Doctor’s diary – The days I don’t like my job .
She penned a couple of friends saying :
‘This is one of the days I don’t like my job —my legs are jelly —yet I have to pretend all is well, put up a brave face and carry on as normal. This particular one hits hard. Ask God for strength for me please ‘
Yes, that was me on one of those days…
Breaking bad news is an important and frequent part of my role.
Breaking bad news can be intense; you are trained to be fairly detached so that you can deliver facts and titrate expectations with reality but yet being human dictates you have to share some hint of optimism in some form or shape around the devastating news whilst inwardly wrestling with balancing your faith and medical ethics.
Since I have been thinking about penning the emotional diary and psychological baggage of a doctor, a flood gate of emotions has whirled up, the wishfully unhinged urge of expression curbed and tamed by ethical and professional limitations.
All doctors break bad news, but family physicians ( GPS) are in a particularly unique position because of the continuity of care which enables you to get to know different generations of the same extended family. It is different from a hospital doctor where the job is done there and then and your paths never cross again.
As a family doctor, you are likely to manage the ongoing effects on the recipients of the news and their families. This news often negatively impact the affected index or their relatives and loved ones.
The effect can vary from initial denial where they keep seeking your stamping their denial and sharing some form of optimism that is by nature opposed to the medical evidence associated with such conditions. In some cases where they recognise you share similar faith, they want you to hold up in your shared faith with them and because one understands the ultimate answer truly lies with the Almighty despite medical reports it then brings a conflict with your profession because you still have to share the hard evidence and prognosis in front of you. Such an emotional and psychological heart-wrenching dilemma to be in over and over again.
The other effect is on their mental health – I have seen where bad news tips children or spouses or siblings of an index person or the index into debilitating mental illness e.g severe depression, psychosis and schizophrenia. These outcomes then have to be picked up and managed. The course of their lives altered forever and you feel so sad for them knowing why it all began.
Another impact is on their socio-economic status – loss of health can lead to loss of ability to work or maintain wealth leading to a decline in economic power for the index and their families again causing untold family hardships. When coupled with the fact that they become a dependant who needs to be cared for, these can be stressful for all concerned putting a strain on relationships and tearing families apart.
The cultural burden is another dimension. Different cultures respond to critical illness, life changing illness, terminal illness and bereavement in different ways. Some divert their anger and frustrations at you. As their GP you are meant to be acutely aware of these differences in expectations and expressions and manage them accordingly within confidential and ethical boundaries.
The charged emotion and grief locked up in a room where you break such news to family members can be emotionally choking more so if you probably know or have also been involved in the long term care of the index person that has just received a nasty life long diagnosis, a terminal diagnosis or has just died. Many a time the blood that flows in your veins catches up and you are torn between holding hands or giving hugs and shedding tears with the deeply saddened or just holding up knowing the many other patients out there and the whole staff are waiting on you for the call of duty to keep the day running. They exit your room leaving you behind with a lump in your throat and a fast heartbeat. Listening to and being involved in the ongoing physical, emotional, psychological, mental and social care of your different generations of patients can at times put a strain and burden on you. So much so that it is sometimes hard to separate yourself from their experiences whilst trying to support them with available resources.
How do doctors cope?
We are trained to psychologically and emotionally debrief ourselves regularly.
But we know at times these safety mechanisms snap!
You have to absorb it all in, debrief yourself yet again, shake it off and go on- that’s one’s daily reality.
Getting formal help: Doctors are encouraged by their professional bodies to seek support overtly but covertly any declarations of mental or psychological or emotional instability risks you being deemed unfit and unsafe for the job – herein lies the dilemma! However, thank goodness these issues of getting support for Doctors without them risking their jobs and mental health are being improved upon.
When does it get too much? It’s all of these questions – and many more. This is where one’s protective factors come in.
I have a safe haven called home where I can show my emotions and vulnerabilities safely without censoring.
I have something bigger that I run to for support, renewal and restoration to get my strength renewed for the job and task ahead. Yes, it’s my faith that had carried me through – armed with family and friends that genuinely care.
Ultimately I have my faith, my God and my Lord who understands deeply even when I am even yet to think it nor have I yet spoken!
And who restores me to a place I can genuinely say: most days I love my job!
Are Doctors’ experience of their vulnerability beneficial for the patients or not?
The excerpt below from an article by the Scandinavian Journal of Primary Health Care (by Taylor and Francis) – When doctors experience their vulnerability as beneficial for the patients– gives a fairly balanced study outcome from which to draw individual inferences :
The doctor is expected to be detached and omnipotent, yet compassionate and empathetic. Attention is usually drawn to the negative aspects of doctors’ vulnerability and emotionality related to burnout or misconduct.
- Focusing on the potential benefits of vulnerability in the doctor, we find that it may bring strength, but must be used with caution.
- Vulnerability may be experienced as positive in situations where the commonalities of human life trigger off a sense of identification, enhancing the doctor’s ability to understand the patient.
- Events implying professional or personal uncertainty may have improved the doctor’s reflexivity and awareness of sensitive matters of interaction.
I will end by saying in all, I look inwards and balance my professional and human instincts .