We’ve talked a lot about demoralisation amongst doctors, but I think it’s not always easy to understand. Because we do love our jobs and we do want to help people. We want to love our jobs. We all started off desperately wanting to be doctors, and many of us do actually enjoy the doctoring bit. So why are we all so down? I’ll try to give you a taste.
Imagine wanting to do something, to be someone so badly, that you spent your entire childhood and adolescence working singlemindedly towards it. You give it your everything, extra study, more tests, the works. Imagine being the smart kid at school, eager to work hard and impress, and being good at many things. Imagine being able to be nearly anything you could have wanted. Imagine spending the best years of your life stuck in revision whilst everyone around you was partying or dating or doing things that were fun. Imagine paying serious money for the privilege, and taking years out of your life to achieve it. Years studying. Years not working. Years of getting into debt when you could have been supporting yourself or your family. Imagine being so happy to graduate and finally be able to help people. Imagine your nervous, frenzied first attempts at being a doctor in the big bad world out there. Imagine the excitement of succeeding.
Imagine missing friends’ weddings and relatives’ funerals because there was nobody else who could be there to keep your patients safe. Imagine having to make countless excuses to friends and to family and to partners. Imagine all the dates who decided “this is just too… complicated for me. Sorry.” Imagine losing touch with friends because you were always moving, always busy, and always tired. Sometimes they will understand, sometimes they won’t. Imagine all your friends working reasonable hours, earning a decent amount and having time to actually have some semblance of a life. Imagine rarely being able to see even the ones that understand and love you for who you are. Imagine starting to forget what it’s like to have a hobby or do something that isn’t work. Imagine starting to forget who you are, where your role ends and where your personhood begins.
Imagine working long days and silly shifts only to come home and head straight for your books. For exams you struggle to pay yourself. Imagine being a single parent, and having to wonder whether you can afford to do this job because it’s so hard to get childcare. Imagine hearing your child say “You’re never home. I miss you” nearly every day. Imagine your partner telling you that you seem to be working more and more lately. Imagine feeling that you are neglecting your own loved ones in trying to keep everyone else’s safe. Imagine fearing that you will end up resenting the job you love, because it will have taken so much from your life.
Imagine feeling forced to work another last minute shift because there was literally nobody else. Imagine gradually finding that more and more, every day was short staffed and busy. Imagine feeling that you aren’t giving your best care because you are stuggling just to get the urgent things done and keep patients safe. Imagine skipping meals and lack of sleep so often that it becomes normal. Imagine feeling like you can’t take sick leave because there is nobody else to kee people safe. Imagine things getting busier and busier until work is a nearly constant grind and you barely have time to think. Imagine nearly every day being a ‘major incident’. Imagine increasing pressure from all your colleagues. Imagine feeling unsupported by your seniors or your colleagues on a regular basis. Imagine being left to deal with difficult situations on your own. Imagine how hard it is to deal with grave situations, and how emotionally draining and heartbreaking it can be.
Imagine patients and relatives who don’t see the pressure you are under. Imagine those who scream, yell, demand things are done right away or threaten to sue. Imagine those who are verbally abusive or violent. Imagine the ones that make all your colleagues cry, and from whom you have to hide your tears. Imagine how often your colleagues never report abuse because they don’t feel that they can. Imagine a context where failings are subjected to ‘trial by media’ and individuals are vilified, but the systemic failings which caused mistakes to happen are neither acknowledged nor addressed. Imagine a culture where doctors are under duty by the GMC to whistleblow, but given no legal protection if they do so.
Imagine all your colleagues talking about considering leaving the profession. Imagine your colleagues who have already left telling you life is much better abroad or outside of medicine. Imagine nearly every speciality reporting recruitment shortages, bad morale and overwork. Imagine knowing that you are twice as likely to suffer from mental health problems or suicide.
Imagine becoming more and more afraid that you will slip up due to tiredness. Imagine fearing the impact that this could have on your patients and their families, and how you might live with yourself. Imagine knowing that if you did, you would probably lose your job, but the employers and those who caused those conditions to happen would face no consequences. Imagine having to talk close friends off the ledge. Not just once, but on a regular basis. Imagine knowing that some people don’t succeed. Imagine knowing that this will only get worse if things deteriorate.
Imagine your boss saying that you’re not doing enough. Imagine them saying that you all need to work more days. Imagine them saying that there just need to be more cuts. Imagine your employer having already cut so many things that everyone is always struggling. Imagine a context where services are not appropriately funded, and then individuals working within are blamed for predictable shortcomings which could have been avoided with appropriate funding and safeguards. Imagine fearing that instead of proper investment, those whose job it is to look after your healthcare system may be trying to privatise it for profit. Imagine wondering if your patients and your children will be able to afford healthcare in the future.
Imagine your boss taking the safeguards away which limit how much time your employer can make you work. Imagine your boss reducing pay for the agency staff who are filling empty posts and keeping things afloat. Imagine being expected to work more hours, more weekends for less pay. Imagine the constant pressure to see more patients in less time, and being given less resources to look after them. Imagine knowing that you will probably work far longer than any rostered hours. Imagine knowing that your senior colleagues are fighting a similar battle and their conditions may be similarly affected. Imagine finding out how many of them can’t wait to retire, and remembering the days when doctors used to love working late into life. Imagine realising that you may not win this battle.
Imagine your boss telling everyone they just don’t understand why you are all demoralised and telling everyone that you’re actually getting a pay rise and less hours. Imagine the public believing the lies. Imagine the media believing that everyone is demoralised because the union is telling us to be. Imagine the public telling you that you knew what you were getting into. Imagine the public telling you that you are overpaid, greedy, lazy, incompetent and ought to shut up and get back to work. Imagine the public telling you that the way your profession have chosen to voice your concerns (striking) is unacceptable, but not listening to any of the other ways your colleagues have tried to engage them. Imagine hearing over and over again that the system, which is underfunded compared to every other Western country, is ‘unsustainable’ when this is not true.
Imagine just wanting to do your job and help people, but feeling bogged down in difficulties that should never be a part of your job. Imagine loving being a doctor but hating what it has become. Imagine fearing that situations may get so bad that you too may be forced to leave for your own sanity and health.
This is why so many of my peers are demoralised.