Juggling Fire Daily
I remember a few years back reading an article from Amandip Sidhu who lost his brother Jagdip, to suicide.
For me, the blog brought memories of my own struggles with mental health as a doctor. I remember working as a junior doctor and on one particular rotation I ‘fell out of love’ with medicine. For the senior doctors on the team it was if I didn’t matter or exist: I was just the ward junior doctor who needed to get the paperwork done. Everyday, I was overwhelmed, unsupported and went home feeling tearful, hopeless and the ready to quit the profession I had been so looking forward to join for so many years. Five years on, I felt a moral urgency to reply to Amandip’s article to explain how the system for selecting doctors lauds traits such as delayed gratification and putting patients before their own health, can be harmful to doctors. I called this the Superhero Complex and once the blog was published, that was that.
A few months passed by when Amandip contacted me as he set up his charity, Doctors in Distress. He had collected 721 responses to his survey circulated by the Doctors’ Association UK identifying the reasons behind the mental health crisis faced by doctors up and down the country. We met to discuss this a few weeks’ before Christmas 2019 to discuss the survey findings and whether results could be published in a peer review paper. I had never analysed data from words before (qualitative data) so I needed help and got the views of some great colleagues, Dr Nina Fudge and Dr Anna Dowrick. I spent much of Christmas 2019 looking at data printouts of the horrifying accounts of poor mental health and working conditions from doctors working up and down the country. It was definitely worth it as the writing was on the wall: the working conditions of NHS doctors was not good enough both for the doctors themselves and their patients.
The data found of the 721 doctors asked, 40% were GPs and 94% worked in the NHS:
One in two (53%) respondents felt unable to raise concerns in the workplace regarding wellbeing and stress or workload: many of those who indicated they were able to raise concerns stated that they felt no solutions would be implemented.
The overwhelming majority (97%, n=695) of respondents felt the NHS has a culture of viewing excessive stress and workload as the norm.
“Doctors are constantly being told to work longer, harder, do more, be more resilient when it is the system that is actually broken” (Participant 604, GP)
“Expected to deal with traumatic events and second-hand trauma from patients’ difficult lives without it affecting us.” (Participant 367, Palliative Care Staff grade doctor)
“The NHS only runs today on the goodwill of its staff. Every member of staff works copious hours above those paid through a duty of care and compassion for patients, but nobody extends that duty of care and compassion to the staff.” (Participant 38, GP)
“I think all clinical staff are struggling with workload…there is an unwillingness on the part of management to acknowledge there is a problem on the ground, so to me there is no point in raising concerns as I do not believe it would be listened to.” (Participant 437, Locum junior doctor in acute internal medicine)
“We can all see that everyone is under considerable stress and no-one can see any way out. We need 2–3 times as many doctors…we are often having to deal with the patient in front of us, at the same time as a trainee and a physician associate messaging for advice, a receptionist knocking on the door re a prescription query or an angry patient in reception, someone calling on the phone, red flagged tasks and letters building up during clinic (which you know won’t be dealt with till after 10pm). It is like juggling fire daily.” (Participant 491, GP)
“Things which are compulsory, such as keeping up to date with mandatory training modules, doing compulsory audits as part of training etc do not have any time allocated for them to be done, so they have to be done in ‘free time’. In other careers if the company expects you to do an audit you would be allocated work time to do it.” (Participant 27, Cardiology registrar)
I asked one of the medical students, Cathy Dominic, to assist me on the project with a view to present the work at an international conference in April 2020. The pandemic struck and the conference was postponed and only presented this year in April 2021. As well as this, much of the work on the journal manuscript had to pushed back due to the pandemic but I am pleased to report that the manuscript was published this week in the journal WORK: A Journal of Prevention, Assessment & Rehabilitation.
At the moment much of the changes that help support doctors and NHS healthcare staff are based around improving personal resilience such as via yoga or mindfulness rather than targeting the root causes of high workloads, understaffing, problematic culture and excessive bureaucracy. A systematic review found that upstream interventions, such as organisation change, were 16% more effective than downstream interventions, such as at individual level, at preventing physician burnout.
The NHS and social care sector are in dire need of investment and resourcing that goes beyond clapping if we are to prevent an exodus of staff after the pandemic.
If you reading this and are struggling please do not be afraid to reach out:
Anxiety UK — UK charity aiming to promote the relief and rehabilitation of people suffering with anxiety disorders through information and provision of self-help services.
BMA Wellbeing Support — The BMA runs a dedicated 24 hour support line staffed by professional counsellors as well as a peer support service.
Cavell Nurses Trust — Trust helping nurses, midwives and healthcare assistants, both working and retired, when they’re suffering personal or financial hardship. They offer specific financial support for Nurses who are struggling with Long Covid.
Depression Alliance — UK charity for people affected by depression, offering help to people with depression, run by people with personal experience of depression themselves.
DocHealth — A specialist paid-for psychotherapeutic service for doctors supported by the BMA and the Royal Medical Benevolent Fund. Self-referring doctors can access up to six face to face sessions with the service and further care can be advised. All doctors in the UK are able to self-refer to this service.
Frontline 19 — Free and confidential psychological support service for people working in frontline services in the UK.
FutureLearn — Psychology and mental health course to provide learners with vital skills, research and training for their professional development.
MIND — A mental health charity in England and Wales, working to create a better life for everyone with experience of mental distress.
Practitioner Health — Established in 2008, the Practitioner Health Programme supports practitioners with mental or physical health problems including; addiction, particularly if these affect their work. A dedicated 24 hour text crisis support is available to all doctors in England.
Papyrus — Working to prevent youth suicide — for people under 35.
Psychiatrists Support Service, Royal College of Psychiatrists — A confidential support and advice telephone helpline for Members or Associates of the College.
Royal College of Surgeons Confidential Support and Advice for Surgeons (CSAS) — Offers a confidential telephone line as a point of personal contact between surgeons, which is intended to offer a listening ear and will act as an informed signpost to appropriate sources of advice and support.
Samaritans — For everyone and anyone, whether you’re having a difficult time yourself or are worried about someone else.
Sick Doctors Trust — Provides early intervention and treatment for doctors suffering from addiction to alcohol or other drugs.
Suicide Bereaved Community — Offers support to and from a community of people who have suffered bereavement by suicide, by providing opportunities for social get-togethers and for networking, both online and in person.
The Cameron Fund — The GPs’ own charity. It is the only medical benevolent fund solely supports general practitioners and their dependants. We provide support to GPs and their families in times of financial need, whether through ill-health, death or loss of employment. We help those who are already suffering from financial hardship and those who are facing it.
The Couch (doctors.net) — You need to register with doctors.net but this ensures that only genuine UK doctors can gain access. There is a forum “The Couch” for mutual support and advice, plus the option of anonymous posting for delicate issues. The Couch also carries a long list of doctors around the UK who are happy to help others who are in distress.
The Tea & Empathy Group — Is an open Facebook group for health professionals to provide informal peer support to each other.
