The idea of creating a “compassionate workplace” is currently popular and it is well worth us exploring in healthcare.
The Huffington Post reporting on the subject recently cited a study performed in a health-care facility. The results of introducing a culture of compassion not only included lower levels of absenteeism and employee burnout, higher levels of employee engagement with their work, greater teamwork and employee satisfaction, but the culture of compassion spread to include patients and their families.
Should the healthcare workplace not be a place where both patients and staff can receive the care we all deserve?
If they are not, could it be that we are failing because the culture of the medical profession is far from compassionate towards its own, and that doctors and other staff who are suffering themselves are less able to be compassionate towards others?
The reported suicides amongst doctors are simply the tip of the iceberg, reflecting deep levels of stress and unhappiness, particularly amongst junior doctors.
Does this really have to be so? Can we not train confident and competent doctors without damaging them psychologically in the process? Can we not provide consistently high standards of medical care while also supporting and caring for our junior staff? In fact, all of our staff. Our doctors shoulder never be collateral damage in an uncaring system. What does this say about the state of our profession if we continue to accept what is happening without calling for and making true and lasting changes?
Demanding the impossible
Dr Chloe Abbot very sadly took her own life last year, one of several doctors driven to suicide. This beautiful young woman was herself an advocate for reform in Medicine.
Her story is not atypical of the life of a junior doctor, as I well know, being a medical educator now. I remember for myself the stress of working full time and studying for my Paediatrics exams, exams with a 70% failure rate. This was over 40 years ago and the situation appears to have become worse, not better. Today’s young doctors seem to be under even more pressure than we were. The breadth of medical knowledge is ever expanding and changing. Medicine itself is much more intense, not only in our highly technical age, but because patient expectations are so high as to be almost unrealistic. Levels of accountability are also very high. Fear of making errors of judgement, harming patients, being sued or worse, being accused of manslaughter, create levels of tension at work resulting in unacceptably high anxiety.
For high achieving young doctors, often demanding perfection of themselves, the pressure is enormous. There is little chance to have any sense of normality in what little life is left. Medicine affects relationships, family life, limits time for outside hobbies and interests and offers little opportunity to deeply rest and care for ourselves. At times, we can feel that there is hardly space to breathe.
On top of this, consider the highly competitive nature of specialist training positions. Doctors wanting to train in any specialty, feel the need to obtain very high marks during their undergraduate training, work with incredible dedication to obtain superb references, sit their basic physician training while they are still interns, publish erudite papers in reputable journals and even complete PhDs. Is it any wonder that this results in burnout, cynicism and progresses on to depression and unforgivably, to suicidality. Not even Superman could achieve all of that.
Doctors are not superhuman
Why have we always felt that medical degrees bestow some kind of superhuman quality on doctors? They don’t, we are human and we hurt too.
Why do we assume that stress and psychological illness do not happen in ourselves or in our profession so that when they do occur, we offer ourselves and our colleagues less compassion and care than we offer our patients?
Trainee obstetrician Angela Jay spoke very courageously recently at the Royal Australasian College of Surgeons Annual Scientific Congress. She was part of a team of medical women raising awareness of domestic violence experienced by doctors and other professionals and talking of how shame prevented them from reporting it or asking friends and colleagues for support. Her story is horrific. What made it even worse was that she felt she had to return to work too soon after appalling trauma. It was reported that Dr Jay was determined not to look weak to her colleagues. “As a blossoming surgeon, I couldn’t show weakness,” she said. She returned to work “as soon as her hands were healed enough to scrub.”
What shocked me about this story was how fear of judgement by her peers could have led her into such a vulnerable position that she barely escaped with her life, then felt she had to return to work far too early after major physical and psychological trauma and as she reported it, she was then asked to leave when she was deemed “a burden”.
What does this say about the medical profession, about the intense pressure on young doctors and about the lack of compassion in medical workplaces?
Change is overdue
Chloe Abbot’s family, spurred on by the tragedy of her death, have challenged a system which causes such high levels of distress in young doctors and have called for change, which is long overdue.
I hear of programs to make doctors more “resilient” and better able to cope with the system. For instance, the Royal Prince Alfred Hospital’s director of physician training Bethan Richards said she believed around 10 per cent of trainees needed expert psychological help to cope with their stress. She set up BPT-OK (Basic Physician Training OK), which teaches doctors to cope with traumatic events at work and encourages them to open up about any anxieties.
These are all laudable projects but any change should never involve hardening doctors, and asking them to cope with a dysfunctional, even abusive system. What is more important is the medical profession itself taking a very hard look at its own culture. While some of the expectations imposed on doctors come from government, and others come from the medical administration, we would be very dishonest if we did not admit that they primarily come from us, or at the very least from our lack of protest.
Last month, Greg Hunt, Federal Minister of Health, issued a statement about doctors’ mental health. He admitted that because of mandatory reporting requirements there had been significant barriers to health professionals seeking and receiving appropriate mental health care. “What has been agreed is a system that will both protect patients, but critically, remove barriers to doctors and nurses receiving and accessing the mental health treatment that they want.” Final legislation has yet to be passed, but this is a move in the right direction.
Revision of mandatory reporting laws will hopefully mean that those facing mental health disorders can receive the care they need but what is more important is changing the system which led them there in the first place. These changes cannot be left to government; they need to come from within, they need to come from us.
We cannot leave it any longer to have this conversation.
In a report about the youth of America protesting against the gun lobby I saw a poster which said:
“If not ME, who? If not NOW, when?”
Surely the tragic death of young doctors, and the deep unhappiness of others should galvanise us to have the conversation. Change is possible, but only if we all choose it, and work together to make it happen.
If this article has raised concerns for you, help is available.
Here is a list of some resources.
Lifeline on 13 11 14
Suicide Call Back Service 1300 659 467 for 24-hour Australian counselling services.
Beyondblue (1300 22 4636) for 24-hour phone support, online chat, resources and apps.
Mindout for mental health and suicide support for lesbian, gay, bisexual, transgender and intersex (LGBTI) people.
Headspace offers online counselling for young people aged 12-25 and
ReachOut has online forums, chat and information about youth mental health.