Life in the front line: a junior doctor’s view
Nadia is a senior trainee anaesthetist in London. She was part of the Justice for Health campaign against the imposition of the junior doctors' contract in England in 2016.
“I’m fine”, I responded automatically to a colleague who paused to ask me how I was as we crossed paths one day in the hospital. Five minutes later I was being consoled by her in a staff room as tears streamed down my face. I was anything but fine. I had given everything all morning to be meticulous and safe during a jam-packed list of procedures on young children. Everything had had gone by without a hitch, but then, feeling spent, I had been asked to do yet another case – the insertion of an intravenous line in a child - since there was such a backlog of patients waiting. Acutely conscious of having these young lives in my exhausted hands, my emotions rose up and attacked me, refusing to be ignored any longer.
When you are a doctor on shift you cease to exist as a person. With patients’ lives in your hands, there is no other way to get through the job. The problem is, we are spending increasingly more time at work. Most NHS staff regularly work extra hours and shifts as staffing gaps widen and service pressures rise.
My realisation of how damaging this was to me as a person came slowly and reluctantly. I did not want to admit I needed time away to be myself. I was worried I would be seen as a failure – after all, that was how I saw myself. When I began my journey as a doctor over a decade ago I could never have imagined I would find myself feeling this way. I remember how proud I was of my job. I felt supported and valued as a human being, I had time to be me. This largely continued as I entered my specialty training in anaesthesia, where there is still a real sense of community. My training school has never made me feel like a number on a spreadsheet, although in that respect I suspect that I am one of the fortunate few. Despite all this I still found myself in that staff room feeling broken.
I am not the only one. In December 2016 the Royal College of Anaesthetists conducted a survey of the morale and welfare of trainee anaesthetists. Over half of all trainees, 2300 of us, completed the survey. The results, although unsurprising to those of us familiar with the stresses of working in the NHS, were more than worrying. Over 60% said their mental health, and a greater number felt their physical health, were being adversely affected by their jobs. When asked what impacted patient safety the most, the top three answers were bed shortages, rota gaps (i.e. staff shortages), and low morale.
The NHS has been in crisis for a long time, and it is breaking junior doctors. As they find themselves battling to keep up with unmanageable service demands alongside their training commitments, the latter often falls to the wayside; patients will always take priority. Doctors are left feeling as if they have failed – failed to deliver their best care at work and failed to meet their training commitments. The harder they try, the closer they come to breaking point. They cannot possibly work any harder. What they need is a better understanding from those in charge of the NHS of the resources that doctors and other healthcare staff need to fulfil their duties effectively and safely.
This feeling of failure is compounded by the constant media narrative of a “failing NHS”. being constantly told that you are working in a "failing" system makes you feel part of that failure, or even worse, a cause of it. It is no surprise then that morale is at its lowest point ever, and this seems to be driving talented doctors out of the NHS, doctors who desperately want to stay and whom we desperately need. But what choice do they have when they can’t face any further blows to their mental and physical wellbeing? If we don’t address the root cause of low morale we will be left with fewer doctors, more broken than ever.
Last year, thousands of junior doctors united over a contract dispute. The weight of losing the contract dispute makes it hard for many of us to see what we gained in the process. As the contract imposition rolled in, many of us slowly resumed our previous trance-like state of quiet resignation towards the disintegration of our working conditions. But there were gains that we can hold on to from last year, if we really want to. Many of us found a voice we did not know we had. We found empowerment in speaking honestly and openly about our working conditions, something many of us had never done before, certainly not on the scale that we did last year. We found courage in challenging those we believed were abusing their positions of power and threatening the NHS in the process.
Last year there was an extraordinary awakening amongst junior doctors to the threat confronting the health service, and the last thing we should do now is go back to sleep. As well as the patients in front of us every day we have a duty to consider all the patients who will need our care in the future. That means fighting to keep the NHS on the principles it was founded, that good healthcare should be available to all regardless of wealth.
We need to find our voices again. This time with the aim of reclaiming our love for our jobs, and our pride in our profession. We need to start speaking out about what we need to do our jobs, but don’t have. We don’t have enough staff, so we need to talk about it. We don’t have enough beds, so talk about that. We can’t afford to let more hospitals and services be downgraded and closed. Talk about it. Tell the public what we really need to keep them healthy and safe.
We are not ‘failing’, and neither is the NHS. It is not waiting to be put out of its misery. It is a world-class system but it is being subjected to cuts in funding that will eventually destroy it. That it is not yet destroyed is down to healthcare staff who give everything and more to their work for their patients, but who are being brought close to breakdown in the process.
Editor’s note: Across the UK there are over 60,000 junior doctors in the NHS. They are ‘junior’ in that they are not yet fully trained in a specialty, but are in training to become hospital consultants. A consultant’s training takes 8 years or more and during that time junior doctors form the backbone of the hospital medical workforce. We hope to publish a number of blogs by junior doctors based on their working life in the NHS in 2017.
