It's no secret that a career in medicine can be tough. For many, the challenges it poses are part of the attraction, but as well as the stress that everyday life brings - the long hours, steep learning curve and exams - doctors have to be able to cope with some traumatic scenes and heart breaking situations, which may stay with us for some time.
We also have a duty to respond to complaints and explain when things haven't gone entirely as planned. Most doctors go into the profession wanting to help, so when there isn't a happy ending, it can be difficult to remain objective.
You will probably have attended courses on communication skills and breaking bad news. These are useful ways of learning and practising the skills, but perhaps they don't explain how exhausting and distressing these conversations can be.
There has also been heated debate in the medical press and social media on the need for resilience training amongst medical professionals. Following publication in December 2014 of the independent review of doctors who committed suicide whilst under investigation by the GMC, the GMC has suggested that medical students and qualified doctors might benefit from emotional resilience training.
Training for the tough times
Even without the pressure of an investigation, medicine can be stressful. The concept of resilience training isn't new. It's been used by the military for some time, and while debate still persists about how effective it might be in medicine, as well as whether resilience can actually be taught in the first place, several Trusts are now introducing this kind of training.
So what is 'resilience'? Simply put, it's an individual’s ability to bounce back after being knocked down. This might include not only the individual's physical ability, but also their emotional and psychological capacity to cope with stress.
It's important to remain vigilant for signs that you, or perhaps one of your colleagues may be finding it difficult to cope. Irritability, errors, difficulty in sleeping and absence can be some of the signs. At the very least, developing a healthy work-life balance and having the insight to actively seek support when required are essential skills sets for a healthy clinician.
Stress is personal to the individual. It's entirely possible that an individual may cope with lots of different types of a stressful situations, but what might appear to be a relatively minor matter to someone else could be the final straw. Equally, stress does not just affect junior or inexperienced staff. It can happen at any point in your medical career.
Picture the scene. You've been on duty since 9am, and have had a busy day with clinics, inpatients and teaching students. It's almost 5pm, and you are looking forward to going out for dinner with friends tonight when a nurse pages you to say the test results for Mr Smith, one of your patients, have come back. The results confirm he has cancer, and his family are with him in the ward waiting for the results.
You go to the ward and spend time explaining to Mr Smith and his daughters that he has cancer, and that unfortunately it has already spread and you will refer him for palliative care. He takes the news in his usual pragmatic fashion, but his daughters are both extremely distressed. After some time, he thanks you for your kindness, and you leave.
As you drive home, you can't get Mr Smith out of your mind, particularly the way he tried to comfort his daughters after hearing that he was dying. You can't face going out tonight and instead just stay home with your thoughts.
Such experiences are not unusual in medicine. Some doctors harden themselves, but others might seek solace in alcohol. These strategies can be harmful to you as a doctor, and can hinder your ability to provide good care to your patients.
Being resilient doesn't mean that doctors need to become automatons. It's not wrong to be moved by a patient - it's human. Bursting into tears every time you speak to a patient is unlikely to help you get the work done, but showing that you are touched by events can demonstrate your empathy, and this ability to show our human side and empathise is an essential component of being a medical professional. Being able to deal with the huge variety of stress factors to which we will be exposed is important, not only to protect your own mental and physical health, but also to ensure that your ability to care for patients isn't affected.
Although 'resilience' may conjure up a tough image, it's important to have coping strategies in place. Talking to friends (whilst maintaining confidentiality), keeping up with your interests, exercise and taking care of your health are all ways of helping you deal with the day to day stresses of medicine. Using your annual leave can leave you feeling refreshed and better able to cope.
If you notice that the stress is getting to you, don't ignore it or try to battle on alone. Perhaps you are more irritable than usual, not sleeping, avoiding difficult conversations or making mistakes.
Support can come from lots of different sources, at the heart of which are friends, family and colleagues. In the past, admitting that things were getting on top of you might have been seen as a sign of weakness, but the GMC now places a duty on doctors to seek appropriate help if they are affected by a condition that could affect their judgement or performance (Good medical practice, paragraph 28). You're more likely to be criticised if you don’t ask for help.
If you need it, there is professional help available to you as well. Your Deanery may have support available, the BMA has a 24/7 telephone counselling service (0845 920 0169), and Occupational Health and your GP can help if stress is impacting on your health.
And of course, the MDU's team of medico-legal advisers are always on hand if you're worried about the effect that stress is having on your work or that of a colleague. Contact us here.
Medicine is an immensely rewarding career, but the daily demands, the constant requests from all directions, the long hours and the emotionally draining work can and do take their toll. It's a good idea to prepare for this aspect of your future career, as well as learning to examine patients and cannulate. Your future patients, family and self will thank you for it.
Dr Beth Durrell Potter
Dr Beth Durrell Potter
BSc(Hons) MB ChB MRCPsych PGDip(Mental Health Law)
Beth qualified from Manchester University in 2002 and completed her psychiatry training in the North West. She obtained a CCT in general adult psychiatry and worked as an inpatient consultant before leaving to join the MDU as a medico-legal adviser. She holds a postgraduate diploma in mental health law.
See more by Dr Beth Durrell Potter
Dr Nicola Lennard
Dr Nicola Lennard
MBChB MD FRCS(General Surgery) GDL
Nicola completed her post graduate training in general and vascular surgery before taking up post, initially as a senior medical officer, then Deputy Medical Director in the medical devices division of the MHRA. She joined the MDU as a medico-legal advisor in 2013 and completed her graduate diploma in law in 2014.
See more by Dr Nicola Lennard