In Medicine, we learn that life is about marks and doing work for patients. We are not taught to work together nor are we taught of the importance of working together in a collegiate manner. We are not taught to take care of ourselves or to take care of our colleagues. Too often there is open hate and hostility on display between doctors in hospitals and in private practice. Stress and tension run our relationships and very often judgement and condemnation of each other, whether vocalized or hidden, are the order of the day. In this day and age where the mental health of the profession is worse in many regards than that of the general public and suicide rates are higher than the general public, are our relationships with each other important in medicine?
I’ve been in Medicine now for over 20 years. One of the things that I have observed over the years is that our relationships with each other in Medicine are in general sadly not good. We are competitive. We work in isolation as a general rule. We don’t really support each other or ask for support, or allow support when it is on offer. We are the ones who are supposed to be ‘OK’. We learn to work with random people in teams in hospital and we keep the relationships ‘professional’ and consider them short term professional relationships that we have to ‘survive’! They are about work and they are about training. It is rare to develop relationships at work that are truly personal, ones where you feel truly safe where you can share and seek and give support and care that is non-judgmental. As doctors, we don’t let each other in, and we only share certain aspects of ourselves. We place huge expectations on ourselves and each other leaving little to no room for a true care.
In Medicine we learn that you have to be ‘tough to survive’. We learn to toughen up, and to not show any emotion. We pretend that we can ‘handle it all’. If we show that we are not able to ‘handle it’, then we learn that we are seen as defective, as a nuisance, and a problem who is not tough enough to handle it all. Those who are seen as weak in the profession are ostracized, eternally. I to this day remember a woman in my intern year who took a few days off ‘sick leave’ after a long stretch of days working, and was later seen down the street with her husband. She was judged within an inch of her life and complained about by many of the interns and she lost all credibility, forever. No care or concern was given towards her mental health and whether or not she was coping with the job or, whether she needed support. Support?! That thought never even entered our minds! The only focus was to judge her for not coming to work because she was clearly able to walk and to move and had not broken all 4 limbs.
And this is how it is in medicine. If you can breathe at least through one nostril, and stand up – at least on one leg, you must come to work no matter how you are feeling. There is no care and concern for how you are feeling. Mental and emotional health does not rate a mention. In retrospect, this woman was clearly struggling with the work and her life and she did the best thing she knew at the time to best support herself. Looking back, she actually needed our support too! At the time she was judged and condemned as not being committed, as causing a strain on the rest of us who had to ‘pick up the slack’. And this is a common scenario in Medicine, more particularly in bigger institutions where people do not know one another. None of us took the time to consider the bigger picture, or to care for her health and well-being – as none of us took the time to take care of ourselves either. And how often does this happen in medicine when one part of the team is not doing well and the rest of the team instead of coming in to support and care simply judges and gets impatient?
There are many strains and stresses in medicine, but we are our harshest critics, both of ourselves and of each other. We learn from the culture to place high demands and expectations on ourselves. We carry ourselves on expectations of perfection that we should be able to do it all perfectly on our own. That we shouldn’t ask for help or support and that we never ever reveal what we are really feeling to our colleagues. In fact, we are so trained at burying our feelings that we do not even realise ourselves what we are feeling and how we are affected by things!
We learn early in Medicine that any sign of emotion is seen as a sign of ‘weakness’ to such an extent that I know a medical student who in a case based learning scenario shed a few subtle tears as she had been recently bereaved and the case reminded her of her relative who had just died. Rather than being supported and counselled she was taken aside and disciplined and told that she was being unprofessional and that she had to get herself together.
There was much to process about medicine, about human suffering, death, team work or lack thereof and the impact – or lack thereof – our treatments made on people, yet no real scope to have deep and true conversations about these things with people who understood as students and as hospital doctors in training. Medicine was so tough that I recall as an intern at my first resuscitation in the first 2 weeks of my job, the patient died and the medical registrar didn’t spend any time with me to counsel me or support me but just walked off. It was the first death I had experienced and it was not an easy or expected death. Left on my own to write it up, I had to pretend that I was totally fine with the sudden and unexpected death of a man in his 40s. And this is the culture of Medicine. Experience it and suck it up and pretend you felt nothing and move on to the next person. Having a supportive relationship with that senior doctor who I idolised and adored would have made all the difference in that very sensitive moment as a young doctor. Instead, it swiftly inducted me into the culture of insensitivity and emotional shutdown, one where no support was available from colleagues and where you had to fend for yourself. I had more support offered to me from the nurse on duty than my colleague, support which I could not allow myself to accept in full because of ‘doctor’ ‘nurse’ professional barriers!
I’ve now worked in a few different practices for a number of years, and despite the deepest respect that we have for each other, we barely have time to spend with one another. We may pass each other in the corridors and exchange a few words, and from time to time take time out to have a few short chats with one another, but more than that we do not do, yet we share a business together! Is this not strange? We spend more time in each patient consultation than we do with each other in conversation! And this is a common experience in medicine.
All of this leads me to wonder,
How many of us truly know our colleagues?
How many of us truly get to know and care about our colleagues?
And how many of us keep our colleagues at arms-length, saving our personal interactions for when we finally get home to our families, if we have them? And for those of our colleagues who do not have families, do we consider them? Do we consider the colleagues who have a difficult home life and do we know or care?
How many of us know what is going on in the lives of our colleagues and how many of us care? And do we have compassion fatigue feeling that if we spend our day caring for our patients we don’t have any more care left for anyone else….!
Medical practices these days are about being in our own patient cubicles. We may work with other doctors, nurses and administration, but most of us focus on our role, keeping our head down, occupying our treatment/consultation room, dealing with patients and ducking in and out of the practice as quickly as possible. I think it is uncommon for us to take the time to truly get to know and appreciate the people in our working sphere. We tend to keep ourselves a bit separate from them, only showing ourselves in a ‘professional’ capacity. Yet these are the very people who we spend more time with than anyone else!
We learn and are trained to operate as lone wolves. But is this ‘lone wolf’ quality adversely affecting our health and well-being? (I note here that actual wolves operate very well as a group together 😉 )
In Medicine and as doctors, we have been so trained to make relationships ‘professional’ and about ‘job quality’.
If we were to build truly caring and personal relationships in medicine, might it alter the stresses that we feel in the job?
Could we collectively learn better from each other through support and encouragement rather than judgment and critique?
Let’s face it. Medicine is stressful. There are many emotional demands of the job. Much of the skills that we need we are not taught, and we learn as we go. We learn about the business aspect, we learn about the personal aspects and we are constantly learning about illness and disease and its new and varying presentations. There is much that we do not know! And of course there are the medico legal and regulatory aspects that are also stressful.
It can be a hostile, intense world and our colleagues are the very people who are in the same world as we are. Who better to be able to offer insight and support than the very people who are in the same playing field as us! And who more situated to contribute to greater stress than our colleagues and ourselves to other colleagues through hostile relationships…
Given that we spend most of our time at work with patients, staff and colleagues, could it be possible that some of the stress contributing to our stress and ill health is the poor quality of relationships that we have with one another?
Burnout rates in Medicine are 40-55%. We have higher stress levels, anxiety and high psychological distress than the general population. We have higher rates of suicide than the general public and higher rates of suicidal ideation than the general public. It is clear that support is needed.
We all know that absent support, feeling unsupported and the presence of hostility are big contributors to stress and tension in life.
If we were to take the time to develop more meaningful and caring relationships with one another and take the time to be more truly supportive of ourselves and one another, could this possibly improve our personal and professional well-being?
Could supportive relationships be the very prescription that our profession needs?