I have just finished reading Henry Marsh’s book – Do No Harm- a memoir of the eminent neurosurgeon's practice over many years. If you haven't read it yet, I heartily recommend it as it provides a fascinating insight into the thoughts and emotions of a surgeon coming to terms on a daily basis with his uncertainties and anxieties about treating people. It’s a painfully honest book, making you think more about the interactions between patients and doctors and the inherent anxieties of the encounter from the doctor's perspective.
By coincidence an article by GP Anne Robinson was published in The Guardian online on 25 March entitled ‘It's difficult being a doctor in the age of the empowered patient’ using the case of Aysha King as its hook. The article considers the changing relationship between doctors and patients in an age where information is more readily available through the internet and public expectations of what healthcare can achieve and what people feel entitled to has risen. The comments posted after the article demonstrate a range of views from sympathy for doctors dealing with difficult cases and demanding patients to those that feel their care has been adversely affected by at best medical paternalism and at worst medical incompetence. Whatever the viewpoint, the level of interest and feeling the topic arouses reinforces the view that the doctor-patient relationship is a complex interaction, laden with emotion and fraught with anxiety from both sides of the consulting desk.
The Health Foundation's 2012 publication When doctors and patients talk provides an interesting typology of this anxiety derived from their research into doctor-patient interactions - see table below. Doctors are human too but it's easy to forget that sometimes when we are looking for them to provide a quick solution to our health problems and concerns. It is not surprising that the clamour of need can become overwhelming.
Stress, anxiety and depression among the NHS workforce as a whole appear to be rising - the day before the Guardian article appeared, the BBC published its own findings on staff absences for mental health problems in hospital trusts in England - suggesting these have doubled in the past four years. Earlier research also suggests that surgeons in particular report high levels of anxiety and burnout (Green et al 1990, and Sharma et al, 2008), though figures such as those reported by the BBC might not represent the true extent of the problem as surgeons are potentially more likely to struggle on and suffer in silence. This finding emerges from a project undertaken by Dr Clare Gerada and Richard Jones for the Practitioner Health Programme (PHP), a specialist service for doctors and dentists in the London area with mental health / addiction problems (www.php.nhs.uk). Meanwhile, the reporting of stress among GPs is well documented – a survey by Pulse in 2013 suggested that 43% of GPs are at high risk of burnout.Pulse is currently repeating its survey, the results of which might make even more sobering reading.
There is a growing momentum behind the work of my own colleagues Yvonne Sawbridge and Alistair Hewison (2015) on emotional labour in nursing but perhaps we should also be opening this up to consider the emotional labour of doctors too? And, whatever the next Government turns out to be, could it also be doing more to tackle this head on - not least by acknowledging that NHS staff have been under intense pressure for several years and that further exhortations to do more with less, or punishments for not meeting targets are fundamentally unhelpful and counter-productive in an environment that is already inherently angst-ridden? Support, not stricture is required, and a little more recognition perhaps that doctors, while often performing miracles, are only human too.
Green A., Duthre L., Young H. and Peters T. (1990) 'Stress in surgeons'. British Journal of Surgery1990;77(10):1154-8.
Sawbridge Y. and Hewison A. (2015) 'Compassion costs nothing' – the elephant in the room? Practice Nursing2015, Vol 26, No 4.
Sharma A., Sharp D.M., Walker L.G., et al. Stress and burnout in colorectal and vascular surgical consultants working in the UK National Health Service. Psychooncology2008;17(6):570-6.feature