The Blog

Black Wednesday: When Doctors Are as Vulnerable as Their Patients

Black Wednesday is upon us. This Wednesday, there will be thousands of newly qualified doctors and junior doctors rotating commencing and rotating posts coupled with a general summer holiday exodus for most senior healthcare professionals.

Black Wednesday is upon us.

This Wednesday, there will be thousands of newly qualified doctors and junior doctors rotating commencing and rotating posts coupled with a general summer holiday exodus for most senior healthcare professionals.

This day has been reported to be linked to an increase in death rates by up to 6%; reasons for this remain unclear and are still under speculation.

The main difference this year is that we lie in the wake of a junior doctor contract imposition and declaration from thousands of junior doctors that they are planning to leave the country and/or profession.

My first day as a junior doctor

I remember my first day in post during my early years as a junior doctor. I was put on the on call rota at a busy district general hospital, Familiarising myself with the hospital layout, let alone the protocols, patients, computer systems and staff members was beyond overwhelming, hence consequently I made a near fatal mistake on interpreting an investigation for a patient.

The patient thankfully survived, however I was left with unremitting guilt and despair that this was a sign that I clearly wasn't meant to be a doctor. There was an inordinate amount of blame placed upon me by some senior staff members, however others were relatively supportive.

Yet nobody admitted that placing a junior on call in a new hospital on their first day may have been a poorly thought out idea.

Nor did I have the courage to speak out accordingly.

Looking after yourself - because nobody else will

Reflecting on this incident and the current workplace culture, I realised that with all the preparation you're given in medical school to be geared up as a safe doctor, there's one key element that's missing;

How to look after yourself at work.

When I say 'look after yourself' - most of this is central on communication with colleagues, self-awareness and preventing & recognising burnout.

This would feature points like "how to say 'no'", taking actual breaks, standing up for yourself, engaging in difficult discussions with your seniors, sticking to your core values and being 100% non-tolerant to abuse at work in whichever shape or form.

Switching off from work and enjoying a fulfilling life outside work is another important and usually under-recognised factor.

Working as a healthcare professional can be extremely rewarding, however a great deal of psychological and physical preparation is essential to survive the challenges of 21st century healthcare delivery.

12 hour night and day shifts, managing hundreds of patients & their relatives, working in a complex and hierarchical hospital environment where you risk your health at the expense of others - is enough to turn any prospective candidate away.

The politics of staff health and wellbeing

Junior doctors are one of the most vulnerable staff group when it comes to wellbeing.

Last year junior doctors finally welcomed a high media profile thanks to Jeremy Hunt and the Junior Doctors Contract negotiations; however the reality is that these events were simply adding extra fuel to an already slow burning fire of low morale.

Low morale perpetuated by extensive hours in critical life/death scenarios, colleagues projecting signs and symptoms of stress, feeling undervalued, loss of contact with self-identity and simply not knowing who to talk to about it and what to say, out of fear that this may threaten their livelihood if they exhibit any signs of weakness.

Earlier this year, a plan for an independent investigation into low morale amongst the junior doctor workforce was later cancelled on announcement of the junior doctor contract agreement.

A political move at best, perhaps based on assumptions that a completed contract would somehow sort out doctors' wellbeing.

To the contrary - there was nothing in the contract that directly addressed wellbeing, leaving this to the responsibility of NHS trusts.

NHS trusts themselves are struggling to address this problem.

Until the recent Five Year Forward View and the realisation that staff morale and patient care are linked, staff wellbeing has ranked relatively low on most trusts' agenda. Despite NHS England's attempt to boost staff health by providing financial incentives for trusts to improve the health of staff, the topic of health and wellbeing at work remains suspiciously absent from most NHS trust staff inductions.

I recently gave a talk to junior doctors on staying healthy at work - scheduled 8 months into their post when the vast majority declared that they had already made up their minds about leaving medicine.

Plea to doctors on the front line

Hence my plea for all my doctor colleagues starting new posts is to identify and utilise their support networks pre-emptively.

Familiarise with the signs of burnout and depression in the event that you or any of your colleagues experience it, and remember that if you feel that this type of clinical practice is not for you, it's my duty to let you know that there is way #moretomedicine than you realise.