Saturday 19 October 2019

This is going to hurt... why doctors are walking away

A bullying culture among senior staff and poor pay structure produce a toxic mix in hospitals for junior medics, writes Mary Coghlan

Mary Coghlan at home with a photo of her five-year-old son Darragh hanging in the backround. Photo: Steve Humphreys
Mary Coghlan at home with a photo of her five-year-old son Darragh hanging in the backround. Photo: Steve Humphreys

A few years ago, a friend of mine asked me what it was like being a doctor, and I responded that it was like being a film star. Well, not that it was like being a film star in the sense of everyday reality. No... but in the sense that, for some people, being a film star would probably be their dream job.

For me being a doctor and practising clinical medicine was my dream job, a fulfilment of my dream.

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There are the great parts...

Such as walking into the hospital every day feeling that you (excuse the cliche) had the chance to make a really positive difference in the world; of being able to fill in the gaps and explain to vulnerable humans what was going on that was causing their symptoms.

In a great many cases, that meant being able to reassure them that it wasn't as bad as they feared. In other cases it meant being the one that pretty much confirmed their worst fears - but hopefully doing it in a compassionate and skilled way.

Then there is working with great teams and truly amazing consultant physicians at times; knowing on some occasions that the immediate actions you took and decisions you made may have been the difference between life and death.

On the good days, it was feeling ultimately that doing this was your destiny in life.

Being a doctor is a true privilege. You are privy to people's most challenging moments. You perform procedures that are invasive and potentially painful. You are party to potentially life-changing, even life-ending information even before the person themselves is aware of it.

And then there are the not-so-great parts...

There are no parts of the job to do with patients that are terrible. Yes, they can be difficult, challenging, sad and you can be faced with aggression and rudeness and even physical assault at times, but that's just the deal. None of us really know how we'll behave or react in the most extreme circumstances when we're in pain or frightened for our lives.

I doubt many, if any, doctors consider their future in clinical medicine in Ireland in 2019 because of patient-associated factors.

I think some of my personal experiences, though, will better explain just why there is a crisis in Irish hospitals:

• "Don't think of phoning in sick unless you're in the intensive care unit" - a consultant on the first day on the job.

• A phone call in Christmas week from hospital management demanding to know why you can't ask a neighbour to mind your two-year old on a night you are simply unable to work and have given months' notice of your unavailability.

• A consultant using foul language when you ask them to sign your time sheet, a ritual experienced frequently by hospital doctors.

• Encountering massive problems almost every time you try to organise annual leave.

• Being met with obstacles and sometimes ridicule when trying to book tests for your patients (and if this isn't a risk to patient safety, what is?)

• Never, ever being confident you will be able to get out in time to collect your son from childcare.

These are just some of the day-to-day difficulties faced by hospital doctors - the ones that keep the show on the road and without whom (among others) the whole system could ground to a halt.

These difficulties accumulate as a series of irritations and their sum is something more than an irritation. As someone who had a career before medicine, I am aware that some of the behaviours I witnessed in the professional clinical environment simply wouldn't be tolerated in many other professional environments. But there is a bigger picture to be considered - and rightly or wrongly, these issues are put up with, undoubtedly contributing to the problems.

But they are rarely the single source of what drives our so-called junior hospital doctors elsewhere.

In this country, approximately 700 freshly minted doctors graduate every year (actually a lot more than this graduate, but a substantial number are for immediate export as they are not entitled to work in this country).

The traditional model has been that from graduation to eventual "anointment" as a hospital consultant, they are moved around this country to various posts - often at a frequency of every three months with little consideration of any personal circumstances.

Each time they move hospital, they have historically been subjected to emergency tax. They have to find new accommodation. And they have to put up with whatever treatment and call rosters are imposed on them.

There is no small amount of "we put up with it so you have to" in the system - even from physicians who would be considered to be reasonably enlightened.

When the shuffling around Ireland bit of training is completed, it is typical for the junior doctor to be compelled to complete their training abroad (again, frequently because "that was the way we did it in the past") rather than any tangible reason for the training not being possible in Ireland.

Of course, having many doctors experience other systems and world class centres in other countries is of tremendous benefit to ours - but it should not be the only way.

If one can navigate all of the above and formally complete medical training it may now be possible to apply for a consultant post in this country. The problems with filling these posts are well documented and the most recent number of unfilled posts I believe is of the order of 500.

So, a combination of these working conditions and an inequitable remuneration structure are more than enough to keep many of our brightest and best in other countries and outside the domain of clinical medicine here.

Back to myself. I went back to study medicine as a graduate entry student to fulfil a dream after what can be described as a reasonably successful career in another profession. I loved every minute of my four years as a medical student and inhaled all aspects of the education that was on offer.

I paid a high financial price in terms of both lost income and direct course fees (€60,000 or thereabouts for the privilege of studying medicine if you have previously obtained a degree in the EU), but this really didn't concern me at the time. I felt truly privileged to graduate with a medical degree a number of years ago. This level of privilege was enhanced by the knowledge that my five-month old baby son was in the auditorium the day I graduated - that was a good year!

I walked into the hospital on the first day as an intern full of joy and excitement and not a small amount of healthy trepidation about what was to come. Clinical medicine as practised was all I hoped. In the first year, I was certain about so many things and knew exactly what specialty I was going to aim for. The mentors I met in this specialty were simply amazing.

But...

As time went on, the day-to-day issues became a bit more difficult to put up with. There are only so many family occasions you feel you can miss. There are only so many days you can go in knowing that you actually should be at home sick or at home with your sick child.

All those irritations, and the fact I would have to relocate my family at least three times to complete my training, added up to one possible outcome for me: I had to walk away from clinical medicine for now.

So I walked away - with a broken heart but an intact spirit. I walked away knowing I was doing the right thing for my little family.

I'm in a new job now and I'm really enjoying it. I believe it gives me the opportunity to make a difference in our healthcare system and this is important to me.

So many of my positive day-to-day professional experiences and interactions now remind me of the contrast with our broken clinical system and how poorly it treats its most valuable assets.

The recruitment and retention crisis with our hospital doctors (not to mention GPs) is well and truly documented. And so it will continue when we let people walk away and don't even ask why.

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