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13 Nov 2019

BY DR TESSA KENNEDY, CHAIR, AMA COUNCIL OF DOCTORS IN TRAINING  

Omniscient. Unwavering. In control.

Many traditional ideas about medical leaders evoke the stoic hero. Always decisive, never tiring, unperturbed by the suffering and grief around them.

Over the last near decade as a doctor, I like to think I’ve been pretty good at managing that balance of compassion and empathy that defends against emotional exhaustion. Acknowledging the stresses of the job and the experience of patients and families but generally being able to leave it at the front door.

Everything changed when I returned to work after the birth of my son, to the paediatric intensive care no less. Suddenly every distressed or unmoving child wheeled through our doors was re-imagined as my own. Vivid and intrusive, like a flashback to a trauma I’d never lived.

It has faded a little as I’ve recalibrated my sense of normalcy, re-immersed myself of the emotionally monotone science of it all, and reframed disease and injury as problems to be solved again. But it doesn’t take much to scratch the surface.

It seems maintaining good psychological hygiene will be a topic of continued learning – especially in the face of hunger, fatigue, shift number six and trackwork. What has helped the most is realising that I am not alone in the struggle. And importantly, that it’s not just other doctors in training, but highly experienced, respected, senior consultants who have and continue to struggle too.

I have previously been very sceptical of hospital ‘wellbeing’ initiatives (that usually score low on a scale of yoga to paying my un-rostered overtime), but I’ll admit I could be a convert.

It started with a regularly scheduled meditation session. Uptake hadn’t been great as it was the middle of winter chaos, no one was terribly sure what to expect, and frankly the critical mass required to ensure peer pressure favoured attendance over avoidance hadn’t been reached.

But I was not terribly busy and hadn’t thought of an excuse, so I went.

The essential oil diffuser was going, and three consultants and I sat in the room with the facilitator. Half an hour of meditation was promised, preceded by an exercise where we would pick a card naming an emotion, followed by an art card which spoke to our experience of this emotion, to be discussed in the group. Oh good. This sounds… confronting to say the least.

One of the consultants began. They picked one card, then the other, and spoke softly about their experiences. Of anxieties, difficulties, hopes, and reflections across the span of their career. Not seeking to impart any divine wisdom, but simply offering up their thoughts and a little window into their self, as a person like any other. With struggles like any other. When my turn came it required a small leap of faith to abandon the hierarchy and speak freely, but I was so grateful for my senior colleagues’ willingness to do just that.

Since then I’ve tried to go whenever I can.

The meditation is nice. But It’s the sense of community and culture that is fostered that is the real game changer. This protected time for the clinical team to sit together as equals, sharing and reflecting on different aspects of our emotional existence – building great trust, respect and humility.

Having discussion guided by an external facilitator disarms the usual hierarchy and reveals omniscient consultants as imperfect humans among the rest of us. In this little pocket of calm so hard to find in a windowless room lit by fluorescent strip lights and beeping screens, we were offered connection, and I as struck by the power of introducing a little vulnerability, of earnest imperfect humanity into interactions as a leader, a supervisor, a teacher.

Sometimes it feels in this medico-political world of the AMA that it’s all doom and gloom. Bullying, harassment and discrimination remain rife in the profession. The intern tsunami is now trying to push into the specialty training pipeline with a gross mismatch between trainees and the places available to them. So, CV buffing has taken over Friday nights drinks as the primary focus of residency. And the pharmacists keep trying to prescribe things, which is all that seems to separate some of us from secretaries…

But actually after five years of shining lights into the dark corners of our culture, of facing some painful home truths, there are signs of change. The conversation is moving from the whether and why, to the how: how to ensure kindness and humanity are emphasised in a system that tries to squeeze it out of us as an efficiency dividend. How to ensure work and life outside it can co-exist, realising the benefit of perspective they each bring to the other. How to spread the things that work and leave behind the things that don’t. How to fit our oxygen masks before assisting others.

At the Australia and New Zealand Prevocational Medical Education Conference in Canberra recently, a colleague from WA presented on her research surveying doctors who had considered leaving or left medicine. The most commonly cited suggestion to improve retention? Better morale and culture.

To anyone who has felt this way. I hope you find yourself in a quiet room with some colleagues, and ideally an oil diffuser, where you too can find the value in shared reflection and vulnerable leadership.


Published: 13 Nov 2019