hand-and-pen-blog

By Tony Whitehouse, Council member

Have we learnt nothing from burn-out failures of the past? asks Tony Whitehouse. I was struck by the high number of colleagues whom I knew as my trainers in anaesthetics that had started their life as a consultant working in ICU but had given it up. Emboldened by my newly found seniority, I enquired why. While a few said that they were forced to do sessions in the ICU because of providing workload cover, most gave their reason: “burn-out”.

As one comes to the end of training, the trainee-mentor interaction changes. Conversations that were once about ventilator settings or antibiotic dosing moved to ones about wives, families and interests outside the hospital. It sometimes felt to me a bit like a sixth-former going to the pub with their teachers. During those conversations, I learned that many of my colleagues had given up their ICU career because they were worn down by their workload.

With the aftershocks of the junior doctor strike still rumbling, and as a consultant at the mid-point of his career, I find myself mulling over whether I will be able to sustain the work intensity that I’ve maintained for the 25 years or so. Some of my senior colleagues remember the days of being single-handed ICU consultants and yet have survived to work to this day.  My perception is that even their tenacity is being broken by a working day that can be relentless. Since starting as a consultant over 10 years ago, patient expectations have increased and the APACHE scores (how sick they are) are higher. And yes, my expectations have increased too; why shouldn’t a 95 year old get admitted to and survive ICU?

I believe that these changes in mind-set have impacted on the NHS workforce. Sitting down for a coffee with our nurses reveals a group who are being worn down by the unremitting workload.

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“In the past, you would have had a bit of a quieter time in August, but not now” they say.

Our nursing turnover is high; we have lost some of our best staff to areas of healthcare that have a more controlled working pace. And yet, the drive for making staff work at full pelt, all the time is regarded as “efficient”. Have we learnt nothing from the burn-out failures of the past?

Whilst the NHS contract negotiations are likely to concentrate on how many hours a doctor, nurse or AHP works, their metric is wrong. If you were to buy a 3 year old car, you also want to know how many miles it has been driven – a car that has been driven a long distance is more likely to break down compared with one whose milometer hasn’t been so troubled. In ICU, it’s not just how often your week on the ICU comes around or how many shifts you do, it’s what you pack into it when you are there that also matters.

Editorial note: Stress is more prevalent among health professionals compared to the general population. For example, 28 % of doctors experience psychological distress compared to 18 % among the general population. See this list of services if you need advice.

At this year’s State of the Art session ‘Who cares for the carers? Staff welfare and morale in the ICU’ we invite critical care staff to help us unravel the reason behind the crucial 10 % gap from a critical care perspective. Share your experience on Twitter by using #10percentgap #icssoa2016.

One thought on “Is a career in ICU sustainable?

  1. From my mid 40’s I have been wondering what would make a consultant post in Intensive Care sustainable. I have worked in a number of parts of the country and abroad (Sweden briefly & Holland 10 years} As a junior I saw the single consultant model kill several colleagues, and yet be survived by others to a good old age. What I saw, however, and they didn’t, was what happened when they cleared off on holiday or to conferences. Not a pretty sight. Another model is the ubergruppenfurer with an army of sub consultants who jumped to their command. This at least gives a continuity of care to the patient population, and frustration to those with no further career prospects. On being offered 6 sessions to cover ITU singlehanded 24/7 in a new DGH I resigned. What I finally achieved was a group of 4 then 5 then 6 like minded colleagues who self selected over time and shared the daily tasks for a number of days at a time. I guess that would be the UK norm at present with numbers made up to fit the clinical demand. . This arrangement means that sanity and income can be protected by spending some time away from ITU. For this I have no apology. Honing other skills, whether they be anaesthesia, acute or chest medicine, surgery or whatever, private or NHS, can only contribute to the ITU skill mix. I think we would be very foolish to go down the road of the Paediatric Anaesthetists and Intensivists who, because of their self imposed exclusivity are never available when you need them. There is a massive advantage in any hospital when a large cadre of consultants are active in ITU. I know these views are unfashionable, but I know that this sustained my ability to keep going until aged 67

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