breaking bad news to patients – actors of course, but boy does it feel like the real deal. Before you begin, the whole room stops. You all close your eyes, and practice mindfulness – just for three minutes – but as you return to the room, you find you’re truly present and ready to take on this consult. You each have your turn breaking bad news. You have to tell a father that his six year old daughter has died. You fumble through the conversation. You almost cry with him. You collect your things and leave, once all your colleagues have had a turn, but you return to that workshop later that evening through your reflective journal. What did you learn about this skill? More importantly, what did you learn about yourself? And how, when you’re faced with this in future, are you going to do better, or differently?
Medical school equipped me with a skill set in addition to that of clinical medicine. The extras included how to manage difficult relationships in the workplace, dealing with emotionally challenging experiences, how to be vigilant of my own health and wellbeing, and simple practices I can employ throughout my practice and life to make myself the best doctor I can be. These skills were reinforced in my intern education sessions and at multiple conferences. I’m now a junior doctor – an occasionally very stressed, often very busy, and at times burnt-out junior doctor.
We know doctors have high rates of emotional distress and mental health issues. But our conversation around this is fixated around teaching more personal resilience skills at medical school. I’ve been taught these skills, and many medical schools have a similar emphasis to mine. Why, then, does this continue to be the centre of our conversation on doctors’ wellbeing? Yes, we should continue to pressure medical schools, teaching hospitals and training colleges into fostering these skills in their trainees. But we urgently need to broaden the conversation.
Junior doctors are often put in positions where we are stretched to our limits both personally and professionally, with immense workloads, long hours, having to adapt to a new department, system or even hospital every five to ten weeks. On top of this, we need to remain competitive and employable by doing research, extra degrees and study for training programs. We exhaust all our energies and wellbeing strategies managing these challenges, leaving us with little to give when faced with a difficult case, complex scenario, or personal challenge.
The daisy in the desert
A daisy won’t grow in a desert. We’ve made enormous strides in teaching doctors resilience: now need to broaden our focus to the system itself. We work in an environment where the bar is set close to perfection. We rarely forgive ourselves for our mistakes. We work ourselves harder than we could have imagined, to ensure the very best for our patients. We work unpaid overtime, we skip meal breaks. Honestly, there are days when I wonder if my own creatinine isn’t higher than my patients’.
So let’s do some primary prevention. Let’s work on the things further upstream that affect our wellbeing. Perhaps we need to start with the simple things: making sure we take a lunch break. Or even just a water break, so we’re not so dehydrated we don’t even need to go to the bathroom. We need supportive and positive feedback, not only highlighting what could have been done better. We need leaders who encourage and support us in these endeavours. Find the issues causing your colleagues to burn out, and find a way to create change. We need to look at the bigger picture and see how we can alter the desert, not the daisy.
This conversational shift comes with a risk. Let’s go back to some high school physics – bear with me, I promise it’s worth it. Force = pressure x area. We’ve been focussing on one part of the conversation – a small area. So a little bit of pressure, and we get a reasonable force. If we broaden the conversation without the extra pressure, we risk reducing our impact. The challenge is to not get lost in the vastness of this problem – find the next, impactful step and take it, and remember the endpoint. The goal should not be more resilient doctors. It should be doctors working in environments that allow and encourage them to be healthier, happier people. That allow us to use our resilience skills to tackle challenging scenarios, not the everyday.
With all this in mind, my challenge to you is this. Find one small change to make, that will make you happier and healthier at the end of the day. Find it, and make it happen. Let’s share our simple step with a colleague from a different practice or hospital, find what they have changed and swap ideas. Let’s encourage leaders to support this, and advocate for changes that need to occur. Let’s create a subtle creep of wellbeing that isn’t taught in a lecture theatre. And then, let’s tackle the desert.
Dr Nicola Campbell is a resident medical officer currently working in regional Queensland. She studied medicine at Griffith University and aspires to be a rural GP with an advanced skill in mental health.
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