Medicine has always attracted the brightest and the best. Young people, whose excellence would lead to success in many fields, choose instead to follow the demanding and altruistic path of a career in medicine.
Our society could not function without the thousands of doctors and healthcare workers who dedicate their lives to looking after others, and this is particularly true at the moment. And yet, our appreciation seems conditional; we are willing to applaud their sacrifice and skill during a deadly pandemic, but memories are short and this support seems to evaporate when we believe they have fallen below our high standards.
We expect doctors to be superhumans, to bear the brunt of abuse and complaints (see link here) which would be devastating at any time, let alone in the context of an intense workload, exhaustion and trauma, wrought by the coronavirus pandemic.
Sadly, this attitude is nothing new. The MDU sees it time and again in the wake of adverse incidents where the clinicians involved may be left unsupported when they are most vulnerable. To make matters worse, doctors often blame themselves for poor outcomes, even ones outside their control.
This corrosive self-recrimination is something I think we probably all recognise from our own medical careers. An incident that took place 40 years ago remains vivid in my own memory. I was a pre-registration house officer on my very first day on the wards after graduating. I was asked by the consultant to perform a venesection on a patient with polycythaemia. No sooner had I inserted the needle to begin the procedure, when the patient suddenly died, which was a dreadful shock. My consultant when informed said to me, to his great credit, "I expect you thought you killed him - well, you didn't. He was extremely ill and likely to die at any moment". I was immensely relieved he had picked up on what I was feeling, because that support at that time was very important to me.
Of course, patients and their families must be at the centre of our attention when something goes wrong during their treatment but we should not leave the doctor to cope with the aftermath alone - or worse, be made to feel stigmatised by their involvement. Rather, we need a supportive culture of learning and openness.
There is some reason to hope this issue is gaining traction within the healthcare sector. In January 2021, a Healthcare Safety Investigation Branch (HSIB) report considered the potentially traumatic impact of patient safety incidents on healthcare staff. It concluded that, "it would be beneficial for organisations to implement programmes to support staff following patient safety incidents" which should be formally evaluated to "assist understanding of what is good practice in terms of support delivered and resource required".
The HSIB report followed a guide to good practice in supporting surgeons after adverse events by the Royal College of Surgeons (RCS) and Bournemouth University which focused on the wellbeing of this group of professionals. The authors noted that the link between (in)action and outcome is perceived to be more direct in surgery and, "as a group, surgeons are profoundly affected by adverse events and are particularly unlikely to make use of available support". They proposed a number of measures for trusts to address this issue, including establishing a 'first responder' service. This would meet the surgeon within 24-48 hours of an adverse event to check on their welfare and provide "a kind, non-adversarial source of support and signposting" to support services such as occupational health.
The MDU's Dr Michael Devlin was on the RCS working group that helped develop the guidance, and we welcome the good practice recommendations. We hope they will be adopted by trusts and, if successful, rolled out more widely. This is not about mollycoddling members of the profession or avoiding accountability. It is an essential ingredient for a healthy culture where learning from adverse outcomes is the priority rather than rushing to assign blame.
We should not leave the doctor to cope with the aftermath alone – or worse, be made to feel stigmatised by their involvement.
Of course, effective support for doctors' wellbeing is more urgent in the context of a pandemic that has already pushed many NHS services and healthcare professionals to the brink. In a report on so called "never events", the HSIB recently noted that "COVID-19 has created further conditions that may increase the risk of never events occurring", including factors such as increased fatigue, redeployment of staff and the difficulties of communicating while wearing PPE. And in the longer term, there is risk that the doctors who have looked after seriously ill and dying patients for more than a year will experience higher levels of depersonalisation and lose the very qualities that made them such compassionate clinicians.
In my last column, I mentioned Dr Clare Gerada's book, Beneath the White Coat: Doctors, Their Minds and Mental Health which reflects on the mental health crisis within the profession. This issue includes a thought-provoking interview with Clare about the book, the impact of the pandemic and how doctors' own coping mechanisms can make matters worse. One of the book's strongest messages is that doctors have to be prepared to ask for help.
I wholeheartedly agree with Clare on this point. At the MDU, we see how deeply doctors can be affected by an adverse incident and their distress on the rare occasions that a patient is harmed. Our trained advisers are available 24/7 to support members in this position, as well as provide medico-legal advice and assistance. We exist to guide, support and defend you. If you need help, please contact us.
Dr Christine Tomkins
Chief executive of the MDU
Dr Christine Tomkins
Chief executive of the MDU
BSc(Hons) MBChB(Hons) DO FRCS FRCOphth MBA FFFLM FRCP
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