Dr Linda Jayne Mottram, Intensive Care Consultant at Belfast HSC Hospital discusses the crucial importance of maintaining clinicians mental wellbeing in the current medical culture.
Basic life support algorithms start with the premise that clinicians check for danger before approaching the patient. The rationale being that if you are injured by something in the environment, you will be of little practical use to a patient in extremis. The same logic applies to scene safety in prehospital medicine. No one questions your commitment to the patient by protecting yourself first, because it makes common sense to do so. You have to be free from injury in order to provide any meaningful assistance.
In principle, protecting your own mental wellbeing is really no different. Your capacity to care properly for patients is reduced if you are experiencing workplace exhaustion or burnout. Clinician wellbeing is completely at the heart of good patient care. However, until recently, this is a fundamental truth that we have ignored or disregarded. Why does it feel indulgent and guilt-inducing to prioritise our own welfare?
The answer probably lies in medical culture.
The current medical culture suggests that we lack professional commitment if we put our own health and wellbeing foremost. That somehow doing so is an offence reportable to the General Medical Council. The patient always comes first, surely? A culture where compassion is supposedly valued, but is rarely applied to ourselves. A culture where resting is not seen as a fundamental physiological requirement. At best we regard it as supplemental and in some departments it is openly unacceptable – the retort being ‘you’re not being paid to rest at night’. If you think you lack unconscious bias in this area, ask yourself how often you’ve interchanged ‘rest’ for ‘laziness’ with your colleagues.
Burnout is about culture, and we are the culture.
The same heroic backdrop in which clinicians over-extend themselves to the point of exhaustion, is a false economy. However well intentioned our desire to fill the cracks in a pressurized service, the effects of doing so actually perpetuate the problem. Burnout results in motivational and cognitive decline, which reduces our ability to do the job safely. Negative patient outcomes are now being linked to physician and nursing burnout including medical error, healthcare infections and the associated economic burden.1 The biggest scandal might be that it takes this kind of data to convince healthcare organisations to take action. When we are counting the human cost to healthcare workers, surely the moral argument is strong enough? One more clinician suicide is one too many.
Monday the 4th of September 2017 was an important landmark in the ICS events calendar. It was the inaugural seminar on supporting wellbeing in critical care staff. Critical care providers were at the centre of the agenda, and rightly so.
A number of themes emerged during the day including the factors within the critical care environment which act as stressors and antecedents to burnout, adaptive and maladaptive coping mechanisms, uncertainty as a cause of stress, leadership, team relationships, compassion and the role of fatigue. Dr Michael Farquhar addressed the cultural barriers in his session on ‘sleep hygiene’ along with some practical resources, which can be found here. He made a compelling argument for the effects of sleep deprivation on information processing, decision making and assessment of risk.
Professor Stephen Brett touched on the wider socio-political context as a driver for workplace stress when he made a case for the NHS having broken its psychological contract with its workers. It doesn’t just exist for the care and safety of patients, but for you and I working within it.
The cultural barriers need to be overcome to make progress. We must remember that we do not dishonour the relationship we have with our patients by having a regard for the health of the professional. Rather we uphold it and preserve it for the future.
We are the culture, and the opportunity to change it lies in our hands. Failing to address this now results in a short and unfulfilling life cycle for intensive care workers.
- Shanafelt TD, Mungo M, Schmitgen J, et al. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clin Proc 2016; 91: 422–31.
Sleep Hygiene & Fatigue Resources
If you’re interested in a taster of ICS Wellbeing Day you can view a short video interview with Dr Julie Highfield, clinical psychologist at Cardiff.
All the seminars for the event are available on the ICS Podcast that can be found here.
If you’re interested in other ICS events you can find out more here.