The Silence of the Profession

Many of us in Australia will remember an ad for toothpaste in the 1990s where a man (with a great toned and tanned upper torso mind you) has his back to us whilst he is facing the mirror brushing his teeth. We are told they can’t show us his face, because he is a dentist. Apart from learning about this particular brand of toothpaste (?!) we learn from this that medical professionals are not allowed to be seen in public.

For me this is a great adage of the medical profession where there is some strange notion that we should be neither seen nor heard, and this extends to many in the profession who feel constrained to be seen as a person in public, or to have and voice their opinion in public for fear of being hauled before the medical board, or having their reputation as a doctor undermined or destroyed.

Many doctors will not be on social media, have blog sites or websites, and do not want to have themselves in the public eye, lest something ‘go wrong’ and their reputations be destroyed.

But lets consider this.

Does this even make sense?

Why is it that we would feel that being seen as the person that we are would possibly get in the way of people respecting us professionally. And why do we seek so much to separate the two? Are we really such a Jekkyl and Hyde? Are we one person at work and then some strange demonic being in our private lives that we would not want anyone to know about? Surely not… Continue reading

Doctor, who do you think you are?!

Are we the ‘role’ of ‘doctor’? Are we ‘the white coat’? Are we the ‘caring physician’, the ‘selfless physician’, the ‘exhausted surgeon’, the ‘busy GP’, the ‘doctor who can’t go on’? or is there something more to us than the world sees or trains us to be?

Now that’s a question that’s not in our final medical school exams, or our specialist exams! That’s not one that our patients ask of us either.

But actually, why not? Is not who we are within the foundation of everything that we do? Is not that our humanity, which is utterly vital when working in a caring profession that has care for humanity and connection with people at its heart.

And if we don’t know who we are at the end of our training, then what purpose has our training served us in truth, and the people that we serve? Continue reading

Sensitivity in Medicine – Really?

In medicine we are trained that we need to be tough, hard, strong, and the latest buzz word to come from the NHS – ‘resilient’. ie no matter what comes at us, we need to be tough and hard enough to handle it. Well, we all know how well that works out in the army! Post Traumatic Stress Disorder abounds…

Besides, should we really be treating health care like a battle zone? Come on. Lets get serious here.

Resilience and toughness builds barriers between people. It creates hardness, coldness, efficaciousness, and distance between people. There is no care in resilience, nor love in hardness or toughness.

Perhaps toughness is required for the battlefield where truly awful things are seen and done to other people, but health care is about people; specifically, the profession has the word ‘care’ in it…..

How can we care for others when we are hard, tough, strong and have created protective barriers between us and others? Continue reading

Are you a doctor, or a person?

In medicine we get taught how to be a medical student, how to dress and how to act, and then we get taught how to be a ‘doctor’, how to talk, dress and act. Most of us go through life thinking of ourselves as being either a ‘medical student’ or then ‘a doctor’ and these roles become so ingrained as part of ‘who we are’ that we are unable to separate ourselves from it.

In my twenties, I remember going out and meeting people, not wanting them to know I was a ‘doctor’ (especially the guys, in case they felt intimidated and ran away… *doh* !!) but then being unable to talk to them as me anyway – even though I was being ‘social’, I was always in that ‘doctor’ mode of question and answer and efficient interrogation with the provision of answers and solutions! It’s how we’re trained to communicate! It was agonising! Nothing I could do could get rid of that way of being with people, it was so ingrained, and then it became so ingrained, that I didn’t even realise I was in ‘doctoring mode’ the whole time… and I know that I am not alone in this as I have seen it everywhere in medicine!

We’re so ingrained to think of ourselves as ‘doctors’ and we spend so many long and ridiculously long hours trying to ‘become’ a ‘doctor’ and then to become not just a doctor, but a ‘specialist doctor’. We are referred to as ‘doctors’ everywhere we go, from census forms, hotel bookings to drivers licenses and bookings for flights. ‘Doctor’ is our title that precedes us, everywhere that we go, but:

Do we ever stop to consider that we are people, the lovely man or woman that we are, and not ‘doctors’?

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Medicine is health care. Why aren’t doctors healthy?

I went to a meeting this week and there was a room full of perhaps 100-120 doctors from various different specialties. I looked around the room, and not one person looked well and healthy – apart from myself and the drug rep sitting next to me. Most people looked, grey, tired, withdrawn, inwards, uncomfortable speaking to people, unable to speak without being in ‘doctor’ mode. Nobody looked truly alive, vital, or well, and this is reflective of my more general experience in medicine, where I was shocked and horrified and alarmed at both the state of physical health and well-being of my training doctors as well as their emotional health and well-being.

Over the last 25 years, it has been the rare few who to me appeared to be truly well, joyful and vital. Most of them in my training, were either angry, cynical, withdrawn, stressed out, depressed, anxious, grey, tired unhappy and unhealthy and not coping but doing their best to survive – or any of the above combination! I was terrified that I was going to end up like them.

I have also watched many of the lovely people I have trained with become tired, drawn out and grey over the last 10 years, losing the joy and zest for life they had 10 years earlier.

We are not a healthy group of people.

We know that it is reported that the rates of burnout in the medical profession are nearly 50% with burnout rates being 65% in some specialties. These rates are far higher than any other professional group and the general population.

In my opinion, those rates are likely to be even higher in reality.

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Why don’t we talk about burnout in medicine?

With recorded rates of burnout up to 85% in medical students, nearly 50% in qualified doctors overall, and burnout rates reported to be up to 65% in some specialties our profession is in crisis. We cannot truly serve ill people if we ourselves are ill, and the doctors that are not burnt out are not necessarily truly well either.

In medicine diagnoses are based on laboratory tests. There is this notion that if there is a test for it, it must be real, and if there is nothing showing on a test then somehow it is not so real. Burnout doesn’t show up in a blood test or an x-ray, so how real is it for a doctor? Can we say that we have a condition for which there are no positive tests results? The medical profession has a tradition of dismissing and ignoring symptoms and conditions for which there are no ‘test’ results.

Doctors are not allowed to be sick – in particular they are not allowed to be sick about their work! To be sick about your work implies somehow that you are not good at your work and that you have failed. To fail at your work is a big ‘no no’ for doctors.

There is a culture in medicine that says that doctors have to be superhuman, they have to be masters of everything, know everything and be everything to everyone at all times. They have to be able to survive on no sleep, be courteous and professional at all times, know everything, give the best diagnoses, be able to cure everyone, along with the social expectation they should do it all for free as some sort of charity, simply for the ‘privilege’ of being a doctor, unlike every other profession where it is understood that you deserve to be paid for your expertise…

Doctors are supposed to be ‘the ones’ with ‘all the answers’. If you are a sick person, treating sick people, then how can you possibly have all of the answers?! Well, this is how the culture goes. To admit sickness, is to admit human frailty and acknowledge the fact that you are not the one with the answers.

In medicine, if you show signs of humanity and sensitivity, in particular signs of not coping, or finding things difficult, you are not supported: you are instead at times bullied, mocked, demeaned and labeled ‘impaired’. There is this culture that has you in fear of being bullied, of being thought to be less than capable and less than reliable by your colleagues.

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