Is compassion a luxury?

In January 2013, I started a PhD.  For various reasons, I’ve ended up doing this part-time over 4 years, whilst I continue my clinical training less-than full time.  I’m a 50% clinical trainee, and a 50% PhD student.  I’ve struggled with the idea of being a paediacademiatrician; about missing clinical time; about not being a “real” doctor anymore…

But the sad reality is that I don’t think that I would still be a doctor if I was doing it full time.

This is why.

I started my medical training in 2001; six years later, I’d qualified; in 2008 I started working in paediatrics.

For as long as I can remember, I have wanted to be a paediatrician.  There were brief periods where I wanted to be other things, but they were never real options. (1. Ballet dancer – at 6 years old, I was too old to do that properly; 2. Robopsychologist – realised fairly early on that all that Asimov I’d been reading wasn’t going to materialise quickly enough for that to be a viable career path despite by ambitions to become Susan Calvin; 3. Lawyer – in the brief period after I’d messed up my A-levels and decided that I couldn’t do sciences.)

By the time I’d started my PhD, I wasn’t being a paediatrician the way that I wanted to be.

I was worn out.  Physically, it was fine.  Mentally, not a problem.  After all, this was nothing to what I’d been expecting.  I’d learnt about the NHS and junior doctors by watching things like Cardiac Arrest.  My career trajectory, I’d assumed, would be to work until I dropped and burnt out.  A 48-hour working week, as regulated by the European Working Time Directive, actually seemed mild compared to parts of medical school.  Parts of the rotas I’ve worked involved a 12 day stretch with 7 long days interspersed with “short” days; night shifts come in runs of 3, or 4, or 7. It’s not difficult to clock-up a 90+ hour week without any major events which lead to you staying behind a few extra hours.  Breaks are apparently included in the rules, but they rarely happen.  (How can you have 30 minutes of a break when you’re the only person holding the bleep?)  I know this is nothing compared to junior doctors working hours before, but it matters.

Was I still a good doctor at the end of those weeks?  Competent? Yes. Effective? Probably.  Emotionally? ……..

Compassionate?

Empathetic?

Listening?

As summed up beautifully in this blog by @Adsthepoet‘s mother, empathetic practice is what gives healthcare professionals job satisfaction.  It’s what gets us out of bed in the morning/evening/afternoon; it’s why you can stay 2 or 3 hours late and leave with a smile on your face; why you stop on your way home and just pop in to make sure everything is OK on your ward…

But I was finding this harder and harder to do.  I think that I was retreating further and further behind the mask of professionalism; into my doctor bubble; into that world of different language and rules and social norms.  I think as the workload increases, this becomes more comforting and secure; the short-cuts in terminology and labelling become easier; patients stop being individuals and become “the diabetic in bed 4″… And my response to losing what makes me tick has been to work harder, stay later, try to be better… Eventually, it doesn’t matter how many patients you have waiting to be seen,That’s not a sustainable approach to work.

Discussions this week have led me to question if I’m actually the right kind of person to be a doctor.  I don’t think I’m “tough” enough to work a 90+ hour clinical week on a regular basis.  I love my job because I get to be a part of somebody’s life for a tiny segment, not because I’m sticking drips into them.  Training at 50% certainly hasn’t cut my total working hours (seriously, a PhD in 4 years part-time is not sensible), but it has given me a different perspective on work.  I suspect the same is true if you have a family; run marathons; grow vegetables; travel; go to the theatre, or pole-dance… Whatever it is that gives you another viewpoint on life, and reminds you that it’s OK to be human.

Where will the time to do this come in the new contracts?  Where will the staff come from to ensure that there is still time to tease my patients about the football results; get film recommendations from a 6 year old (Minions is quite funny); get beaten at playing ball by a 22 month old (in my defence, I was wearing high heels!)?  Will I get the time to make sure that I can do all this with them? Because that’s real doctoring: not sticking needles in and writing up inhalers.  It’s listening to who people are when they’re not attached to chemotherapy (and when they are).  It’s recognising being human is important, for all of us; and it’s having the time and space away from work to realise that.

I find it difficult to reconcile the NHS that I see developing at the moment with a truly safe and healthy environment for patients.  There is increasing evidence about the importance of compassionate care; avoiding burnout in healthcare professionals; and supportive structures to ensure patient safety.  These issues seem to have been forgotten in the current discussions on pay and working hours and consultant presence.

It’s not just enough to say that there are x number of doctors working x number of hours; the quality of what we do matters to.  Not just to be technically proficient, but to take the time to see people for who they are and learn what matters to them.  After all, that’s what being a doctor should be about.  That shouldn’t be a luxury, but an integral part of their care.

But will that matter?

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5 thoughts on “Is compassion a luxury?

  1. Incredibly thought provoking, and worrying. Some of our families worst experiences have been because of just what you are describing, that retreating from the humanity of the job you do, behind the professional curtain, where you don’t have to think quite so hard about how your choices affect the children and their families. You are one of the most reflective doctors I have had the pleasure of meeting, so you recognise this in yourself, but you are sadly not representative of most doctors. That is my worry, that good doctors with good intentions slip into a habit of not caring enough, and this is only going to get worse.

  2. Hi there. I found your blog by chance (a friend linked your great 7 day NHS posts to Facebook) but by coincidence I’m an aspiring academic paediatrician currently enrolled in a postgrad degree in the East Midlands. I don’t suppose you’d do me a huge favour and have a quick chat about academic training vs time out and similar stuff some time? WordPress has a private message plugin we could use, or else exchange emails?

  3. Pingback: Contracts and the things that go unsaid | PaediAcademiatrician

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