Dr Christine Tomkins
We need to work together to create a supportive community in which doctors can thrive and flourish, says Dr Christine Tomkins.
Becoming a doctor was one of the proudest achievements of my youth. I am sure this feeling is true of every MDU member - at last, I had an opportunity to put all the years of study to good use. But more than that, I had a real sense of being part of something worthwhile, as a new member of a profession dedicated to making a difference to people's lives.
I fear this feeling of belonging, for some, may have been slipping away over recent years under the strain of stretched resources, challenging working conditions, a persistent blame culture and the impact of all of these on mental health and wellbeing in the profession.
Most recently, the NHS Staff Survey found that only 48% of NHS employees were satisfied with the extent that their organisation values their work, although that was a 2% increase on the previous year. And only 59.7% believed their organisation treated staff fairly if they had been involved in an error, near miss or adverse incident.
This echoes the sobering findings of the GMC's annual report into the State of Medical Education and Practice in the UK last December, which included a wealth of research and data on wellbeing in the profession. It noted that 28% of doctors said they had struggled to cope with their workload at least once a week, and that one sixth of doctors fell into the category of a high risk of burnout which left them at higher risk of making a clinical error. And a third of doctors said they were likely to reduce their hours in clinical practice in the next year, largely because of the excessive demands they were facing in their current role.
Surely, any employer whose employees are demonstrating or acknowledged to be at high risk of mental health problems, addiction and burnout as currently reported for NHS clinicians would have serious questions to answer? Those who choose medicine as a profession come to it as highly empathetic, conscientious and motivated young people. They need those around them to care.
They need to know they are surrounded by colleagues of all seniorities, who know their name and to whom they can turn when they need to. They need senior clinicians who will teach them and help develop their skills and who will give them regular, real time feedback on what they have done well, and help them to learn what they can do better. This is how they maintain that empathy and motivation and develop into the type of competent clinicians we would all like to be and to be treated by.
In this issue of the journal, for example, we read a junior doctor member's experience of being summoned to give evidence at an inquest. The account eloquently describes the member's distress at the patient's death, and anxiety about being a witness. But tellingly, we also hear that, "At times I felt isolated during this process. Friends and family were a great source of comfort and personal support and while I felt there was a lack of senior medical support, the MDU provided the professional expertise and support that I needed."
If doctors become disengaged from the job they once loved or join an exodus from the profession, it will also be a tragedy for their colleagues, for patients and for society. To its credit, the GMC has recognised the need to improve the working lives of doctors and help them deliver high quality care. As I explained in my last column, it is already trying to implement a more supportive and proportionate approach to regulation that focuses on prevention rather than fitness to practise investigations.
Those who choose medicine as a profession come to it as highly empathetic, conscientious and motivated young people. They need those around them to care.
The GMC is also seeking collaboration with other interested organisations across the healthcare domain to address concerns about doctors' wellbeing and, I hope, to really bring about practical change. In February, for example, I attended a roundtable event led by GMC chair, Dame Clare Marx, which explored ways to improve patient safety, local cultures and the working lives of all healthcare staff. The discussion covered themes such as effective induction, feedback and mentoring, compassionate and collective leadership, and a better understanding of the role of human factors in patient safety.
As an organisation that exists to represent the best interests of doctors, it is important that the MDU engages with these initiatives and campaigns to improve working conditions. At the same time, I'm proud to say we are using our expertise in supporting members in difficulty to inform new services we're developing to help members to reduce the emotional and psychological impact on them of an investigation and to enable doctors to manage workplace pressures.
For instance, we are launching a new e-learning course on health and wellbeing aimed at helping junior doctors to recognise the warning signs for anxiety, depression and burnout, and to develop the skills to manage stressful situations. And we are developing a peer support programme so members can use their experience of a being subjected to a claim, complaint, inquest or other investigation in a positive way, to support others going through the same gruelling process.
We will also continue to publish advice articles on our website and journals about how to cope with common causes of anxiety or concern such as violence in the workplace, as well as providing information about additional sources of support.
It was my good fortune that I always knew I had someone to watch over me and help me learn throughout my years in clinical practice. I want today's doctors to have that same feeling of security throughout their careers and to know they are valued professionals. As the leader of a membership organisation, I believe the whole is greater than the sum of its parts and that a sense of professional belonging is precious. We are working on your behalf to restore and preserve it.