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Doctors shouldn’t reveal so much

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2495 (Published 11 June 2018) Cite this as: BMJ 2018;361:k2495

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Re: Doctors shouldn’t reveal so much

This article was categorised under 'Provocations' and I'd say that based on the response, it has justified that label.
I welcome the public demand for the 'extreme' candour Mr Sokol describes[1]. There is now, it seems, a market for the sort of confessional which the author is against. We're seeing an increasing number of books (This Is Going To Hurt by Adam Kay [2]), documentaries (BBC One's Celebrities On The NHS Frontline) and even blog posts and social media meme pages detailing the sticky end of medicine. Good. Should the naked truth be ugly let us not cover it up for fear of embarrassment.

I would hope by now that Mr Sokol is aware that medical professionals are human beings. A greater public perception of this might lead towards greater empathy towards doctors struggling with the increasing demands placed on them, as he acknowledges. It is fitting that the article cites sources from sixty and two hundred years ago [1]; the paternalistic attitude this belies is equally dated. We would not withhold poor prognostic information from a patient who asks for results; we should not deceive the public by keeping calm and carrying on when clearly there are systemic problems within the NHS. The patient-centred medicine sword cuts both ways; if we are to (rightfully) recognise our foibles when prescribing and administering treatment then I welcome a wider recognition that healthcare staff are human beings. If we are not to dispense with it and doctors are to remain aloof on their pedestals, then as one holding GMC registration, I would caution the any spokesperson who does not to remain silent on the matter for fear of being a hypocrite. If the position of 'doctor' is to remain sacrosanct, then I can expect anyone who doesn't work in that environment not to have sufficient understanding of what it is like.

These public airings of grievances, as well as giving patients a more realistic glimpse of the NHS, also warn future professionals of what to expect. Resilience is a popular word in medical school lectures at the moment. Working in current conditions isn't always the dream job - I say this not to discourage anyone, but ensure that there is an accurate perception of the lifestyle prospective medical students are signing up for. I'm not convinced that anybody is truly aware of what being a doctor means when they apply to read medicine. If we keep these experiences behind closed doors, we risk giving future professionals false expectations of what it means to work in the most human career. Should any of these ill-informed future doctors struggle at work, they may not reach out if they feel as though they are the only one who has trouble coping.

In my own experience, I dislike any lofty capital 'P' Professionalism ideas which dehumanise the interactions I have with patients. The environment I am in often calls for empathy and understanding for relatives having the worst day of their lives or patients coming to the end of theirs. I do introduce myself as George if I feel that Dr Huntington is putting up too much of a barrier. It is unkind to hold people in these extremes at arm's length. In practising medicine, we are exposed to some truly awful situations. It is hardly surprising that these may affect someone and change their perspectives. If this leads to better public understanding of these crises then it isn't wrong to disseminate that information [3].

Finally, I do not feel that the comparison with airline pilots is apt. A pilot announcing his struggles with insomnia over the tannoy is a gross abuse of trust. But if lack of sleep across all employees of an airline company has the potential to harm passengers, we have a duty to discuss it [4]. This affects change by creating the sadly necessary political climate to encourage a review. To do otherwise sweeps the problem under the rug. As doctors, we have experience of managing patients with mental health. I know of no clinician who, upon reviewing a patient with a low mood who is struggling at work, discourages them from discussing their problems. While doing so at work directly is an infraction of trust, if the public are not aware that there are concerns because nobody breaks ranks, it is as though the problem does not exist as there is no impetus to act.

Sources
1. Sokol D. Doctors shouldn't reveal their vulnerabilities. BMJ 2018;361:k2495
2. Kay A. This Is Going To Hurt. Picador. 2018
3. Huntington G. CPR rarely works – why do people have so much faith in it? The Guardian. 2018. Available online here: https://www.theguardian.com/healthcare-network/views-from-the-nhs-frontl...
4. Rimmer, A. Urgent action is needed to manage doctors’ fatigue, says BMA. (2018) BMJ 2018;360:k127

Competing interests: I have written publicly about difficult situations at work. Example included in the sources.

19 June 2018
George R Huntington
Junior Doctor
William Harvey Hospital, Ashford, Kent