Unto them a child is bornBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5029 (Published 12 December 2018) Cite this as: BMJ 2018;363:k5029
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Physician mothers with children with complex needs – untapped wisdom, resilience and a hidden workforce
The recent editorial (1) in BMJ and the linked paper (2) discusses the challenges and discrimination faced by physician mothers. There is however another group of physician mothers- those who have children with complex needs. We do not find their voices in the literature, or hear their stories of resilience, or know of avenues where their personal insights could enrich healthcare delivery and leadership.
Mothers with children with complex needs learn to ‘live in the present’(3) showing tremendous resilience following their grief. They become experts at managing individualized care but struggle to coordinate services of care(4). Physician mothers, owing to their relationship with healthcare, become experts both at the care as well as in coordinating services. Their strength lies in shared decision making to ensure compassionate clinical care that addresses not just the clinical condition but nurtures the child and the family.
The financial and employment challenges devalue all the achievements of the physician mothers. In the UK, the Royal Benevolent Fund and BMA charities offer much needed assistance to those in difficulty. The Colleges are financially constrained to waive membership fees though they provide reduced membership fees. Some NHS trusts provide three days of paid ‘Carers leave’ in the entire year. Working less than full time does not necessarily address caring needs at home or sufficiently relieve financial hardship. Some physician mothers who are the sole earners in their family are required not only to be resilient in the face of their child’s suffering but also to be resilient in the face of poverty.
Despite significant shortages of doctors and trainees in the UK (5), recruitment fails to give due weightage to these special circumstances. In addition, selection processes for training sometimes have short clinical scenarios as gate keeper, reduplicating college membership examinations, without giving due consideration to clinical and academic achievements and the context of difficult circumstances. This is especially unfortunate in fields such as Psychiatry where empathy, person cantered care (6) and resilience have tremendous clinical relevance in changing the lives of patients.
From the diary of a physician mother “My work colleagues have sent me a card; they miss me. I flick through some work emails and learn that some of the adolescents we are looking after aren’t doing that well. I am deeply saddened. I wish to be with them as much as I want to be with my son. I cannot be at two places and there is no opportunity of being formally involved in the team discussions other than being physically present. In other careers, there is the option of online degree courses, businesses run with conference calls but clinical work is fairly limited to typing on the electronic health record sitting in the office at work. Reading is the only clinical habit I have access to and it helps me feel connected to the adolescents I look after. I reflect on others like me, an invisible workforce, in isolated rooms. I send an apology email for my absence.”
As we aim for gender parity in work and life, it is time to recognize the strengths of physician mothers with children with complex needs, and find creative solutions to support and benefit from this hidden insightful resilient workforce in our healthcare.
1. Lovett Kate F. Unto them a child is born BMJ 2018; 363: k5029
2. Halley MC, Rustagi AS, Torres JS, et al. Physician mothers’ experience of workplace discrimination: a qualitative analysis. BMJ2018;363: k4926. doi:10.1136/bmj. k4926
3. Johnson BS. Mothers' perceptions of parenting children with disabilities. The American Journal of Maternal/Child Nursing, 2000; 25: 127–132.
4. Kirk S, Glendinning C, Callery P. Parent or nurse? The experience of being a parent of technology‐dependent child. Journal of Advanced Nursing, 2005; 51: 456–464.
5. In depth review of psychiatrist workforce. Main report. Centre for workforce intelligence 2014. https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
6. Person-centred care: implications for training in psychiatry. CR215. Royal College of Psychiatrists 2018. https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-p...
Competing interests: No competing interests