Was written originally as a JMO, but unsurprisingly, the relentless exhaustion persists, even as a registrar
“You’ve just got to re-learn how to do nothing,” my dad said, laughing into the phone like he was talking to some alien life-form he couldn’t get through to. I got defensive – literally staring at a computer applying for master’s degrees at the time – “I can’t just sit back and do nothing, Dad, I feel like I need to have a win.” I explained, “this entire year I’ve worked so much, and I haven’t achieved anything.” I told him this knowing the statement wasn’t objectively true, but I couldn’t help but feel it. Huh, do nothing? I haven’t done nothing in as long as I can remember, not since I made the lifestyle-defining decision what seems like forever ago to be a doctor. Doing nothing isn’t an option once you’re caught up in it all, and from what I can tell, many of you might understand what I mean.
I’m referring to a significant chunk of my med colleagues out there (you know who you are) who live in a continuous haze of unnerving restlessness, baseline uncertainty and fatigue from consistently sprinting toward a finish line that seems absurdly far away. I’ve been there. I AM there, and I’ve started this blog to vocalise my frustration because I feel like I’m probably not the only one who’s anxiously lost in it. I read Kay’s ‘This is Going to Hurt,’ the Summer prior to the whirlwind of PGY1 to validate fears of what I already hypothesised would be a sh*tshow of mistakes, sleeplessness and doubt (not to mention, literal sh*t), and, although it definitely cushioned the transition, there was no book that could prepare me for the emotional dysregulation that would come from actually working in a system that kind of, well, sucks.
I can recall at least twenty medical friends who would concur that the disillusionment is hella real. After 12 months of living the JMO dream of 14-hour Saturdays, weekdays largely filled with repetitive administration (mixed in with some spicy after-hours shifts of pure chaos, of course), I can’t imagine why anyone would choose to be a part of this culture if it weren’t for some underlying passion or purpose. I personally chose to be a doctor for the sake of helping people – most of my peers do – but the rigid healthcare system seems to leave many of us idealists sourly underwhelmed with our haphazard (and frankly confusing) role within it. It’s not hard to see why – we’re all guts no glory, and although this is inherently expected since we’re the bottom of the proficiency food chain, it settles itself as a lingering dissatisfaction that I feel we’re all too ashamed to address. I struggled to articulate that in writing because I know my life is privileged as a doctor: I have regular income, I have security, I have what my non-medical peers chime wistfully as ‘greater purpose,’ but sometimes, if not regularly, I feel disillusioned.
Junior doctor disillusionment no doubt contributes heavily to the mental health crisis in young doctors. The sentiment festers in difficult peer relationships with shitty superiors whose empathy has been broken by the system (or – on the unfortunate occasion – potentially didn’t exist in the first place). It’s amplified by personal unrest after back-to-back procedures that force discomfort on patients for ‘medical good’, yet seemingly provide little benefit for their condition or their morale. It sits quietly with you on weekends off that are never really ‘off’, regardless of whether you’re on-call or not. It breaks down your sense-of-self via unintentional manifestation of medicine’s ugly tradition of self-importance when you’re merely trying to be assertive in dealing with an unrelenting workload spinning out of your control. Finally, it culminates in the indescribable loneliness of an insidious, cut-throat industry that lies underneath an outward façade of empathy, whereby the only way to escape the workhorse is to be irrefutably better than the person next to you. This is enough to burn out any flame of passion, and suicide rates in medical professionals reflects this in chilling clarity.
I’m a culprit of assuming that the end-goal of becoming a ‘staff specialist’ (aka boss) ASAP will remedy excessive burn-out, even though I know deep down this outlook isn’t healthy, or even true. I am realising (slowly) that I should be able to attain job satisfaction regardless of my official rank or level. I’m aware that this is not exclusive to medicine. Many of my friends in academia, law and practically all hierarchical professions feel the pressure to ‘get there’ – whether that be professor, partner etc. This pressure specifically in medicine is exponentially increasing, as bottlenecks dictating the ease of ‘getting there’ get more chokingly severe each year, with many doctors accepting the reality of shiftwork and continuing further education for upwards of a decade prior to attaining any genuine level of career fulfilment. Unfortunately, this doesn’t look like it will change in the near future as there continues to be no palatable remedy for the gross oversupply of doctors within a system resistant to transformation. So, for the sake of my mental health, rather than committing to fight a never-ending battle forward, I’m choosing to focus on confronting my anxiety in the present. I have determined that I need to earnestly address why I am unsettled and maybe in turn I will be able to moderate my expectations, find peace within the system, and remedy the cynicism that’s unhappily seeded itself in the core of my passion.
I am openly dissatisfied with certain aspects of being a junior doctor and I will list them here as a self-indulgent catharsis, but also as a step in the productive path of tackling my feelings toward these issues and mentally overcoming them. The list below is by no means exhaustive; however, it reflects some of the issues that I personally feel contributes to widespread burnout amongst myself and my peers:
- A relentless toxic culture of ~continuous success~, which is beautiful tool for innovation, but also a horrific detriment to our collective mental health as doctors
- Endless bureaucracy within a health system that often leaves us exasperated and dissatisfied with its limitations in providing optimal patient care
- Health system complacency with blatant medical understaffing – I mean, I know we’re expensive to roster, but there is a reason so many of us develop pager-tone anxiety and oftentimes come home feeling shaken after nightmare shifts (one doctor for five wards just ain’t safe)
- Inevitable compassion fatigue – not necessarily in respect to patients, but most prominently regarding compassion toward fellow colleagues and, just as importantly, compassion for ourselves
- Inflexibility due to fixed career trajectories, many of which squash healthy curiosity outside of specialty confines due to widespread cultural disapproval of ‘idleness’ in any doctor’s career path (it should be pointed out that working conditions generally improve as you compete to advance within a specialty, and generally stagnate if specialist training isn’t ruthlessly pursued)
- The prevalence of entrenched – oftentimes problematic – cultures (did someone say surgery?) that still reflect largely paternalistic, hierarchical and ‘we-went-through-it-and-so-should-you’ attitudes
- Lastly, embedded knowledge that all these issues are not new and that all doctors before you have lived through it, which leads to the unsurprising (albeit unhealthy) widely held internal conception that you might just be inadequate if you’re unable to prosper within a system that was otherwise survived by all others that came before you (collectively, we say we’re working on dismantling this, but… are we?)
There are copious emphatic underlines in the last point because it openly struck a nerve. Whilst contemplating this entire post, I came to the conclusion that we’re entrenching burnout for generations to come by regurgitating the same medical narrative. We might even be limiting our own capacity for growth by smothering and rejecting our internal struggles. I know we don’t do it on purpose; the only way to survive is to maintain that outward façade of okayness we’ve all perfected… but sometimes, I know it gets really f*cking hard to be ‘OK’.
Just putting it out there.
Big love to my medical pals. I feel you.
Good luck for interview season! x
