the dark side of being a doctor Part 1

Introduction:

Depends on what you define as “dark side”. If you’re a doctor or nurse, a lot of what follows may resonate very strongly with you. If you’re

not a person working in hospitals and around patients is any way, shape or form, I am not sure how this post would make you feel about healthcare workers in general.

 

Heavy Workplace Realities

This would be a very honest description of the life of an average doctor in the NHS who is expected to be working all the time and looking after a large number of patients that would make him or her feel very unsafe. This modern doctor would be on his or her feet from the moment of stepping into the ward, spending the next 3 to 4 hours on ward rounds, taking histories, checking test/radiology results, examining new patients, re examining previously admitted patients, making new referrals to other specialist doctors and/or nurses, chasing old referrals and patients’ case records, facing nurses who cannot or will not do their own duties and expect you to do their jobs for them, answering questions and queries from patients and their families, try to keep up with your appraisals, CPD requirements and revalidation while being overworked and not having time for yourself to go to the toilet and eat or drink something.

This list is not exhaustive. Many senior doctors and consultants have it worse. They have to undertake morning rounds for the first half of their working day, then keep running from ward to ward to see patient on their outlier referral lists. On top of this, specialist consultants and senior registrars are expected to complete their lists of procedures such as endoscopies, bronchoscopies, angioplasties, colonoscopies, drains, surgeries, ERCPs etc. A senior doctor has to do all of this on an average working day and is expected to maintain complete records of patients daily progress or deterioration and record details of invasive procedures to keep themselves legally safe and clinically competent. Consultants and senior registrars are always going home late on a nearly daily basis in the NHS due to the aforementioned reasons. Would they have the time and energy to give attention to their partners and children after all of this?

Is it surprising after all of the above to learn that doctors suffer very high rates of depression, divorce, substance abuse problems and suicides compared to other working groups in the same age bracket?

Workplace Predators

To make matters worse, your senior colleagues (registrars, consultants and nurses) would make your life hell by criticizing and/or humiliating you before patients and their attendants. They would expect you to take care of the jobs of many patients on the ward by yourself. Expect yourself having to deal with the workload of 2 to 3 doctors while being paid only your salary. During night shifts, you would find yourself alone as a junior doctor, expected to make decisions of unstable patients while accepting the liabilities that come with it. If I was told about the brotherhood and camaraderie of doctors, I have yet to see it in real life. Everyone is for himself or herself, period.

Senior doctors are supposed to be there to provide mentorship. They are in a position of power to make or break your career. With great power comes great responsibility and unfortunately in some instances, abuse of authority.

My first job in Medicine in the NHS was with a foreign origin consultant who was always short tempered and impossible to approach. The workload on the ward was always heavy and relentless. The nurses and ward managers wanted all discharge summaries to be ready before lunchtime. The nurses were never interested in passing canulas, claiming they had zero experience and training. Seriously? What do they actually teach in UK nursing schools? Only staff room politics, verbal slandering, character assassinations and deflecting blame and criticisms?

A Royal College of Physicians article here  and open BMJ  career article here for the same study gives a good idea of the prevalence of aggressive communication among doctors in the NHS. A survey of 606 doctors employed in three UK hospitals revealed around a third of these doctors had experienced “rude, dismissive, or aggressive communication several times in a week”. 

If you’re headed to Australia as an IMG to work as a doctor, it’s important to understand being in Australia will not be a protection against experiencing harassment and abuse of power in hospital practice. In the video below, Dr Tan was targeted by her consultant supervisor for an illegal sexual favor in the workplace. She refused and exposed this man for his unethical behavior. Instead of receiving support, she was put under trial by the system for being the problem rather than the victim. In the end, she was awarded damages by the concerned hospital. But the bad news is that she has effectively been blacklisted to work and train in public hospitals in Australia. Another Australian doctor who quit a career in surgery had to endure abuse from a registrar until the abuser was himself abused by a consultant after an incident in the operating theater. A neurosurgery registrar was also subjected to workplace abuse by her consultant. An interesting comment from the GP in the video below was how he felt being in the army with rigid and unspoken rules and regulations. If you have the strength to watch, the video is below:

Another video on youtube showed a particularly dark side of being in Medicine: bullying and harassment from your seniors. I had experienced this first hand in the NHS, nearly all of these at the hands of foreign origin NHS consultants. Just to make everyone aware that this is not out of personal or racial bias, I am a foreign born and origin IMG in the UK. I have no reason to speak negatively against anyone until and unless I have had a negative experience. This young doctor in South Africa dropped out of clinical Medicine after her unfortunate workplace experience. Her appeals for help and justice were rebuffed by her seniors. She used the words “institutional coercion” and “systematic culture of abuse”, which exactly describes what I have experienced at the hands of my NHS seniors in the UK and back home in Asia. It strikes me that Yumna says a health official was thinking of removing the feedback process for interns to prevent the stories of abuse from spreading. She was expected to set aside internship logbook and accept her bad experiences as “acts of God” and “God works in mysterious and wonderful ways”. I wonder if the senior clinician who gave Yumna this advice after being an “old man in this game for a long time” would have given the same advice across the dining table to his child? It’s easy to tell someone to move on after a harrowing experience if they are not your child. What would make it the same or different if it was your own child who had suffered? Yumna aptly describes a medical career as a “military hierarchy” where you only take orders without the right to raise questions and concerns. This is the second time I have heard a reference to the military with respect to a career in Medicine. Kindness, mercy and honesty are rare to experience in this military camp. Anyway, why don’t you hear what Yumna has to say. Till next time, take care of yourselves, and each other!

Sources:

  1. Sticks and stones: investigating rude, dismissive and aggressive communication between doctors: http://www.clinmed.rcpjournal.org/content/15/6/541 , http://www.clinmed.rcpjournal.org/content/15/6/541.full.pdf+html
  2. A third of doctors experience rude, dismissive, or aggressive communication from colleagues: BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i30 (Published 04 January 2016)Cite this as: BMJ 2016;352:i30
admin Written by:

An IMG doctor- lost in this tightly restrictive world of shrinking opportunities in Medicine and closed labour markets for medical graduates. I am against the bullying and harassment of all doctors. I believe society, parents and politicians are not telling the truth about the realities of medical practice and education to teenagers.

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