I have a disgusting cold that has kept me away from work for the past few days. Maybe it’s the season, maybe I am exhausted and rundown. I am actually doing the public a service by staying at home an quarantining myself until I get better (I am trying not to think about the two clinics that i have not been able to to because I have not been at work).  I was flicking through the BMJ this morning, something I have not done in years, because I never have time to do this. I read two interesting articles. An editorial on Burnout and an interview with Dr Laurie Tomlinson a nephrologist in Birmingham. Both articles made me reflect on my current working life as a doctor. 


Dr Tomlinson is an accomplished woman working as a consultant nephrologist in Brighton and associate professor at the London School of Tropical medicine. She took the brave step of leaving her training post in Cambridge and pursuing the academic career that she wanted. She was successful and I found that inspirational. I was however upset by the answer to the last question she was asked “If you weren’t in your present position what would you be doing instead ?” Her answer hit a painful cord with me I’d be an utterly miserable and flailing full-time NHS consultant

I thought to myself “that’s me!” I’m a full time NHS consultant and I am currently miserable and struggling with my high workload. At the same time that my bosses are telling me that they want to increase my workload and potentially decrease the time available for me to manage my workload. It is now wonder that I am buckling.


At the moment Sunday evenings full me with dread, not unlike that which I used to experince when going to school and I was ploughing through my GCSEs and ‘A’Ievels. I now no longer look forward to going to work. That is a monumentally terrible thing. I’ve always wanted to be a doctor. I don’t know how to be anything else. I spent six years at medical school. I spent 11 years training as a junior doctor and I have been a consultant for just under eight years. That’s 25 years in the medical world. I’m 43 this year, that’s all of my adult life, that’s over half my life. I’ve known nothing else. I now think I have come to the stage of almost complete burnout. I’m mentally and physically exhausted. The amount of work that I have to do, in the time available, for me, is just not sustainable. 


I changed jobs two years ago, thinking that a fresh start and new beginning might help things. I hoped that I might be able to shed what I felt were my own very dysfunctional and entrenched working habits. Alas, I might have changed locations  but the NHS is the same everywhere with demand outstripping capacity in all areas. In order to get things done I still found myself found myself starting to come in early and leave late, or see extra patients in clinic. The only think I have stopped doing is writing work and sending work emails at night and in the evenings. It just does not seem to be a thing that my colleagues in my Trust do. However, I do find that I am still occasionally up late writing long emails but I will not press send until a socially acceptable time (i.e. just before I leave the house for my long commute to work). 


On my last working day this week, I arrived at work at seven in the morning, to sit down and dictate the two child protection neglect medicals for children I had seen on Friday. On the Friday before I had already stayed back to carefully write up the paper records, update the electronic records, think about my conclusions and recommendations, check that all the information I needed was present to enable me for dictate the report. So on Monday morning I was able to dictate both reports with ease. They were typed the same day by my secretary and I am a managed to edit and correct them before I crawled out of the office with a streaming cold that had developed and worsened over the course of the day. It is unusual that that would happen, the report writing not the development of the cold, but I was ‘fortunate’ enough to have two patients not arrive for my morning clinic. This gave me time to finish all the work for the morning clinic (dictating letters for the patient that did attend, calling and writing to the ones that did not) and try and tackle my clinic report backlog. I will not tell you how many clinic letters I have to dictate and sign off. It is depressing. But I send a silent cheer to the universe wheneverI complete a report. The highlight of my day is when place a small red cross in the Excel spreadsheet of my list of jobs to do. Very sad, who’d have thought it would have come to this.

When I got home, aching and tired, sneezing with a runny nose, it was clear that I was not going to make it back to work for my next shift and clinic.
Sitting at home now for the past few days, I have had he headspace to process the idea that for a long time that I have been running on empty and now I have come to a slow screeching halt.

It was interesting to me that on the day I am home sick in bed I am reading an editorial on Burnout. I learnt a few new things.  The term is reported to have originated  in the early 1970’s by Jewish-German psychologist Herbert Freudenberger. He defined it as “state of mental and physical exhaustion caused by one’s professional life”. It is something that  is really associated which those in the caring professionals which can be emotionally demanding, however is something that had been described in the aviation industry. United States air traffic controllers were reporting “vocational burnout “ a form of exhaustion , which is manifest in a decline in quantity and quality of work production. 
I’m not sure I read any ground breaking solutions except acknowledging that there is evidence that effective interventions for reducing burnout needs to come from both organisational and individual levels. There was an acknowledgment that medical practice is changing because of the increasing demand and complexity but which has not balanced with adequate resources to cope with this need.  We might also adapt the experience of professionals in the aviation industry who provide stress management programmes for critical incidents including preventive education teaching and training on normal reactions to chronic and acute work stress (cognitive, emotional, physical, and behavioural reactions). The author rightly states that we need to rethink how we work, factoring the human element to practising medicine with it’s inherent limitations and more importantly this should be embedded into system wide training and support. 


So I’m lying in my ‘sickbed’ now thinking about how I am going to cope when I eventually return to work. How is it going to be different?

References:

  1. https://www.bmj.com/content/364/bmj.k5345
  2. Samra, Rajvinder (2018). Brief history of burnout. BMJ, 363, article no. K5268 http://oro.open.ac.uk/58472/9/58472VOR.pdf

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