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Also Human: Caroline Elton on Five Ways to Change the Medical Profession

Posted on 19th February 2019 by Martha Greengrass

As a psychologist who has spent her career working with doctors, Caroline Elton has seen first-hand the psychological toll of working under near constant pressure in a health system stretched to breaking point. Her book, Also Human, is a challenging and humane new examination of a profession on the frontline of human trauma. Here, exclusively for Waterstones, she considers five ways we should be supporting our doctors and changing the medical profession.

Doctors are the people we turn to when we fall ill. They are the people we trust with our lives, and with the lives of those we love. But all is far from well with the medical profession. A recent survey in the UK found that a quarter of doctors in training felt that their work seriously impacted on their mental health. This matters for the doctors themselves but also for the patients they treat. A consistent finding from other studies is that depressed doctors make significantly more mistakes. 

So what can we do to better support our doctors? 

1. Lobby for a better funded system. 

The same study that reported the negative impact of medical work on doctors’ mental health also found that nearly 60% worked beyond their rostered hours each week, 70% worked on a rota that was permanently under-staffed and at least four times per month they completed a full 13 hour day or night shift without having a break to eat. Unsurprisingly, all of this takes a toll on doctors’ well-being. 

Of the G7 nations only Italy spends less of their GDP on health than the UK; the NHS is stretched to breaking point. As Martin Wolf, chief economics commentator of the Financial Times argued in February, we’ve moved beyond a point where efficiencies can make a significant difference – if we want better healthcare, then the government needs to spend more. It’s as simple as that. 

2 Acknowledge the psychological costs of care

But whilst under-funding of the NHS is a crucial issue – it’s also not the whole story. Medical work – indeed any role where one is supporting people who are suffering – is psychologically demanding. There’s no way round this because surrounding oneself with people in distress inevitably reminds us of difficult things that have happened in the past as well as what could happen to us or those we love in the future. The potential for medical work to be psychologically unsettling needs to be acknowledged from the outset.

As an example, I once saw a doctor who within weeks of starting training as an oncologist (the specialism that treats patients suffering from cancer) crashed her car twice in a desperate rush to leave the hospital at the end of her shift. In our sessions it emerged that her father had died of cancer when she was young, and also that the only time she had fainted at medical school was when she encountered a middle aged man, bald from chemo, who reminded her of her father. Eventually she realised that oncology for her was like ‘scratching open a wound’ and she changed specialty. But she might have been spared a lot of misery if she had been taught to be curious about her atypical fainting in medical school, and started to think seriously about patient groups that she might find too upsetting to treat. 

3. Manage transitions more effectively

Any transition in our lives (marriage, parenthood, divorce, career change, retirement) has the potential to be psychologically unsettling. Medical training, however, is an endless succession of transitions. Postgraduate training after leaving medical school can take over ten years in some specialties. That’s ten years of moving around to a new job every six months or year – often with little advance notice as to where one will be working. New colleagues, new ways of working, new organisations to slot into with scarce attention given to a comprehensive induction into the new role. 

Currently help for doctors with managing these transitions -  particularly if they have a young family, or other caring responsibilities – is woefully inadequate. Little wonder then that some doctors with young families give up, wasting years of training (and significant amounts of NHS funds) defeated by what has come to feel like a never-ending series of hurdles.  Little wonder too, that hospital mortality increases in the week after the August change-over of jobs, as poorly managed transitions compromise clinical care. 

4. Tackle Racism

Doctors are not hermits, cut off from the wider world so the racism that occurs in society as a whole also infects the medical profession. But as being on the receiving end of racism corrodes one’s self-confidence, the effects of racism may be particularly pernicious in medicine given the enormous responsibility that we require our doctors to shoulder. 

Ridding the profession of racism is an enormous task – but at least the GMC has taken the important step of acknowledging that there is a problem. And the GMC also realises that the first task is to collect, analyse and publish a range of outcome data. This is in stark contrast to the US where the national organisation responsible for matching 30,000 medical students each year to their first job as a doctor doesn’t collect any data whatsoever on gender or ethnicity. The ostrich approach to managing diversity. 

5. Avoid quick-fix solutions

Imagine for a moment if the emotional well-being of the medical workforce (and the healthcare workforce more generally) was accorded the same priority as the control of infection. Rightly, infection control is attended to at each level of clinical activity – the individual doctor, the practice within clinical teams, hospital policies and even regional and national plans for controlling the spread of disease. 

We don’t manage infection control in a hospital by putting up a sign saying ‘now wash your hands’ in the toilets – and leaving it at that. Yet attempts to improve staff well-being are often crudely simplistic (putting up-beat posters on the wall) rather than looking at what is happening to individuals, within teams, and to the culture of the organisation as a whole. 

It’s time now to have greater parity between the infective and the affective, and give the emotional well-being of those who care for us the attention it deserves. 

If we don’t, both doctors and the patients they treat, will continue to suffer. 

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