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Dublin: 14 °C Wednesday 14 November, 2018

Column: Pain, shame and blame – the emotional life of doctors

With the Irish Medical Organisation moving to ballot junior doctors on industrial action over “dangerously long” working hours, Dr Bríd McGrath writes about the emotional toll current working conditions are having on her and her colleagues.

Dr Brid McGrath

THE BALLOT FOR industrial action among non-consultant doctors has begun. Decades of extreme working hours, employment rights abuses and frequent non-payment of hours have finally tipped the Irish health service to a silent crisis. Doctors are walking away in higher numbers than ever, not just because of the abuse of their employment conditions, but just simply because of a prevalent culture of abuse towards doctors. No one speaks out, because no one listens.

In the time since I’ve begun to write about working conditions for doctors in the HSE, the most common question from colleagues has been “Weren’t you afraid to put your name to it?”

Always, there has been this consensus: I was only talking about the things that happen every day in Irish hospitals. Always, people said “Fair play to you”, often followed with “you must have some balls”. Always, the implication was “Won’t this impact on your career? Won’t someone start giving out to you?”

Doctors have a strong mental barrier against doing the obvious and responsible thing: getting help. What I am trying to do is get help from the public.

Paralysed by fear

I have quickly realised, the majority of doctors’ lives are paralysed by fear. Some are afraid even to comment, let alone write articles on the current issues. It’s not for their lack of literacy skills.

Berated by the cheap-shot elements of the media, litigated against, under-resourced – and therefore under-providing to the public, often a target for the frustrations of nurses, and constantly letting our friends and family down by missing social occasions… every doctor has times when they want to crawl under the rock. Why put your head above the parapet just to get it shot down?

When someone suggests that doctors do something about this, it is often followed by protracted infighting as to how it should be done. Ultimately, no-one has any energy after a long working day to go and fight for our right to a shorter working day: it the perfect Catch-22.

No-one wants to be the doctor that lets down the team. No-one wants to phone in sick, even when they are. Unfortunately though, like a pack of wild animals, there is also the fear that if you appear wounded or lame, you may be shunned for slowing down the others. Make no mistake, sometimes it feels like “being hunted” when you carry a bleep in a hospital. Adrenaline: I would love to know how much of it flows when the bleep goes.

Despite being in the business of “giving help”, doctors have a strong impulse to hide their anguish and not seek help. This may come from the very correct expectation that their needs will fall on deaf ears, or on ears that may understand but who cannot effectively help. Instead, we are expected to become “hardened”. If we become “hardened”, is that really the best outcome?

Bullying in hospitals: the ultimate taboo

It is a taboo above all taboos, but if the doctors are being hunted then the people on the horses are often nurses, followed in the flanks by some of the patients. People wrongly perceive that the hospital hierarchy places all the doctors at top. Consultant doctors are pretty important, but non-consultant doctors are only on 6-month contracts, therefore completely disposable. Long-standing nurses have the power, and some of them abuse it.

It’s all fine when there are good nurses. A good CNM (Clinical Nurse Manager) is an asset to the ward, a team leader who makes things run smoothly. Everyone’s job satisfaction improves on that day.

However, any nurse who chooses to can make life hard for doctors.  It is the taboo of all taboos, but there is daily, open bullying of non-consultant doctors on many wards.

If a CNM decides to slag a particular doctor, or doctors in general, then other nurses and indeed patients may also begin to get their drift. I’ve often been told by patients how much they prefer the nurses to the doctors, when they assume I’m their nurse. You realise that there is actually a “popularity contest” going on in hospitals. Female doctors don’t rank highly in it, nor do foreign doctors – which is basically the majority of non-consultant doctors.

Daily examples

I’ve worked on wards where a CNM would routinely use the line “you’re getting paid enough for it” whenever a doctor said they were tired from working more than 24 hours, setting a fine example to junior nurses of how you can openly treat doctors like sub-humans.

I’ve experienced trying to manage two patients at one time, whilst a CNM pulled me aside to threaten to “report me to my Consultant for insubordination” because I told her that her request regarding a third patient would have to wait until I finished the work I already had in hand.

I’ve known a CNM to bleep nine times in a 30 minute period to write a non-urgent discharge letter for a patient who was a relative of a another nurse in the hospital.

I’ve overheard myself being described by a staff nurse as a “saucy pup” for refusing to work at a station where that same nurse would not allow me to use the desk and computer needed to manage that set of patients. I was walking away with tears in my eyes, yet again.

You see, I am a doctor. I am one of “them”. No feelings, that’s what’s expected.

No more ‘them and us’

I know not all nurses are like that. There are nurses who have mopped up my tears when a CNM has been out of order. There are nurses that have brought me a cup of tea when I’ve been on-call for hours on end and had nothing to eat or drink. There are nurses who think our conditions are plain wrong. There are nurses who get bullied by the same nurses who bully doctors. Sadly though, it’s just not what’s being taught on the curriculum.

Other nurses feed on a steady diet of doctor-bashing, expressing sentiments of: “I could do your job better”, “You earn too much money” and “If you really cared about the patient, you’d do exactly as I say”. If those nurses want to plumb their earnings into the fiscal black-hole that is retraining in medicine, and come out earning less than they do now for twice the hours, they are more than welcome. If not, they really should just back off.

We are not “fair game”.

It wouldn’t cost much, but if every hospital and every ward had a strong ethos of respect across all levels, then life would just be easier. Hospitals need a heart, not demoralisation. Doctors should not be excluded from the circle.

More than changing working hours and getting paid for our hours, we need to change the whole hospital culture. The “them and us” mentality is neither helping them nor us. Doctors need to fully assume their role as humans: we need to talk like humans, express the same needs as humans, and look for the same rights as humans.

Will it ever really change?

Some particularly resilient doctors may wish to cling to the notion that we are “super-humans”. I don’t wish to insult the doctors with the thick skin to weather all conditions, but really, does it need to be so psychologically harrowing?

If we are no longer “super-human”, sure we have to surrender those old delusions of infallibility. Basic respect would be better than prestige, surely?

That is one reason why we are losing doctors: they want to get out of what is now perceived to be a rat-race. They are getting out by immigration and, more disturbingly, they are getting out by suicide. Doctors are at twice the risk of suicide of the general population, with female doctors having a 140 per cent higher risk. Further study is required to establish what the particular pressures on women are, but people can make some educated guesses in the meantime.

The truth is that if I live with a fear, it is the fear that this job will break my colleagues – or indeed me. I write these articles in the hope that there is something we can do to make things better. To make the changes needed requires not just doctors, but nurses and patients agreeing that this environment is no longer healthy for any of us. We want people’s support, not snide and uninformed remarks.

There is a simple reason I always put my name at the end.  I know what I am saying is true, and I would rather stand up and say what I mean, than continue to crawl through my career. I hope everyone else will stand up too.

To read other pieces by Dr Bríd McGrath please click here.

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About the author:

Dr Brid McGrath

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